personality disorders in dsm5
DESCRIPTION
Main changes to personality disorders in DSM5TRANSCRIPT
Personality disorders in DSM5Ahmed Eid ElaghouryArab & Egyptian Boards in PsychiatryPsychiatry registrarArmed Forces Center for Psychiatric Care, TAIF
DSM5 changes series 2
Same criteria as DSM IV
Taif, Jun 2014
DSM5 Task Force List
DSM5 changes series 3Taif, Jun 2014
DSM5 changes series 4
DSM 5 field trialsIn USA & Canada: 279 clinicians, 2246
pts, most of them (86%) interviewed twice to test 23 disorders
Borderline PD: good interrater reliability
Obsessive compulsive PD & antisocial PD: questionable reliability range
Other PDs: too few pts to test reliability (Kappa test)
Taif, Jun 2014
Bret S. Stetka, MD, Christoph U. Correll, MD: A Guide to DSM-5. Medscape Psychiatry, May 21, 2013
DSM5 changes series 5
DSM-5 field trials: diagnostic reliability in adults. Modified from: Freedman R, Lewis DA, Michels R, et al. The initial field trials of DSM-5: new blooms and old thorns. Am J Psychiatry. 2013;170:1-5.
Taif, Jun 2014
DSM5 changes series 6
Multiaxial system Introduced with DSM III (1980): to
complete evaluation and not overlook any symptom
Axis II: personality ds & specific developmental ds
Axes I & II: were mental dsRemoved in DSM5 (2013):
◦Axes I, II & III: as a list by principal diagnosis◦Axis IV ICD10 Z codes◦Axis V WHO disability assessment schedule
(WHODAS 2.0)
Taif, Jun 2014
DSM5 changes series 7Taif, Jun 2014
DSM5: pg 21
DSM5 changes series 8
We are back!! Keep skeptical
Taif, Jun 2014
DSM I, 1952: pg 46
DSM II, 1968: pg 2
DSM5 changes series 9
New concept: Cross-cutting symptom measuresModeled on general medicine’s
review of systemsReviewing psychopathological
domainsLevel 1: brief survey:
◦(13) domains for adult◦(12) domains for child & adolescent
Level 2: more in-depth assessment
Both: at initial interview and followup
Taif, Jun 2014
DSM5 changes series 10
Personality functioning
Domain XII in level 1 cross-cutting symptom measure
Taif, Jun 2014
DSM5 changes series 11
Personality functioning
Taif, Jun 2014DSM5
DSM5 changes series 12Taif, Jun 2014
DSM5
DSM5 changes series 13
Generic diagnostic criterion in DSM5
DISABILITY
Taif, Jun 2014
DSM5: pg 21
DSM5 changes series 14Taif, Jun 2014
DSM5 changes series 15
Alternative DSM5 Model for personality disorders In section III, so NOT official or for clinical use Still a research model Based on the “Big Five” Five Factor Model of
Personality “FFM” and the Personality Psychopathology Five “PSY5” model.
Trait approach: ie dimensional Categorical approach may be uninformative
eg other specified / unspecified PD Distinguishing traits, symptoms and specific
behaviors. Allow to describe a personality disorder – trait
specified (PD-TS) Taif, Jun 2014
DSM5 changes series 16
Alternative DSM5 ModelMain premise:
◦Personality functioning: impaired (criterion A)
◦Personality traits: pathological (criterion B)
◦Pervasiveness & Stability (criteria C&D)
◦Absence of alternative explanation (criteria E, F & G)
Taif, Jun 2014
DSM5 changes series 17
Five personality disorder trait domains1. Negative Affectivity (vs emotional stability)2. Detachment (vs Extraversion)3. Antagonism (vs Agreeableness) 4. Disinhibition (vs Conscientiousness)5. Psychoticism (vs Lucidity) Each domain has “facets” eg: anxiousness,
depressivity, etc inside Negative Affectivity All are 25 facets Only 6 specific PDs applied to this model:
antisocial, avoidant, borderline, narcissistic, obsessive-compulsive & schizotypal
Taif, Jun 2014
DSM5 changes series 18
ICD-11 Beta DraftPersonality disorder:
◦Mild◦Moderate◦Severe◦Other◦Unspecified
Allows “late onset” qualifierNo specific subtypes of PDs.
Taif, Jun 2014
http://apps.who.int/classifications/icd11/browse/f/en
DSM5 changes series 19
Summary Multiaxial documentation is REMOVED from
DSM5 Only BORDERLINE PD is of good interrater
reliability in DSM5 field trials “PERSONALITY FUNCTIONING” & “CROSS-
CUTTING SYMPTOM MEASURES” are new DSM5 concepts
“DISABILITY” is the generic diagnostic criterion in DSM5
Personality functioning should be ASSESSED ROUTINELY as a domain of level 1 cross-cutting symptom measure OR as a domain of disability in WHODAS 2.0
ALTERNATIVE DSM5 MODEL FOR PERSONALITY DISORDERS is “five factor” dimensional (trait) model and still under research, NOT for official use
ICD 11 BETA CRITERIA for personality disorders are dimensional and removing the specific subtyping till now
Taif, Jun 2014