DSM-II

This group of disorders is characterized by deeply ingrained maladaptive patterns of behavior that are perceptibly different in quality from psychotic and neurotic symptoms. Generally, these are life-long patterns, often recognizable by the time of adolescence or earlier. Sometimes the pattern is determined primarily by malfunctioning of the brain, but such cases should be classified under one of the non-psychotic organic brain syndromes rather than here.

Disorders

  1. Paranoid personality
  2. Cyclothymic personality
  3. Schizoid personality
  4. Explosive personality (Epileptoid personality disorder)
  5. Obsessive compulsive personality (Anankastic personality)
  6. Hysterical personality (Histrionic personality disorder)
  7. Asthenic personality
  8. Antisocial personality
  9. Passive-aggressive personality
  10. Inadequate personality
  11. Other personality disorders of specified types (Immature personality)

DSM-III

Disorders

  1. Paranoid Personality Disorder
  2. Schizoid Personality Disorder
  3. Schizotypal Personality Disorder
  4. Histrionic Personality Disorder
  5. Narcissistic Personality Disorder
  6. Antisocial Personality Disorder
  7. Borderline Personality Disorder
  8. Avoidant Personality Disorder
  9. Dependent Personality Disorder
  10. Compulsive Personality Disorder
  11. Passive-Aggressive Personality Disorder
  12. Atypical, Mixed or Other Personality Disorder

DSM-IV

Disorders

Cluster A Personality Disorders

  1. Paranoid Personality Disorder
  2. Schizoid Personality Disorder
  3. Schizotypal Personality Disorder

Cluster B Personality Disorders

  1. Antisocial Personality Disorder
  2. Borderline Personality Disorder
  3. Histrionic Personality Disorder
  4. Narcissistic Personality Disorder

Cluster C Personality Disorders

  1. Avoidant Personality Disorder
  2. Dependent Personality Disorder
  3. Obsessive-Compulsive Personality Disorder

Personality Disorder NOS

Diagnostic Criteria

A. An enduring pattern of inner experience and behavior that deviates markedly from the expectations of the individual's culture. This pattern is manifested in two (or more) of the following areas:

  1. cognition (i.e., ways of perceiving and interpreting self, other people, and events)
  2. affectivity (i.e., the range, intensity, lability, and appropriateness of emotional response)
  3. interpersonal functioning
  4. 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 significant 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 accounted for as a manifestation or consequence of another mental disorder.

F. The enduring pattern is not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition (e.g., head trauma).

Recording Procedures

When (as if often the case) an individual's pattern of behavior meets criteria for more than one Personality Disorder, the clinician should list all relevant Personality Disorder diagnoses in order of importance. When a mental disorder is not the principal diagnosis or the reason for visit, the clinician is encouraged to indicate which Personality Disorder is the principal diagnosis or the reason for visit by noting "Principal Diagnosis" or "Reason for Visit" in parentheses. In most cases, the principal diagnosis or the reason for visit is also the main focus of attention or treatment. Personality Disorder Not Otherwise Specified is the appropriate diagnosis for a "mixed" presentation in which criteria are not met for any single Personality Disorder but features of several Personality Disorders are present and involve clinically significant impairment.

Specific maladaptive personality traits that do not meet the threshold for a Personality Disorder may also be listed. For example, the clinician might record "No diagnosis, histrionic personality traits." The use of particular defense mechanisms may also be indicated. For example, a clinician might record "Dependent Personality Disorder; Frequent use of denial."

When an individual has a chronic Psychotic Disorder (e.g., Schizophrenia) that was preceded by a preexisting Personality Disorder (e.g., Schizotypal, Schizoid, Paranoid), the Personality Disorder should be recorded, followed by "Premorbid" in parentheses. For example: Schizophrenia, Paranoid Type; Schizoid Personality Disorder (Premorbid).

Differential Diagnosis

Other mental disorders

Many of the specific criteria for the Personality Disorders describe features (e.g., suspiciousness, dependency, or insensitivity) that are also characteristic of episodes of other mental disorders. A Personality Disorder should be diagnosed only when the defining characteristics appeared before early adulthood, are typical of the individual's long-term functioning, and do not occur exclusively during an episode of another mental disorder. It may be particularly difficult (and not particularly useful) to distinguish Personality Disorders from those disorders (e.g., Dysthymic Disorder) that have an early onset and a chronic, relatively stable course. Some Personality Disorders may have a "spectrum" relationship to particularly mental conditions (e.g., Schizotypal Personality Disorder with Schizophrenia; Avoidant Personality Disorder with Social Phobia) based on phenomenological or biological similarities or familiar aggregation.

Psychotic Disorders

For the three Personality Disorders that may be related to the Psychological Disorders (i.e., Paranoid, Schizoid, and Schizotypal), there is an exclusion criterion stating that the pattern of behavior must not have occurred exclusively during the course of Schizophrenia, a Mood Disorder With Psychotic Features, or another Psychotic Disorder. When an individual has a chronic Psychotic Disorder (e.g., Schizophrenia) that was preceded by a preexisting Personality Disorder, the Personality Disorder should also be recorded, followed by "Premorbid" in parantheses.

