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What is a personality disorder?
Personality disorders are associated with ways of thinking and feeling about oneself and others that significantly and adversely affect how an individual functions in many aspects of life.
How many personality disorders are there?
There are 10 distinct types:
- paranoid personality disorder,
- schizoid personality disorder,
- schizotypal personality disorder,
- antisocial personality disorder,
- borderline personality disorder,
- histrionic personality,
- narcissistic personality disorder,
- avoidant personality disorder,
- dependent personality disorder and
- obsessive compulsive personality disorder.
Why does the DSM 5 not use the 5 axis diagnosis?
This multiaxial system was introduced in part to solve a problem that no longer exists:
- Certain disorders, like personality disorders, received inadequate clinical and research
- focus. As a consequence, these disorders were designated to Axis II to ensure they received greater attention. However, the axis system was seen by some clinicians as burdensome and time consuming. Given that there is no fundamental difference between disorders described on DSM-IV’s Axis I and Axis II, DSM-5 has shifted to a single axis system.
What is the benefit of a single axis diagnosis system?
This system combines the first three axes outlined in past editions of DSM into one axis with all mental and other medical diagnoses. Doing so removes artificial distinctions among conditions, benefitting both clinical practice and research use.
A practical evolution of clinical practice will marry the diagnostic criteria for personality
disorders to the most useful aspects of DSM-IV criteria with features from the first revision’s
- The hybrid methodology retains six personality disorder types:
- • Borderline Personality Disorder
- • Obsessive-Compulsive Personality Disorder
- • Avoidant Personality Disorder
- • Schizotypal Personality Disorder
- • Antisocial Personality Disorder
- • Narcissistic Personality Disorder
What is substance abuse?
In the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), the revised chapter of “Substance-Related and Addictive Disorders” includes substantive changes to the disorders grouped there plus changes to the criteria of certain conditions.
Substance Use Disorder
Substance use disorder in DSM-5 combines the DSM-IV categories of substance abuse and substance dependence into a single disorder measured on a continuum from mild to severe. Each specific substance (other than caffeine, which cannot be diagnosed as a substance use disorder) is addressed as a separate use disorder (e.g., alcohol use disorder, stimulant use disorder, etc.), but nearly all substances are diagnosed based on the same overarching criteria. In this overarching disorder, the criteria have not only been combined, but strengthened.
What is the difference between use and dependence?
In DSM-IV, the distinction between abuse and dependence was based on the concept of abuse as a mild or early phase and dependence as the more severe manifestation. In practice, the abuse criteria were sometimes quite severe. The revised substance use disorder, a single diagnosis, will better match the symptoms that patients experience. Additionally, the diagnosis of dependence caused much confusion. Most people link dependence with “addiction” when in fact dependence can be a normal body response to a substance.
Gambling as an addictive behavior
The chapter also includes gambling disorder as the sole condition in a new category on behavioral addictions. DSM-IV listed pathological gambling but in a different chapter. This new term and its location in the new manual reflect research findings that gambling disorder is similar to substance-related disorders in clinical expression, brain origin, comorbidity, physiology, and treatment.
What about other addictive behaviors?
While gambling disorder is the only addictive disorder included in DSM-5 as a diagnosable condition, Internet gaming disorder will be included in Section III of the manual. Disorders listed there require further research before their consideration as formal disorders. This condition is included to reflect the scientific literature on persistent and recurrent use of Internet games, and a preoccupation with them, can result in clinically significant impairment or distress. Much of this literature comes from studies in Asian countries. The condition criteria do not include general use of the Internet, gambling, or social media at this time
Is caffeine an addiction?
DSM-5 will not include caffeine use disorder, although research shows that as little as two to three cups of coffee can trigger a withdrawal effect marked by tiredness or sleepiness. There is sufficient evidence to support this as a condition, however it is not yet clear to what extent it is a clinically significant disorder. To encourage further research on the impact of this condition, caffeine use disorder is included in Section III of DSM-5.
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