Unlike patients with depression or anxiety, people with personality disorders do not present to a primary care physician seeking relief from their personality difficulties. They may have little or no insight into their personality issues. The comorbidity of more than one personality disorder is common. The approach to diagnosis is focused on broad symptom categories. These may be observable in physician-patient encounters or present in the patient's history, whether obtained from the patient him/herself or from collateral sources of information.
While there is ongoing and unresolved debate in the fields of psychiatry and psychology regarding the validity of categorical versus dimensional models of personality, the approach taken in this monograph is consistent with the categorical model. The diagnostic and statistical manual of mental disorders, fifth edition (DSM-5) may, in future versions, include a hybrid model of assessment, including evaluation of adaptive functioning.
The continuity between DSM-IV-TR axis I (major mental) and axis II (personality) disorders has been another area of active investigation. Some personality disorders have many features in common with axis I disorders (e.g., avoidant personality disorder and social phobia, generalised type), while others may share a common genetic substrate with axis I disorders (e.g., schizotypal personality disorder and schizophrenia). The DSM-5 has moved away from the multi-axial system to a new assessment that removes these arbitrary boundaries between personality disorders and other mental disorders.
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