Personality disorders (1) (1)


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Personality disorders (1) (1)

  2. 2. Personality disorders (Axis II)Cluster A (odd or eccentric)301.0 Paranoid personality disorder301.20 Schizoid personality disorder301.22 Schizotypal personality disorderCluster B (dramatic, emotional, or erratic)301.7 Antisocial personality disorder301.83 Borderline personality disorder301.50 Histrionic personality disorder301.81 Narcissistic personality disorderCluster C (anxious or fearful)301.82 Avoidant personality disorder301.6 Dependent personality disorder301.4 Obsessive-compulsive personality disorder
  3. 3. Four personality disorders were excluded from the main body of thelatest version of the DSM (DSM-IV-TR) but this diagnosis may be usedinstead.The four personality disorders are:Sadistic personality disorderSelf-defeating personality disorderDepressive personality disorderPassive–aggressive personality disorderIt is a requirement of DSM-IV that a diagnosis of any personalitydisorder also satisfies a set of general personality disorder criteria.Diagnostic
  4. 4. ICD-10(F60) Specific personality disorders (F60.0) Paranoid personality disorder(F60.1) Schizoid personality disorder(F60.2) Dissocial personality disorder Antisocial personality disorder(F60.3) Emotionally unstable personality disorder Borderline personality disorder(F60.4) Histrionic personality disorder(F60.5) Anankastic personality disorder Obsessive-compulsive personality disorder(F60.6) Anxious (avoidant) personality disorder(F60.7) Dependent personality disorder(F60.8) Other specific personality disorders Eccentric personality disorder Haltlose personality disorder Immature personality disorder Narcissistic personality disorder Passive-aggressive personality disorder Psychoneurotic personality disorder(F60.9) Personality disorder not otherwise specified|Personality disorderunspecified
  5. 5. Narcissistic PersonalityDisorder andHistrionic PersonalityDisorderTo Be Eliminated in theDSM-V
  6. 6. DSM-IV-R recognizes 10 personalitydisorders plus Personality Disorder NotOtherwise Specified:Paranoid Personality DisorderSchizoid Personality DisorderSchizotypal Personality DisorderAntisocial Personality Disorder (ASPD)Borderline Personality Disorder (BPD)Histrionic Personality Disorder (HPD)Narcissistic Personality Disorder (NPD)Avoidant Personality DisorderDependent Personality DisorderObsessive-Compulsive Personality Disorder
  7. 7. They plan to collapse these 10 into thefollowing 5 buckets:Antisocial/Psychopathic TypeAvoidant TypeBorderline TypeObsessive-Compulsive TypeSchizotypal Type
  8. 8. will try to interpret the rationalefor the elimination of 5 of the 10currently recognized DSM-IV-Rpersonality disorders with aspecific focus on the Cluster Bor “dramatic” personalitydisorders (NPD, BPD, ASPDand HPD).
  9. 9. The New York Times reports in A Fate thatNarcissists Will Hate: Being IgnoredThe fifth edition of the Diagnostic andStatistical Manual of Mental Disorders(due out in 2013, and known as DSM-5)has eliminated five of the 10personalitydisorders that are listed in the currenteditionNarcissistic personality disorder is themost well-known of the five, and itsabsence has caused the most stir inprofessional circles.
  10. 10. The APA seems to be folding NPD and HPDinto the Antisocial/Psychopathic Type;while the Borderline Type shares 2 of the3 traits is viewed as being the mostsociopathic with the Antisocial/PsychopathicType: Antagonism:Aggression and Antagonism: HostilityAggression is defined as “being mean, cruel,or cold-hearted; verbally, relationally, orphysically abusive; humiliating anddemeaning of others; willingly and willfullyengaging in acts of violence against personsand objects; active and open belligerence orvengefulness; using dominance andintimidation to control others.”
  11. 11. Hostility is defined as “irritability, hottemperedness; being unfriendly, rude,surly, or nasty; responding angrily tominor slights and insults.” Antagonism: Callousnessisnot included in the Borderline Type,which is defined as “lack of empathyor concern for others’ feelings orproblems; lack of guilt or remorseabout the negative or harmful effectsof one’s actions on others;exploitativeness.”
  12. 12. the rationale for reformulating the Cluster B personalityConsiderable research has shown excessive co-occurrence among personality disorders diagnosed usingthe categorical system of the DSM (Oldham et al., 1992;Zimmerman et al., 2005). In fact, most patients diagnosedwith personality disorders meet criteria for more than one.In addition, all of the personality disorder categories havearbitrary diagnostic thresholds, i.e., the number of criterianecessary for a diagnosis.
  13. 13. PD diagnoses have been shown in longitudinalfollow-along studies to be significantly less stableover time than their definition in DSM-IV implies(e.g., Grilo et al., 2004). The reduction in the numberof types is expected to reduce co-morbid PDdiagnoses, the use of a dimensional rating of typesrecognizes that personality psychopathology occurson a continuum, and the replacement of behavioralPD criteria with traits is anticipated to result ingreater diagnostic stability.
  14. 14. For example, there used to bea Passive-Aggressive PersonalityDisorder in the DSM-III, but it wasremoved from the DSM-IV becausewomen’s groups felt it unfairlypathologized women. This doesn’tmean that these behaviors ceased toexist; it’s just that the APA terminateda specific cognitive-behavioralphenomenon and hid it in PersonalityDisorder Not Otherwise Specifieddueto political pressure.
  15. 15. Another example is the APA’s failure toofficially acknowledge Parental AlienationSyndrome(PAS) and Hostile AggressiveParenting (HAP). Numerous studies havebeen done by credible researchersdocumenting and quantifying thesebehaviors. Individuals who have been thetarget of these pathological and maliciousbehaviors know full well how real they are.Yet, the APA won’t touch it with a 10-footpole, probably because it would also assignpathology to a great many women.