Personality Disorder Diagnostic Guidelines

Characteristics and Identifiers

The formal diagnosis of antisocial personality disorder, or dissocial personality disorder, rests on these symptoms, which can be evaluated by psychiatrists and other mental health professionals.

The following information is reproduced verbatim from the ICD-10 Classification of Mental and Behavioural Disorders, World Health Organization, Geneva, 1992.

(Since the WHO updates the overall ICD on a regular basis, individual classifications within it may or may not change from year to year; therefore, you should always check directly with the WHO to be sure of obtaining the latest revision for any particular individual classification.)

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Personality Disorders

A personality disorder is a severe disturbance in the characterological constitution and behavioural tendencies of the individual, usually involving several areas of the personality, and nearly always associated with considerable personal and social disruption. Personality disorder tends to appear in late childhood or adolescence and continues to be manifest into adulthood. It is therefore unlikely that the diagnosis of personality disorder will be appropriate before the age of 16 or 17 years. General diagnostic guidelines applying to all personality disorders are presented below; supplementary descriptions are provided with each of the subtypes.

Diagnostic Guidelines

Conditions not directly attributable to gross brain damage or disease, or to another psychiatric disorder, meeting the following criteria:

  • markedly disharmonious attitudes and behaviour, involving usually several areas of functioning, e.g. affectivity, arousal, impulse control, ways of perceiving and thinking, and style of relating to others;
  • the abnormal behaviour pattern is enduring, of long standing, and not limited to episodes of mental illness;
  • the abnormal behaviour pattern is pervasive and clearly maladaptive to a broad range of personal and social situations;
  • the above manifestations always appear during childhood or adolescence and continue into adulthood;
  • the disorder leads to considerable personal distress but this may only become apparent late in its course;
  • the disorder is usually, but not invariably, associated with significant problems in occupational and social performance.

For different cultures it may be necessary to develop specific sets of criteria with regard to social norms, rules and obligations. For diagnosing most of the subtypes listed below, clear evidence is usually required of the presence of at least three of the traits or behaviours given in the clinical description.

Antisocial Personality Disorder According to the ICD-10

F60.2 Dissocial (Antisocial) Personality Disorder

Personality disorder, usually coming to attention because of a gross disparity between behaviour and the prevailing social norms, and characterized by at least 3 of the following:

  • callous unconcern for the feelings of others;
  • gross and persistent attitude of irresponsibility and disregard for social norms, rules and obligations;
  • incapacity to maintain enduring relationships, though having no difficulty in establishing them;
  • very low tolerance to frustration and a low threshold for discharge of aggression, including violence;
  • incapacity to experience guilt and to profit from experience, particularly punishment;
  • marked proneness to blame others, or to offer plausible rationalizations, for the behaviour that has brought the patient into conflict with society.

There may also be persistent irritability as an associated feature. Conduct disorder during childhood and adolescence, though not invariably present, may further support the diagnosis.

Includes:

  • amoral, antisocial, asocial, psychopathic, and sociopathic personality (disorder)

Excludes:

  • conduct disorders
  • emotionally unstable personality disorder

Borderline Personality Disorder Symptoms According to the ICD-10

F60.3 Emotionally Unstable (Borderline) Personality Disorder

A personality disorder in which there is a marked tendency to act impulsively without consideration of the consequences, together with affective instability. The ability to plan ahead may be minimal, and outbursts of intense anger may often lead to violence or "behavioural explosions"; these are easily precipitated when impulsive acts are criticized or thwarted by others. Two variants of this personality disorder are specified, and both share this general theme of impulsiveness and lack of self-control.

Impulsive type: The predominant characteristics are emotional instability and lack of impulse control. Outbursts of violence or threatening behaviour are common, particularly in response to criticism by others.

Includes:

  • explosive and aggressive personality (disorder)

Excludes:

  • dissocial personality disorder

Borderline type: Several of the characteristics of emotional instability are present; in addition, the patient's own self-image, aims, and internal preferences (including sexual) are often unclear or disturbed. There are usually chronic feelings of emptiness. A liability to become involved in intense and unstable relationships may cause repeated emotional crises and may be associated with excessive efforts to avoid abandonment and a series of suicidal threats or acts of self-harm (although these may occur without obvious precipitants).

