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Personality disorders in DSM5

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Main changes to personality disorders in DSM5

Main changes to personality disorders in DSM5

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  • 1. Personality disorders in DSM5 Ahmed Eid Elaghoury Arab & Egyptian Boards in Psychiatry Psychiatry registrar Armed Forces Center for Psychiatric Care,TAIF
  • 2. Same criteria as DSM IV Taif, Jun 2014 DSM5 changes series 2 DSM5 Task Force List
  • 3. Taif, Jun 2014 DSM5 changes series 3
  • 4. DSM 5 field trials  In USA & Canada: 279 clinicians, 2246 pts, most of them (86%) interviewed twice to test 23 disorders  Borderline PD: good interrater reliability  Obsessive compulsive PD & antisocial PD: questionable reliability range  Other PDs: too few pts to test reliability (Kappa test) Taif, Jun 2014 DSM5 changes series 4 Bret S. Stetka, MD, Christoph U. Correll, MD:A Guide to DSM-5. Medscape Psychiatry, May 21, 2013
  • 5. DSM-5 field trials: diagnostic reliability in adults. Modified from: Freedman R, Lewis DA, Michels R, et al. The initial field trials of DSM-5: new blooms and old thorns. Am J Psychiatry. 2013;170:1-5. Taif, Jun 2014 DSM5 changes series 5
  • 6. Multiaxial system  Introduced with DSM III (1980): to complete evaluation and not overlook any symptom  Axis II: personality ds & specific developmental ds  Axes I & II: were mental ds  Removed in DSM5 (2013): ◦ Axes I, II & III: as a list by principal diagnosis ◦ Axis IV  ICD10 Z codes ◦ AxisV  WHO disability assessment schedule (WHODAS 2.0) Taif, Jun 2014 DSM5 changes series 6
  • 7. Taif, Jun 2014 DSM5 changes series 7 DSM5: pg 21
  • 8. We are back!! Keep skeptical Taif, Jun 2014 DSM5 changes series 8 DSM I, 1952: pg 46 DSM II, 1968: pg 2
  • 9. New concept: Cross-cutting symptom measures  Modeled on general medicine’s review of systems  Reviewing psychopathological domains  Level 1: brief survey: ◦ (13) domains for adult ◦ (12) domains for child & adolescent  Level 2: more in-depth assessment  Both: at initial interview and followup Taif, Jun 2014 DSM5 changes series 9
  • 10. Personality functioning  Domain XII in level 1 cross-cutting symptom measure Taif, Jun 2014 DSM5 changes series 10
  • 11. Personality functioning Taif, Jun 2014 DSM5 changes series 11 DSM5
  • 12. Taif, Jun 2014 DSM5 changes series 12 DSM5
  • 13. Generic diagnostic criterion in DSM5 DISABILITY Taif, Jun 2014 DSM5 changes series 13 DSM5: pg 21
  • 14. Taif, Jun 2014 DSM5 changes series 14
  • 15. Alternative DSM5 Model for personality disorders  In section III, so NOT official or for clinical use  Still a research model  Based on the “Big Five” Five Factor Model of Personality “FFM” and the Personality Psychopathology Five “PSY5” model.  Trait approach: ie dimensional  Categorical approach may be uninformative eg other specified / unspecified PD  Distinguishing traits, symptoms and specific behaviors.  Allow to describe a personality disorder – trait specified (PD-TS) Taif, Jun 2014 DSM5 changes series 15
  • 16. Alternative DSM5 Model  Main premise: ◦ Personality functioning: impaired (criterion A) ◦ Personality traits: pathological (criterion B) ◦ Pervasiveness & Stability (criteria C&D) ◦ Absence of alternative explanation (criteria E, F & G) Taif, Jun 2014 DSM5 changes series 16
  • 17. Five personality disorder trait domains 1. Negative Affectivity (vs emotional stability) 2. Detachment (vs Extraversion) 3. Antagonism (vs Agreeableness) 4. Disinhibition (vs Conscientiousness) 5. Psychoticism (vs Lucidity)  Each domain has “facets” eg: anxiousness, depressivity, etc inside Negative Affectivity  All are 25 facets  Only 6 specific PDs applied to this model: antisocial, avoidant, borderline, narcissistic, obsessive-compulsive & schizotypal Taif, Jun 2014 DSM5 changes series 17
  • 18. ICD-11 Beta Draft  Personality disorder: ◦ Mild ◦ Moderate ◦ Severe ◦ Other ◦ Unspecified  Allows “late onset” qualifier  No specific subtypes of PDs. Taif, Jun 2014 DSM5 changes series 18 http://apps.who.int/classifications/icd11/browse/f/en
  • 19. Summary  Multiaxial documentation is REMOVED from DSM5  Only BORDERLINE PD is of good interrater reliability in DSM5 field trials  “PERSONALITY FUNCTIONING” & “CROSS-CUTTING SYMPTOM MEASURES” are new DSM5 concepts  “DISABILITY” is the generic diagnostic criterion in DSM5  Personality functioning should be ASSESSED ROUTINELY as a domain of level 1 cross-cutting symptom measure OR as a domain of disability in WHODAS 2.0  ALTERNATIVE DSM5 MODEL FOR PERSONALITY DISORDERS is “five factor” dimensional (trait) model and still under research, NOT for official use  ICD 11 BETA CRITERIA for personality disorders are dimensional and removing the specific subtyping till now Taif, Jun 2014 DSM5 changes series 19

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