Personality disorder classification: Difference between revisions

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==Overview==
==Overview==
There are two approaches used to classify personality disorders; [[categorical]] and [[dimensional]]. [[Categorical]] [[classification]] is based on distinct [[operational]] criteria depending on [[behavioral]] [[characteristics]]. [[DSM-5]] and [[ICD-10]] both uses this approach. As compared to this, [[dimensional]] classification is based on the personality traits and using a [[quantitative]] distinction. It places normality at one end and disorder at other. DSM-5 classifies 10 personality disorders into three clusters due to similar [[characteristics]]:
There are two approaches used to classify [[personality disorders]]; [[categorical]] and [[dimensional]]. [[Categorical]] [[classification]] is based on distinct [[operational]] criteria depending on [[behavioral]] [[characteristics]]. [[DSM-5]] and [[ICD-10]] both uses this approach. As compared to this, [[dimensional]] classification is based on the [[personality traits]] and using a [[quantitative]] distinction. It places normality at one end and [[Disorder (medicine)|disorder]] at other. [[DSM-5]] classifies 10 [[personality disorders]] into three clusters due to similar [[characteristics]]:
[[CLUSTER A]] is defined as odd and eccentric and include [[Paranoid]], [[Schizoid]], and[[Schizotypal]]. CLUSTER B is defined by erratic and emotional behavior and includes [[Antisocial]], [[Borderline]], [[Histrionic]] and [[Narcissist]]. CLUSTER C PDs patients are anxious and fearful and incorporate [[Avoidant]], [[Dependent]] and [[Obsessive-Compulsive]]. [[ICD-10]] classifies into 3 clusters as well, which are A, Odd/eccentric and includes[[Paranoid]] and [[Schizoid]], B, Dramatic and includes [[Dissocial], [[Emotionally unstable borderline]] type, [[Emotionally unstable impulsive]] type and[[Histrionic]], and C, Anxious/fearful that include [[Anxious]], [[Dependent]] and [[Anankastic]].
[[CLUSTER A]] is defined as odd and eccentric and include [[Paranoid]], [[Schizoid]], and [[Schizotypal]]. CLUSTER B is defined by erratic and [[Emotional and behavioral disorders|emotional]] [[behavior]] and includes [[Antisocial]], [[Borderline]], [[Histrionic]] and [[Narcissist]]. CLUSTER C PDs patients are anxious and fearful and incorporate [[Avoidant]], [[Dependent]] and [[Obsessive-Compulsive]]. [[ICD-10]] classifies into 3 clusters as well, which are A, Odd/eccentric and includes[[Paranoid]] and [[Schizoid]], B, Dramatic and includes [[Dissocial personality disorder|Dissocial]], [[Emotionally unstable borderline]] type, [[Emotionally unstable impulsive]] type and [[Histrionic]], and C, Anxious/fearful that include [[Anxious]], [[Dependent]] and [[Anankastic]].


==Classification==
==Classification==
===List of Personality Disorders Defined in the DSM===
===List of Personality Disorders Defined in the DSM===
*DSM-5 classifies 10 personality disorders into three clusters due to similar characteristics:
 
*[[DSM-5]] classifies 10 [[personality disorders]] into three clusters due to similar characteristics:
**CLUSTER A: odd and eccentric
**CLUSTER A: odd and eccentric
***[[Paranoid]]-distrust and suspiciousness
***[[Paranoid]]-distrust and suspiciousness
***[[Schizoid]]-detachment from social relationships
***[[Schizoid]]-[[detachment]] from social relationships
***[[Schizotypal]]-distortion in interpersonal relationships and cognition, and behavioural eccentrism
***[[Schizotypal]]-distortion in [[Interpersonal relationship|interpersonal relationships]] and [[cognition]], and behavioural [[eccentrism]]
**CLUSTER B: erratic and emotional
**CLUSTER B: erratic and [[Emotional and behavioral disorders|emotional]]
***[[Antisocial]]-disregard and violation of rights of others
***[[Antisocial]]-disregard and violation of rights of others
***[[Borderline]]-instability in interpersonal relationships, and impulsivity
***[[Borderline]]-instability in [[Interpersonal relationship|interpersonal relationships]], and [[impulsivity]]
***[[Histrionic]]-eccessive emotionality and attention-seeking behaviour
***[[Histrionic]]-eccessive emotionality and [[attention-seeking behaviour]]
***[[Narcissist]]-grandiosity and lack of empathy
***[[Narcissist]]-grandiosity and lack of [[empathy]]
**CLUSTER C: anxious and fearful
**CLUSTER C: anxious and fearful
***[[Avoidant]]-social inhibition and fear of criticism
***[[Avoidant]]-social [[inhibition]] and fear of criticism
***[[Dependent]]-submissive and excessive need for reassurance  
***[[Dependent]]-[[Submissiveness|submissive]] and excessive need for reassurance
***[[Obsessive-Compulsive]]-preoccupation with perfectionism and orderliness
***[[Obsessive-Compulsive]]-preoccupation with perfectionism and orderliness
*ICD-10 classifies into 3 clusters as well, which are as follows:
*[[ICD-10]] classifies into 3 clusters as well, which are as follows:
**A: Odd/eccentric
**A: Odd/eccentric
***[[Paranoid]]
***[[Paranoid]]
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***[[Anankastic]]
***[[Anankastic]]


