Disinhibited type: If the predominant feature is poor impulse control as evidenced by sexual indiscretions, etc.
Aggressive type: If the predominant feature is aggressive behavior.
Apathetic type: If the predominant feature is marked apathy and indifference.
Paranoid type: It the predominant feature is suspiciousness or paranoid ideation.
Other type: If the presentation is not characterized by any of the above subtypes.
Combined type: If more than one feature predominates in the clinical picture.
Coding note: Include the name of the other medical condition (e.g., 310.1 [FO7.0] person- ality change due to temporal lobe epilepsy). The other medical condition should be coded and listed separately immediately before the personality disorder due to another medical condition (e.g., 345.40 [640.209] temporal lobe epilepsy; 310.1 [FO7.0] personality change due to temporal lobe epilepsy).
Personality Change Due to Another Medical Condition 683
The particular personality change can be specified by indicating the symptom presenta— tion that predominates in the clinical presentation.
The essential feature of a personality change due to another medical condition is a persis- tent personality disturbance that is judged to be due to the direct pathophysiological ef- fects of a medical condition. The personality disturbance represents a change from the individual’s previous characteristic personality pattern. In children, this condition may be manifested as a marked deviation from normal development rather than as a change in a stable personality pattern (Criterion A). There must be evidence from the history, physical examination, or laboratory findings that the personality change is the direct physiological consequence of another medical condition (Criterion B). The diagnosis is not given if the disturbance is better explained by another mental disorder (Criterion C). The diagnosis is not given if the disturbance occurs exclusively during the course of a delirium (Criterion
D). The disturbance must also cause clinically significant distress or impairment in social, occupational, or other important areas of functioning (Criterion E).
Common manifestations of the personality change include affective instability, poor impulse control, outbursts of aggression or rage grossly out of proportion to any precipi- tating psychosocial stressor, marked apathy, suspiciousness, or paranoid ideation. The phenomenology of the change is indicated using the subtypes listed in the criteria set. An individual with the disorder is often characterized by others as ”not himself [or herself].”
Although it shares the term “personality” with the other personality disorders, this diag— nosis is distinct by virtue of its specific etiology, different phenomenology, and more vari- able onset and course.
The clinical presentation in a given individual may depend on the nature and localiza- tion of the pathological process. For example, injury to the frontal lobes may yield symp- toms such as lack of judgment or foresight, facetiousness, disinhibition, and euphoria.
Right hemisphere strokes have often been shown to evoke personality changes in asso- ciation with unilateral spatial neglect, anosognosia (i.e., inability of the individual to recognize a bodily or functional deficit, such as the existence of hemiparesis), motor im- persistence, and other neurological deficits.
A variety of neurological and other medical conditions may cause personality changes, including central nervous system neoplasms, head trauma, cerebrovascular disease,
Huntington’s disease, epilepsy, infectious conditions with central nervous system in- volvement (e.g., HIV), endocrine conditions (e.g., hypothyroidism, hypo- and hyperadre- nocorticism), and autoimmune conditions with central nervous system involvement (e.g., systemic lupus erythematosus). The associated physical examination findings, laboratory findings, and patterns of prevalence and onset reﬂect those of the neurological or other medical condition involved.