Includes:

  • borderline personality (disorder)

Histrionic Personality Disorder According to the ICD-10

Personality disorder characterized by at least 3 of the following:

  • self-dramatization, theatricality, exaggerated expression of emotions;
  • suggestibility, easily influenced by others or by circumstances;
  • shallow and labile affectivity;
  • continual seeking for excitement, appreciation by others, and activities in which the patient is the centre of attention;
  • inappropriate seductiveness in appearance or behaviour;
  • over-concern with physical attractiveness.

Associated features may include egocentricity, self-indulgence, continuous longing for appreciation, feelings that are easily hurt, and persistent manipulative behaviour to achieve own needs.

Includes:

  • hysterical and psychoinfantile personality (disorder)

Narcissistic Personality Disorder According to the ICD-10

Characterised by a pervasive pattern of grandiosity and self-importance, need for admiration, and lack of empathy, people with narcissistic personality disorder overestimate their abilities and inflate their accomplishments, often appearing boastful and pretentious, whilst correspondingly underestimating and devaluing the achievements and accomplishments of others.

Often the narcissist will fraudulently claim to have qualifications or experience or affiliations or associations which they don't have or aren't entitled to. Belief in superiority, inflating their self-esteem to match that of senior or important people with whom they associate or identify, insisting on having the "top" professionals or being affiliated with the "best" institutions, but criticising the same people who disappoint them are also common features of narcissistic personality disorder.

Narcissists react angrily to criticism and when rejected, the narcissist will often denounce the profession which has rejected them (usually for lack of competence or misdeed) but simultaneously and paradoxically represent themselves as belonging to the profession they are vilifying.

Fragile self-esteem, a need for constant attention and admiration, fishing for compliments (often with great charm), an expectation of superior entitlement, expecting others to defer to them, and a lack of sensitivity especially when others do not react in the expected manner, are also hallmarks of the disorder. Greed, expecting to receive before and above the needs of others, overworking those around them, and forming romantic (sic) or sexual relationships for the purpose of advancing their purpose or career, abusing special privileges and squandering extra resources also feature.

People with narcissistic personality disorder also have difficulty recognizing the needs and feelings of others, and are dismissive, contemptuous and impatient when others share or discuss their concerns or problems. They are also oblivious to the hurtfulness of their behaviour or remarks, show an emotional coldness and a lack of reciprocal interest, exhibit envy (especially when others are accorded recognition), have an arrogant, disdainful and patronizing attitude, and are quick to blame and criticise others when their needs and expectations are not met.

The DSM-IV Diagnostic Criteria for Narcissistic Personality Disorder are:

A pervasive pattern of grandiosity, need for admiration, lack of empathy, as indicated by at least five of:

  • a grandiose sense of self-importance
  • is preoccupied with fantasies of unlimited success, power, brilliance, beauty, or ideal love
  • believes that he or she is "special" and can only be understood by, or should associate with, other special or high-status people (or institutions)
  • requires excessive admiration
  • has a sense of entitlement, ie unreasonable expectations of especially favourable treatment or automatic compliance with his or her expectations
  • is interpersonally exploitative, ie takes advantage of others to achieve his or her own ends
  • lacks empathy and is unwilling to recognize or identify with the feelings and needs of others
  • is often envious of others or believes that others are envious of him or her
  • shows arrogant, haughty behaviours or attitudes

While the ICD-10 does not specifically define the characteristics of this personality disorder, it is classified in the category "Other Specific Personality Disorders".

ICD-10 states that Narcissistic Personality Disorder is "a personality disorder that fits none of the specific rubrics F60.0-F60.7". That is, this personality disorder does not meet the diagnostic criteria for any of the following:

  • F60.0 Paranoid Personality Disorder
  • F60.1 Schizoid Personality Disorder
  • F60.2 Dissocial (Antisocial) Personality Disorder
  • F60.3 Emotionally unstable (borderline) Personality Disorder
  • F60.4 Histrionic Personality Disorder
  • F60.5 Anankastic (Obsessive-Compulsive) Personality Disorder
  • F60.6 Anxious (Avoidant) Personality Disorder
  • F60.7 Dependent Personality Disorder

Includes:

  • eccentric, "haltlose" type, immature, narcisstic, passive-aggressive, and psychoneurotic personality disorder

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