1lmoLhy A.

Murphy, Mu
!" $"%&'$() "* '%(+,+)(
ersonallLy ulsorders
araphlllc ulsorders
CLher MenLal ulsorders
Medlcauon-lnduced MovemenL ulsorders and CLher
Adverse LecLs of Medlcauon
CLher Condluons 1haL May 8e a locus of Cllnlcal Auenuon
uSM-3 ls a reglsLered Lrademark, and all conLenL, wheLher ln nal or
proposed form, ls proLecLed by copyrlghL held by Lhe AA. All rlghLs are
reserved, and wrluen permlsslon ls requlred from Lhe AA for use ln any
way, commerclal or noncommerclal. ermlsslon ls noL granLed for use of
Lhe uSM-3 Lrademark.
PERSONALITY DISORDERS
PERSONALITY DISORDERS,
CONT.
no Change !!!
PERSONALITY DISORDERS,
CONT.
-./ %"(0 -+,+ 1+,)"%23'(/ 4')",5+,) 5++6+5 (" 7+ '%
'% %" %++5 "* $",,+$8"%0
Work Croup 92%(+5 a ma[or change ln approach Lo us.
uSM lv-18 crlLerla descrlbed as woefully lnadequaLe"
Plgh use of u-nCS
PERSONALITY DISORDERS,
CONT.
1he llmlLauons of Lhe caLegorlcal model of personallLy dlsorder
classlcauon [of Lhe uSM lv-18] were well recognlzed.aruclpanLs aL Lhe
conference largely endorsed a converslon Lo a dlmenslonal model of
classlcauon, [and hlghllghLed] Lhe advanLages of, and emplrlcal supporL
for, !" $"%&'(!)*&+ ,$&(!(-,$-!. /$0&"1$2"!. -.!11$3-!)2" 24 5&(12"!.$%6
/$12(/&(+ -2"1$1)"' 24 427( 2( 3*& 8(2!/ /20!$"1 24 5&(12"!.$%6
47"-)2"$"'. 1hls research lncluded a conslderable number of 1%7/$&1
!//(&11$"' 8&,!*$2(!. '&"&)-1+ /&*&.250&"%!. !"%&-&/&"%1+ -(2119
-7.%7(!. !55.$-!)2"+ -2"*&('&"-& :$%, 2%,&( 0&"%!. /$12(/&(1+ -2*&(!'&+
!"/ -.$"$-!. 7).$%6."
-'5':+, 2%5 ;'6"%)+%< =%> 4'6+%)'"%23 ?"5+3) "* 1+,)"%23'(/ 4')",5+,)> @+A%'%:
(.+ @+)+2,$. B:+%52 *", 4;?CD EB1B< FGGHI
PERSONALITY DISORDERS,
CONT.
Work group was slow Lo agree on a new approach. Challenges
lncluded:
lacLor analyuc LralL psychology ls exLenslve, wlLh Lerms LhaL are
unfamlllar Lo many cllnlclans
vesLed lnLeresLs of varlous research groups, cllnlcal experLs, educaLors
llrsL proposal deemed Lo compllcaLed for mosL cllnlclans, leadlng
work group Lo propose a hybrld model.
1lme became shorL Lo LesL, and bulld supporL for new approach
AA 8oard of 1rusLees voLed Lo puL new approach ln Secuon lll -
Lmerglng Measures and Models"
Ceneral CrlLerla for a ersonallLy ulsorder
A. ModeraLe or greaLer lmpalrmenL ln personallLy funcuonlng
8. Cne or more paLhologlcal personallLy LralLs
C. lmpalrmenL of personallLy funcuonlng ls relauvely lnexlble and
pervaslve
u. lmpalrmenL of personallLy funcuonlng ls relauvely sLable, wlLh
onseL ln adolescence or early adulLhood
L. noL explalned by oLher menLal lllness
l. noL prlmarlly Lhe resulL of subsLance abuse
C. noL undersLood as normal for developmenLal sLage, or for
socloculLural envlronmenL
PERSONALITY DISORDERS
ALTERNATIVE MODEL
Self:
1. ldenuLy
2. Self-dlrecuon
lnLerpersonal:
1. LmpaLhy
2. lnumacy
PERSONALITY DISORDERS
ALTERNATIVE MODEL
A. ModeraLe or greaLer lmpalrmenL ln personallLy
funcuonlng"
8equlres lmpalrmenL ln > 2 Core LlemenLs of
personallLy funcuonlng:
Self:
1. ldenuLy - experlence of oneself as unlque, wlLh boundarles
beLween self and oLhers, sLable self-esLeem, accuraLe self-
appralsal, capaclLy for a range of emouons, ablllLy Lo regulaLe
Lhem
2. Self-dlrecuon - goal dlrecLed, sLandards of behavlor, able Lo self-
reecL
lnLerpersonal:
1. LmpaLhy - comprehenslon and appreclauon of oLhers'
experlences and mouvauons, Lolerance of dlerlng perspecuves,
undersLandlng eecLs of one's behavlor on oLhers
2. lnumacy - depLh and durauon of connecuon wlLh oLhers, deslre/
capaclLy for closeness
PERSONALITY DISORDERS
ALTERNATIVE MODEL
8. Cne or more paLhologlcal personallLy LralLs
ldenued ln a Lable whlch llsLs 3 LralL domalns, and a LoLal of
23 dlerenL LralL faceLs wlLhln Lhose domalns.
