The document discusses changes to personality disorder classifications in the DSM. It summarizes the current DSM-IV personality disorders clusters and specific disorders. It then discusses proposals for the DSM-V to reduce the number of personality disorder types by collapsing some into broader categories. The rationale given for this reformulation is the high co-occurrence of disorders in the current system and issues with diagnostic stability over time.

1. PERSONALITY DISORDERS

2. Personality disorders (Axis II)
Cluster A (odd or eccentric)
301.0 Paranoid personality disorder
301.20 Schizoid personality disorder
301.22 Schizotypal personality disorder
Cluster B (dramatic, emotional, or erratic)
301.7 Antisocial personality disorder
301.83 Borderline personality disorder
301.50 Histrionic personality disorder
301.81 Narcissistic personality disorder
Cluster C (anxious or fearful)
301.82 Avoidant personality disorder
301.6 Dependent personality disorder
301.4 Obsessive-compulsive personality disorder

3. Four personality disorders were excluded from the main body of the
latest version of the DSM (DSM-IV-TR) but this diagnosis may be used
instead.
The four personality disorders are:
Sadistic personality disorder
Self-defeating personality disorder
Depressive personality disorder
Passive–aggressive personality disorder
It is a requirement of DSM-IV that a diagnosis of any personality
disorder also satisfies a set of general personality disorder criteria.
Diagnostic

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 disorder
unspecified

6. Narcissistic Personality
Disorder and
Histrionic Personality
Disorder
To Be Eliminated in the
DSM-V

7. DSM-IV-R recognizes 10 personality
disorders plus Personality Disorder Not
Otherwise Specified:
Paranoid Personality Disorder
Schizoid Personality Disorder
Schizotypal Personality Disorder
Antisocial Personality Disorder (ASPD)
Borderline Personality Disorder (BPD)
Histrionic Personality Disorder (HPD)
Narcissistic Personality Disorder (NPD)
Avoidant Personality Disorder
Dependent Personality Disorder
Obsessive-Compulsive Personality Disorder

8. They plan to collapse these 10 into the
following 5 buckets:
Antisocial/Psychopathic Type
Avoidant Type
Borderline Type
Obsessive-Compulsive Type
Schizotypal Type

9. will try to interpret the rationale
for the elimination of 5 of the 10
currently recognized DSM-IV-R
personality disorders with a
specific focus on the Cluster B
or “dramatic” personality
disorders (NPD, BPD, ASPD
and HPD).

10. The New York Times reports in A Fate that
Narcissists Will Hate: Being Ignored
The fifth edition of the Diagnostic and
Statistical Manual of Mental Disorders
(due out in 2013, and known as DSM-5)
has eliminated five of the 10personality
disorders that are listed in the current
edition
Narcissistic personality disorder is the
most well-known of the five, and its
absence has caused the most stir in
professional circles.

11. The APA seems to be folding NPD and HPD
into the Antisocial/Psychopathic Type;
while the Borderline Type shares 2 of the
3 traits is viewed as being the most
sociopathic with the Antisocial
/PsychopathicType: Antagonism:
Aggression and Antagonism: Hostility
Aggression is defined as “being mean, cruel,
or cold-hearted; verbally, relationally, or
physically abusive; humiliating and
demeaning of others; willingly and willfully
engaging in acts of violence against persons
and objects; active and open belligerence or
vengefulness; using dominance and
intimidation to control others.”

12. Hostility is defined as “irritability, hot
temperedness; being unfriendly, rude,
surly, or nasty; responding angrily to
minor slights and insults.”
Antagonism: Callousness
isnot included in the Borderline Type,
which is defined as “lack of empathy
or concern for others’ feelings or
problems; lack of guilt or remorse
about the negative or harmful effects
of one’s actions on others;
exploitativeness.”

13. the rationale for reformulating the
Cluster B personality
Considerable research has shown excessive co-
occurrence among personality disorders diagnosed using
the categorical system of the DSM (Oldham et al., 1992;
Zimmerman et al., 2005). In fact, most patients diagnosed
with personality disorders meet criteria for more than one.
In addition, all of the personality disorder categories have
arbitrary diagnostic thresholds, i.e., the number of criteria
necessary for a diagnosis.

14. PD diagnoses have been shown in longitudinal
follow-along studies to be significantly less stable
over time than their definition in DSM-IV implies
(e.g., Grilo et al., 2004). The reduction in the number
of types is expected to reduce co-morbid PD
diagnoses, the use of a dimensional rating of types
recognizes that personality psychopathology occurs
on a continuum, and the replacement of behavioral
PD criteria with traits is anticipated to result in
greater diagnostic stability.

16. For example, there used to be
a Passive-Aggressive Personality
Disorder in the DSM-III, but it was
removed from the DSM-IV because
women’s groups felt it unfairly
pathologized women. This doesn’t
mean that these behaviors ceased to
exist; it’s just that the APA terminated
a specific cognitive-behavioral
phenomenon and hid it in Personality
Disorder Not Otherwise Specifieddue
to political pressure.

17. Another example is the APA’s failure to
officially acknowledge Parental Alienation
Syndrome(PAS) and Hostile Aggressive
Parenting (HAP). Numerous studies have
been done by credible researchers
documenting and quantifying these
behaviors. Individuals who have been the
target of these pathological and malicious
behaviors know full well how real they are.
Yet, the APA won’t touch it with a 10-foot
pole, probably because it would also assign
pathology to a great many women.

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