The [[DSM-IV-TR|DSM-IV]] lists ten personality disorders, grouped into three clusters. The DSM also contains a category for behavioral patterns that do not match these ten disorders, but nevertheless exhibit characteristics of a personality disorder. This category is labeled ''Personality Disorder NOS'' (Not Otherwise Specified).
The [[DSM-IV-TR|DSM-IV]] lists ten [[personality disorders]], grouped into three clusters. The [[Diagnostic and statistical manual of mental disorders|DSM]] also contains a category for behavioral patterns that do not match these ten disorders, but nevertheless exhibit characteristics of a [[personality disorder]]. This category is labeled ''Personality Disorder NOS'' (Not Otherwise Specified).


''Cluster A'' (odd or eccentric disorders)
''Cluster A'' (odd or eccentric disorders)
:* [[Paranoid personality disorder]]
 
:* [[Schizoid personality disorder]]
:*[[Paranoid personality disorder]]
:* [[Schizotypal personality disorder]]
:*[[Schizoid personality disorder]]
:*[[Schizotypal personality disorder]]


''Cluster B'' (dramatic, emotional, or erratic disorders)
''Cluster B'' (dramatic, emotional, or erratic disorders)
:* [[Antisocial personality disorder]]
 
:* [[Borderline personality disorder]]
:*[[Antisocial personality disorder]]
:* [[Histrionic personality disorder]]
:*[[Borderline personality disorder]]
:* [[Narcissistic personality disorder]]
:*[[Histrionic personality disorder]]
:*[[Narcissistic personality disorder]]


''Cluster C'' (anxious or fearful disorders)
''Cluster C'' (anxious or fearful disorders)
:* [[Avoidant personality disorder]]
 
:* [[Dependent personality disorder]] (''not'' the same as [[Dysthymia]])
:*[[Avoidant personality disorder]]
:* [[Obsessive-compulsive personality disorder]] (''not'' the same as [[Obsessive-compulsive disorder]])
:*[[Dependent personality disorder]] (''not'' the same as [[Dysthymia]])
:*[[Obsessive-compulsive personality disorder]] (''not'' the same as [[Obsessive-compulsive disorder]])


====Revisions and Exclusions from Past DSM Editions====
====Revisions and Exclusions from Past DSM Editions====
The revision of the previous edition of the DSM, DSM-III-R, also contained the ''Passive-Aggressive Personality Disorder'', the ''Self-Defeating Personality Disorder'', and the ''Sadistic Personality Disorder''. [[Passive-aggressive behavior|Passive-Aggressive Personality Disorder]] is a pattern of negative attitudes and passive resistance in interpersonal situations. [[Self-defeating personality disorder]] is characterised by behaviour that consequently undermines the person's pleasure and goals. Sadistic Personality Disorder is a pervasive pattern of cruel, demeaning, and aggressive behavior. These categories were removed in the current version of the DSM, because it is questionable whether these are separate disorders. Passive-Aggressive Personality Disorder and [[Depressive personality disorder]] were placed in an appendix of DSM-IV for research purposes.
The revision of the previous edition of the DSM, DSM-III-R, also contained th[[Passive-aggressive personality disorder|e ''Passive-aggressive Personality Disorder'']], the ''[[Self-defeating personality disorder|Self-defeating Personality Disorder]]'', and the [[Sadistic personality disorder|''Sadistic Personality Disorder''.]] [[Passive-aggressive behavior|Passive-Aggressive Personality Disorder]] is a pattern of negative attitudes and passive resistance in [[interpersonal]] situations. [[Self-defeating personality disorder]] is characterised by behaviour that consequently undermines the person's [[pleasure]] and goals. [[Sadistic personality disorder|Sadistic Personality Disorder]] is a pervasive pattern of cruel, demeaning, and aggressive behavior. These categories were removed in the current version of the [[Diagnostic and statistical manual of mental disorders|DSM]], because it is questionable whether these are separate [[Disorder (medicine)|disorders]]. [[Passive-aggressive personality disorder|Passive-aggressive Personality Disorder]] and [[Depressive personality disorder]] were placed in an appendix of [[DSM-IV]] for [[research]] purposes.
=== World Health Organization ===
===World Health Organization===


The [[ICD-10]] section on mental and behavioral disorders includes categories of personality disorder and enduring personality changes. They are defined as ingrained patterns indicated by inflexible and disabling responses that significantly differ from how the average person in the culture perceives, thinks and feels, particularly in relating to others.<ref>WHO (2010) [http://apps.who.int/classifications/icd10/browse/2010/en#/F60 ICD-10: Specific Personality Disorders]</ref>
The [[ICD-10]] section on [[Mental Disorders|mental]] and [[behavioral]] [[Disorder (medicine)|disorders]] includes categories of [[personality disorder]] and enduring [[personality changes]]. They are defined as ingrained patterns indicated by inflexible and disabling responses that significantly differ from how the average person in the culture perceives, thinks and feels, particularly in relating to others.<ref>WHO (2010) [http://apps.who.int/classifications/icd10/browse/2010/en#/F60 ICD-10: Specific Personality Disorders]</ref>


