DSM-IV

In DSM-IV, this disorder is called Personality Change Due to a General Medical Condition

For more information, see Mental Disorders Due to a General Medical Condition

Diagnostic Criteria

A. A persistent personality disturbance that represents a change from the individual's precious characteristic personality pattern. (In children, the disturbance involved a marked deviation from normal development or a significant change in the child's usual behavior patterns lasting at least 1 year).

B. There is evidence from the history, physical examination, or laboratory findings that the disturbance is the direct physiological consequence of a general medical condition.

C. The disturbance is not better accounted for by another mental disorder (including other Mental Disorders Due to a General Medical Condition).

D. The disturbance does not occur exclusively during the course of a delirium and does not meet criteria for a dementia.

E. The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.

Specify type:

  • Labile Type: if the predominant feature is affective lability
  • Disinhibited Type: if the predominant feature is poor impulse control as evidenced by sexual indiscretions, etc.
  • Aggressive Type: if the predominant feature is aggressive behavior
  • Apathetic Type: if the predominant feature is marked apathy and indifference
  • Paranoid Type: if the predominant feature is suspiciousness or paranoid ideation
  • Other Type: if the predominant feature is not one of the above, e.g., personality change associated with a seizure disorder
  • Combined Type: if more than one feature predominates in the clinical picture
  • Unspecified Type

Note: Include the name of the general medical condition, e.g., Personality Change Due to Temporal Lobe Epilepsy; also record the general medical condition.

Subtypes

The particular personality change can be specified by indicating the symptom presentation that predominates in the clinical presentation:

Labile Type

This subtype is used if the predominant feature is affective lability.

Disinhibited Type

This subtype is used if the predominant feature is poor impulse control (e.g., as evidenced by sexual indiscretions).

Aggressive Type

This subtype is used if the predominant feature is marked apathy and indifference.

Paranoid Type

This subtype is used if the predominant feature is suspiciousness or paranoid ideation.

Other Type

This subtype would be used, for example, for a personality change associated with a seizure disorder.

Combined Type

This subtype is used if more than one feature predominates in the clinical picture.

Recording Procedures

In recording Personality Change Due to a General Medical Condition, the clinician should note both the specific phenomenology of the disturbance, including appropriate subtype, and the general medical condition judged to be causing the disturbance (e.g., Personality Change Due to Systemic Lupus Erythematosus, Paranoid Type). The general medical condition (e.g., systemic lupus erythematosus) should also be noted.

Associated General Medical Conditions

A variety of neurological and other general medical conditions may cause personality changes, including central nervous system neoplasms, head trauma, cerebrovascular disease, Huntington's disease, epilepsy, infectious conditions with central nervous system involvement (e.g., human immunodeficiency virus), endocrine conditions (e.g., hypothyroidism, hypo- and hyperadrenocorticism), and autoimmune conditions with central nervous system involvement (e.g., systemic lupus erythematosus). The associated physical examination findings, laboratory findings, and patterns of prevalence and onset reflect those of the neurological or other general medical condition involved.

Differential Diagnosis

Chronic general medical conditions

Chronic general medical conditions associated with pain and disability can also be associated with changes in personality. The diagnosis of Personality Change Due to a General Medical Condition is given only if a direct pathophysiological mechanism can be established.

Dementia and delirium

Personality change is a frequent associated feature of a dementia (e.g., Dementia of the Alzheimer's Type). A separate diagnosis of Personality Change Due to a General Medical Condition is not given if criteria are also met for a dementia or if the change occurs exclusively during the course of a delirium.

Another Mental Disorder Due to a General Medical Condition

The diagnosis of Personality Change Due to a General Medical Condition is not given if the disturbance is better accounted for by another Mental Disorder Due to a General Medical Condition (e.g., Mood Disorder Due to Brain Tumor, With Depressive Features).

Substance Dependence

Personality changes may also occur in the context of Substance Dependence, especially if the dependence is long-standing. The clinician should inquire carefully about the nature and extent of substance use. If the clinician wishes to indicate an etiological relationship between the personality change and substance use, the Not Otherwise Specified category for the specific substance (e.g., Cocaine-Related Disorder Not Otherwise Specified) can be used.

