Personality disorder classification

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Ayesha Anwar, M.B.B.S[2]

Overview[edit | edit source]

There are two approaches used to classify personality disorders; categorical and dimensional. Categorical classification is based on distinct operational criteria depending on behavioral characteristics. DSM-5 and ICD-10 both uses this approach. As compared to this, dimensional classification is based on the personality traits and using a quantitative distinction. It places normality at one end and disorder at other. DSM-5 classifies 10 personality disorders into three clusters due to similar characteristics: CLUSTER A is defined as odd and eccentric and include Paranoid, Schizoid, and Schizotypal. CLUSTER B is defined by erratic and emotional behavior and includes Antisocial, Borderline, Histrionic and Narcissist. CLUSTER C PDs patients are anxious and fearful and incorporate Avoidant, Dependent and Obsessive-Compulsive. ICD-10 classifies into 3 clusters as well, which are A, Odd/eccentric and includesParanoid and Schizoid, B, Dramatic and includes Dissocial, Emotionally unstable borderline type, Emotionally unstable impulsive type and Histrionic, and C, Anxious/fearful that include Anxious, Dependent and Anankastic.

Classification[edit | edit source]

List of Personality Disorders Defined in the DSM[edit | edit source]

• DSM-5 classifies 10 personality disorders into three clusters due to similar characteristics:
  • CLUSTER A: odd and eccentric
    • Paranoid-distrust and suspiciousness
    • Schizoid-detachment from social relationships
    • Schizotypal-distortion in interpersonal relationships and cognition, and behavioural eccentrism
  • CLUSTER B: erratic and emotional
    • Antisocial-disregard and violation of rights of others
    • Borderline-instability in interpersonal relationships, and impulsivity
    • Histrionic-eccessive emotionality and attention-seeking behaviour
    • Narcissist-grandiosity and lack of empathy
  • CLUSTER C: anxious and fearful
    • Avoidant-social inhibition and fear of criticism
    • Dependent-submissive and excessive need for reassurance
    • Obsessive-Compulsive-preoccupation with perfectionism and orderliness
• ICD-10 classifies into 3 clusters as well, which are as follows:
  • A: Odd/eccentric
    • Paranoid
    • Schizoid
  • B: Dramatic
    • Dissocial
    • Emotionally unstable borderline type
    • Emotionally unstable impulsive type
    • Histrionic
  • C: Anxious/fearful
    • Anxious
    • Dependent
    • Anankastic

The DSM-IV lists ten personality disorders, grouped into three clusters. The DSM also contains a category for behavioral patterns that do not match these ten disorders, but nevertheless exhibit characteristics of a personality disorder. This category is labeled Personality Disorder NOS (Not Otherwise Specified).

Cluster A (odd or eccentric disorders)

• Paranoid personality disorder
• Schizoid personality disorder
• Schizotypal personality disorder

Cluster B (dramatic, emotional, or erratic disorders)

• Antisocial personality disorder
• Borderline personality disorder
• Histrionic personality disorder
• Narcissistic personality disorder

Cluster C (anxious or fearful disorders)

• Avoidant personality disorder
• Dependent personality disorder (not the same as Dysthymia)
• Obsessive-compulsive personality disorder (not the same as Obsessive-compulsive disorder)

Revisions and Exclusions from Past DSM Editions[edit | edit source]

The revision of the previous edition of the DSM, DSM-III-R, also contained the Passive-aggressive Personality Disorder, the Self-defeating Personality Disorder, and the Sadistic Personality Disorder. Passive-Aggressive Personality Disorder is a pattern of negative attitudes and passive resistance in interpersonal situations. Self-defeating personality disorder is characterised by behaviour that consequently undermines the person's pleasure and goals. Sadistic Personality Disorder is a pervasive pattern of cruel, demeaning, and aggressive behavior. These categories were removed in the current version of the DSM, because it is questionable whether these are separate disorders. Passive-aggressive Personality Disorder and Depressive personality disorder were placed in an appendix of DSM-IV for research purposes.

World Health Organization[edit | edit source]

The ICD-10 section on mental and behavioral disorders includes categories of personality disorder and enduring personality changes. They are defined as ingrained patterns indicated by inflexible and disabling responses that significantly differ from how the average person in the culture perceives, thinks and feels, particularly in relating to others.^[1]

The specific personality disorders are: paranoid, schizoid, dissocial, emotionally unstable (borderline type and impulsive type), histrionic, anankastic, anxious (avoidant) and dependent.^[2]

There is also an 'Other' category involving conditions characterized as eccentric, haltlose (derived from "haltlos" (German) = drifting, aimless and irresponsible),^[3] immature, narcissistic, passive-aggressive or psychoneurotic. An additional category is for unspecified personality disorder, including character neurosis and pathological personality.

There is also a category for Mixed and other personality disorders, defined as conditions that are often troublesome but do not demonstrate the specific pattern of symptoms in the named disorders. Finally there is a category of Enduring personality changes, not attributable to brain damage and disease. This is for conditions that seem to arise in adults without a diagnosis of personality disorder, following catastrophic or prolonged stress or other psychiatric illness.

Other[edit | edit source]

Some types of personality disorder were in previous versions of the diagnostic manuals but have been deleted. This includes two types that were in the DSM-III-R appendix as "proposed diagnostic categories needing further study" without specific criteria, namely sadistic personality disorder (a pervasive pattern of cruel, demeaning and aggressive behavior) and Self-defeating personality disorder (masochistic personality disorder) (characterised by behaviour consequently undermining the person's pleasure and goals).^[4] The psychologist Theodore Millon and others consider some relegated diagnoses to be equally valid disorders, and may also propose other personality disorders or subtypes, including mixtures of aspects of different categories of the officially accepted diagnoses.^[5]

* – Not actually to be classified as a personality disorder; classified instead as a form of schizophrenia-spectrum disorder.
** – Originally proposed for deletion; status remains unclear for DSM-5.

Millon's Description of Personality Disorders[edit | edit source]

Psychologist Theodore Millon, who has written numerous popular works on personality, proposed the following description of personality disorders:

Additional Classification Factors[edit | edit source]

Except for classifying by category and cluster, it is possible to classify personality disorders using such additional factors as severity, impact on social functioning, and attribution.^[8]

References[edit | edit source]

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