personality disorders in dsm5

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Personality disorders in DSM5 Ahmed Eid Elaghoury Arab & Egyptian Boards in Psychiatry Psychiatry registrar Armed Forces Center for Psychiatric Care, TAIF

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Main changes to personality disorders in DSM5

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Page 1: Personality disorders in DSM5

Personality disorders in DSM5Ahmed Eid ElaghouryArab & Egyptian Boards in PsychiatryPsychiatry registrarArmed Forces Center for Psychiatric Care, TAIF

Page 2: Personality disorders in DSM5

DSM5 changes series 2

Same criteria as DSM IV

Taif, Jun 2014

DSM5 Task Force List

Page 3: Personality disorders in DSM5

DSM5 changes series 3Taif, Jun 2014

Page 4: Personality disorders in DSM5

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

Page 5: Personality disorders in DSM5

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

Page 6: Personality disorders in DSM5

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

Page 7: Personality disorders in DSM5

DSM5 changes series 7Taif, Jun 2014

DSM5: pg 21

Page 8: Personality disorders in DSM5

DSM5 changes series 8

We are back!! Keep skeptical

Taif, Jun 2014

DSM I, 1952: pg 46

DSM II, 1968: pg 2

Page 9: Personality disorders in DSM5

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

Page 10: Personality disorders in DSM5

DSM5 changes series 10

Personality functioning

Domain XII in level 1 cross-cutting symptom measure

Taif, Jun 2014

Page 11: Personality disorders in DSM5

DSM5 changes series 11

Personality functioning

Taif, Jun 2014DSM5

Page 12: Personality disorders in DSM5

DSM5 changes series 12Taif, Jun 2014

DSM5

Page 13: Personality disorders in DSM5

DSM5 changes series 13

Generic diagnostic criterion in DSM5

DISABILITY

Taif, Jun 2014

DSM5: pg 21

Page 14: Personality disorders in DSM5

DSM5 changes series 14Taif, Jun 2014

Page 15: Personality disorders in DSM5

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

Page 16: Personality disorders in DSM5

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

Page 17: Personality disorders in DSM5

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

Page 18: Personality disorders in DSM5

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

Page 19: Personality disorders in DSM5

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