Personality Disorders Differential Diagnoses

Updated: Nov 22, 2021
  • Author: David Bienenfeld, MD; Chief Editor: David Bienenfeld, MD  more...
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Diagnostic Considerations

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.

It can be difficult to accurately diagnose an axis II disorder in the context of acute and severe axis I symptoms unless the clinician is very familiar with the patient's long-term history. For example, signs and symptoms of individuals with major depression, mania, panic attacks, obsessive-compulsive disorder, or substance abuse may resolve with successful treatment. Examples may include dependent or avoidant features in major depression or obsessive-compulsive disorder, antisocial behaviors in substance abuse, or histrionic or narcissistic features in mania.

Consider the following in the differential diagnosis of personality disorders:

  • Paraphilias

  • Posttraumatic stress disorder

  • Schizoaffective disorder

  • Schizophrenia

  • Schizophreniform disorder

  • Social phobia

Differential Diagnoses