The specific personality disorders are: [[Paranoid personality disorder|paranoid]], [[Schizoid personality disorder|schizoid]], [[Dissocial personality disorder|dissocial]], [[Emotionally unstable personality disorder|emotionally unstable]] (borderline type and impulsive type), [[Histrionic personality disorder|histrionic]], [[Anankastic personality disorder|anankastic]], [[Avoidant personality disorder|anxious (avoidant)]] and [[Dependent personality disorder|dependent]].<ref>[http://apps.who.int/classifications/icd10/browse/2010/en#/F60-F69 "International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10) Version for 2010 (Online Version)"]. Apps.who.int. Retrieved on 2013-04-16.</ref>
The specific personality disorders are: [[Paranoid personality disorder|paranoid]], [[Schizoid personality disorder|schizoid]], [[Dissocial personality disorder|dissocial]], [[Emotionally unstable personality disorder|emotionally unstable]] (borderline type and impulsive type), [[Histrionic personality disorder|histrionic]], [[Anankastic personality disorder|anankastic]], [[Avoidant personality disorder|anxious (avoidant)]] and [[Dependent personality disorder|dependent]].<ref>[http://apps.who.int/classifications/icd10/browse/2010/en#/F60-F69 "International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10) Version for 2010 (Online Version)"]. Apps.who.int. Retrieved on 2013-04-16.</ref>
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There is also an 'Other' category involving conditions characterized as [[eccentricity (behavior)|eccentric]], ''[[haltlose personality disorder|haltlose]]'' (derived from "haltlos" (''German'') = drifting, aimless and irresponsible),<ref>{{cite journal|title='Haltlose' type personality disorder (ICD-10 F60.8)|journal=The Psychiatrist|year=2000|volume= 24|pages= 235–236 |doi=10.1192/pb.24.6.235-b|last1=Langmaack|first1=C.|issue=6}}</ref> [[Maturity (psychological)|immature]], [[narcissistic]], [[passive-aggressive]] or [[psychoneurotic]]. An additional category is for unspecified personality disorder, including character [[neurosis]] and [[pathological]] personality.
There is also an 'Other' category involving conditions characterized as [[eccentricity (behavior)|eccentric]], ''[[haltlose personality disorder|haltlose]]'' (derived from "haltlos" (''German'') = drifting, aimless and irresponsible),<ref>{{cite journal|title='Haltlose' type personality disorder (ICD-10 F60.8)|journal=The Psychiatrist|year=2000|volume= 24|pages= 235–236 |doi=10.1192/pb.24.6.235-b|last1=Langmaack|first1=C.|issue=6}}</ref> [[Maturity (psychological)|immature]], [[narcissistic]], [[passive-aggressive]] or [[psychoneurotic]]. An additional category is for unspecified personality disorder, including character [[neurosis]] and [[pathological]] personality.


There is also a category for Mixed and other personality disorders, defined as conditions that are often troublesome but do not demonstrate the specific pattern of symptoms in the named disorders. Finally there is a category of Enduring personality changes, not attributable to brain damage and disease. This is for conditions that seem to arise in adults without a diagnosis of personality disorder, following catastrophic or prolonged stress or other psychiatric illness.
There is also a category for Mixed and other [[Personality disorders|personality disorders,]] defined as conditions that are often troublesome but do not demonstrate the specific pattern of [[symptoms]] in the named [[Disorder (medicine)|disorders]]. Finally there is a category of Enduring [[personality changes]], not attributable to [[brain damage]] and [[disease]]. This is for [[conditions]] that seem to arise in adults without a [[diagnosis]] of [[personality disorder]], following catastrophic or prolonged [[Stress (biological)|stress]] or other [[Psychiatric Disorders|psychiatric]] illness.
=== Other ===
===Other===


Some types of personality disorder were in previous versions of the diagnostic manuals but have been deleted. This includes two types that were in the DSM-III-R appendix as "Proposed diagnostic categories needing further study" without specific criteria, namely [[Sadistic personality disorder]] (a pervasive pattern of cruel, demeaning and aggressive behavior) and [[Self-defeating personality disorder]] (masochistic personality disorder) (characterised by behaviour consequently undermining the person's pleasure and goals).<ref>{{cite journal|author=Fuller, AK, Blashfield, RK, Miller, M, Hester, T |title=Sadistic and self-defeating personality disorder criteria in a rural clinic sample|doi=10.1002/1097-4679(199211)48:6<827::AID-JCLP2270480618>3.0.CO;2–1|year=1992|journal=Journal of Clinical Psychology|volume=48|issue=6|pages=827–31|pmid=1452772}}</ref> The psychologist [[Theodore Millon]] and others consider some relegated diagnoses to be equally valid disorders, and may also propose other personality disorders or subtypes, including mixtures of aspects of different categories of the officially accepted diagnoses.<ref name="millon3">Millon, Theodore (2004) ''Personality Disorders in Modern Life'', John Wiley & Sons, ISBN 0471668508.</ref>
Some types of [[personality disorder]] were in previous versions of the [[Diagnosis|diagnostic]] manuals but have been deleted. This includes two types that were in the [[DSM-III-R]] appendix as "proposed [[diagnostic]] categories needing further study" without specific criteria, namely [[sadistic personality disorder]] (a pervasive pattern of cruel, demeaning and aggressive behavior) and [[Self-defeating personality disorder]] (masochistic personality disorder) (characterised by behaviour consequently undermining the person's pleasure and goals).<ref>{{cite journal|author=Fuller, AK, Blashfield, RK, Miller, M, Hester, T |title=Sadistic and self-defeating personality disorder criteria in a rural clinic sample|doi=10.1002/1097-4679(199211)48:6<827::AID-JCLP2270480618>3.0.CO;2–1|year=1992|journal=Journal of Clinical Psychology|volume=48|issue=6|pages=827–31|pmid=1452772}}</ref> The psychologist [[Theodore Millon]] and others consider some relegated diagnoses to be equally valid [[disorders]], and may also propose other [[personality disorders]] or subtypes, including mixtures of aspects of different [[categories]] of the officially accepted diagnoses.<ref name="millon3">Millon, Theodore (2004) ''Personality Disorders in Modern Life'', John Wiley & Sons, ISBN 0471668508.</ref>


