Judgments about personality functioning must take into account the individual’s ethnic, cul- tural, and social background. Personality disorders should not be confused with problems as- sociated with acculturation following immigration or with the expression of habits, customs, or religious and political values professed by the individual’s culture of origin. It is useful for the clinician, especially when evaluating someone from a different background, to obtain ad- ditional information from informants who are familiar with the person’s cultural background.
Certain personality disorders (e.g., antisocial personality disorder) are diagnosed more frequently in males. Others (e.g., borderline, histrionic, and dependent personality disor- ders) are diagnosed more frequently in females. Although these differences in prevalence probably reﬂect real gender differences in the presence of such patterns, clinicians must be cautious not to overdiagnose or underdiagnose certain personality disorders in females or in males because of social stereotypes about typical gender roles and behaviors.
Other mental disorders and personality traits. Many of the specific criteria for the per- sonality disorders describe features (e.g., suspiciousness, dependency, insensitivity) that are also characteristic of episodes of other mental disorders. A personality disorder should be diagnosed only when the defining characteristics appeared before early adulthood, are typical of the individual’s long-term functioning, and do not occur exclusively during an episode of another mental disorder. It may be particularly difficult (and not particularly useful) to distinguish personality disorders from persistent mental disorders such as per- sistent depressive disorder that have an early onset and an enduring, relatively stable course. Some personality disorders may have a ”spectrum” relationship to other mental disorders (e.g., schizotypal personality disorder with schizophrenia; avoidant personality disorder with social anxiety disorder [social phobia]) based on phenomenological or bio- logical similarities or familial aggregation.
the threshold for a personality disorder. Personality traits are diagnosed as a personality disorder only when they are inﬂexible, maladaptive, and persisting and cause significant functional impairment or subjective distress.
Psychotic disorders. For the three personality disorders that may be related to the psy- chotic disorders (i.e., paranoid, schizoid, and schizotypal), there is an exclusion criterion stating that the pattern of behavior must not have occurred exclusively during the course of schizophrenia, a bipolar or depressive disorder with psychotic features, or another psy- chotic disorder. When an individual has a persistent mental disorder (e.g., schizophrenia) that was preceded by a preexisting personality disorder, the personality disorder should also be recorded, followed by ”premorbid" in parentheses.
Anxiety and depressive disorders. The clinician must be cautious in diagnosing per- sonality disorders during an episode of a depressive disorder or an anxiety disorder, be- traits and may make it more difficult to evaluate retrospectively the individual’s long-term patterns of functioning.
Posttraumatic stress disorder. When personality changes emerge and persist after an individual has been exposed to extreme stress, a diagnosis of posttraumatic stress disorder should be considered.
Substance use disorders. When an individual has a substance use disorder, it is impor- tant not to make a personality disorder diagnosis based solely on behaviors that are con- sequences of substance intoxication or withdrawal or that are associated with activities in the service of sustaining substance use (e.g., antisocial behavior).
Personality change due to another medical condition. When enduring changes in per- sonality arise as a result of the physiological effects of another medical condition (e.g., brain tumor), a diagnosis of personality change due to another medical condition should be considered.
Diagnostic Criteria 301.0 (F60.0)