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personality disorder classifications

HOW PERSONALITY DISORDER IS CLASSIFIED

The International Classification of Mental and Behavioural Disorders (ICD-10)defines a personality disorder as:

A severe disturbance in the Carachterological condition and behavioural tendenciesof the individual usually involving several areas of the personality and nearly always associated with considerable personal and social disruption. (World Health Organization1992).The fourth edition of the Diagnostic and Statistical Manual of Mental Disorders(DSM-IV) defines personality disorders as:

An enduring pattern of inner experience and behaviour that deviates markedly from the expectations of the individual’s culture, is pervasive and inflexible, has an onset in adolescence or early adulthood, is stable over time, and leads to distress or impairment.

It could be suggested that these definitions are imprecise and open to interpretation.This has led to difficulties with diagnosis. These diagnostic criteria are evenless helpful as a description of the problem, both for health care professionals and for those diagnosed with these disorders.

MacFarlane  suggests that researchers have found a high incidence of overlap between the different categories. There has been much discussion of problems using these diagnostic criteria, for example when a person with a personality disorder does not meet the full criteria for any one diagnosis but nonetheless hasa significant impairment and symptoms spread across several different categories.Another fundamental problem with these criteria is that many of the traitsdiscussed can be seen in most people at times, for example manipulation, emotional coldness and suspiciousness can all be seen in the general population. Therefore,it becomes necessary to ask at what point this should be seen as a symptom of personality disorder and not just a personality trait within the bounds of normality.Other criticisms include a lack of consistent theoretical basis for understanding theaetiology of these conditions and a lack of significance in terms of treatment planning or clinical interventions. Certainly, the long-held belief that these conditions were part of a person’s personality and therefore fixed and untreatable has been disproved (National Institute for Mental Health in England 2003).

There are nine categories of ICD-10 personality disorder and ten categories ofDSM-IV personality disorder. These classification schemes should be treated withcaution as patients with personality disorder can often be fitted into several different categories and many of the behaviours described can be observed in many healthy people.

The DSM-IV attempts to simplify things by grouping the subcategories into threebroad clusters:

1. Cluster A (odd or eccentric types): paranoid, schizoid and schizotypal.

Traits:suspicious, bears grudges, tenacious, litigious, paranoid, emotionally cold, solitary,indifferent to others’ views, odd beliefs, ideas of reference, socially withdrawn.

2. Cluster B (dramatic, emotional or erratic types): histrionic, narcissistic,antisocial and borderline. Traits: unstable relationships, low self-esteem, impulsivity,repetitive suicidal or self-harm behaviour, mood fluctuations, deceitfulness,lying, reckless, antisocial behaviour, overdramatic, attention-seeking,seductive, shallow, self-important, need for admiration, grandiose.

3. Cluster C (anxious and fearful types): obsessive-compulsive, avoidant and dependent.

Traits: submissive, clinging, fear of separation, excessive need for others to take responsibility for them, hypersensitive, inadequate, orderly, need for rules and order, pedantic, rigid, stubborn, cautious, obsessive.

It is a matter of severity of the dysfunctional responses and behaviours coupled to the fact that these dysfunctional patterns have an enduring quality. It is important tonote, however, that current research demonstrates that with the appropriate treatment people can recover from personality disorder – although, despite the mounting body of evidence, this remains a controversial issue.

 

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