{| class="wikitable"
{| class="wikitable"
|-
|-
! style="text-align: center" colspan="6" | '''Personality disorder diagnoses in each edition of American Psychiatric Association's Diagnostic Manual'''<ref name="Widiger 99">Widiger, Thomas (2012). ''The Oxford Handbook of Personality Disorders.'' Oxford University Press. ISBN 978-0199735013.</ref>
! colspan="6" style="text-align: center" |'''Personality disorder diagnoses in each edition of American Psychiatric Association's Diagnostic Manual'''<ref name="Widiger 99">Widiger, Thomas (2012). ''The Oxford Handbook of Personality Disorders.'' Oxford University Press. ISBN 978-0199735013.</ref>
|-
|-
! '''DSM-I'''
!'''DSM-I'''
! '''DSM-II'''
!'''DSM-II'''
! '''DSM-III'''
!'''DSM-III'''
! '''DSM-III-R'''
!'''DSM-III-R'''
! '''DSM-IV(-TR)'''
!'''DSM-IV(-TR)'''
! '''DSM-V Proposals'''
!'''DSM-V Proposals'''
|-
|-
| ''Personality''
|''Personality''
|
|
|
|
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|
|
|-
|-
| ''Pattern disturbance:''
|''Pattern disturbance:''
|
|
|
|
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|
|
|-
|-
| Inadequate
|Inadequate
| Inadequate
|Inadequate
|
|
|
|
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|
|
|-
|-
| Schizoid
|Schizoid
| Schizoid
|Schizoid
| Schizoid
|Schizoid
| Schizoid
|Schizoid
| Schizoid
|Schizoid
|
|
|-
|-
| Cyclothymic
|Cyclothymic
| Cyclothymic
|Cyclothymic
|
|
|
|
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|
|
|-
|-
| Paranoid
|Paranoid
| Paranoid
|Paranoid
| Paranoid
|Paranoid
| Paranoid
|Paranoid
| Paranoid
|Paranoid
|
|
|-
|-
|
|
|
|
| Schizotypal
|Schizotypal
| Schizotypal
|Schizotypal
| Schizotypal
|Schizotypal
| Schizotypal*
|Schizotypal*
|-
|-
| ''Personality''
|''Personality''
|
|
|
|
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|
|
|-
|-
| ''Trait disturbance:''
|''Trait disturbance:''
|
|
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|
|
|-
|-
| Emotionally unstable
|Emotionally unstable
| Hysterical
|Hysterical
| Histrionic
|Histrionic
| Histrionic
|Histrionic
| Histrionic
|Histrionic
|
|
|-
|-
|
|
|
|
| Borderline
|Borderline
| Borderline
|Borderline
| Borderline
|Borderline
| Borderline
|Borderline
|-
|-
| Compulsive
|Compulsive
| Obsessive-compulsive
|Obsessive-compulsive
| Compulsive
|Compulsive
| Obsessive-compulsive
|Obsessive-compulsive
| Obsessive-compulsive
|Obsessive-compulsive
| Obsessive-compulsive
|Obsessive-compulsive
|-
|-
| ''Passive-aggressive:''
|''Passive-aggressive:''
|
|
|
|
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|
|
|-
|-
| Passive-depressive subtype
|Passive-depressive subtype
|
|
| Dependent
|Dependent
| Dependent
|Dependent
| Dependent
|Dependent
|
|
|-
|-
| Passive-aggressive subtype
|Passive-aggressive subtype
| Passive-aggressive
|Passive-aggressive
| Passive-aggressive
|Passive-aggressive
| Passive-aggressive
|Passive-aggressive
|
|
|
|
|-
|-
| Aggressive subtype
|Aggressive subtype
|
|
|
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|-
|-
|
|
| Explosive
|Explosive
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|-
|-
|
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| Asthenic
|Asthenic
|
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|
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|
|
|
|
| Avoidant
|Avoidant
| Avoidant
|Avoidant
| Avoidant
|Avoidant
| Avoidant
|Avoidant
|-
|-
|
|
|
|
| Narcissistic
|Narcissistic
| Narcissistic
|Narcissistic
| Narcissistic
|Narcissistic
| Narcissistic**
|Narcissistic**
|-
|-
| ''Sociopathic personality''
|''Sociopathic personality''
|
|
|
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|
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|-
|-
| ''Disturbance:''
|''Disturbance:''
|
|
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|
|
|-
|-
| Antisocial reaction
|Antisocial reaction
| Antisocial
|Antisocial
| Antisocial
|Antisocial
| Antisocial
|Antisocial
| Antisocial
|Antisocial
| Antisocial-psychopathic
|Antisocial-psychopathic
|-
|-
| Dyssocial reaction
|Dyssocial reaction
|
|
|
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|-
|-
| Sexual deviation
|Sexual deviation
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|-
|-
| ''Addiction''
|''Addiction''
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| ''Appendix:''
|''Appendix:''
| ''Appendix:''
|''Appendix:''
| ''Appendix:''
|''Appendix:''
|-
|-
|
|
|
|
|
|
| Self-defeating
|Self-defeating
| Negativistic
|Negativistic
| Dependent
|Dependent
|-
|-
|
|
|
|
|
|
| Sadistic
|Sadistic
| Depressive
|Depressive
| Histrionic
|Histrionic
|-
|-
|
|
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|
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|
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| Paranoid
|Paranoid
|-
|-
|
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| Schizoid
|Schizoid
|-
|-
|
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| Negativistic
|Negativistic
|-
|-
|
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|
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| Depressive
|Depressive
|}
|}


