eMedicine Specialties > Psychiatry > Adult

Personality Disorders: Differential Diagnoses & Workup

Author: David Bienenfeld, MD, Vice-Chair, Program Director, Professor, Department of Psychiatry, Wright State University School of Medicine
Contributor Information and Disclosures

Updated: Jul 17, 2008

Differential Diagnoses

Alcoholism
Mental Disorders Secondary to General Medical Conditions
Anxiety Disorders
Mental Retardation
Brief Psychotic Disorder
Paraphilias
Bulimia
Posttraumatic Stress Disorder
Depression
Schizoaffective Disorder
Dissociative Disorders
Schizophrenia
Ganser Syndrome
Schizophreniform Disorder
Hypochondriasis
Social Phobia

Other Problems to Be Considered

The diagnosis of personality disorders in patients who have comorbid Axis I disorders, including mood, substance abuse, and medical disorders (eg, head injury, seizure disorders), can make the diagnosis of personality disorders more difficult because of overlapping features. Premorbid and developmental history, especially from collateral sources, is helpful in differential diagnosis.

Workup

Laboratory Studies

  • Toxicology screen: Substance abuse is common in many personality disorders, and intoxication can lead patients to present with some features of personality disorders.
  • Screening for HIV and other sexually transmitted diseases: Patients with personality disorders often exhibit poor impulse control and many act without regard to risk.

Other Tests

  • Psychological testing may support or direct the clinical diagnosis.3,2
    • The Minnesota Multiphasic Personality Inventory (MMPI) is the best-known psychological test. The Eysenck Personality Inventory and the Personality Diagnostic Questionnaire are also used. None of these has been reliably validated against DSM-IV-TR diagnoses.
    • The Structured Clinical Interview for DSM-IV-TR for Axis II Disorders (SCID-II) can also be used to aid in diagnosis.

More on Personality Disorders

Overview: Personality Disorders
Differential Diagnoses & Workup: Personality Disorders
Treatment & Medication: Personality Disorders
Follow-up: Personality Disorders
References

References

  1. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR). Washington, DC: American Psychiatric Association; 2000.

  2. Widiger TA, Sanderson CJ. Personality disorders. In: Tasman A, Kay J, Lieberman JA, eds. Psychiatry. Philadelphia, Pa: Harcourt Brace & Co; 1997:1291-1317.

  3. Shedler J, Westen D. Refining personality disorder diagnosis: integrating science and practice. Am J Psychiatry. Aug 2004;161(8):1350-65. [Medline].

  4. Raine A, Lencz T, Bihrle S, et al. Reduced prefrontal gray matter volume and reduced autonomic activity in antisocial personality disorder. Arch Gen Psychiatry. Feb 2000;57(2):119-27; discussion 128-9. [Medline].

  5. Lyons-Ruth K, Holmes BM, Sasvari-Szekely M, Ronai Z, Nemoda Z, Pauls D. Serotonin transporter polymorphism and borderline or antisocial traits among low-income young adults. Psychiatr Genet. Dec 2007;17(6):339-43. [Medline].

  6. Britton R. Narcissistic disorders in clinical practice. J Anal Psychol. Sep 2004;49(4):477-90. [Medline].

  7. Beck AT, Freeman A. Cognitive Therapy of Personality Disorders. London, England: Guilford Press; 1990.

  8. Livesley WJ. A practical approach to the treatment of patients with borderline personality disorder. Psychiatr Clin North Am. Mar 2000;23(1):211-32. [Medline].

  9. Kavoussi RJ, Coccaro EF. Divalproex sodium for impulsive aggressive behavior in patients with personality disorder. J Clin Psychiatry. Dec 1998;59(12):676-80. [Medline].

  10. Soloff PH. Psychopharmacology of borderline personality disorder. Psychiatr Clin North Am. Mar 2000;23(1):169-92, ix. [Medline].

  11. [Best Evidence] Binks CA, Fenton M, McCarthy L, Lee T, Adams CE, Duggan C. Pharmacological interventions for people with borderline personality disorder. Cochrane Database Syst Rev. Jan 25 2006;CD005653. [Medline][Full Text].

  12. Simeon D, Baker B, Chaplin W, Braun A, Hollander E. An open-label trial of divalproex extended-release in the treatment of borderline personality disorder. CNS Spectr. Jun 2007;12(6):439-43. [Medline].

  13. Herpertz SC, Zanarini M, Schulz CS, Siever L, Lieb K, Möller HJ. World Federation of Societies of Biological Psychiatry (WFSBP) guidelines for biological treatment of personality disorders. World J Biol Psychiatry. 2007;8(4):212-44. [Medline].

  14. Suominen KH, Isometsa ET, Henriksson MM, et al. Suicide attempts and personality disorder. Acta Psychiatr Scand. Aug 2000;102(2):118-25. [Medline].

Further Reading

Contributor Information and Disclosures

Author

David Bienenfeld, MD, Vice-Chair, Program Director, Professor, Department of Psychiatry, Wright State University School of Medicine
David Bienenfeld, MD is a member of the following medical societies: American Medical Association, American Psychiatric Association, and Association for Academic Psychiatry
Disclosure: Nothing to disclose.

Medical Editor

Sarah C Aronson, MD, Associate Professor, Departments of Psychiatry and Medicine, Case Western Reserve School of Medicine/University Hospitals of Cleveland
Sarah C Aronson, MD is a member of the following medical societies: American Academy of Family Physicians, American Medical Association, and American Psychiatric Association
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Iqbal Ahmed, MBBS, Professor, Department of Psychiatry, John A Burns School of Medicine, University of Hawaii
Iqbal Ahmed, MBBS is a member of the following medical societies: Academy of Psychosomatic Medicine, American Association for Geriatric Psychiatry, American Neuropsychiatric Association, and American Psychiatric Association
Disclosure: Nothing to disclose.

CME Editor

Harold H Harsch, MD, Program Director of Geropsychiatry, Department of Geriatrics/Gerontology, Associate Professor, Department of Psychiatry and Department of Medicine, Froedtert Hospital, Medical College of Wisconsin
Harold H Harsch, MD is a member of the following medical societies: American Psychiatric Association
Disclosure: lilly Honoraria Speaking and teaching; Forest Labs Honoraria Speaking and teaching; AstraZeneca Honoraria Speaking and teaching; Pfizer Grant/research funds Speaking and teaching; Northstar Grant/research funds Research; Novartis Grant/research funds research; Pfizer  Speaking and teaching; Sanofi-avetis Grant/research funds research; Otsuke Grant/research funds reseach; GlaxoSmithKline Grant/research funds research

Chief Editor

Stephen Soreff, MD, President of Education Initiatives, Nottingham, NH; Faculty, Metropolitan College of Boston University, Boston, MA
Stephen Soreff, MD is a member of the following medical societies: American College of Mental Health Administration and American Psychosomatic Society
Disclosure: Nothing to disclose.

 
 
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