In the patient with a personality disorder
Personality disorders: Diagnostic criteria
Types of personality disorders
There are 10 specific personality disorders in the DSM-5. They have a varying degree of research supporting their diagnosis. The most commonly diagnosed personality disorders are antisocial personality disorder and borderline personality disorder. Another personality disorder that primary care providers sometimes find difficult to diagnose and treat is narcissistic personality disorder.
Borderline personality disorder
When considering borderline personality disorder, the diagnosis must fulfil five out of nine criteria. These can best be recalled by the mnemonic IMPULSIVE:
Impulsiveness in two potentially damaging areas (e.g., sex, substance use, shopping)
Mood instability due to marked reactivity
Paranoia or dissociation under stress
Unstable self-image
Labile intense relationships
Suicidal gestures
Inappropriate anger
Vulnerability to abandonment, frantic efforts to avoid real or imagined abandonment
Emptiness, chronic feelings of emptiness
Antisocial personality disorder
Antisocial personality disorder involves a pervasive pattern of disregard for and violation of the rights of others that has occurred since age 15. The person must meet three or more of the following criteria:
- engagement in illegal activity
- deceitfulness
- impulsivity
- irritability and aggressiveness
- reckless disregard for safety of self or others
- consistent irresponsibility
- lack of remorse
The person must be at least 18 years old and there must be evidence that the person developed conduct disorder before age 15.
Narcissistic personality disorder
People with narcissistic personality disorder have chronic, maladaptive and persistent personality styles characterized by a pervasive pattern of grandiosity, a need for admiration and a lack of empathy beginning by early adulthood and presenting in various contexts.
At least five of the following characteristics need to be present:
- grandiose sense of self-importance
- preoccupation with fantasies of unlimited success, power and brilliance; belief that the person is special and unique and can only be understood by or associate with other special or high-status people
- need for excessive admiration and feeling a sense of entitlement
- interpersonally exploitive behaviour (i.e., taking advantage of others to achieve one's ends)
- lack of empathy
- envy of others or belief that others envy the person, arrogance
- haughty behaviours or attitudes
Psychiatry in primary care toolkit
A powerful mobile app packed with features that will streamline screening and assessment in primary care.
Clinical guidelines
Borderline personality disorder: recognition and management (NICE guideline CG78, 2009)
Antisocial personality disorder: prevention and management (NICE guideline CG77], 2008)
Clinical Practice Guideline for the Management of Borderline Personality Disorder (National Health and Medical Research Council, 2012)
Treatment guidelines for personality disorders (Project Air, 2015)