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''** – Originally proposed for deletion; status remains unclear for DSM-5.''
''** – Originally proposed for deletion; status remains unclear for DSM-5.''


=== Millon's Description of Personality Disorders ===
===Millon's Description of Personality Disorders===


Psychologist [[Theodore Millon]], who has written numerous popular works on personality, proposed the following description of personality disorders:
Psychologist [[Theodore Millon]], who has written numerous popular works on [[personality]], proposed the following description of [[personality disorders]]:


{| class="wikitable"
{| class="wikitable"
|-
|-
! style="text-align: center" colspan="2" | '''Millon's brief description of personality disorders'''<ref name="Millon">Millon, Theodore (2004). ''Personality Disorders in Modern Life'', p. 4. John Wiley & Sons, Inc., Hoboken, New Jersey. ISBN 0-471-23734-5.</ref>
! colspan="2" style="text-align: center" |'''Millon's brief description of personality disorders'''<ref name="Millon">Millon, Theodore (2004). ''Personality Disorders in Modern Life'', p. 4. John Wiley & Sons, Inc., Hoboken, New Jersey. ISBN 0-471-23734-5.</ref>
|-
|-
! Type of personality disorder
!Type of personality disorder
! Description
!Description
|-
|-
| '''Paranoid'''
|'''Paranoid'''
| Guarded, defensive, distrustful and suspiciousness. Hypervigilant to the motives of others to undermine or do harm. Always seeking confirmatory evidence of hidden schemes. Feels righteous, but persecuted.
|Guarded, defensive, distrustful and suspiciousness. Hypervigilant to the motives of others to undermine or do harm. Always seeking confirmatory evidence of hidden schemes. Feels righteous, but persecuted.
|-
|-
| '''Schizoid'''
|'''Schizoid'''
| Apathetic, indifferent, remote, solitary, distant, humorless. Neither desires nor need human attachments. Withdrawal from relationships and prefer to be alone. Little interest in others, often seen as a loner. Minimal awareness of feelings of self or others. Few drives or ambitions, if any.
|Apathetic, indifferent, remote, solitary, distant, humorless. Neither desires nor need human attachments. Withdrawal from relationships and prefer to be alone. Little interest in others, often seen as a loner. Minimal awareness of feelings of self or others. Few drives or ambitions, if any.
|-
|-
| '''Schizotypal'''
|'''Schizotypal'''
| Eccentric, self-estranged, bizarre, absent. Exhibits peculiar mannerisms and behaviors. Thinks can read thoughts of others. Preoccupied with odd daydreams and beliefs. Blurs line between reality and fantasy. Magical thinking and strange beliefs.
|Eccentric, self-estranged, bizarre, absent. Exhibits peculiar mannerisms and behaviors. Thinks can read thoughts of others. Preoccupied with odd daydreams and beliefs. Blurs line between reality and fantasy. Magical thinking and strange beliefs.
|-
|-
| '''Antisocial'''
|'''Antisocial'''
| Impulsive, irresponsible, deviant, unruly. Acts without due consideration. Meets social obligations only when self-serving. Disrespects societal customs, rules, and standards. Sees self as free and independent.
|Impulsive, irresponsible, deviant, unruly. Acts without due consideration. Meets social obligations only when self-serving. Disrespects societal customs, rules, and standards. Sees self as free and independent.
|-
|-
| '''Borderline'''
|'''Borderline'''
| Unpredictable, manipulative, unstable. Frantically fears abandonment and isolation. Experiences rapidly fluctuating moods. Shifts rapidly between loving and hating. Sees self and others alternatively as all-good and all-bad. Unstable and frequently changing moods.
|Unpredictable, manipulative, unstable. Frantically fears abandonment and isolation. Experiences rapidly fluctuating moods. Shifts rapidly between loving and hating. Sees self and others alternatively as all-good and all-bad. Unstable and frequently changing moods.
|-
|-
| '''Histrionic'''
|'''Histrionic'''
| Dramatic, seductive, shallow, stimulus-seeking, vain. Overreacts to minor events. Exhibitionistic as a means of securing attention and favors. Sees self as attractive and charming. Constant seeking for others' attention.
|Dramatic, seductive, shallow, stimulus-seeking, vain. Overreacts to minor events. Exhibitionistic as a means of securing attention and favors. Sees self as attractive and charming. Constant seeking for others' attention.
|-
|-
| '''Narcissistic'''
|'''Narcissistic'''