aLhologlcal 1ralL uomalns (wlLh examples of LralL faceLs)
1. negauve AecuvlLy (e.g., lablllLy, hosullLy, submlsslveness)
2. ueLachmenL (e.g., wlLhdrawal, lnumacy avoldance, resLrlcLed aecL)
3. AnLagonlsm (e.g., manlpulauveness, deceluulness, callousness)
4. ulslnhlbluon (e.g., rlsk Laklng, lmpulslvlLy, lrresponslblllLy)
3. sychouclsm (e.g., unusual bellefs and experlences, eccenLrlclLy)
PERSONALITY DISORDERS
ALTERNATIVE MODEL
Ceneral CrlLerla for a ersonallLy ulsorder
!ModeraLe or greaLer lmpalrmenL ln personallLy funcuonlng
!Cne or more paLhologlcal personallLy LralLs
C. lmpalrmenL of personallLy funcuonlng ls relauvely lnexlble and
pervaslve
u. lmpalrmenL of personallLy funcuonlng ls relauvely sLable, wlLh
onseL ln adolescence or early adulLhood
L. noL explalned by oLher menLal lllness
l. noL prlmarlly Lhe resulL of subsLance abuse
C. noL undersLood as normal for developmenLal sLage, or for
socloculLural envlronmenL
PERSONALITY DISORDERS
ALTERNATIVE MODEL
!+J( - lf pauenL has meL general crlLerla A-C for a u, deLer-
mlne lf crlLerla for a ;K+$'A$ ersonallLy ulsorder are meL.
Speclc ersonallLy ulsorders:
Anusoclal u
AvoldanL u
8orderllne u
narclsslsuc u
Cbsesslve-Compulslve u
SchlzoLypal u
PERSONALITY DISORDERS
ALTERNATIVE MODEL
LJ26K3+> Anusoclal ersonallLy ulsorder
A. ModeraLe or greaLer lmpalrmenL ln personallLy funcuonlng,
manlfesLed by characLerlsuc dlmculues ln > 2 of Lhe
followlng core elemenLs:
A. ldenuLy - egocenLrlsm, self-esLeem derlved from personal galn,
power, or pleasure
8. Self-dlrecuon - Coal semng based on personal graucauon, absence
of prosoclal lnLernal sLandards, assoclaLed wlLh fallure Lo conform Lo
lawful/eLhlcal behavlor
C. LmpaLhy - Lack of concern for feellngs, needs, suerlng, lack or
remorse aer hurung/mlsLreaung oLhers
u. lnumacy - lnablllLy Lo have muLually lnumaLe relauonshlps, whlch
are lnsLead characLerlzed by explolLauon, decelL, coerclon,
domlnance, lnumldauon
PERSONALITY DISORDERS
ALTERNATIVE MODEL
Anusoclal ersonallLy ulsorder, conunued
8. > 6 of Lhe followlng 7 LralLs
A. Manlpulauveness
8. Callousness
C. ueceluulness
u. PosullLy
L. 8lsk Laklng
l. lmpulslvlLy
C. lrresponslblllLy
C. Ceneral CrlLerla C-C musL be saused
u. Speclers: sychopaLhy" (23)"< "(.+, 623252K8M+ (,2'() "N()'5+ "*
(.")+ ,+ON',+5 *", 5J 62/ 7+ ,+$",5+5)
PERSONALITY DISORDERS
