1. Diagnostic and Treatment Implications
DSM-5™ in Action:
Diagnostic and Treatment Implications
Section 2, Chapters 5–13
PART 2 of Section 2
Chapters 8–16
by Sophia F. Dziegielewski, PhD, LCSW
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2. Anxiety and Stress
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3. Chapter 13: Personality Disorders
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4. PDs—General Information
Personality Traits: inflexible and maladaptive that cause significant impairment and distress
Stable pattern of long duration must be able to trace back to adolescence or early adulthood
May be applied to children in RARE instances when patterns are pervasive, persistent, and not related to developmental state
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5. DSM-IV and DSM-IV-TR
Enduring pattern of behavior that deviates markedly from expectations of individuals culture.
Manifested in two of the following:
Cognition, affect, interpersonal functioning, impulse control
Pattern is inflexible and pervasive
Pattern leads to distress or impairment
Stable pattern over a long duration
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6. DSM-IV-TR Personality Disorders
Cluster A: The following often have odd/eccentric behavior:
Paranoid Personality Disorder
Schizoid Personality Disorder
Schizotypal Personality Disorder
Cluster B: The following often have dramatic, emotional,
and/or erratic behavior:
Antisocial Personality Disorder
Borderline Personality Disorder
Narcissistic Personality Disorder
Histrionic Personality Disorder
Cluster C: The following have anxious or fearful behavior:
Avoidant Personality Disorder
Dependent Personality Disorder
Obsessive Compulsive Personality Disorder
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7. Other Personality Disorders
10 Personality Disorders Plus These Three!
Personality Change Due to Another Medical Condition
Other Specified Personality Disorder
Unspecified Personality Disorder
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8. Test Your Skill: Question
Can children have a Personality Disorder?
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9. Can Children Have PD? Yes, but in rare cases only.
To diagnose a personality disorder in children, it must be present for at least 1 year.
Must be persistent and not related to a particular developmental stage.
EXCEPTION: Antisocial cannot be diagnosed in children under the age of 18.
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10. Test Your Skill: Question
Can an older adult develop a Personality Disorder?
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11. Can an Older Adult Develop a PD?
No, but could be indicative of other circumstances that need to be assessed.
By definition it occurs in young adulthood.
A personality disorder may be exacerbated in later life by life circumstances, etc.
Or come to the attention of the clinician in later life.
Be sure to complete an evaluation to make sure behaviors are not due to another medical condition or unrecognized substance abuse.
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12. Occurs in TWO situations:
Other Specified Personality Disorder and Unspecified Personality Disorder (not on handout)
Occurs in TWO situations:
Has the traits of several different PDs but does not meet specific criteria for any specific one.
The personality pattern meets the criteria for a PD not currently included in the DSM (e.g., passive-aggressive).
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13. DSM-5 Will Remain the Same and add trait-specific methodology in a separate area of Section 3.
Specify the traits that stand out (traits that can be made more specific).
Does the client meet the threshold for having a PD?
Does not have to have PD to assess the traits.
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14. DSM-5: Personality Disorders
Trait-Specific Criteria will be included in Section 3:
A differentiation is made between personality traits and having a disorder, as severe traits can exist without a disorder.
Each category must have SIGNIFICANT problems with self-identity and interpersonal functioning.
Impaired functioning is linked directly to an extreme personality trait.
Adaptive failure is manifested in one or both of the following:
Failure to develop a sense of self-identity
Failure to develop effective interpersonal functioning
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15. DSM-5 Outline the Diagnostic Process for PD
Assess level of functioning (0—no impairment to 4—extreme impairment).
Match the personality types from the narrative description.
Assess for trait profiles for any type of PD and list all moderate or extreme traits.
Cumulate totals and decide if the client meets the criteria for a diagnosis of PD.
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16. Nonadherence to Medical Treatment
Examples
Overweight or Obesity: This condition is the focus of clinical intervention.
Wandering Associated with a Mental Disorder
Borderline Intellectual Functioning: Does not qualify as mild intellectual disability.
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17. Additional Questions?
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