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. | self-inflicted wounds | 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 | low mood, ecstasy | abnormal sleep pattern | lack of concern for symptoms | 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 | ||||||||||