Questions on Personality Disorders

Reader’s Question

I have always been curious about psychiatry, particularly personality disorders, and I am aware that in the DSM-III it also included Sadistic, Passive-Aggressive, and Self-Defeating Personality Disorders. The DSM-IV contains an Axis B Depressive Personality Disorder. If you have the time to answer this question, can you explain to me why they aren’t in the DSM anymore? Well, not used for specific diagnoses currently. Oh, and is there the possibility of a Manic Personality Disorder? I am just curious and don’t know if this the kind of question you receive all the time. If you take the time to read this, thank you. I am a high-school student who lives in Warrensburg, Missouri, and I think there’s a kid in my grade who might have the sadistic personality disorder.

Psychologist’s Reply

The DSM diagnostic codes have changed over the years. When I began practice over 30 years ago, we actually had the diagnosis “Inadequate Personality” and “Emotionally Unstable Personality”. In studies, we found these described behaviors more than personalities.

As the DSM series improved, the profession looked for diagnoses that could be supported by research. While “Inadequate Personality” might describe a specific patient accurately, it couldn’t be used to describe a group with the same accuracy — that kind of thing.

We also found some overlap in diagnoses. We don’t have a Manic Personality Disorder but we do have Bipolar Disorder, Hypomanic or Attention-Deficit/Hyperactivity Disorder (ADHD) as an adult diagnosis.

Keep in mind, having certain behaviors doesn’t create a personality disorder. Being “passive-aggressive” is a common behavior in adult and children. Using passive-aggressive behaviors doesn’t make it a diagnosis, however.

The profession is constantly improving the diagnostic system. The current DSM-IV and DSM-IV-TR is the current state of the art. A DSM V will come out soon, maybe with some new codes and some eliminated.

Keep in mind, teenagers go though a variety of unusual stages and at various times will appear paranoid, sadistic (burning ants with a magnifying glass?), antisocial, and obsessive-compulsive. For this reason, we don’t use a personality diagnosis until the person reaches the age of 18. Your friend may have some unusual behaviors, but is not suitable for a diagnosis yet.

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