How to Think about Personality DIsorders

By John M Oldham MD

I was recently contacted by the organizers of a new online educational program called the Certificate of Advanced Studies in Brain Health. The program is jointly sponsored by the University of Bern, Switzerland, and the European Academy of Neurology. I provided a lecture entitled “Borderline Personality Disorder (BPD) & other personality disorders,” as one of 24 topics in the Brain Disorders module. In my presentation, I discussed NPSP25, illustrating the continuum between normal personality traits and their extremes, the personality disorders. Then I described how we’re conceptualizing revisions in the classification of personality disorders in the US for a future edition of the diagnostic manual.

We are proposing a more dimensional system, consolidating all PDs under one heading, Personality Disorder. The disorder is defined by impairment in functioning in a sense of self and in interpersonal relationships, along with the presence of pathological personality traits. Then there would be the option to indicate, for a given individual, if a familiar pattern of behavior applies, such as borderline, narcissistic, etc. This proposal has been approved by the Steering Committee for potential future changes of the diagnostic manual of the American Psychiatric Association and is now under study. If adopted, it aligns with the newest revision (the 11^th) of the International Classification of Diseases.

It’s interesting that there’s a growing consensus about how we think about personality impairment, across the globe. The “bones” of NPSP25, reflect that familiar patterns of normal behavior called personality traits or styles characterize human behavior. And that, when extreme, these patterns can lead to impairment in functioning. These principles align well with the latest international thinking about personality disorders.