| Egotistical, arrogant, grandiose, insouciant. Preoccupied with fantasies of success, beauty, or achievement. Sees self as admirable and superior, and therefore entitled to special treatment.
|Egotistical, arrogant, grandiose, insouciant. Preoccupied with fantasies of success, beauty, or achievement. Sees self as admirable and superior, and therefore entitled to special treatment.
|-
|-
| '''Avoidant'''
|'''Avoidant'''
| Hesitant, self-conscious, embarrassed, anxious. Tense in social situations due to fear of rejection. Plagued by constant performance anxiety. Sees self as inept, inferior, or unappealing. Feels alone and empty.
|Hesitant, self-conscious, embarrassed, anxious. Tense in social situations due to fear of rejection. Plagued by constant performance anxiety. Sees self as inept, inferior, or unappealing. Feels alone and empty.
|-
|-
| '''Dependent'''
|'''Dependent'''
| Helpless, incompetent, submissive, immature. Withdraws from adult responsibilities. Sees self as weak or fragile. Seeks constant reassurance from stronger figures.
|Helpless, incompetent, submissive, immature. Withdraws from adult responsibilities. Sees self as weak or fragile. Seeks constant reassurance from stronger figures.
|-
|-
| '''Obsessive–compulsive'''
|'''Obsessive–compulsive'''
| Restrained, conscientious, respectful, rigid. Maintains a rule-bound lifestyle. Adheres closely to social conventions. Sees the world in terms of regulations and hierarchies. Sees self as devoted, reliable, efficient, and productive.
|Restrained, conscientious, respectful, rigid. Maintains a rule-bound lifestyle. Adheres closely to social conventions. Sees the world in terms of regulations and hierarchies. Sees self as devoted, reliable, efficient, and productive.
|-
|-
| '''Depressive'''
|'''Depressive'''
| Somber, discouraged, pessimistic, brooding, fatalistic. Presents self as vulnerable and abandoned. Feels valueless, guilty, and impotent. Judges self as worthy only of criticism and contempt.
|Somber, discouraged, pessimistic, brooding, fatalistic. Presents self as vulnerable and abandoned. Feels valueless, guilty, and impotent. Judges self as worthy only of criticism and contempt.
|-
|-
| '''Passive–aggressive (Negativistic)'''
|'''Passive–aggressive (Negativistic)'''
| Resentful, contrary, skeptical, discontented. Resist fulfilling others’ expectations. Deliberately inefficient. Vents anger indirectly by undermining others’ goals. Alternately moody and irritable, then sullen and withdrawn.
|Resentful, contrary, skeptical, discontented. Resist fulfilling others’ expectations. Deliberately inefficient. Vents anger indirectly by undermining others’ goals. Alternately moody and irritable, then sullen and withdrawn.
|-
|-
| '''Sadistic'''
|'''Sadistic'''
| Explosively hostile, abrasive, cruel, dogmatic. Liable to sudden outbursts of rage. Feels selfsatisfied through dominating, intimidating and humiliating others. Is opinionated and closeminded.
|Explosively hostile, abrasive, cruel, dogmatic. Liable to sudden outbursts of rage. Feels selfsatisfied through dominating, intimidating and humiliating others. Is opinionated and closeminded.
|-
|-
| '''Self-defeating (Masochistic)'''
|'''Self-defeating (Masochistic)'''
| Deferential, pleasure-phobic, servile, blameful, self-effacing. Encourages others to take advantage. Deliberately defeats own achievements. Seeks condemning or mistreatful partners.
|Deferential, pleasure-phobic, servile, blameful, self-effacing. Encourages others to take advantage. Deliberately defeats own achievements. Seeks condemning or mistreatful partners.
|}
|}


=== Additional Classification Factors ===
===Additional Classification Factors===


Except for classifying by category and cluster, it is possible to classify personality disorders using such additional factors as severity, impact on social functioning, and [[Attribution (psychology)|attribution]].<ref name="Murray">Murray, Robin M. et al (2008). ''Psychiatry. Fourth Edition''. Cambridge University Press. ISBN 978-0-521-60408-6.</ref>
Except for classifying by category and cluster, it is possible to classify [[personality disorders]] using such additional factors as severity, impact on social functioning, and [[Attribution (psychology)|attribution]].<ref name="Murray">Murray, Robin M. et al (2008). ''Psychiatry. Fourth Edition''. Cambridge University Press. ISBN 978-0-521-60408-6.</ref>


==References==
==References==

Latest revision as of 22:15, 9 September 2021

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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

