Personality Disorder

Excerpt

Temperament classification dates back to ancient Greece when Hippocrates proposed his humoral theory regarding the classifications of behavior. The postulated temperaments, consisting of sanguine, choleric, melancholic, and phlegmatic, remained in use as recently as the 20th century. Emil Kraepelin classified manic-depressive patients as depressive, hypomanic, or irritable, which in turn correlated with melancholic, sanguine, or choleric dispositions. Temperament classifications evolved into the 7 personality disturbances in the Diagnostic and Statistical Manual of Mental Disorders, First Edition (DSM-I), in 1952. The DSM-II (1968) was heavily influenced by psychoanalysis and separated personality disruptions from neuroses of the same name. Over the next 3 decades, psychiatric conceptualizations of personality disorders shifted away from the psychoanalytic model to a categorical model correlating with the medical model originally proposed by Kraepelin. This model was represented by the 11 personality disorders listed in the DSM-III (1980). Current diagnostic criteria sets were introduced in the DSM-IV (1994), with 10 personality disorders divided into 3 clusters.

During the production of DSM-5 (2013), editors considered combining a dimensional 5-factor model of behavior with the existing psychoanalytic typological models of personality. Ultimately, the categories remained unchanged. The 10 personality disorders are classified into 3 clusters. Cluster A includes paranoid, schizoid, and schizotypal personality disorders. Cluster B includes antisocial, borderline, histrionic, and narcissistic personality disorders. Cluster C includes avoidant, dependent, and obsessive-compulsive personality disorders. Personality disorders are currently described as pervasive, maladaptive, and chronic patterns of behavior, thinking, and feeling. Patients with personality disorders often have distorted perceptions of reality and abnormal affective behavior, manifesting in maladaptive coping mechanisms and distress.

The DSM-5-TR defines a personality disorder as an enduring pattern of inner experience and behavior that deviates significantly from the norms and expectations of the surrounding culture. The behavioral pattern is pervasive, inflexible, and generally starts in adolescence and persists through adulthood, causing distress or impairments. Although there are 10 specific personality disorders listed in the DSM-5-TR, there is also a diagnosis for "general personality disorder" for clinical situations where a personality disorder is apparent but difficult to classify. This general diagnosis exists because personality is broad, case-specific, and unique, even among those with the same personality disorder diagnosis.

The DSM-5-TR introduced an alternative diagnostic model for personality disorders in the Emerging Measures and Models section. The alternative diagnostic model for personality disorders in the DSM-5-TR is a hybrid dimensional-categorical model that defines personality disorders in terms of impairments in personality functioning and pathological personality traits.