Diagnosis manual (DSM) revision of personality disorders

Diagnosis manual revision of personality disorders

By Liz Lockhart

Changes are planned to the Diagnostic and Statistical Manual of Mental Disorders (DSM) with regard tothe diagnosing of personality disorders.

The Diagnostic and Statistical Manual of Mental Disorders (DSM)

Perhaps it would simplify this reading matter if the implications of this change and the purpose of the DSM itself are first explained.  Forgive this if you already understand this, many will not.

The DSM is published by the  American  Psychiatric Association and provides a common language and standard criteria for the classification of mental disorders.  It is used in the United States of America and in varying degrees  around the world,  clinicians, researchers, psychiatric drug regulation agencies, health insurance companies, pharmaceutical companies and policy makers.  (Thus giving it the power to influence the diagnosis and treatment of mental health disorders globally to one extent or another.)

The Changes

The draft principles reduce the 10 categories that are currently listed in the DSM-IV to six and to acknowledge varying levels of impairment.  This, they say, simplifies the number of conditions and allows for greater variety of impairment levels.

The proposed recommendations were put in place following the receipt of more than 8,000 public comments on the DSM-5 in 2010.  The comments centered on all aspects of the DSM-5, not just personality disorders.

The goal of the new criteria is to maximize their utility to clinicians and benefit to patients, according to the American  Psychiatric  Association.

One of the changes is to reduce the 10 personality disorder categories in DSM-IV to six.  These six are antisocial, avoidant, borderline, narcissistic, obsessive-compulsive and schizotypal.   The removed categories are dependent, histrionic, paranoid and schizoid personality disorders.

Andrew Skodal, MD, chair of the Personality and Personality Disorders Work Group and research professor of psychiatry at the University of Arizona College of Medicine says that the change will eliminate overlapping conditions, which often lead to patients being diagnosed with more than one personality disorder.

Dr. Skodal added that what is also significant is the elimination of personality Disorder Not Otherwise Specified, which is in DSM-IV and  does not offer doctors information about an individual’s mental health.  In its place, the work group proposes Personality Disorder Trait Specified for patients whose condition does not meet the full criteria for any specific disorder.

To diagnose this condition, as well as the six specific personality disorder types, a patient must have significant impairment in the two areas of personality functioning, self and interpersonal, which are not part of DSM-IV.

Self-functioning is defined as how patients view themselves and how they identify and pursue their goals. Interpersonal functioning is the ability of an individual to understand other people's perspectives and form close relationships.

The work group proposes that patients also have at least one pathological personality trait, such as antagonism or detachment.

The proposed revisions are available online 


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