Saturday, July 26, 2014

Personality Disorders:Video Playlist and DSM Description

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Note the link of the video playlist below was uploaded in 2009, before the DSM 5 publication. So largely what is being discussed are those of  DSM4-TR.


Personality Disorders & DSM 4

Personality disorders are a class of mental disorders characterized by enduring maladaptive patterns of behavior, cognition and inner experience, exhibited across many contexts and deviating markedly from those accepted by the individual's culture. These patterns develop early, are inflexible and are associated with significant distress or disability.[1] The definitions may vary some according to other sources.[2][3]

Official criteria for diagnosing personality disorders are listed in the Diagnostic and Statistical Manual of Mental Disorders, published by the American Psychiatric Association, and in the mental and behavioral disorders section of the International Statistical Classification of Diseases and Related Health Problems, published by the World Health Organization. The DSM-5 published in 2013 now lists personality disorders in exactly the same way as other mental disorders, rather than on a separate 'axis' as previously.[4]

The Diagnostic and Statistical Manual of Mental Disorders (currently the DSM-5) provides a definition of a General personality disorder that stress such disorders are an enduring and inflexible pattern of long duration that lead to significant distress or impairment and are not due to use of substances or another medical condition. DSM-5 lists ten personality disorders, grouped into three clusters. The DSM-5 also contains three diagnoses for personality patterns that do not match these ten disorders, but nevertheless exhibit characteristics of a personality disorder.[18]

Cluster A (odd disorders)

Cluster B (dramatic, emotional or erratic disorders)

Cluster C (anxious or fearful disorders)

Other personality disorders

  • Personality change due to another medical condition – is a personality disturbance due to the direct effects of a medical condition
  • Other specified personality disorder – symptoms characteristic of a personality disorder but fails to meet the criteria for a specific disorder, with the reason given
  • Personality disorder not otherwise specified

Signs and symptoms

In the workplace

Depending on the diagnosis, severity and individual, and the job itself, personality disorders can be associated with difficulty coping with work or the workplace - potentially leading to problems with others by interfering with interpersonal relationships. Indirect effects also play a role; for example, impaired educational progress or complications outside of work, such as substance abuse and co-morbid mental diseases, can plague sufferers. However, personality disorders can also bring about above-average work abilities by increasing competitive drive or causing the sufferer to exploit his or her co-workers.[41][42]
In 2005, psychologists Belinda Board and Katarina Fritzon at the University of Surrey, UK, interviewed and gave personality tests to high-level British executives and compared their profiles with those of criminal psychiatric patients at Broadmoor Hospital in the UK. They found that three out of eleven personality disorders were actually more common in executives than in the disturbed criminals:
According to leading leadership academic Manfred F.R. Kets de Vries, it seems almost inevitable these days that there will be some personality disorders in a senior management team.[44]

Relationship with other mental disorders

The disorders in each of the three clusters may share some underlying common vulnerability factors involving cognition, affect and impulse control, and behavioral maintenance or inhibition, respectively, and may have a spectrum relationship to certain syndromal mental disorders:[45]


The DSM-IV lists General diagnostic criteria for a personality disorder, which must be met in addition to the specific criteria for a particular named personality disorder. This requires that there be (to paraphrase):[46]
  • An enduring pattern of psychological experience and behavior that differs prominently from cultural expectations, as shown in two or more of: cognition (i.e. perceiving and interpreting the self, other people or events); affect (i.e. the range, intensity, lability, and appropriateness of emotional response); interpersonal functioning; or impulse control.
  • The pattern must appear inflexible and pervasive across a wide range of situations, and lead to clinically significant distress or impairment in important areas of functioning.
  • The pattern must be stable and long-lasting, have started as early as at least adolescence or early adulthood.
  • The pattern must not be better accounted for as a manifestation of another mental disorder, or to the direct physiological effects of a substance (e.g. drug or medication) or a general medical condition (e.g. head trauma).
The ICD-10 'clinical descriptions and diagnostic guidelines' introduces its specific personality disorder diagnoses with some general guideline criteria that are similar. To quote:[47]
  • Markedly disharmonious attitudes and behavior, generally involving several areas of functioning; e.g. affectivity, arousal, impulse control, ways of perceiving and thinking, and style of relating to others;
  • The abnormal behavior pattern is enduring, of long standing, and not limited to episodes of mental illness;
  • The abnormal behavior pattern is pervasive and clearly maladaptive to a broad range of personal and social situations;
  • The above manifestations always appear during childhood or adolescence and continue into adulthood;
  • The disorder leads to considerable personal distress but this may only become apparent late in its course;
  • The disorder is usually, but not invariably, associated with significant problems in occupational and social performance.
The ICD adds: "For different cultures it may be necessary to develop specific sets of criteria with regard to social norms, rules and obligations."

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Personality Disorders & DSM 5

Personality disorders are associated with ways of thinking and feeling about oneself and others that
significantly and adversely affect how an individual functions in many aspects of life. They fall within
10 distinct types: paranoid personality disorder, schizoid personality disorder, schizotypal personality
disorder, antisocial personality disorder, borderline personality disorder, histrionic personality, narcissistic personality disorder, avoidant personality disorder, dependent personality disorder and obsessive-compulsive personality disorder.

DSM-5 moves from the multiaxial system to a new assessment that removes the arbitrary boundaries
between personality disorders and other mental disorders. A hybrid model that included evaluation of impairments in personality functioning (how an individual typically experiences himself or herself as well as others) plus five broad areas of pathological personality traits. Although this hybrid proposal was not accepted for DSM-5’s main manual, it is included in Section III for further study. Using this alternate methodology, clinicians would assess personality and diagnose a personality disorder based on an individual’s particular difficulties in personality functioning and on specific patterns of those pathological traits.

The hybrid methodology retains six personality disorder types:
• Borderline Personality Disorder
• Obsessive-Compulsive Personality Disorder
• Avoidant Personality Disorder
• Schizotypal Personality Disorder
• Antisocial Personality Disorder
• Narcissistic Personality Disorder

Each type is defined by a specific pattern of impairments and traits. This approach also includes a diagnosis of Personality Disorder—Trait Specified (PD-TS) that could be made when a Personality Disorder is
considered present, but the criteria for a specific personality disorder are not fully met. For this diagnosis,
the clinician would note the severity of impairment in personality functioning and the problematic
personality trait(s). This hybrid dimensional-categorical model and its components seek to address existing issues with the categorical approach to personality disorders.

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