Personality disorder differential diagnosis

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

Overview

Boderline disorder needs to be differentiated from mood disorders like Bipolar disorder, anxiety and delusional disorder. Cluster-A disorders have to distinguished from delusional disorder (persecutory type), schizophreniform, bipolar disorder with psychotic symptoms and schizophrenia. Post-traumatic stress disorder (PTSD) can also have interchangeable presenting complaints to the cluster-C PDs.. Thus, Axis-1 disorders and Axis-2 disorders have similar presentation and needs to be evaluated and ruled out before making the diagnosis of Axis-2 disorders.

Differentiating Personality Disorder from other Diseases

Personality disorders present with symptoms which corresponds to other psychiatric illnesses as well. It makes imperative to employ the [DSM-5] criterion to make the diagnosis of PD. Additionally, many patients with PDs also suffer from co-morbid conditions like mood disorders, substance abuse and organic brain lesions which have overlapping symptoms and signs with PDs. This requires a complete long history including duration of symptoms and developmental history and essential investigations.

Differentiating personality disorders from other diseases

Diseases	Symptoms				Physical Examination					Investigations								Gold Standard
		Symptom 1	Symptom 2	Symptom 3		Physical Examination 1	Physical Examination 2	Physical Examination 3		Lab Findings	Imaging Findings
Axis I Psychiatric disorders		mood dysregulatory symptoms; depressed mood, euphoria or anxious	delusions, hallucinations and paranoia	nighttime awakenings and nightmares		dishevelled appearance, provocative, fleeting eye contact, and repeated purposeless movements.	dysphoria	disorganised thought process		no findings	volumetric changes in gray matter in hypothalamus and limbic system
Adjustment Disorder		low mood	poor concentration	insomnia		tenderness at various points, depressed mood	DSM-V criteria	Varying blood pressure and heart rate		hemoglobin, vitamin D, TSH	decreased gray matter volume in the right medial frontal gyrus
Central Nervous System Disorder		early morning headache	vomiting	paresis or numbness		dysarthria, echolalia, palilalia or alogia	focal neurological deficit	raised intracranial pressure, papilledema		deranged sodium, increased calcium, cytology in CSF, abnormal tumor markers	single or multiple space-occupying lesion with contrast enhancement.
Substance Use Disorder		dishevelled appearance, akathisia, bradykinesia	inability to follow commands and abnormal gait	dysarthria and anosognosia		abnormal liver, renal tests and cardiac enzymes, urine or serum drug screen	homogenous hypo-density in case of infarction with cocaine use
Metabolic Derangement		waxing and waning consciousness	seizures	constipation, dry skin, hair loss, weight changes		not oriented in time, place and person	impaired memory, speech and gait	changes in blood pressure and heart rate		sodium, potassium, calcium, glucose, cortisol, TSH, urine examination	hyperintense signals in t1-weighted images in basal ganglia, thalami, and hemispheric white matter