How to Differentiate between Different Personality Disorders
It can be a daunting task to differentiate between personality disorders (PD). There is so much cross-over from one type to another that a person may appear to have multiple PD’s. While the DSM-V chose not to use the five model factor as described in Widiger and Costa’s book, Personality Disorders and the Five-Factor Model of Personality, that doesn’t mean it is not a useful tool for current diagnosing.
The table below summarizes the five model factor and the implications for each of the PD’s. In assessing a client, determine which of the factors apply and to which extreme the behavior is demonstrated. For instance, does the client present with anxiety or are they completely unconcerned. If neither is the case, move onto the next factor. For anxious clients, they may have Schizotypal, Borderline, Avoidant, Dependent, or Obsessive Compulsive PD. Unconcerned clients may have Anti-Social PD. At the end of the factor list, review each of the PDs to see which the right fit.
Clients who present in several of the categories but do not consistently fit into one, may have Other Specified or Unspecified PD. The purpose of diagnosis is to provide an accurate treatment for the PD. Anti-Social PD is not treated in the same manner as Borderline PD.
| Factors | PPD | SzPD | StPD | ASPD | BPD | HPD | NPD | AvPD | DPD | OCPD | PAPD | DpPD |
| Neuroticism (vs. emotional stability) | ||||||||||||
| Anxiousness (vs. unconcerned) | n/a | n/a | High | Low | High | n/a | n/a | High | High | High | n/a | n/a |
| Angry hostility (vs. dispassionate) | High | n/a | n/a | High | High | n/a | High | n/a | n/a | n/a | High | n/a |
| Depressiveness (vs. optimistic) | n/a | n/a | n/a | n/a | High | n/a | n/a | n/a | n/a | n/a | n/a | High |
| Self-consciousness (vs. shameless) | n/a | n/a | High | Low | n/a | Low | Low | High | High | n/a | n/a | High |
| Impulsivity (vs. restrained) | n/a | n/a | n/a | High | High | High | n/a | Low | n/a | Low | n/a | n/a |
| Vulnerability (vs. fearless) | n/a | n/a | n/a | Low | High | n/a | n/a | High | High | n/a | n/a | n/a |
| Extraversion (vs. introversion) | ||||||||||||
| Warmth (vs. coldness) | Low | Low | Low | n/a | n/a | n/a | Low | n/a | High | n/a | Low | Low |
| Gregariousness (vs. withdrawal) | Low | Low | Low | n/a | n/a | High | n/a | Low | n/a | n/a | n/a | Low |
| Assertiveness (vs. submissiveness) | n/a | n/a | n/a | High | n/a | n/a | High | Low | Low | n/a | Low | n/a |
| Activity (vs. passivity) | n/a | Low | n/a | High | n/a | High | n/a | n/a | n/a | n/a | Low | n/a |
| Excitement seeking (vs. lifeless) | n/a | Low | n/a | High | n/a | High | High | Low | n/a | Low | n/a | Low |
| Positive emotionality (vs. anhedonia) | n/a | Low | Low | n/a | n/a | High | n/a | Low | n/a | n/a | n/a | n/a |
| Openness (vs. closedness) | ||||||||||||
| Fantasy (vs. concrete) | n/a | n/a | High | n/a | n/a | High | n/a | n/a | n/a | n/a | n/a | n/a |
| Aesthetics (vs. disinterest) | n/a | n/a | n/a | n/a | n/a | n/a | n/a | n/a | n/a | n/a | n/a | n/a |
| Feelings (vs. alexithymia) | n/a | Low | n/a | n/a | High | High | Low | n/a | n/a | Low | n/a | n/a |
| Actions (vs. predictable) | Low | Low | n/a | High | High | High | High | Low | n/a | Low | Low | n/a |
| Ideas (vs. closed-minded) | Low | n/a | High | n/a | n/a | n/a | n/a | n/a | n/a | Low | Low | Low |
| Values (vs. dogmatic) | Low | n/a | n/a | n/a | n/a | n/a | n/a | n/a | n/a | Low | n/a | n/a |
| Agreeableness (vs. antagonism) | ||||||||||||
| Trust (vs. mistrust) | Low | n/a | n/a | Low | n/a | High | Low | n/a | High | n/a | n/a | Low |
| Straightforwardness (vs. deception) | Low | n/a | n/a | Low | n/a | n/a | Low | n/a | n/a | n/a | Low | n/a |
| Altruism (vs. exploitative) | Low | n/a | n/a | Low | n/a | n/a | Low | n/a | High | n/a | n/a | n/a |
| Compliance (vs. aggression) | Low | n/a | n/a | Low | n/a | n/a | Low | n/a | High | n/a | Low | n/a |
| Modesty (vs. arrogance) | n/a | n/a | n/a | Low | n/a | n/a | Low | High | High | n/a | n/a | High |
| Tender-mindedness (vs. tough-minded) | Low | n/a | n/a | Low | n/a | n/a | Low | n/a | High | n/a | n/a | n/a |
| Conscientiousness (vs. disinhibition) | ||||||||||||
| Competence (vs. laxness) | n/a | n/a | n/a | n/a | n/a | n/a | n/a | n/a | n/a | High | Low | n/a |
| Order (vs. disorderly) | n/a | n/a | Low | n/a | n/a | n/a | n/a | n/a | n/a | n/a | High | Low |
| Dutifulness (vs. irresponsibility) | n/a | n/a | n/a | Low | n/a | n/a | n/a | n/a | n/a | High | Low | High |
| Achievement striving (vs. lackadaisical) | n/a | n/a | n/a | n/a | n/a | n/a | n/a | n/a | n/a | High | n/a | n/a |
| Self-discipline (vs. negligence) | n/a | n/a | n/a | Low | n/a | Low | n/a | n/a | n/a | High | Low | n/a |
| Deliberation (vs. rashness) | n/a | n/a | n/a | Low | Low | Low | n/a | n/a | n/a | High | n/a | High |
| Abbreviations used: PPD – Paranoid Personality Disorder, SzPD – Schizoid Personality Disorder, StPD – Schizotypal Personality Disorder, ASPD – Antisocial Personality Disorder, BPD – Borderline Personality Disorder, HPD – Histrionic Personality Disorder, NPD – Narcissistic Personality Disorder, AvPD – Avoidant Personality Disorder, DPD – Dependent Personality Disorder, OCPD – Obsessive-Compulsive Personality Disorder, PAPD – Passive-Aggressive Personality Disorder, DpPD – Depressive Personality Disorder, n/a – not available. | ||||||||||||
In the future, this model may become the more accepted method for diagnosis. In the meantime, it is very useful for differentiating PDs.
Posted under: Personality Disorders Writings from Christine
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