DSM-5 revisions for personality disorders reflect major change
The American Psychiatric Associations diagnostic criteria for the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM) propose a significant reformulation in how personality disorders are identified and assessed. The change integrates disorder types with pathological personality traits and, most importantly, levels of impairment in what is known as personality functioning.
With its multidimensional framework, this hybrid model is very different from the way personality disorders are presented as rigid behavioral categories in the current manual. The goal of the new criteria is to maximize their utility to clinicians and benefit to patients.
DSM is the standard classification used by mental health and other health professionals for diagnostic and research purposes. The manuals next edition, representing the latest scientific understanding of the etiology, characteristics and relationships of mental disorders, will be published in 2013. Release of DSM-5 will culminate more than a decade of rigorous work involving hundreds of experts from the United States and abroad.
The new draft criteria for personality disorders are currently being evaluated through field trials in real-world clinical settings across the country. Public comment also is invited on the proposed revisions to these and other diagnostic criteria. Submissions will now be accepted through July 15. All criteria are available for review on www.dsm5.org .
As recommended by the DSM-5 Personality and Personality Disorders Work Group, 10 categories will be reduced to six specific personality disorder types (antisocial, avoidant, borderline, narcissistic, obsessive/compulsive and schizotypal). But for a diagnosis within these descriptive classifications, several conditions must be met.
Critically, a person must have significant impairment in the two areas of personality functioning self and interpersonal. Self is defined as how patients view themselves as well as how they identify and pursue goals in life. Interpersonal is defined as whether an individual is able to understand other peoples perspectives and form close relationships. The scale by which these will be judged ranges from mild to extreme.
In addition, the work group determined that pathological personality traits must be present in at least one of five broad areas such as whether a person is antagonistic versus able to get along with others, or impulsive versus able to think through possible consequences of action.
The importance of personality functioning and personality traits is the major innovation here, said Andrew Skodol, M.D., the work groups chair and a research professor of psychiatry at the University of Arizona College of Medicine. In the past, we viewed personality disorders as binary. You either had one or you didnt. But we now understand that personality pathology is a matter of degree.
Noted Robert Krueger, Ph.D., a member of the work group and a professor of psychology at the University of Minnesota, Our proposed criteria get away from the idea that personality pathology is just a group of disorders. Were instead defining it as a much broader characteristic.
Underlying the work groups recommendations are longitudinal studies and other clinical research since the early 1990s that have revealed the shortcomings of the current behavior-based criteria. Because behavior can be intermittent and changeable over time, the criteria can hinder an accurate diagnosis and even impede treatment.
By contrast, impairments in personality functioning and pathological personality traits tend to be more stable over time and consistent regardless of the situation. Both stability and consistency would be required under the revisions to the diagnostic criteria.
Over the next year, the DSM-5 Task Force and its work groups will continue refining the categories and specifics of all disorders to be included in the next edition. The current public comment period will play into their deliberations. As with the first public review last year, when the APA received more than 8,000 written responses from clinicians, researchers and family and patient advocates, every comment will be considered. As of mid-June, nearly 1,800 additional responses had been submitted.
In the meantime, the first round of field trials continues at nearly a dozen larger academic and clinical centers; almost 3,900 mental health professionals in individual practice and smaller settings also will participate before the trials conclude. Another public comment period on the criteria will then follow.
The DSM-5 diagnostic criteria will be determined by 2012 and submitted to the APAs Board of Trustees for review and approval.
Provided by American Psychiatric Association
- New framework proposed for manual of mental disorders May 05, 2011 | not rated yet | 0
- Driving change in diagnosis of personality disorders Jan 26, 2011 | not rated yet | 0
- Researchers propose new way to classify personality disorders Oct 12, 2010 | not rated yet | 0
- APA announces draft diagnostic criteria for DSM-5 Feb 10, 2010 | not rated yet | 0
- Is it really bipolar disorder? Mar 25, 2010 | not rated yet | 0
- Motion perception revisited: High Phi effect challenges established motion perception assumptions Apr 23, 2013 | 3 / 5 (2) | 2
- Anything you can do I can do better: Neuromolecular foundations of the superiority illusion (Update) Apr 02, 2013 | 4.5 / 5 (11) | 5
- The visual system as economist: Neural resource allocation in visual adaptation Mar 30, 2013 | 5 / 5 (2) | 9
- Separate lives: Neuronal and organismal lifespans decoupled Mar 27, 2013 | 4.9 / 5 (8) | 0
- Sizing things up: The evolutionary neurobiology of scale invariance Feb 28, 2013 | 4.8 / 5 (10) | 14
Why is zone 1 in liver more prone to ischemic injury?
