Personality disorder not otherwise specified
Personality disorder not otherwise specified (PD-NOS) is a subclinical[a] diagnostic classification for some DSM-IV Axis II personality disorders not listed in DSM-IV.[1]
| Personality disorder, unspecified | |
|---|---|
| Other names | Personality disorder NOS (PDNOS) |
| Specialty | Psychiatry |
The DSM-5 does not have a direct equivalent to PD-NOS. However, the DSM-5 other specified personality disorder and unspecified personality disorder are substantially comparable to PD-NOS.[2]
Additionally, the DSM-5 introduced the diagnosis Personality disorder - trait specified (PD-TS) as an alternative to let clinicians define the presentation in detail in terms of "impairment of personality functioning" and "pathological personality traits".[3]
Diagnostic criteria
editIn all cases of non-specific diagnoses it is a requirement that the person meet the general criteria for personality disorders.
DSM-IV-TR
editClinicians may give this diagnosis when no other personality disorder in the DSM fits the patient's symptoms.[4]
The DSM-IV-TR excluded four personality disorders, but this diagnosis may be used instead. The four excluded personality disorders are:
- Sadistic personality disorder
- Self-defeating personality disorder
- Depressive personality disorder
- Passive–aggressive personality disorder
DSM-5
editThe DSM-5 split PD-NOS into two diagnoses: Other Specified Personality Disorder and Unspecified Personality Disorder. They share the general criteria for personality disorders, but let clinicians specify why the presentation does not meet the criteria for any specific personality disorder (e.g. mixed personality features).[5]
ICD-10
editThe World Health Organization's ICD-10 defines two conceptually similar diagnoses:
- Other specific personality disorder (F60.8) for personality disorders that don't have a separate code. This diagnosis allows the following type specifiers: "eccentric", "haltlose", "immature", "narcissistic", "passive-aggressive", and "psychoneurotic".
- Personality disorder, unspecified (F60.9) for general personality disorder diagnoses.
ICD-11
editICD-11 uses general diagnoses with specifiers to fully describe a condition. The closest diagnosis to PD-NOS would be Personality disorder, severity unspecified (6D10.Z).
Epidemiology
editThe National Comorbidity Survey Replication estimated the prevalence of PD-NOS in the general population at around 1.6% (0.3-2.9%). Comorbidity measures indicated a strong association with antisocial personality disorder (and generally Cluster B), moderate association with obsessive-compulsive personality disorder, and strong negative association with schizoid and dependent personality disorders.[6]
A 2004 meta-analysis estimated the prevalence of PD-NOS in patient samples between 8-13%. In structured interview studies it is the third most common diagnosis given, in unstructured studies it is the single most frequent diagnosis. Half the studies did not give further definition for the diagnosis, and those that did used "mixed" most often.[7]
In another study, out of 1760 psychotherapy referrals, 21.6% was diagnosed exclusively with PD-NOS. In terms of severity, patients with PD-NOS fell between a formal personality disorder diagnosis and no personality disorder. Patients who received PD-NOS as an additional diagnosis to their formal personality disorder diagnosis had the most severe problems.[8]
See also
editNotes
edit- ^ "Subclinical" in the sense that the person does not meet the diagnostic criteria for any specific personality disorder, but does meet the general criteria for a personality disorder diagnosis.
References
edit- ^ Verheul, Roel; Bartak, Anna; Widiger, Thomas (August 2007). "Prevalence and construct validity of Personality Disorder Not Otherwise Specified (PDNOS)". Journal of Personality Disorders. 21 (4). New York City: Guilford Press: 359–70. doi:10.1521/pedi.2007.21.4.359. PMID 17685833.
- ^ Diagnostic and Statistical manual of Mental Disorders (5th ed.). Washington, DC: American Psychiatric Association. 2013. pp. 15. ISBN 978-0-89042-555-8.
- ^ "Alternative DSM-5 Model for Personality Disorders". Diagnostic and Statistical Manual for Mental Disorders (fifth edition). Washington, DC: American Psychiatric Association. p. 761.
- ^ Diagnostic and Statistical Manual of Mental Disorders Fourth edition Text Revision (DSM-IV-TR) American Psychiatric Association (2000)
- ^ American Psychiatric Association (2013). Diagnostic and Statistical Manual of Mental Disorders (fifth edition). p. 684.
- ^ Lenzenweger, Mark F.; Lane, Michael C.; Loranger, Armand W.; Kessler, Ronald C. (15 September 2007). "DSM-IV personality disorders in the National Comorbidity Survey Replication". Biological Psychiatry. 62 (6): 553–564. doi:10.1016/j.biopsych.2006.09.019. PMC 2044500. PMID 17217923.
- ^ Verheul R, Widiger T (September 2004). "A meta-analysis of the prevalence and usage of the personality disorder not otherwise specified (PDNOS) diagnosis". Journal of Personality Disorders. 18 (4). New York City: Guilford Press: 309–19. doi:10.1521/pedi.18.4.309.40350. PMID 15342320.
- ^ Verheul R, Bartak A, Widiger T (Aug 2007). "Prevalence and construct validity of Personality Disorder Not Otherwise Specified (PDNOS)". Journal of Personality Disorders. 21 (4): 359–370. doi:10.1521/pedi.2007.21.4.359. PMID 17685833.