Personality Disorders As part of the Advanced Psychopathology class requirement I was asked to write a paper on personality disorders. Due to the length of the disorder and the latest changes on the DSM IV we will focus on the disorders that make the cut, changes in the DSM and the treatment to the disorders. Personality Disorder is an enduring pattern of inner experience and behavior that deviates markedly from the expectations of the individual’s culture, is pervasive and inflexible, has an onset in adolescence or early adulthood, is stable over time and leads to distress or impairment, (The American Psychiatric Association, 1994). The DSM-5 Proposal for Personality and Personality Disorders (PDs) ( American Psychiatric Association [APA], 2010) initiated much hand-wringing, anger, and suspicion among clinical scientists and practitioners, with many individual responses and “official positions” from scientific societies posted to the DSM-5 Website; and, many other commentaries and critiques being developed and disseminated across numerous scientific outlets. DSM-5 PD workgroup reported that there is need for “a significant reformulation of the approach to the assessment and diagnosis of personality psychopathology” (APA, 2010, pp. 1). These changes would transform how we conceptualize and diagnose personality disorders, but they are so complex and multifaceted that many of us would be “lost in translation.”
The new version of the Diagnostic and Statistical Manual of Mental Disorders—fifth edition (DSM-5) is to be released in May 2013. Although there will be changes throughout the manual, none are likely to be quite as dramatic as those proposed to the personality disorders (PDs) section (http://www.dsm5.org). The proposal put forth by the DSM-5 Personality and Personality Disorders Workgroup represents a major reconceptualization of personality psychopathology. The proposed changes are extensive and include a hybrid dimensional-categorical model; removal of four PDs (dependent, histrionic, schizoid, paranoid); dropping explicit behavioral criterion sets in favor of personality traits; separate ratings for distinct types of personality functioning (self vs. interpersonal); and a novel 5-domain, 25-facet trait dimensional model of personality. Bid farewell to schizoid, paranoid, histrionic, narcissistic, and dependent personality disorders, as well as that admittedly overused standby, personality disorder NOS. Surviving the cut are the following five: schizotypal, avoidant, borderline, antisocial/psychopathic, and obsessive compulsive personality disorders. While the reduction in the personality disorder types represents a significant change from DSM-IV, it is the shift to a dimensional model of personality assessment that would likely leave many in the psychiatric community scratching their heads. In an effort to create an individualized, person-centered approach, the DSM-5 would include a four part assessment of personality, which would include: Severity scale. Rated from zero (no impairment) to four (extreme impairment) ,Type match: To what degree does a patient’s personality match one of the five remaining personality types, from one (no match) to five (a good match). Trait domains and facets. Each personality type may have up to six “trait domains”—negative emotionality, introversion, antagonism, disinhibition, compulsivity, and schizotypy. Each trait domain is further broken down to more specific “trait facets.” You then rate each trait on a scale from zero (very little or not at all descriptive) to three (extremely descriptive).
1. Personality disorder. Finally, you determine: “Does the person meet criteria for a personality disorder?”
In summary the proposed approach to PD diagnosis in the DSM-5 is a two-step process, with an initial determination of impairment