17 hours ago Hi, Is it because around central vein, there is only deoxygenated blood from the vein where as in the periphery there is hepatic artery. Also why...
How can there be villous adenoma in colon, if there are no villi there
May 22, 2013 As title suggest. Thanks :smile:
How can there be a term called "intestinal metaplasia" of stomach
May 21, 2013 Hello everyone, Ok Stomach's normal epithelium is simple columnar, now in intestinal type of adenocarcinoma of stomach it undergoes "intestinal...
Pressure-volume curve: Elastic Recoil Pressure don't make sense
May 18, 2013 From pressure-volume curve of the lung and chest wall (attached photo), I don't understand why would the elastic recoil pressure of the lung is...
If you became brain-dead, would you want them to pull the plug?
May 17, 2013 I'd want the rest of me to stay alive. Sure it's a lousy way to live but it beats being all-the-way dead. Maybe if I make it 20 years they'll...
MRI bill question
May 15, 2013 Dear PFers, The hospital gave us a $12k bill for one MRI (head with contrast). The people I talked to at the hospital tell me that they do not...
- More from Physics Forums - Medical Sciences
More news stories
A brief visual task can predict IQ, according to a new study. This surprisingly simple exercise measures the brain's unconscious ability to filter out visual movement. The study shows that individuals whose ...
Psychology & Psychiatry 8 hours ago | 4.9 / 5 (7) | 0 |
Nervous about that upcoming job interview? You might want to take steps to reduce your jitters, especially if you are a man.
Psychology & Psychiatry 9 hours ago | 5 / 5 (1) | 0
(Medical Xpress)—Research by U of T Mississauga psychology professor Glenn Schellenberg reveals that two key personality traits – openness-to-experience and conscientiousness—predict better than IQ ...
Psychology & Psychiatry 11 hours ago | 3 / 5 (2) | 0 |
Parents naturally are concerned for their children's safety, particularly when there is news of a child abduction that happens close to home. Finding the balance between emotions and the "teachable moment" as parents talk ...
Psychology & Psychiatry 12 hours ago | not rated yet | 0
A new report on suicide in Ireland shows that suicide cases experienced a significant number (and intensity) of life events in the 6 months prior to their death.
Psychology & Psychiatry 12 hours ago | not rated yet | 0
(HealthDay)—Type 2 diabetes is more aggressive in children than adults, with signs of serious complications seen just a few years after diagnosis, new research finds.
35 minutes ago | not rated yet | 0
(Medical Xpress)—Regulating the distribution of power in neurons is done by a system that makes the national electric grid look simple by comparison. Each neuron has several thousand mitochondria confined ...
3 hours ago | 4.7 / 5 (3) | 0 |
Scientists at the National Institutes of Health report they have discovered in mouse studies that a small molecule released in the spinal cord triggers a process that is later experienced in the brain as ...
6 hours ago | 5 / 5 (2) | 0 |
Teams of highly respected Alzheimer's researchers failed to replicate what appeared to be breakthrough results for the treatment of this brain disease when they were published last year in the journal Science.
6 hours ago | 5 / 5 (1) | 1 |
Little is known about why asthma develops, how it constricts the airway or why response to treatments varies between patients. Now, a team of researchers at Weill Cornell Medical College, Columbia University Medical Center ...
7 hours ago | not rated yet | 0 |
Ethnic background plays a surprisingly large role in how diabetes develops on a cellular level, according to two new studies led by researchers at the Stanford University School of Medicine.
4 hours ago | not rated yet | 0 |