Personality disorder diagnostic study of choice

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Ayesha Anwar, M.B.B.S[2]

Overview

The diagnosis of personality disorder is intricate as most patients present with symptoms related to depression and anxiety, and many times, two or more personality disorders co-exist. Also, an overlap in certain personality characteristics among different personality disorders. Therefore, the diagnosis of a personality disorder requires a specific criterion after a complete evaluation of cognitive, behavioral, interpersonal, and social features in an individual. DSM-5 and ICD-10 criteria are usually employed for this purpose.

Diagnostic Criteria

The diagnosis of personality disorder is intricate as most patients present with symptoms related to depression and anxiety, and many times, two or more personality disorders co-exist. Also, an overlap in certain personality characteristics among different personality disorders. Therefore, the diagnosis of a personality disorder requires a specific criterion after a complete evaluation of cognitive, behavioral, interpersonal, and social features in an individual.

• In DSM-5, the following criteria must be met:
  • A persistent and enduring pattern of behavior and traits that do not comply with one's culture involving  2 of the following: cognition (ways of perceiving and interpreting self, others, or events), affectivity (degree or range of a person's emotional response), interpersonal functioning and impulse control.
  • This maladaptive pattern causes significant distress and impaired responses in social, occupational, and other areas.
  • The onset is in early adolescence or early adulthood, and hence, the duration of symptoms is long.
  • The symptoms should be present for greater than one year if age is less than 18 years, and for antisocial PD, age should be greater than 18 years.
  • The symptomatology cannot be explained with any other psychological or neurological abnormality, and substance abuse disorders have been ruled out.
• In ICD-10, World Health Organization (WHO) lists the following criteria:
  • The deeply engrained and enduring pattern of behavioral tendencies in various aspects of personality, including affectivity, impulse control, arousal, perception and thinking, and style of relating to others, producing personal and social disruption.
  • The PDs may co-exist with other mental disorders; however, the behavior is continuous and not limited to episodes of mental illness.
  • The inflexible attitude started in adolescence or early adulthood and diagnosed later in life.
  • It is of long duration and follows a stable course.
  • The symptoms are responsible for considerable personal distress and significant social impairment.

At least 3 of these criteria must be met, and ICD-10 adds that 'for different cultures, it may be necessary to develop specific sets of criteria with regards to social norms, rules, and obligations.'