Table of Contents:

  1. Introduction
  2. Personality Change Due to Another Medical Condition
  3. Other Specified Personality Disorder
  4. Unspecified Personality Disorder
  5. Non-DSM personality disorders
  6. PDM-2 personality diagnoses

Other DSM Personality Disorders

The DSM-5-TR includes 3 other PD diagnoses other than the ones discussed.

Personality Change Due to Another Medical Condition

A diagnosis given when a person's personality has changed as a result of the effects of a non-PD disorder (a brain tumour, for example). That it's an effect of another condition must be verified, and it can't be exclusively during a period of delirium. There are 7 subtypes, where the predominant feature is specified, and an unspecified type:

  1. Labile type (mood swings)
  2. Disinhibited type (impulsive)
  3. Aggressive type
  4. Apathetic type
  5. Paranoid type
  6. Other type
  7. Combined type

Other Specified Personality Disorder

Other Specified Personality Disorder (OSPD) is a diagnosis given when a person has clinical features typical of a PD, but doesn't meet the criteria for any PD. OSPD is diagnosed when a clinician specifies the reason why a person didn't meet any PD criteria but was given an OSPD diagnosis; for example, a person has traits of many PDs but doesn't meet the criteria for any of them, so they're diagnosed with OSPD, specified as mixed personality disorder traits.

Unspecified Personality Disorder

This is a diagnosis given when it's clear there is a PD present in a person, but the clinician doesn't specify which. This could be to time restraints, needing a code for insurance purposes but not having enough information to make a solid diagnosis, or when OSPD could be diagnosed but the clinician doesn't want to specify why.

Other Non-DSM Personality Disorders

Melancholic / Depressive, Masochistic / Self-Defeating, Sadistic, and Passive-Aggressive / Negativistic were previously in the DSM.

Previous editions of the DSM included Inadequate, Explosive, and Asthenic PDs, as well as the now reclassified disorders Cyclothymia, Paraphilic Disorder, and addiction.

Haltlose, Eccentric, Immature and Psychoneurotic were in the ICD-10's Other Specified Personality Disorder category.

The Psychodynamic Diagnostic Manual (PDM-2) includes Borderline, Sadistic, Psychopathic, Paranoid, Narcissistic, Hysteric-Histrionic, Somatising, Schizoid, Obsessive-Compulsive, Anxious-Avoidant & Phobic, Dependent, Depressive (with Hypomanic & Masochistic subtypes) diagnoses.

(The PDM-2 uses the terms syndrome, pattern, style and type interchangeably in order to avoid the term disorder, since personality is a spectrum.).

The key features of the PDM-2 personality diagnoses are:

  • Anxious-Avoidant & Phobic:
    • Contributing patterns: Anxious or timid
    • Central tension / preoccupation: Safety vs danger
    • Belief about self: "I am in danger constantly and I must avoid it"
    • Belief about others: "Others are sources of either danger or magical protection"
    • Defense mechanisms: Symbolisation, displacement, avoidance, rationalisation, anxiety (may mask other, deeper anxieties)
    • Converse manifestation: Counterphobic
  • Borderline:
    • Contributing patterns: Difficulties with emotional dysregulation, intensity, aggression, ability to be soothed
    • Central tension / preoccupation: Wholeness vs fragmentation; engulfing vs abandonment
    • Central affects (emotional expression): Generally intense, especially rage, shame & fear
    • Belief about self: "I don't know who I am, I'm dissociated and fragmented"
    • Belief about others: "Others are defined by my interactions with them and their effects on me"
    • Defense mechanisms: Splitting, projecting others identities and values onto themself, denial, dissociation, acting out
  • Dependent:
    • Central tension / preoccupation: Keeping vs losing relationships
    • Belief about self: "I am inadequate, needy and impotent"
    • Belief about others: "Others are powerful and I need their care (even if I resent it)"
    • Defense mechanisms: Regression, reversal, avoidance, somatisation
    • Converse manifestation: Counterdependent
    • Subtype: Passive-aggressive
  • Depressive:
    • Contributing patterns: Genetic predispossesion to depression
    • Central tension / preoccupation: Self-criticsm and punishment, preoccupation with loss
    • Central affects (emotional expression): Sadness, guilt, shame
    • Belief about self: "Something is inherently wrong with me", "Someone or something necessary for happiness has been irretrievably lost"
    • Belief about others: "People who get to know me will reject me"
    • Defense mechanisms: Introjection, reversal, idealising others, devaluing themself
    • Converse manifestation: Hypomanic
    • Subtypes: Introjective / melancholic, anaclitic
  • Hysteric-Histrionic:
    • Contributing patterns: Sensitivity, 'sociophilia'
    • Central tension / preoccupation: Gender & power, unconsciously devaluing their own gender and envious yet fearful of other genders
    • Central affects (emotional expression): Fear, shame, guilt (over competition)
    • Belief about self: "There is something problematic about my gender and its meaning"
    • Belief about others: "The world is best understood in terms of gender binaries and conflicts"
    • Defense mechanisms: Repression, regression, somatising, sexualisation, acting out
    • Subtypes: Inhibited, demonstrative
  • Narcissistic:
    • Central tension / preoccupation: Over-valuing vs devaluing of self & self-esteem
    • Central affects (emotional expression): Shame, humiliation, contempt, envy
    • Belief about self: "I need to be perfect to feel okay"
    • Belief about others: "Others have success, fame, riches, beauty & power; the more I have, the better I'll feel"
    • Defense mechanisms: Idealisation, devaluing
    • Subtypes: Overt, covert, malignant
  • Obsessive-Compulsive:
    • Contributing patterns: Aggression, irritability, orderliness
    • Central tension / preoccupation: Submission vs rebellion against controlling authorities
    • Central affects (emotional expression): Anger, guilt, shame, fear
    • Belief about self: "My feelings are dangerous and must be controlled"
    • Belief about others: "Others aren't as precise and controlled as I am, so I must do the controlling and resist being controlled"
    • Defense mechanisms: Isolating emotions, reaction formation, intellectualising / reasoning, moralising, undoing
  • Paranoid:
    • Contributing patterns: Irritability, aggression
    • Central tension / preoccupation: Being attacked vs attacking first (by humiliation)
    • Central affects (emotional expression): Fear, rage, shame, contempt
    • Belief about self: "I am in constant danger"
    • Belief about others: "Everyone is dangerous and wants to use me"
    • Defense mechanisms: Projection, denial, reaction formation
  • Psychopathic (Antisocial):
    • Contributing patterns: Aggression, high threshold for emotions
    • Central tension / preoccupation: Manipulating vs fear of being manipulated
    • Central affects (emotional expression): Rage, envy
    • Belief about self: "I can do what I want"
    • Belief about others: "Everyone is selfish, dishonourable, manipulative, or else they're weak"
    • Defense mechanisms: Control
    • Subtypes: Passive-parasitic / “con artist”, aggressive
  • Sadistic:
    • Central tension / preoccupation: Suffering indignity vs being humiliated
    • Central affects (emotional expression): Cold hatred, contempt, pleasure
    • Belief about self: "I am entitled to hurt others"
    • Belief about others: "Others exist so I can hurt and humilate them"
    • Defense mechanisms: Detachment, control, reversal, enactment
  • Schizoid:
    • Contributing patterns: Hypersensitive, shy, easily overwhelmed, vulnerable to psychosis
    • Central tension / preoccupation: Fear vs longing for closeness
    • Central affects (emotional expression): Emotional pain when overstimulated, feel like emotions are overwhelming so they must be suppressed
    • Belief about self: "Dependency and love are dangerous"
    • Belief about others: "The world wants to control / engulf me"
    • Defense mechanisms: Withdrawal, fantasy
  • Somatising:
    • Contributing patterns: Physically fragile, childhood sickness, possibly childhood physical and/or sexual abuse
    • Central tension / preoccupation: Fragmentation vs wholeness of the body
    • Central affects (emotional expression): Distress, rage, alexithymia (inability to name emotions)
    • Belief about self: "I am fragile, vulnerable, and in fear of dying"
    • Belief about others: "Others are healthy, powerful, and indifferent"
    • Defense mechanisms: Somatisation, regression

Converse manifestation = A different way the personality syndrome manifests, as a defense mechanism.