DSM 5 Hints at New Criteria for Personality Disorders

Personality disorders are a group of 10 officially recognized mental health conditions listed by the American Psychiatric Association (APA) in the Diagnostic and Statistical Manual of Mental Disorders, the preeminent text for diagnosing mental illness in the U.S. All of these conditions feature some sort of ongoing pattern of thought and behavior that varies substantially from generally socially acceptable thoughts and behaviors.
The APA almost changed part of the definition of personality disorders when it released the most recent edition of the Diagnostic and Statistical Manual in May 2013. However, instead of making an outright change, the organization kept the current definition and simultaneously designated a new, unofficial personality disorder definition for further study and review.

Background Information

The definitions for mental illness (and all other health problems) in use at any given time come from a combination of two sources: the advances in understanding provided through scientific research and the practical experiences of doctors who work with ailing patients on an everyday basis. Since the 1950s, the American Psychiatric Association—a group that represents essentially all of the psychiatrists currently licensed in America—has functioned as a collecting and coordinating body for research and doctors’ reports relating to mental disorders. The APA takes the information it gathers and uses it as a basis for defining general categories of illness, as well as the individual conditions contained within each category.

Since scientific and medical knowledge changes over time, the terms used to define mental illness also change. Committees within the APA meet regularly to decide if the state of knowledge in any given area of mental health warrants a reexamination of the definitions currently included in the Diagnostic and Statistical Manual (DSM). Changes recommended by these committees and approved by the APA go into revised or new editions of the manual. However, the process used to designate official conditions is not always straightforward; sometimes, the APA doesn’t have enough information to determine whether or not it needs to change the definition of an illness category or a specific illness. In these circumstances, the organization can designate the category or illness in question as the target of “further study or review” and make its final decision at a later date when it has more information.

Current Personality Disorder Definitions

All personality disorders feature ongoing, adult personality characteristics that restrict affected individuals’ ability to interact with others (or relate to themselves) in a manner that supports stability and well-being. As a result of their restrictive personality traits, these individuals experience significant mental anguish and/or experience meaningful impairments in some aspect of their social lives or their work- or school-related routines. The 10 officially designated personality disorders in the DSM are listed in three separate groupings, called clusters, according to certain features they share in common. The Cluster A personality disorders (schizoid, schizotypal and paranoid personality disorder) all center on psychosis-related thoughts and behaviors. The Cluster B personality disorders (antisocial, histrionic, borderline and narcissistic personality disorder) all center on depression- or bipolar illness-related thoughts and behaviors. The Cluster C personality disorders (avoidant, dependent and obsessive-compulsive personality disorder) all center on anxiety-related thoughts and behaviors.

The Proposed Alternate Definition

Current scientific research indicates that people diagnosed with serious personality disturbances frequently have symptoms that are too diverse or overlapping to fall within the confines of a single personality disorder definition. The American Psychiatric Association acknowledges this fact, and prior to the publication of the new fifth edition of the DSM (DSM 5) in May 2013, the organization seriously considered changing the criteria for diagnosing these disorders. This criteria change would have eliminated some of the officially recognized personality disorders and grouped the remaining disorders according to a new method of diagnosis, which would allow doctors to consider general personality traits and real-world functional problems rather than rigid symptom lists when examining their patients. The six conditions that would have remained in the DSM under this plan are avoidant, borderline, antisocial, schizotypal, obsessive-compulsive and narcissistic personality disorder.

Ultimately, after consulting with mental health professionals both inside and outside the organization, the APA decided to retain the definitions for the 10 personality disorders that appeared in the previous edition of the Diagnostic and Statistical Manual. Officially, doctors must still diagnose their patients according to these definitions. However, the APA also included the details of the reorganized scheme for personality disorders in a portion of DSM 5 called Section III, which contains illnesses and illness categories that don’t have official status, but still have enough evidence in their favor to merit ongoing research and consideration. In future editions of the DSM, the American Psychiatric Association may ultimately decide to adopt the proposed plan for personality disorders, or keep the current definitions intact.