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Treatment & Therapy

How the Proposed Changes in the DSM Will Affect Diagnosis of BPD

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Clinicians refer to the Diagnostic and Statistical Manual of Mental Disorders (DSM), published by the American Psychiatric Association (APA), as the definitive source when diagnosing patients. The APA is currently preparing a major revision to the DSM that will represent a considerable change in how personality disorders will be defined and diagnosed.

Current DSM

To understand the significance of what the changes mean, it helps to be familiar with the two aspects used to diagnose personality disorders under the current edition of the DSM, DSM-IV.  The first aspect involves the definition of what qualifies as a personality disorder. The DSM-IV defines a personality disorder as a pervasive pattern of “inner experience and behavior” that deviates from an individual’s cultural norms.

The second aspect focuses on identifying what type of personality disorder is present. According to the DSM-IV, there are 10 defined personality disorders. Each disorder is diagnosed by the number of criteria exhibited by an individual. For example, to diagnose Borderline Personality Disorder (BPD), clinicians look to identify five of nine criteria.

The problem with the existing system of diagnosis is the vagueness of the definitions and criteria. Because so many of the criteria for the various personality disorders overlap, therapists have tremendous difficulty precisely diagnosing which personality disorder someone is displaying.

Proposed Changes

Under the proposed changes in the DSM-V, personality disorders in general will be defined differently. A major change will be the reduction of the number of defined personality disorders from 10 to five. Consequently, the previous system of basing a diagnosis on identifying a certain number of criteria will be eliminated. In its place, clinicians will refer to a detailed description of the five defined personality disorders:

  • Antisocial/Psychopathic Type
  • Avoidant Type
  • Borderline Type
  • Obsessive-Compulsive Type
  • Schizotypal Type

The next step in the diagnostic process will be for clinicians to rate a patient’s personality type on a five-point scale, with 1 being “no match” and 5 being a “very good match,” to determine how closely it matches a defined disorder. Clinicians will also use a scale to rate various traits associated with each personality disorder to make a more accurate diagnosis.

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