ALTERNATIVE MODEL
Slmllar crlLerla for dlagnoslng oLher ;K+$'A$ us
ulsLurbance ln > 2 of Lhe four core elemenLs of personallLy funcuonlng
(ldenuLy, self-dlrecuon, empaLhy, lnumacy), naLure of dlsLurbance
descrlbed ln uSM 3
Lach requlres a specled number of speclc paLhologlcal LralLs
AvoldanL u - anxlousness, wlLhdrawal, anhedonla, lnumacy avoldance
8orderllne u - lablllLy, anxlousness, separauon lnsecurlLy, depresslvlLy,
lmpulslvlLy, rlsk Laklng, hosullLy
narclsslsuc u - grandloslLy, auenuon seeklng
Cbsesslve-Compulslve u - rlgld perfecuonlsm, perseverauon, lnumacy
avoldance, resLrlcLed aecuvlLy
SchlzoLypal u - cognluve/percepLual dysregulauon, unusual bellefs/
experlences, eccenLrlclLy, resLrlcLed aecuvlLy, wlLhdrawal,
susplclousness
PERSONALITY DISORDERS
ALTERNATIVE MODEL
P", 1+,)"%23'(/ 4')",5+,) E6++8%: :+%+,23 $,'(+,'2 BCQI 9.'$. 5" %"(
6++( $,'(+,'2 *", 2 ;K+$'A$ 14< 5'2:%")') 9'33 7+>
ersonallLy ulsorder - 1ralL Specled E,+K32$+) 14C!R;I
A. ModeraLe or greaLer lmpalrmenL ln personallLy funcuonlng
manlfesLed by > 2 of Lhe core elemenLs:
1. ldenuLy
2. Self-dlrecuon
3. LmpaLhy
4. lnumacy
PERSONALITY DISORDERS
ALTERNATIVE MODEL
ersonallLy ulsorder - 1ralL Specled E$"%8%N+5I
8. Cne or more paLhologlcal LralL domalns C8 speclc LralL
faceLs wlLhln domalns:
1. negauve AecuvlLy (e.g., lablllLy, hosullLy, submlsslveness)
2. ueLachmenL (e.g., wlLhdrawal, lnumacy avoldance, resLrlcLed aecL)
3. AnLagonlsm (e.g., manlpulauveness, deceluulness, callousness)
4. ulslnhlbluon (e.g., rlsk Laklng, lmpulslvlLy, lrresponslblllLy)
3. sychouclsm (e.g., unusual bellefs and experlences, eccenLrlclLy)
Ceneral CrlLerla C-C musL also be meL
ulagnosls should lnclude ldenucauon of elemenLs presenL, ellmlnaung
need for subLypes and speclers
PERSONALITY DISORDERS
ALTERNATIVE MODEL
SeverlLy Measure - Level of ersonallLy luncuonlng Scale"
Applled Lo Lhe four core elemenLs of personallLy
1. ldenuLy
2. Self-dlrecuon
3. LmpaLhy
4. lnumacy
rovldes a way of raung core elemenLs of personallLy on a 0-4
scale, wlLh 2 = moderaLe lmpalrmenL
PERSONALITY DISORDERS
Moderate or Greater
Impairment in Personality
Functioning
Meets Criteria for
Specific Personality
Disorder(s)
PD Trait-Specified
Meets All Other General PD Criteria
PD Diagnosis Confirmed
Clinician Assessment of DSM-5
Personality Disorders
or
! "
" !
