Personality Disorders are the Second Axis of DSM IV

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Diagnostic and Statistical Manual of Mental Disorders, is a manual published by the American Psychiatric Association that includes all curently recognised mental health disorders. The coding system utilised by the DSM-IV is designed to correspond with codes from the international Classification of Disease, commonly referred to as the ICD. Many people suffer from personality disorder and the causes of this illness are the subject of considerable debate and controversy. Some experts believe that personality disorders are caused by early experiences that prevented the development of normal thought and behaviour patterns. Other researchers believe that biological or genetic influences are the root cause of personality disorders. In order to be diagnosed with a personality disorder, an individual must exhibit symptoms that meet the diagnostic criteria established in the DSM IV.

These patterns of behaviour must be chronic and pervasive, affecting many different of the individual’s life, including social functioning, work, school and close relationships. The individual must exhibit symptoms that affect two or more of the following areas: thoughts, emotions, interpersonal functioning, and impulse control. The pattern of behaviours must be stable across time and have an onset that can be traced back to adolescence or early childhood. These behaviours cannot be explained by any other mental disorders, substance abuse or medical conditions. Personality disorders are described on Axis II of the Diagnostic and Statistical Manual. The DSM-IV lists a total of ten different personality disorders. These disorders are classified into there separate clusters: cluster A — odd or eccentric disorders, cluster B — dramatic, emotional or erratic disorders and cluster C — anxious or fearful disorders.

Before a clinician can diagnose a personality disorder, they must rule out other disorder or medical conditions that may be causing the symptoms. The symptoms that characterise personality disorders are often similar to those of other disorders and illnesses. Personality disorders also commonly co-occur with other illnesses. The following are potential differentials that must be ruled out before diagnosing an individual with a personality disorder: substance abuse, anxiety disorders, depression, dissociative disorders, social phobia, post traumatic stress disorder and schizophrenia.

The DSM has attracted praise for standardising psychiatric diagnostic categories and criteria. It has also attracted controversy and criticism. Some critics argue that the DSM represents an unscientific system that enshrines the opinions of a few powerful psychiatrists. There are ongoing issues concerning the validity and reliability of the diagnostic categories.

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