PERSONALITY DISORDERS

Personality disorders (Axis II)Cluster A (odd or eccentric)301.0 Paranoid personality disorder301.20 Schizoid personality disorder301.22 Schizotypal personality disorder

Cluster B (dramatic, emotional, or erratic)301.7 Antisocial personality disorder301.83 Borderline personality disorder301.50 Histrionic personality disorder301.81 Narcissistic personality disorder

Cluster C (anxious or fearful)301.82 Avoidant personality disorder301.6 Dependent personality disorder301.4 Obsessive-compulsive personality disorder

Four personality disorders were excluded from the main body of the latest version of the DSM (DSM-IV-TR) but this diagnosis may be used instead.

The four personality disorders are:Sadistic personality disorderSelf-defeating personality disorderDepressive personality disorderPassive–aggressive personality disorder

It is a requirement of DSM-IV that a diagnosis of any personality disorder also satisfies a set of general personality disorder criteria.Diagnostic

(F60) Specific personality disorders (F60.0) Paranoid personality disorder(F60.1) Schizoid personality disorder(F60.2) Dissocial personality disorder

Antisocial personality disorder(F60.3) Emotionally unstable personality disorder

Borderline personality disorder(F60.4) Histrionic personality disorder(F60.5) Anankastic personality disorder

Obsessive-compulsive personality disorder(F60.6) Anxious (avoidant) personality disorder(F60.7) Dependent personality disorder(F60.8) Other specific personality disorders

Eccentric personality disorderHaltlose personality disorderImmature personality disorderNarcissistic personality disorderPassive-aggressive personality disorderPsychoneurotic personality disorder

(F60.9) Personality disorder not otherwise specified|Personality disorder unspecified

ICD-10

Narcissistic Personality Disorder and Histrionic Personality Disorder

To Be Eliminated in the DSM-V

DSM-IV-R recognizes 10 personality disorders plus Personality Disorder Not Otherwise Specified:

Paranoid Personality DisorderSchizoid Personality DisorderSchizotypal Personality DisorderAntisocial Personality Disorder (ASPD)Borderline Personality Disorder (BPD)Histrionic Personality Disorder (HPD)Narcissistic Personality Disorder (NPD)Avoidant Personality DisorderDependent Personality DisorderObsessive-Compulsive Personality Disorder

They plan to collapse these 10 into the following 5 buckets:

Antisocial/Psychopathic TypeAvoidant TypeBorderline TypeObsessive-Compulsive TypeSchizotypal Type

will try to interpret the rationale for the elimination of 5 of the 10 currently recognized DSM-IV-R personality disorders with a specific focus on the Cluster B or “dramatic” personality disorders (NPD, BPD, ASPD and HPD).

The New York Times reports in A Fate that Narcissists Will Hate: Being Ignored The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (due out in 2013, and known as DSM-5) has eliminated five of the 10personality disorders that are listed in the current edition

Narcissistic personality disorder is the most well-known of the five, and its absence has caused the most stir in professional circles.

The APA seems to be folding NPD and HPD into the Antisocial/Psychopathic Type; while the Borderline Type shares 2 of the 3 traits is viewed as being the most sociopathic with the Antisocial /PsychopathicType: Antagonism: Aggression and Antagonism: Hostility

Aggression is defined as “being mean, cruel, or cold-hearted; verbally, relationally, or physically abusive; humiliating and demeaning of others; willingly and willfully engaging in acts of violence against persons and objects; active and open belligerence or vengefulness; using dominance and intimidation to control others.”

Hostility is defined as “irritability, hot temperedness; being unfriendly, rude, surly, or nasty; responding angrily to minor slights and insults.”

 Antagonism: Callousness isnot included in the Borderline Type, which is defined as “lack of empathy or concern for others’ feelings or problems; lack of guilt or remorse about the negative or harmful effects of one’s actions on others; exploitativeness.”

the rationale for reformulating the Cluster B personality

Considerable research has shown excessive co-occurrence among personality disorders diagnosed using the categorical system of the DSM (Oldham et al., 1992; Zimmerman et al., 2005). In fact, most patients diagnosed with personality disorders meet criteria for more than one. In addition, all of the personality disorder categories have arbitrary diagnostic thresholds, i.e., the number of criteria necessary for a diagnosis.

PD diagnoses have been shown in longitudinal follow-along studies to be significantly less stable over time than their definition in DSM-IV implies (e.g., Grilo et al., 2004). The reduction in the number of types is expected to reduce co-morbid PD diagnoses, the use of a dimensional rating of types recognizes that personality psychopathology occurs on a continuum, and the replacement of behavioral PD criteria with traits is anticipated to result in greater diagnostic stability.

For example, there used to be a Passive-Aggressive Personality Disorder in the DSM-III, but it was removed from the DSM-IV because women’s groups felt it unfairly pathologized women. This doesn’t mean that these behaviors ceased to exist; it’s just that the APA terminated a specific cognitive-behavioral phenomenon and hid it in Personality Disorder Not Otherwise Specifieddue to political pressure.

Another example is the APA’s failure to officially acknowledge Parental Alienation Syndrome(PAS) and Hostile Aggressive Parenting (HAP). Numerous studies have been done by credible researchers documenting and quantifying these behaviors. Individuals who have been the target of these pathological and malicious behaviors know full well how real they are. Yet, the APA won’t touch it with a 10-foot pole, probably because it would also assign pathology to a great many women.

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