#
voyeurlsuc ulsorder
Lxhlbluonlsuc ulsorder
lroueurlsuc ulsorder
Sexual Masochlsm ulsorder
Sexual Sadlsm ulsorder
edophlllc ulsorder
leushlsuc ulsorder
1ransvesuc ulsorder
CLher Specled araphlllc ulsorder
unspecled araphlllc ulsorder
PARAPHILIC DISORDERS
!+9 (+,6'%"3":/
araphllla - lnLense and perslsLenL sexual lnLeresL oLher Lhan
sexual lnLeresL ln genlLal sumulauon or preparaLory fondllng
wlLh phenoLyplcally normal, physlcally maLure, consenung
human parLners"
(ln some clrcumsLances, may noL be lnLense")
araphlllc ulsorder - a paraphllla LhaL ls currenLly causlng
dlsLress or lmpalrmenL, or LhaL has enLalled personal harm (or
rlsk of harm) Lo oLhers
PARAPHILIC DISORDERS
uSM lv-18 araphlllas araphlllc 4')",5+,) ln uMS 3
@28"%23+> 12,2K.'3'2) (.2( 5" %"( '%M"3M+ %"%$"%)+%8%: M'$86) E+S:S<
(,2%)M+)8)6I 2,+ %"( %+$+))2,'3/ '%5'$28M+ "* 2 6+%(23 5')",5+,S
1o have a paraphlllc dlsorder, lL ls requlred Lo have "%+ or more
of Lhe followlng:
ulsLress
lmpalrmenL
Abuse of a non-consenung vlcum
PARAPHILIC DISORDERS
new Speclers for araphlllc ulsorders ln uSM 3:
ln a ConLrolled LnvlronmenL
ln 8emlsslon
@28"%23+> ;K+$'A+,) ,+&+$( '6K",(2%( 2)K+$() "* $3'%'$23 )(2(N) (.2(
62/ '6K2$( )/6K("6 K,+)+%(28"%S
P", +J26K3+< "KK",(N%'8+) (" +%:2:+ '% K2,2K.'3'$ 5')",5+, 7+.2M'",)
62/ 7+ 3'6'(+5 '* (.+ '%5'M'5N23 ') '% 2% '%)8(N8"%23 )+T%: ", "(.+,
$"%(,"33+5 +%M',"%6+%(S
PARAPHILIC DISORDERS
CrlLerla oLherwlse unchangedS
Lxample: ;26&7($1)- <$12(/&(
A. lor > 6 mo, recurrenL, lnLense sexual arousal from observlng an
unsuspecung person who ls naked, dlsroblng, or engaglng ln sexual
acuvlLy, as manlfesLed by fanLasles, urges or behavlors.
8. 1he lndlvldual has acLed on Lhese sexual urges wlLh a
nonconsenung person, or Lhe urges or fanLasles cause cllnlcally
slgnlcanL dlsLress or lmpalrmenL ln soclal, occupauonal, or oLher
lmporLanL areas of funcuonlng.
C. 1he lndlvldual ls aL leasL 18 yo
;K+$'*/ lf: ln a conLrolled envlronmenL
ln full remlsslon (has noL meL crlLerla ln 8 for > D years ln
unconLrolled envlronmenL)
PARAPHILIC DISORDERS
CLher Specled MenLal ulsorder uue Lo AnoLher Medlcal
Condluon (lCu 9 code 294.8)
used when a medlcal condluon causes emouonal/behavloral
sympLoms and dlsLress/lmpalrmenL whlch fall shorL of
meeung requlremenL for a speclc menLal dlsorder
8ecorded by namlng Lhe specled menLal dlsorder followed
by Lhe causauve medlcal condluon.
Coded ln reverse order: medlcal condluon 1
sL
, followed by
294.8
OTHER MENTAL DISORDERS
CLher Specled MenLal ulsorder uue Lo AnoLher Medlcal
Condluon (lCu 9 code 294.8)
LJ26K3+> dlssoclauve sympLoms ln pL wlLh complex parual
selzures descrlbed as:
UR(.+, ;K+$'A+5 ?+%(23 4')",5+, 5N+ (" V"6K3+J 12,823
;+'WN,+)< 5'))"$'28M+ )/6K("6)X EYZDSZG< F[ZS\IX
V3'%'$'2% 5"$N6+%() (.+ +3+6+%(E)I 6'))'%: *", *N33 5'2:%")') "*
4'))"$'28M+ 4')",5+,S
OTHER MENTAL DISORDERS
CLher unspecled MenLal ulsorder uue Lo AnoLher Medlcal
Condluon (lCu 9 code 294.9)
used when a medlcal condluon causes emouonal/behavloral
sympLoms and dlsLress/lmpalrmenL whlch fall shorL of meeung
requlremenL for a speclc menLal dlsorder, and Lhe cllnlclan does
noL Lo ldenufy Lhe crlLerla mlsslng for a specled dlsorder.
May be approprlaLe when noL enough lnformauon ls avallable.
