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Personality disorders in DSM5 Ahmed Eid Elaghoury Arab & Egyptian Boards in Psychiatry Psychiatry registrar Armed Forces Center for Psychiatric Care, TAIF

Personality disorders in DSM5

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Main changes to personality disorders in DSM5

Text of Personality disorders in DSM5

  • Personality disorders in DSM5 Ahmed Eid Elaghoury Arab & Egyptian Boards in Psychiatry Psychiatry registrar Armed Forces Center for Psychiatric Care,TAIF
  • Same criteria as DSM IV Taif, Jun 2014 DSM5 changes series 2 DSM5 Task Force List
  • Taif, Jun 2014 DSM5 changes series 3
  • DSM 5 field trials In USA & Canada: 279 clinicians, 2246 pts, most of them (86%) interviewed twice to test 23 disorders Borderline PD: good interrater reliability Obsessive compulsive PD & antisocial PD: questionable reliability range Other PDs: too few pts to test reliability (Kappa test) Taif, Jun 2014 DSM5 changes series 4 Bret S. Stetka, MD, Christoph U. Correll, MD:A Guide to DSM-5. Medscape Psychiatry, May 21, 2013
  • DSM-5 field trials: diagnostic reliability in adults. Modified from: Freedman R, Lewis DA, Michels R, et al. The initial field trials of DSM-5: new blooms and old thorns. Am J Psychiatry. 2013;170:1-5. Taif, Jun 2014 DSM5 changes series 5
  • Multiaxial system Introduced with DSM III (1980): to complete evaluation and not overlook any symptom Axis II: personality ds & specific developmental ds Axes I & II: were mental ds Removed in DSM5 (2013): Axes I, II & III: as a list by principal diagnosis Axis IV ICD10 Z codes AxisV WHO disability assessment schedule (WHODAS 2.0) Taif, Jun 2014 DSM5 changes series 6
  • Taif, Jun 2014 DSM5 changes series 7 DSM5: pg 21
  • We are back!! Keep skeptical Taif, Jun 2014 DSM5 changes series 8 DSM I, 1952: pg 46 DSM II, 1968: pg 2
  • New concept: Cross-cutting symptom measures Modeled on general medicines review of systems Reviewing psychopathological domains Level 1: brief survey: (13) domains for adult (12) domains for child & adolescent Level 2: more in-depth assessment Both: at initial interview and followup Taif, Jun 2014 DSM5 changes series 9
  • Personality functioning Domain XII in level 1 cross-cutting symptom measure Taif, Jun 2014 DSM5 changes series 10
  • Personality functioning Taif, Jun 2014 DSM5 changes series 11 DSM5
  • Taif, Jun 2014 DSM5 changes series 12 DSM5
  • Generic diagnostic criterion in DSM5 DISABILITY Taif, Jun 2014 DSM5 changes series 13 DSM5: pg 21
  • Taif, Jun 2014 DSM5 changes series 14
  • Alternative DSM5 Model for personality disorders In section III, so NOT official or for clinical use Still a research model Based on the Big Five Five Factor Model of Personality FFM and the Personality Psychopathology Five PSY5 model. Trait approach: ie dimensional Categorical approach may be uninformative eg other specified / unspecified PD Distinguishing traits, symptoms and specific behaviors. Allow to describe a personality disorder trait specified (PD-TS) Taif, Jun 2014 DSM5 changes series 15
  • Alternative DSM5 Model Main premise: Personality functioning: impaired (criterion A) Personality traits: pathological (criterion B) Pervasiveness & Stability (criteria C&D) Absence of alternative explanation (criteria E, F & G) Taif, Jun 2014 DSM5 changes series 16
  • Five personality disorder trait domains 1. Negative Affectivity (vs emotional stability) 2. Detachment (vs Extraversion) 3. Antagonism (vs Agreeableness) 4. Disinhibition (vs Conscientiousness) 5. Psychoticism (vs Lucidity) Each domain has facets eg: anxiousness, depressivity, etc inside Negative Affectivity All are 25 facets Only 6 specific PDs applied to this model: antisocial, avoidant, borderline, narcissistic, obsessive-compulsive & schizotypal Taif, Jun 2014 DSM5 changes series 17
  • ICD-11 Beta Draft Personality disorder: Mild Moderate Severe Other Unspecified Allows late onset qualifier No specific subtypes of PDs. Taif, Jun 2014 DSM5 changes series 18 http://apps.who.int/classifications/icd11/browse/f/en
  • Summary Multiaxial documentation is REMOVED from DSM5 Only BORDERLINE PD is of good interrater reliability in DSM5 field trials PERSONALITY FUNCTIONING & CROSS-CUTTING SYMPTOM MEASURES are new DSM5 concepts DISABILITY is the generic diagnostic criterion in DSM5 Personality functioning should be ASSESSED ROUTINELY as a domain of level 1 cross-cutting symptom measure OR as a domain of disability in WHODAS 2.0 ALTERNATIVE DSM5 MODEL FOR PERSONALITY DISORDERS is five factor dimensional (trait) model and still under research, NOT for official use ICD 11 BETA CRITERIA for personality disorders are dimensional and removing the specific subtyping till now Taif, Jun 2014 DSM5 changes series 19