Disordered Personalities 2ed

Disordered Personalities — Second Edition
HowAre Personality Disorders Diagnosed?
In 1952, the American Psychiatric Association (APA) published the
first edition of Diagnostic and Statistical Manual of Mental Disorders
(DSM). There were five categories with a total of twenty-seven personality
disorders. Diagnoses were made using a general clinical description
which was influenced by psychoanalytic concepts.
The DSM-II was introduced in 1968. In this edition the number of
personality disorders was reduced to twelve, though many from the
DSM were shifted to other categories of disorders. Again, diagnoses
were presented as descriptive paragraphs. Because of this, the DSM-
II was deemed by many to lack validity and inter-clinician reliability. It
was introduced at a time of sweeping cultural and social change and
its shortcomings necessitated significant changes for the next edition.
Introduced in 1980, the DSM-III listed specific diagnostic criteria for its
fourteen personality disorders. These were first established from the
psychiatric research done by Feighner, Robbins & Guze and later
expanded by Spitzer. Five major changes were introduced:
• descriptive features were based on presenting symptoms and not on
presumed etiologic factors (called an atheoretical approach)
• information beyond the criteria was included, such as demographic,
etiologic and prognostic variables
• discrete criteria were used (e.g. symptoms, duration, etc.)
• in response to criticism about the potential harm of labeling patients
with a psychiatric diagnosis, the APA stressed using clinical judgment
when applying the diagnostic criteria
• the concept of a multi-axial diagnosis was introduced, which fostered
a multifaceted approach towards understanding patients
Adapted from Turkat (1990)
The DSM-lll-R (R for revised) was introduced in 1987. Despite the
many advances in the DSM-III, many clinicians felt that there were
problems with the validity, accuracy and clarity of some of the criteria.
The personality disorders were now also grouped into clusters based
on their phenomenologic similarity:
Cluster A: Odd or Eccentric (“Mad”) — Paranoid, Schizoid, Schizotypal
Cluster B: Dramatic, Emotional or Erratic (“Bad") — Antisocial,
Borderline, Histrionic, Narcissistic
Cluster C: Anxious or Fearful (“Sad”) — Avoidant, Dependent,
Obsessive-Compulsive, Passive-Aggressive