LJ26K3+: Cllnlcally slgnlcanL buL poorly dened anxleLy, depresslon
and aglLauon ln a pauenL wlLh AcuLe 1hyroldlus mlghL be dlagnosed as
U]%)K+$'A+5 ?+%(23 4')",5+, 4N+ (" B$N(+ ^./,"'5'8)X EFZDSG< F[ZS[I
OTHER MENTAL DISORDERS
CLher Specled MenLal ulsorder (lCu 9 code 300.9)
Lmouonal/behavloral sympLoms and dlsLress/lmpalrmenL presenL
SympLoms fall shorL of meeung requlremenL for any speclc menLal
dlsorder
Cllnlclan communlcaLes Lhe speclc reason LhaL Lhe presenLauon
does noL meeL crlLerla for any speclc menLal dlsorder.
unspecled MenLal ulsorder (lCu 9 code 300.9)
Lmouonal/behavloral sympLoms and dlsLress/lmpalrmenL presenL
SympLoms fall shorL of meeung requlremenL for any speclc menLal
dlsorder
Cllnlclan chooses noL Lo communlcaLe Lhe speclc reason LhaL Lhe
presenLauon does noL meeL crlLerla for any speclc menLal dlsorder.
(lncludes slLuauons where noL enough lnfo ls avallable)
OTHER MENTAL DISORDERS
noL menLal dlsorders, buL lncluded because of frequenL
lmporLance ln -
1he managemenL of medlcauons
ulerenual ux (e.g., anxleLy vs med-lnduced akasLhlsla)
Condluons/language from uSM 3 expanded
1. Medlcauon-lnduced arklnsonlsm
2. neurolepuc MallgnanL Syndrome
3. Medlcauon-lnduced AcuLe uysLonla
4. Medlcauon-lnduced AcuLe AkasLhlsla
MEDICATION INDUCED
MOVEMENT DISORDERS AND
OTHER ADVERSE EFFECTS OF
MEDICATION
3. 1ardlve uysklnesla
6. 1ardlve uysLonla and 1ardlve AkasLhlsla
(slmllar Lo Lardlve dysklnesla)
3. Medlcauon-lnduced osLural 1remor
6. CLher Medlcauon-lnduced MovemenL ulsorder
7. AnudepressanL ulsconunuauon Syndrome
MEDICATION INDUCED
MOVEMENT DISORDERS AND
OTHER ADVERSE EFFECTS OF
MEDICATION
lncluded sychologlcal lacLors
Aecung Medlcal Condluon
lncluded Medlcauon-lnduced
ulsorders
1hree addluonal secuons
ldenufy 23 condluons
lAMC pulled from Lhls secuon
and puL ln Somauc SympLom and
8elaLed ulsorders
Medlcauon-lnduced MovemenL
ulsorders and CLher Adverse
LecLs of Medlcauon ln a separaLe
chapLer
nlne addluon secuons ldenufy
133 condluons
<=> ? ;9 @A <=> B
OTHER CONDITIONS THAT MAY
BE A FOCUS OF CLINICAL
ATTENTION
1. 8elauonal roblems (3)
2. Abuse and neglecL (3)
3. Addluonal Condluons (13)
1. 8elauonal roblems (8)
2. Abuse and neglecL (78)
SeparaLely ldenues:
lnlual encounLer
SubsequenL encounLer
SuspecLed abuse
LncounLer for vlcum
LncounLer for perpeLraLor
Conrmed, suspecLed cases
<=> ? ;9 @A <=> B
OTHER CONDITIONS THAT MAY
BE A FOCUS OF CLINICAL
ATTENTION
Addluonal Condluons
a. noncompllance
b. Mallngerlng
c. Anusoclal 8ehavlor
d. 8orderllne lnLellecLual lx
e. Age-8elaLed Cognluve uecllne
f. 8ereavemenL
g. Academlc, Cccupauonal rob
h. ldenuLy roblem
l. 8ellglous/SplrlLual rob
[. AcculLurauon roblem
k. hase of Llfe roblem
3. Lducauonal/Cccupauonal roblems
(3)
4. Pouslng and Lconomlc roblems (9)
3. roblems 8elaLed Lo Soclal
LnvlronmenL (3)
6. robs 8elaLed Lo Crlme/lnLer-acuon
wlLh Legal SysLem (3)
7. PealLh Care Advlce/Counsellng (2)
8. sychosoclal, ersonal,
LnvlronmenLal Clrcs. (8)
9. CLher Clrcs of ersonal
ClrcumsLances (14)
<=> ? ;9 @A <=> B
OTHER CONDITIONS THAT MAY
BE A FOCUS OF CLINICAL
ATTENTION
V-Codes
More lnfo avallable aL:
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dsm3.org
lrom !une 7-8 uSM 3 Conference ln La !olla:
dsm3evenL.com
presenLauons under conference maLerlals"
password: dsm3sdps