Chronic medical conditions associated with pain and disability. Chronic medical con- ditions associated with pain and disability can also be associated with changes in person- ality. The diagnosis of personality change due to another medical condition is given only if a direct pathophysiological mechanism can be established. This diagnosis is not given if the change is due to a behavioral or psychological adjustment or response to another med- ical condition (e.g., dependent behaviors that result from a need for the assistance of others following a severe head trauma, cardiovascular disease, or dementia).
Delirium or major neurocognitive disorder. Personality change is a frequently associated feature of a delirium or major neurocognitive disorder. A separate diagnosis of personal— ity change due to another medical condition is not given if the change occurs exclusively during the course of a delirium. However, the diagnosis of personality change due to an- other medical condition may be given in addition to the diagnosis of major neurocognitive disorder if the personality change is a prominent part of the clinical presentation.
Another mental disorder due to another medical condition. The diagnosis of person- ality change due to another medical condition is not given if the disturbance is better ex- plained by another mental disorder due to another medical condition (e.g., depressive disorder due to brain tumor).
Substance use disorders. Personality changes may also occur in the context of substance use disorders, especially if the disorder is longstanding. The clinician should inquire carefully about the nature and extent of substance use. If the clinician wishes to indicate an etiological re- lationship between the personality change and substance use, the unspecified category for the specific substance (e.g., unspecified stimulant-related disorder) can be used.
Other mental disorders. Marked personality changes may also be an associated feature of other mental disorders (e.g., schizophrenia; delusional disorder; depressive and bipolar disorders; other specified and unspecified disruptive behavior, impulse-control, and con- duct disorders; panic disorder). However, in these disorders, no specific physiological fac- tor is judged to be etiologically related to the personality change.
Other personality disorders. Personality change due to another medical condition can be distinguished from a personality disorder by the requirement for a clinically significant change from baseline personality functioning and the presence of a specific etiological medical condition.
301.89 (F60.89)
This category applies to presentations in which symptoms characteristic of a personality disorder that cause clinically significant distress or impairment in social, occupational, or other important areas of functioning predominate but do not meet the full criteria for any of the disorders in the personality disorders diagnostic class. The other specified personality disorder category is used in situations in which the clinician chooses to communicate the specific reason that the presentation does not meet the criteria for any specific personality disorder. This is done by recording “other specified personality disorder” followed by the specific reason (e.g., “mixed personality features”).
301.9 (F60.9)
This category applies to presentations in which symptoms characteristic of a personality disorder that cause clinically significant distress or impairment in social, occupational, or other important areas of functioning predominate but do not meet the full criteria for any of the disorders in the personality disorders diagnostic class. The unspecified personality disorder category is used in situations in which the clinician chooses not to specify the rea- son that the criteria are not met for a specific personality disorder, and includes presenta- tions in which there is insufficient information to make a more specific diagnosis.
Paraphilic disorders included in this manual are voyeuristic disorder (spying on others in private activities), exhibitionistic disorder (exposing the genitals), frotteuristic disorder (touching or rubbing against a nonconsenting individual), sexual masochism disorder (undergoing humiliation, bondage, or suffering), sexual sadism disorder (inﬂict- ing humiliation, bondage, or suffering), pedophilic disorder (sexual focus on children), fe- body parts), and transvestic disorder (engaging in sexually arousing cross-dressing).