There are two approaches used to classify personality disorders; categorical and dimensional. Categorical classification is based on distinct operational criteria depending on behavioral characteristics. DSM-5 and ICD-10 both uses this approach. As compared to this, dimensional classification is based on the personality traits and using a quantitative distinction. It places normality at one end and disorder at other. DSM-5 classifies 10 personality disorders into three clusters due to similar characteristics: CLUSTER A is defined as odd and eccentric and include Paranoid, Schizoid, and Schizotypal. CLUSTER B is defined by erratic and emotional behavior and includes Antisocial, Borderline, Histrionic and Narcissist. CLUSTER C PDs patients are anxious and fearful and incorporate Avoidant, Dependent and Obsessive-Compulsive. ICD-10 classifies into 3 clusters as well, which are A, Odd/eccentric and includesParanoid and Schizoid, B, Dramatic and includes Dissocial, Emotionally unstable borderline type, Emotionally unstable impulsive type and Histrionic, and C, Anxious/fearful that include Anxious, Dependent and Anankastic.

Classification

List of Personality Disorders Defined in the DSM

The DSM-IV lists ten personality disorders, grouped into three clusters. The DSM also contains a category for behavioral patterns that do not match these ten disorders, but nevertheless exhibit characteristics of a personality disorder. This category is labeled Personality Disorder NOS (Not Otherwise Specified).

Cluster A (odd or eccentric disorders)

Cluster B (dramatic, emotional, or erratic disorders)

Cluster C (anxious or fearful disorders)

Revisions and Exclusions from Past DSM Editions

The revision of the previous edition of the DSM, DSM-III-R, also contained the Passive-aggressive Personality Disorder, the Self-defeating Personality Disorder, and the Sadistic Personality Disorder. Passive-Aggressive Personality Disorder is a pattern of negative attitudes and passive resistance in interpersonal situations. Self-defeating personality disorder is characterised by behaviour that consequently undermines the person's pleasure and goals. Sadistic Personality Disorder is a pervasive pattern of cruel, demeaning, and aggressive behavior. These categories were removed in the current version of the DSM, because it is questionable whether these are separate disorders. Passive-aggressive Personality Disorder and Depressive personality disorder were placed in an appendix of DSM-IV for research purposes.

World Health Organization

The ICD-10 section on mental and behavioral disorders includes categories of personality disorder and enduring personality changes. They are defined as ingrained patterns indicated by inflexible and disabling responses that significantly differ from how the average person in the culture perceives, thinks and feels, particularly in relating to others.[1]

The specific personality disorders are: paranoid, schizoid, dissocial, emotionally unstable (borderline type and impulsive type), histrionic, anankastic, anxious (avoidant) and dependent.[2]

There is also an 'Other' category involving conditions characterized as eccentric, haltlose (derived from "haltlos" (German) = drifting, aimless and irresponsible),[3] immature, narcissistic, passive-aggressive or psychoneurotic. An additional category is for unspecified personality disorder, including character neurosis and pathological personality.

There is also a category for Mixed and other personality disorders, defined as conditions that are often troublesome but do not demonstrate the specific pattern of symptoms in the named disorders. Finally there is a category of Enduring personality changes, not attributable to brain damage and disease. This is for conditions that seem to arise in adults without a diagnosis of personality disorder, following catastrophic or prolonged stress or other psychiatric illness.

Other

Some types of personality disorder were in previous versions of the diagnostic manuals but have been deleted. This includes two types that were in the DSM-III-R appendix as "proposed diagnostic categories needing further study" without specific criteria, namely sadistic personality disorder (a pervasive pattern of cruel, demeaning and aggressive behavior) and Self-defeating personality disorder (masochistic personality disorder) (characterised by behaviour consequently undermining the person's pleasure and goals).[4] The psychologist Theodore Millon and others consider some relegated diagnoses to be equally valid disorders, and may also propose other personality disorders or subtypes, including mixtures of aspects of different categories of the officially accepted diagnoses.[5]

Personality disorder diagnoses in each edition of American Psychiatric Association's Diagnostic Manual[6]
DSM-I DSM-II DSM-III DSM-III-R DSM-IV(-TR) DSM-V Proposals
Personality
Pattern disturbance:
Inadequate Inadequate
Schizoid Schizoid Schizoid Schizoid Schizoid
Cyclothymic Cyclothymic
Paranoid Paranoid Paranoid Paranoid Paranoid
Schizotypal Schizotypal Schizotypal Schizotypal*
Personality
Trait disturbance:
Emotionally unstable Hysterical Histrionic Histrionic Histrionic
Borderline Borderline Borderline Borderline
Compulsive Obsessive-compulsive Compulsive Obsessive-compulsive Obsessive-compulsive Obsessive-compulsive
Passive-aggressive:
Passive-depressive subtype Dependent Dependent Dependent
Passive-aggressive subtype Passive-aggressive Passive-aggressive Passive-aggressive
Aggressive subtype
Explosive
Asthenic
Avoidant Avoidant Avoidant Avoidant
Narcissistic Narcissistic Narcissistic Narcissistic**
Sociopathic personality
Disturbance:
Antisocial reaction Antisocial Antisocial Antisocial Antisocial Antisocial-psychopathic
Dyssocial reaction
Sexual deviation
Addiction
Appendix: Appendix: Appendix:
Self-defeating Negativistic Dependent
Sadistic Depressive Histrionic
Paranoid
Schizoid
Negativistic
Depressive

* – Not actually to be classified as a personality disorder; classified instead as a form of schizophrenia-spectrum disorder.
** – Originally proposed for deletion; status remains unclear for DSM-5.

