Personality Disorders 101 : How are PDs diagnosed?

The study of psychological differences and “abnormal” behaviour has received more public attention than many other branches of psychology, but this attention isn’t always beneficial. “Abnormal” behaviour is associated with sensationalist news headlines more than sensible conversation. As a result, people often know about psychological conditions through their portrayals in mass media, rather than from factual explanations.

Of the many psychological differences, the category of personality disorders is most frequently misunderstood. The individual personality disorders (PDs) are often mis-represented, while the idea of a “disordered personality” sparks criticism from anti-psychiatry groups and people diagnosed with PDs.

So what are PDs, and what do we mean by “personality” in this context?

Currently, personality disorders are defined as groups of traits, experiences and behaviours that are significantly different from the majority of people; that affect someone’s thinking, emotions and impulses; and are associated with personal distress and dysfunction. These general criteria needs to be met for any PD diagnosis.

So to be diagnosed with a PD, someone needs to have a collection of unusal behaviours and traits which affects a large portion of their everyday life. Those behaviours and traits must start before early adulthood. They need to cause negative consequences for the person, who should be upset by or annoyed at those behaviours. The name “personality disorder” attempts to represent how far-reaching and impactful those behaviours and experiences are upon almost every aspect of the person’s understanding of themselves and their ability to relate to others.

Currently, the DSM-V follows the same approach as previous editions. Personality disorders (PDs) are diagnosed through a system of criteria based both on a person’s observed behaviour and the feelings and symptoms they report. If a person meets enough criteria for any particular PD, the psychiatrist then needs to establish if the person’s traits and the consequences of those traits have enough impact on their understanding of themselves and others to represent a personality disorder.

PDs are split into three groups, or “clusters”. Cluster A is collectively known as the “eccentric” or “odd” disorders, and it includes :

Cluster B disorders are the “dramatic” or “emotional” disorders, consisting of:

Cluster C disorders are the “anxious” disorders, consisting of:

The International Classification of Diseases, the main European diagnostic guide, is slightly different from the DSM. Borderline PD is instead named Emotionally Unstable PD, while Obsessive-Compulsive PD is known as Anankastic PD. The ICD also includes an “Other/Unspecified” category, which is used when people have unclear symptoms which don’t exactly match one PD. (This normally happens for short-term situations such as obtaining emergency care for someone in a crisis.)

Many researchers and medical experts have already identified problems with the current system of diagnosing and researching PDs. Because of this, the DSM-5 includes a theoretical Alternate Model of PDs, which is under investigation to see if it can make PD diagnoses more accurate and more helpful. The Alternate Model starts by looking at the core of PDs – how severely a person’s difficulties impair how they understand themselves and others. If the person’s self-understanding and relationships are significantly impaired, the conversation then moves to identifying which traits are causing that impairment. This method intends to reduce the amount of overlapping symptoms found in current diagnoses, which should result in people needing fewer diagnoses to cover the symptoms they need help for.

Now that I’ve covered the basic idea of PDs, I’ll go through each in turn to find out more about how they are diagnosed, and how mass media has portrayed people with each condition. I’ll also talk about some of the problems involved in diagnosing each condition.

Stay tuned for the rest of the series!

The header image is from Wikipedia, and can be found at https://commons.wikimedia.org/wiki/File:Psi2.svg.