Appendix A

DSM-IV-TR Classifications

The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR), was published by the American Psychiatric Association in 2000. This work attempts to evaluate psychiatric illnesses along five axes.

Axis I lists most psychiatric disorders, except personality disorders and mental retardation.

Axis II lists personality disorders and degrees of mental retardation.

Axis III consists of any accompanying general medical conditions.

Axis IV denotes psychosocial and environmental problems that may complicate the diagnosis and treatment.

Axis V reports the clinician’s assessment of the patient’s overall level of functioning on the Global Assessment of Functioning (GAF) Scale, which evaluates the range of functioning from 0 to 100.

Axis I Diagnoses

(Partial listing with some examples)

Disorders Usually First Diagnosed in Infancy, Childhood, or Adolescence

Learning Disorder

Attention Deficit/Hyperactivity Disorder

Autism

Tourette’s

Delirium, Dementia, and Amnesic and Other Cognitive Disorders

Substance Intoxication Delirium

Alzheimer’s

Dementia Due to Head Trauma

Substance-Related Disorders

Hallucinogen Intoxication

Schizophrenia and Other Psychotic Disorders

Schizophrenia

Mood Disorders

Major Depressive Disorder

Dysthymic Disorder

Bipolar I Disorder

Bipolar II Disorder

Anxiety Disorders

Panic Disorder

Phobia

Post-Traumatic Stress Disorder

Social Anxiety Disorder

Obsessive-Compulsive Disorder

Generalized Anxiety Disorder

Somatoform Disorders

Somatization Disorder

Hypochondriasis

Conversion Disorder

Body Dysmorphic Disorder

Factitious Disorders

Dissociative Disorders

Dissociative Identity Disorder (Multiple Personality)

Dissociative Amnesia

Dissociative Fugue

Sexual and Gender Identity Disorders

Premature Ejaculation

Sleep Disorders

Sleepwalking Disorder

Impulse-Control Disorders

Intermittent Explosive Disorder

Kleptomania

Pathological Gambling

Trichotillomania (hair or eyebrow pulling)

Adjustment Disorders

With Depressed Mood

With Anxiety

Axis II Diagnoses of Personality Disorders

(Complete listing)

Cluster A (Odd, Eccentric)

Paranoid Personality Disorder

Schizoid Personality Disorder

Schizotypal Personality Disorder

Cluster B (Dramatic, Emotional)

Antisocial Personality Disorder

Borderline Personality Disorder

Histrionic Personality Disorder

Narcissistic Personality Disorder

Cluster C (Anxious, Fearful)

Avoidant Personality Disorder

Dependent Personality Disorder

Obsessive-Compulsive Personality Disorder

Future Diagnostic Definitions

Our current nomenclature defining BPD relies on fulfilling a threshold of descriptive symptoms listed in the APA’s DSM-IV-TR: An individual has BPD if he exhibits at least five of the nine criteria (see chapter 2). Thus, the person who reflects, say, five symptoms and is then able to eliminate just one is immediately relieved of the diagnosis.

This categorical paradigm, however, does not reflect the traditional perception of personality, which is that personality is not altered so abruptly. Thus, it is highly likely that future DSM definitions of BPD will integrate dimensional features. In this paradigm the degree of functioning or disability may be considered. More specifically, the doctor will be able to factor into an evaluation the degree of specific characteristics (such as impulsiveness, emotional lability, reward dependence, harm avoidance, etc.)—not just the presence of these symptoms—to diagnose (or not diagnose) BPD. The intent of such DSM changes is that these adaptations will more accurately measure changes and degrees of improvement, rather than merely determine the presence or absence of the disorder.