Introduction to the DSM Personality Disorders

Not Many Changes in DSM-5

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Personality disorders are psychiatric conditions that begin in adolescence or early adulthood, continue over many years, and cause a great deal of distress. Personality disorders also often interfere with your ability to enjoy life or achieve fulfillment in relationships, work or school.

The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) lists ten personality disorders, including borderline personality disorder (BPD).

How Are Personality Disorders Diagnosed?

The DSM-IV-TR used a "multi-axial" diagnostic system. This means that when a diagnosis was made using DSM-IV, attention was paid to five different areas, or axes, that may have affected the individual being diagnosed.

Personality disorders were diagnosed on Axis II of the multi-axial system. This axis is reserved for very long-standing conditions of clinical significance. Mental retardation is the only other condition that was diagnosed on Axis II.

In DSM-5. the most recent version, there are no axes.

Personality Disorder Clusters

Personality disorders are organized into three "clusters" in both the DSM-IV-TR and DSM-5. The disorders in each cluster share key features or have overlap in terms of the characteristics of individuals who are diagnosed within that cluster.

The "Cluster A" Personality Disorders

The "Cluster A" personality disorders are characterized by odd or eccentric behavior.

Individuals with the personality disorders in this cluster tend to experience major disruptions in relationships because their behavior may be perceived as peculiar, suspicious or detached.

The "Cluster A" personality disorders include:

    The "Cluster B" Personality Disorders

    The "Cluster B" personality disorders are characterized by dramatic or erratic behavior. Individuals with the personality disorders in this cluster tend to either experience very intense emotions or engage in extremely impulsive, theatrical, promiscuous or law-breaking behaviors.

    The "Cluster B" personality disorders include:

    The "Cluster C" Personality Disorders

    The "Cluster C" personality disorders are characterized by anxiety. Individuals with the personality disorders in this cluster tend to experience pervasive anxiety and/or fearfulness.

    The "Cluster C" personality disorders include:

    • Dependent Personality Disorder
    • Obsessive-Compulsive Personality Disorder
    • Avoidant Personality Disorder

    Treatment for Personality Disorders

    Compared to mood disorders, there is remarkably little research on the treatment of personality disorders. Most of the research that exists focuses on the treatment of BPD.

    For BPD, there are a number of treatments that are considered effective in reducing symptoms, including psychotherapy and medication options.

    In general, many experts believe that personality disorders are difficult to treat because they are, by definition, long-standing patterns of personality. That said, this is a question that has not been subjected to a great deal of careful research. More research is needed to examine the effectiveness of treatments for the personality disorders.

    However, recent research has shown that borderline personality disorder is easier to treat than previously thought and that many people improve with continued treatment.

    Personality Disorders and Comorbidity

    There is a great deal of comorbidity between the personality disorders, meaning that a person who meets diagnostic criteria for one personality disorder will often also meet criteria for one or more additional personality disorders. One recent study funded by the National Institute of Mental Health found that about 85% of people with BPD also meet diagnostic criteria for at least one other personality or mood disorder.

    Sources:

    American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders DSM-IV-TR Fourth Edition. American Psychiatric Association: 2000.

    Grant BF, Chou SP, Goldstein RB, et al. "Prevalence, Correlates, Disability, and Comorbidity of DSM-IV Borderline Personality Disorder: Results from the Wave 2 National Epidemiologic Survey on Alcohol and Related Conditions," Journal of Clinical Psychiatry, 69(4): 533-545, 2008.

    "Personality Disorders Fact Sheet." American Psychiatric Association (2013).

    "Personality Disorders." Mayo Clinic (2014).

    "Borderline Personality Disorder." National Institute of Mental Health (2016).

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