- 1 DSM-IV
- 2 DSM-5
A. Progressive development over a period of at least a year of all of the following:
- marked decline in occupational or academic functioning
- gradual appearance and deepening of negative symptoms such as affective flattening, alogia, and avolition
- poor interpersonal repport, social isolation, or social withdrawal
B. Criterion A for Schizophrenia has never been met.
C. The symptoms are not better accounted for by Schizotypal or Schizoid Personality Disorder, a Psychotic Disorder, a Mood Disorder, an Anxiety Disorder, a dementia, or Mental Retardation and are not due to the direct physiological effects of a substance or a general medical condition.
In DSM-IV, individuals whose presentation meets these research criteria would be diagnosed as having Unspecified Mental Disorder.
This pattern should be considered only after all other possible causes of deterioration in functioning have been ruled out. This pattern is distinguished from the disorders included in the "Schizophrenia and Other Psychotic Disorders" section by the absence of prominent positive psychotic symptoms. These disorders include Schizophrenia, Schizoaffective Disorder, Schizophreniform Disorder, Brief Psychotic Disorder, Delusional Disorder, Shared Psychotic Disorder, and Psychotic Disorder Not Otherwise Specified, all of which require at least one positive symptom for some period of time.
This proposed disorder is distinguished from Schizoid and Schizotypal Personality Disorders as well as other Personality Disorders by the requirement of a clear change in personality and marked deterioration in functioning. In contrast, the Personality Disorders represent lifelong patterns without progressive deterioration.
Mood Disorders may mimic the apathy and anhedonia of simple deteriorative disorder, but in a Mood Disorder depressive affect (sadness, hopelessness, helplessness, painful guilt) is experienced, and the course tends to be episodic. Furthermore, in simple deteriorative disorder, there is a sense of emptiness rather than a painful or prominently depressive mood, and the course is continuous and progressive. The distinction can be more difficult with Dysthymic Disorder, in which the course may also be continuous and in which vegetative symptoms and painfully depressed mood may not be prominent.
This proposed disorder may mimic chronic Substance Dependence and should only be considered if the personality change and deterioration precede extensive substance use.
Personality Change Due to a General Medical Condition is distinguished by the presence of an etiological general medical condition.
The cognitive impairment of simple deteriorative disorder may be mistaken for Mental Retardation or dementia. Mental Retardation is distinguished by its typical onset in infancy or childhood. Dementia is distinguished by the presence of an etiological general medical condition or substance use.
No mental disorder
Perhaps the most difficult differential diagnosis is with no mental disorder. Simple deteriorative disorder often leads a person to become a marginal member of society. It does not follow, however, that marginal members of society necessarily have this proposed disorder. The defining features of simple deteriorative disorder involve negative symptoms, which tend to be more on a continuum with normality than are positive symptoms and which may be mimicked by a variety of factors. Therefore, special caution must be taken not to apply this proposed disorder too broadly.