Mood Disorders, Anxiety Disorders, Posttraumatic Stress Disorder, Substance-Related Disorders, and Personality Change Due to a General Medical Condition

The clinician must be cautious in diagnosing Personality Disorders during an episode of a Mood Disorder or an Anxiety Disorder because these conditions may have cross-sectional symptom features that mimic personality traits and may make it more difficult to evaluate retrospectively the individual's long-term patterns of functioning. When personality changes emerge and persist after an individual has been exposed to extreme stress, a diagnosis of Posttraumatic Stress Disorder should be considered. When a person has a Substance-Related Disorder, it is important not to make a Personality Disorder diagnosis based solely on behaviors that are consequences of Substance Intoxication or Withdrawal or that are associated with activities in the service of sustaining a dependency (e.g., antisocial behavior). When enduring changes in personality arise as a result of the direct physiological effects of a general medical condition (e.g., brain tumor), a diagnosis of Personality Change Due to a General Medical Condition should be considered.

Personality traits that do not reach the threshold for a Personality Disorder

Personality Disorders must be distinguished from personality traits that do not reach the threshold for a Personality Disorder. Personality traits are diagnosed as a Personality Disorder only when they are inflexible, maladaptive, and persisting and cause significant functional impairment or subjective distress.

DSM-5

Disorders

Cluster A Personality Disorders

  1. Paranoid Personality Disorder
  2. Schizoid Personality Disorder
  3. Schizotypal Personality Disorder

Cluster B Personality Disorders

  1. Antisocial Personality Disorder
  2. Borderline Personality Disorder
  3. Histrionic Personality Disorder
  4. Narcissistic Personality Disorder

Cluster C Personality Disorders

  1. Avoidant Personality Disorder
  2. Dependent Personality Disorder
  3. Obsessive-Compulsive Personality Disorder

Other Personality Disorders

  1. Personality Change Due to Another Medical Condition
  2. Other Specified Personality Disorder
  3. Unspecified Personality Disorder

Alternative DSM-5 Model for Personality Disorders

Diagnostic Criteria

A. An enduring pattern of inner experience and behavior that deviates markedly from the expectations of the individual's culture. This pattern is manifested in two (or more) of the following areas:

  1. Cognition (i.e., ways of perceiving and interpreting self, other people, and events).
  2. Affectivity (i.e., the range, intensity, lability, and appropriateness of emotional response).
  3. Interpersonal functioning.
  4. 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 significant 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).

Differential Diagnosis

Other mental disorders and personality traits

Many of the specific criteria for the personality disorders describe features (e.g., suspiciousness, dependency, insensitivity) that are also characteristic of episodes of other mental disorders. A personality disorder should be diagnosed only when the defining characteristics appeared before early adulthood, are typical of the individual's long-term functioning, and do not occur exclusively during an episode of another mental disorder. It may be particularly difficult (and not particularly useful) to distinguish personality disorders from persistent mental disorders such as persistent depressive disorder that have an early onset and an enduring, relatively stable course. Some personality disorders may have a "spectrum" relationship to other mental disorders (e.g., schizotypal personality disorder with schizophrenia; avoidant personality disorder with social anxiety disorder [social phobia]) based on phenomenological or biological similarities or familial aggregation.

Personality disorders must be distinguished from personality traits that do not reach the threshold for a personality disorder. Personality traits are diagnosed as a personality disorder only when they are inflexible, maladaptive, and persisting and cause significant functional impairment or subjective distress.

Psychotic disorders

For the three personality disorders that may be related to the psychotic disorders (i.e., paranoid, schizoid, and schizotypal), there is an exclusion criterion stating that the pattern of behavior must not have occurred exclusively during the course of schizophrenia, a bipolar or depressive disorder with psychotic features, or another psychotic disorder. When an individual has a persistent mental disorder (e.g., schizophrenia) that was preceded by a preexisting personality disorder, the personality disorder should also be recorded, followed by "premorbid" in parentheses.

Anxiety and depressive disorders

The clinician must be cautious in diagnosing personality disorders during an episode of a depressive disorder or an anxiety disorder, because these conditions may have cross-sectional symptom features that mimic personality traits and may make it more difficult to evaluate retrospectively the individual's long-term patterns of functioning.

Posttraumatic stress disorder

When personality changes emerge and persist after an individual has been exposed to extreme stress, a diagnosis of posttraumatic stress disorder should be considered.

Substance use disorders

When an individual has a substance use disorder, it is important not to make a personality disorder diagnosis based solely on behaviors that are consequences of substance intoxication or withdrawal or that are associated with activities in the service of sustaining substance use (e.g., antisocial behavior).

Personality change due to another medical condition

When enduring changes in personality arise as a result of the physiological effects of another medical condition (e.g., brain tumor), a diagnosis of personality change due to another medical condition should be considered.

Community content is available under CC-BY-SA unless otherwise noted.