General PD Criteria

Question 1

General PD criteria

Answer 1

• A. An enduring pattern of inner experience and behavior that deviates markedly from the expectations of teh individual’s culture. This pattern is manifested in two (or more) of the following areas:
  
  • Cognition (ie., ways of perceiving and interpreting self, other people, and events).
  • Affectiviy (i.e., the range, intensity, lability, and appropriateness of emotional response)
  • Interpersonal functioning
  • Impulse control
• B. The enduring pattern is inflexible and pervasive across a broad range of personal and social situations
• C. The enduring pattern leads to clinically significiant distress or impairment in social, occupational, or other important areas of functioning
• D. The pattern is stable and of long duration, and its onset can be traced back at least to adolescence or early adulthood
• E. The enduring pattern is not better explained as a manifestation or consequence of another mental disorder
• F. The enduring pattern is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition (e.g., head trauma)

Question 2

General PD criteria

Diagnostic features

Answer 2

• Personality traits are long-lasting ways of thinking, feeling, and behaving across different situations
• They become personality disorders when they are rigid and cause problems in daily life
• To diagnose PD, a person’s long-term behavior must be evaluated, and traits should be present by early adulthood
• Its important to tell the difference between lasting traits and temporary reactions to stress or mental states
• More than one interview, spaced over time, is usually needed for an accurate diagnosis
• Diagnosis can be hard because people with PDs may not see thier traits as a problem

Question 3

General PD criteria

General development and course

Answer 3

• Recognize during adolescence or early adulthood
  
  • Do not need to be diagnosed or to come to clinical attention until later though
• Some become less recognizable over time (BPD, ASPD)
• To be dx before age 18, need sx for at least one year
  
  • Exception is ASPD (need to be 18)

Question 4

General PD criteria

Impact of culture

Answer 4

• Do not confuse sx with issues related to acculturation
• Do not confuse sx with expression of cultural customs
• Obtain info about culture if unfamiliar during assessment

Question 5

General PD criteria

Impact of gender

Answer 5

• Gender differences in some PD diagnoses
  
  • BPD, Histrionic, Depedent more common dx for women
  • ASPD more common for men
• Be careful not to over - or under-diagnose because of social stereotypes

Question 6

General PD criteria

Differential diagnosis

Answer 6

• Other mental disorders and traits
  
  • Many PD sxs can look like sxs of other mental disorders. A PD diagnosis should only be made if the traits started before adulthood, are long-term, and are not just part of another disorder’s episode
• Overlap with other disorders
  
  • Some PDs may overlap with other mental disorders because of similar sxs, biology, or family history
• Psychotic disorders (e.g., schizophrenia, bipolar)
  
  • Don’t diagnose a PD if the traits only appeared during one of these disorders.
  • If a PD existed before the psychotic disorder, it should be listed with “premorbid” in parentheses (e.g., “Paranoid Personality Disorder (premorbid)”)
• Depression and anxiety
  
  • Be careful when diagnosing PDs during depressive or anxiety episodes since temporary sxs can mimic personality traits
• PTSD
  
  • If personality changes happen after trauma and last over time, consider PTSD instead of PD
• Substance use
  
  • Don’t diagnose a PD on behaviors caused by intoxication, withdrawal, or drug-seeking
• Medical conditions
  
  • If personality changes are due to a medical issue (like a brain tumor), the correct diagnosis is “personality change due to another medical condition)

Question 7

General PD Criteria Summary

Answer 7

• Enduring pattern of inner experience and behaviors that deviate markedly from the expectations of the culture
  
  • Pervasive and ineflexible
  • stable over time
  • onset in adolescence or early adulthood
  • leads to distress or impairment
• Pattern expressed in at least two areas
• Not attributed to another disorder, substance, medical condition