Differentials
Mood disorders
SIGNS / SYMPTOMS
Symptoms develop over much shorter periods of time and represent a change in functioning; include somatic symptoms, such as insomnia, weight loss, or psychomotor agitation.[1] In patients with a personality disorder, moods are usually reactive, in reaction to interpersonal events or internal experiences.
Consider personality disorder as a comorbid condition.
INVESTIGATIONS
Clinical interview.
Use of DSM-5-TR criteria.[1]
The Primary Care Evaluation of Mental Disorders (PRIME-MD) may indicate presence of symptoms suggestive of mood disorders.[62]
Mood Disorder Questionnaire may indicate presence of symptoms indicative of elevated mood states (hypomania and mania).[66]
Patient Health Questionnaire-9 (PHQ-9) may indicate presence of self-harm, suicidal ideation.[63] Patient Health Questionnaire PHQ-9 Opens in new window
Psychotic disorders
SIGNS / SYMPTOMS
Absence of persistent delusions and hallucinations in personality disorder.[1] However, patients with borderline personality disorder may experience transient paranoid ideation in response to stress; patients with schizotypal personality disorder may experience ideas of reference (but not delusions), as well as odd beliefs or magical thinking.[1]
Consider personality disorder as a comorbid condition.
Anxiety disorders
SIGNS / SYMPTOMS
Social anxiety disorder can be difficult to differentiate from avoidant personality disorder as many of the symptoms overlap, and there is controversy about whether the two disorders are in fact distinct. However, avoidant personality disorder appears to involve more generalised impairment in multiple spheres of functioning.
Avoidance behaviour in agoraphobia is circumscribed and in relation to occurrence of panic attacks (compared with avoidant personality disorder in which avoidance behaviour is evident in a variety of settings involving interpersonal contact).
Presence of obsessions and compulsions in obsessive-compulsive disorder (compared with obsessive-compulsive personality disorder where perfectionistic traits are apparent).
Consider personality disorder as a comorbid condition.
Substance-use disorders
SIGNS / SYMPTOMS
For antisocial personality disorder diagnosis to be given in addition to a substance-related diagnosis, antisocial personality disorder symptoms must have been present in childhood (typically prior to the establishment of the substance-related disorder) and continued into adulthood.[1]
Consider personality disorder as a comorbid condition.
Personality change due to general medical condition
SIGNS / SYMPTOMS
Personality symptoms represent a change from baseline level of functioning and are due to a direct physiological cause (e.g., head trauma, endocrine condition, or other conditions involving the central nervous system).[1]
INVESTIGATIONS
Physical or neurological examination may reveal features suggestive of a specific medical condition.
Clinical interview with patient and, if possible, collateral source.
Use of DSM-5-TR criteria.[1]
Imaging (CT/MRI of brain), neuropsychological testing, or laboratory tests (e.g., thyroid function tests) may have suggestive findings.
Sub-threshold personality traits
SIGNS / SYMPTOMS
Traits that are not considered rigid, maladaptive, stable, and linked to impairment.
INVESTIGATIONS
Clinical interview
Use of DSM-5-TR criteria to rule out personality disorder diagnosis.[1]
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