Other Mental Disorders

Marked personality changes may also be an associated feature of other mental disorders (e.g., Schizophrenia, Delusional Disorder, Mood Disorders, Impulse-Control Disorders Not Elsewhere Classified, Panic Disorder). However, in these disorders, no specific physiological factor is judged to be etiologically related to the personality change.

Personality Disorders

Personality Change Due to a General Medical Condition can be distinguished from a Personality Disorder by the requirement for a clinically significant change from baseline personality functioning and the presence of a specific etiological general medical condition.

DSM-5

Diagnostic Criteria

A. A persistent personality disturbance that represents a change from the individual's previous characteristic personality pattern. (Note: In children, the disturbance involved a marked deviation from normal development or a significant change in the child's usual behavior patterns, lasting at least 1 year.)

B. There is evidence from the history, physical examination, or laboratory findings that the disturbance is the direct pathophysiological consequence of another medical condition.

C. The disturbance is not better explained by another mental disorder (including another mental disorder due to another medical condition).

D. The disturbance does not occur exclusively during the course of a delirium.

E. The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.

Specify whether:

  • Labile type: If the predominant feature is affective lability.
  • Disinhibited type: If the predominant feature is poor impulse control as evidenced by sexual indiscretions, etc.
  • Aggressive type: If the predominant feature is aggressive behavior.
  • Apathetic type: If the predominant feature is marked apathy and indifference.
  • Paranoid type: If the predominant feature is suspiciousness or paranoid ideation.
  • Other type: If the presentation is not characterized by any of the above subtypes.
  • Combined type: If more than one feature predominates in the clinical picture.
  • Unspecified type

Note: Include the name of the other medical condition (e.g., personality change due to temporal lobe epilepsy). The other medical condition should be listed separately immediately before the personality disorder due to another medical condition (e.g., temporal lobe epilepsy; personality change due to temporal lobe epilepsy).

Subtypes

The particular personality change can be specified by indicating the symptom presentation that predominates in the clinical presentation.

Differential Diagnosis

Chronic medical conditions associated with pain and disability

Chronic medical conditions associated with pain and disability can also be associated with changes in personality. The diagnosis of personality change due to another medical condition is given only if a direct pathophysiological mechanism can be established. This diagnosis is not given if the change is due to a behavioral or psychological adjustment or response to another medical condition (e.g., dependent behaviors that result from a need for the assistance of others following a severe head trauma, cardiovascular disease, or dementia).

Delirium or major neurocognitive disorder

Personality change is a frequently associated feature of a delirium or major neurocognitive disorder. A separate diagnosis of personality change due to another medical condition is not given if the change occurs exclusively during the course of a delirium. However, the diagnosis of personality change due to another medical condition may be given in addition to the diagnosis of major neurocognitive disorder if the personality change is a prominent part of the clinical presentation.

Another mental disorder due to another medical condition

The diagnosis of personality change due to another medical condition is not given if the disturbance is better explained by another mental disorder due to another medical condition (e.g., depressive disorder due to brain tumor).

Substance use disorders

Personality changes may also occur in the context of substance use disorders, especially if the disorder is long-standing. The clinician should inquire carefully about the nature and extent of substance use. If the clinician wishes to indicate an etiological relationship between the personality change and substance use, the unspecified category for the specific substance (e.g., unspecified stimulant-related disorder) can be used.

Other mental disorders

Marked personality changes may also be an associated feature of other mental disorders (e.g., schizophrenia; delusional disorder; depressive and bipolar disorders; other specified and unspecified disruptive behavior, impulse-control, and conduct disorders; panic disorder). However, in these disorders, no specific physiological factor is judged to be etiologically related to the personality change.

Other personality disorders

Personality change due to another medical condition can be distinguished from a personality disorder by the requirement for a clinically significant change from baseline personality functioning and the presence of a specific etiological medical condition.

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