artorious22

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Jul 26, 2016
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When do you guys differentiate between labeling someone with a personality disorder vs personality traits? I thought the general rule was you needed to know the person for at least 2 weeks, I can't find any clear cut rules on this.

Is it personality disorder when it interferes with their daily activities and functioning? or is it personality traits if it doesn't?

Thanks for any clarification.
 

splik

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Nov 30, 2009
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everyone has personality traits (and almost everyone has traits of personality disorder), but yes you often see this b.s. "personality traits" in people's charts. Absolutely avoid it if they do not meet criteria for personality disorder. You don't need to know a person for any length of time to diagnose personality disorder. I might see someone once and diagnose psychopathy, borderline personality disorder etc. a personality disorder diagnosis should ideally be based on a history including detailed premorbid personality history, and social and developmental history. Collateral information, and review of the medical chart and any other records is helpful. You should not base a diagnosis of personality disorder on a mental status examination alone as many mental disorders (depression, bipolar disorder, dementia, alcoholism, pathological gambling, autism, psychosis) may mimic personality disorder.

Personality disorder diagnosis rely on stability over time and range of events. Unfortunate, the stability, and reliability of personality disorder diagnoses is quite poor. People can meet criteria at one point in time, and not another. People can appear personality disorder in response to one crisis but not a similar one at a different point. That is why personality disorder experts suggest moving away from the personality disorder concept to a concept of impaired personality functioning. This accounts for the fact that someone might have very significant impairment in interpersonal, affect regulation, impulse control and so on at a particular point in time, without there being a better descriptor but does not represent a life long condition. Also cluster B personality disorders tend to get better with age. In contrast, cluster C personality disorders tend to become much worse with age.

The only exception to using the term "personality traits" is when you are diagnosing general personality disorder. If the patient meets criteria for general personality disorder and has say 4 criteria for borderline personality disorder, than a diagnosis of personality disorder with borderline personality traits can be made. Similarly, if a patient meets full criteria for one or more personality disorders, and has significant number of relevant criteria from another diagnosis but does not meet threshold then a diagnosis of say borderline personality disorder with narcissistic traits could be made. I would only do this if you can justify the relevance of the additional personality traits to the disorder. Particularly on the east coast it is most common for people to talk about borderline personality organization rather than "borderline personality traits". One proposal for new personality disorder criteria is to get rid of all the different personality disorder diagnoses (which are famously unreliable and lack validity) and replace it with simply "personality disorder" and depending on how many criteria they have (which corresponds with impairment and risk - for example those with 8 or more criteria with BPD will more likely than not commit suicide) stratify as "mild", "moderate" or "Severe". but clinicians love these diagnoses and believe they have utility despite not being scientific so there is no taste to get rid of them. Even the proposal to reduce the number of personality disorders in DSM-5 from 10 to 6 was ceremoniously rejected.
 

birchswing

Non-medical provider
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Nov 17, 2011
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When do you guys differentiate between labeling someone with a personality disorder vs personality traits? I thought the general rule was you needed to know the person for at least 2 weeks, I can't find any clear cut rules on this.

Is it personality disorder when it interferes with their daily activities and functioning? or is it personality traits if it doesn't?

Thanks for any clarification.
What would it mean to know a patient for two weeks? As in see them daily for 2 weeks? I'm not asking to be glib, just curious under what contexts that might happen. I think being seen every two weeks is the shortest interval I've ever had with a psychiatrist.
 

Salpingo

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Dec 6, 2008
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When do you guys differentiate between labeling someone with a personality disorder vs personality traits? I thought the general rule was you needed to know the person for at least 2 weeks, I can't find any clear cut rules on this.

Is it personality disorder when it interferes with their daily activities and functioning? or is it personality traits if it doesn't?

Thanks for any clarification.
I think people use traits to refer to defense/coping style. Everyone is capable of regressing and using primitive defenses when under significant enough stress (severe medical illness/diagnosis, profound grief, trauma, etc.) So if you're seeing someone for the first time in the ED, don't have a great history to go on, and they're acting like a borderline, sociopath, schizotypal person, you can identify the traits and hope for clarification later (which generally does not happen).

The problem and disorder diagnosis occurs when the person acts that away even without that specific stress. Alternatively, they always seem to be experiencing some form of stress -- if you're an analyst you may argue that the person is creating or contributing that distress through enactment (that is, driven to engage in repetitive pattern of behavior by some unconscious desire), while a dialectic behaviorist may argue that the person is simply more sensitive to emotional stimuli (the way someone with a sunburn is more sensitive to touch).

The two week rule may be specific to your training culture. There's nothing magic about that number unless you're assessing for a mood disorder like major depression, or its the average length of stay from presenting to the ED to discharge from the inpatient unit (in which time, collateral and further history can be gathered).
 
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