Millon's Description of Personality Disorders

Psychologist Theodore Millon, who has written numerous popular works on personality, proposed the following description of personality disorders:

Millon's brief description of personality disorders[7]
Type of personality disorder Description
Paranoid Guarded, defensive, distrustful and suspiciousness. Hypervigilant to the motives of others to undermine or do harm. Always seeking confirmatory evidence of hidden schemes. Feels righteous, but persecuted.
Schizoid Apathetic, indifferent, remote, solitary, distant, humorless. Neither desires nor need human attachments. Withdrawal from relationships and prefer to be alone. Little interest in others, often seen as a loner. Minimal awareness of feelings of self or others. Few drives or ambitions, if any.
Schizotypal Eccentric, self-estranged, bizarre, absent. Exhibits peculiar mannerisms and behaviors. Thinks can read thoughts of others. Preoccupied with odd daydreams and beliefs. Blurs line between reality and fantasy. Magical thinking and strange beliefs.
Antisocial Impulsive, irresponsible, deviant, unruly. Acts without due consideration. Meets social obligations only when self-serving. Disrespects societal customs, rules, and standards. Sees self as free and independent.
Borderline Unpredictable, manipulative, unstable. Frantically fears abandonment and isolation. Experiences rapidly fluctuating moods. Shifts rapidly between loving and hating. Sees self and others alternatively as all-good and all-bad. Unstable and frequently changing moods.
Histrionic Dramatic, seductive, shallow, stimulus-seeking, vain. Overreacts to minor events. Exhibitionistic as a means of securing attention and favors. Sees self as attractive and charming. Constant seeking for others' attention.
Narcissistic Egotistical, arrogant, grandiose, insouciant. Preoccupied with fantasies of success, beauty, or achievement. Sees self as admirable and superior, and therefore entitled to special treatment.
Avoidant Hesitant, self-conscious, embarrassed, anxious. Tense in social situations due to fear of rejection. Plagued by constant performance anxiety. Sees self as inept, inferior, or unappealing. Feels alone and empty.
Dependent Helpless, incompetent, submissive, immature. Withdraws from adult responsibilities. Sees self as weak or fragile. Seeks constant reassurance from stronger figures.
Obsessive–compulsive Restrained, conscientious, respectful, rigid. Maintains a rule-bound lifestyle. Adheres closely to social conventions. Sees the world in terms of regulations and hierarchies. Sees self as devoted, reliable, efficient, and productive.
Depressive Somber, discouraged, pessimistic, brooding, fatalistic. Presents self as vulnerable and abandoned. Feels valueless, guilty, and impotent. Judges self as worthy only of criticism and contempt.
Passive–aggressive (Negativistic) Resentful, contrary, skeptical, discontented. Resist fulfilling others’ expectations. Deliberately inefficient. Vents anger indirectly by undermining others’ goals. Alternately moody and irritable, then sullen and withdrawn.
Sadistic Explosively hostile, abrasive, cruel, dogmatic. Liable to sudden outbursts of rage. Feels selfsatisfied through dominating, intimidating and humiliating others. Is opinionated and closeminded.
Self-defeating (Masochistic) Deferential, pleasure-phobic, servile, blameful, self-effacing. Encourages others to take advantage. Deliberately defeats own achievements. Seeks condemning or mistreatful partners.

Additional Classification Factors

Except for classifying by category and cluster, it is possible to classify personality disorders using such additional factors as severity, impact on social functioning, and attribution.[8]

References

  1. ↑ WHO (2010) ICD-10: Specific Personality Disorders
  2. ↑ "International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10) Version for 2010 (Online Version)". Apps.who.int. Retrieved on 2013-04-16.
  3. ↑ Langmaack, C. (2000). "'Haltlose' type personality disorder (ICD-10 F60.8)". The Psychiatrist. 24 (6): 235–236. doi:10.1192/pb.24.6.235-b.
  4. ↑ Fuller, AK, Blashfield, RK, Miller, M, Hester, T (1992). "Sadistic and self-defeating personality disorder criteria in a rural clinic sample". Journal of Clinical Psychology. 48 (6): 827–31. doi:10.1002/1097-4679(199211)48:6<827::AID-JCLP2270480618>3.0.CO;2–1 Check |doi= value (help). PMID 1452772.
  5. ↑ Millon, Theodore (2004) Personality Disorders in Modern Life, John Wiley & Sons, ISBN 0471668508.
  6. ↑ Widiger, Thomas (2012). The Oxford Handbook of Personality Disorders. Oxford University Press. ISBN 978-0199735013.
  7. ↑ Millon, Theodore (2004). Personality Disorders in Modern Life, p. 4. John Wiley & Sons, Inc., Hoboken, New Jersey. ISBN 0-471-23734-5.
  8. ↑ Murray, Robin M. et al (2008). Psychiatry. Fourth Edition. Cambridge University Press. ISBN 978-0-521-60408-6.

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