personality disorders with DSM-5,

 personality disorders with DSM-5,

In the diagnosis of personality disorders with DSM-5, the conceptualization of personality disorder entails self-functioning described in two constructs, i.e., identity and self-direction. Identity involves the perception of self as unique and with clear boundaries between the individual and others. Self-destruction entails the ability of an individual to pursue their life goals and productive self-reflection. In interpersonal functioning, i.e., intimacy and empathy incorporate the comprehension of other individuals’ perspectives and the ability to form social relations. According to DSM-5, a schizotypal personality disorder is characterized by persistent deficits by an individual that is marked by severe discomfort with maintaining close relationships. Also, an individual present with cognitive distortions and the social deficit patterns commence at early adulthood that manifests in myriad contexts. Individuals with the schizotypal disorder feel uncomfortable due to a lack of relationships, although they show little interest in intimacy (Bach et al., 2016). DSM-5 presents the diagnostic criteria for diagnosing schizotypal personality in DSM-5 301.22 (F21). In the diagnostic criteria, patterns of social deficits that occur due to mental distortions in relationships should be accompanied by not less than five other factors. The factors include ideas of reference excluding delusions of reference, odd perceptions, strange thinking that is vague and metaphorical. Also, individuals with SPD are excessively paranoid and suspicious. There should be symptoms of inappropriate feelings and odd appearance. The patient experiences severe social anxiety, and they may seem uncomfortable when dealing with familiar people and places. Also, other symptoms in the manual include lack of association except with their close relatives, and anxieties tend to relate to the paranoid fears.  Thus, the diagnosis of Alex bases on personality disorders with DSM-5,the existence of Schizotypal personality traits exists in at least a single of the five broad domains.

Alex presents with a 301.22 schizotypal personality disorder according to DSM-5 301.22 (F21), which is continuous and unspecified. The reason for the diagnosis is because Alex presents with symptoms of pervasion pattern of interpersonal deficits. The pervasive pattern is manifested by the inability to care for his needs, which are done by his parents. Similarly, reduced capacity to complete his assignments is reported. The ability to close relationships also has reduced for Alex since, in his conversation, he reveals that he has been spending less time with her romantic partner. Besides, there is evidence of cognitive, perception distortions, and eccentric behaviors (Bach et al., 2016). The above features notable in Alex, together with five additional symptoms, confirm the diagnosis of schizotypal personality disorder. Similarly, ideas of preference, that is, the feeling that someone is constantly watching him, could be indicative of schizotypal personality disorder. Likewise, Alex reports odd believes that influences his behavior, unusual perceptions and absence of close confidants except for the first degree relatives.

In my viewpoint, Alex’s schizotypal symptoms may have progressed to Schizophrenia personality disorder. It is because of the delusions and hallucinations notable and the later manifestation of vegetative symptoms such as reduced appetite and intricate sleep patterns. According to Bach et al (2016), sleep disturbance remains a significant problem for patients with schizophrenia. Alex reports symptoms of insomnia and also poor appetite. Alex also says experiences of low energy and disordered thinking whereby his thoughts at times stop midstream. Therefore, according to DSM-5, schizophrenia, and other psychotic conditions, falls in code 87. As for Alex, the diagnosis of 295.90 (F20.9) schizophrenia personality disorder indicates, the first episode currently in acute form. According to DSM-5, the primary symptoms for schizophrenia includes delusions, disorganized speech, negative symptoms, hallucinations, mania symptoms, motor behavior, and depression. The symptoms mentioned earlier fall under diagnostic criteria A for schizophrenia.

Hallucination, delusions, and disorganized speech are the key symptoms that must be identified. Besides, there ought to be a significant period following the onset of the disturbances, level of functioning in areas such as work, school, or interpersonal relations. Besides, the level of disturbance should last for six months and above. In the six months, at least one symptom of schizophrenia in the DSM-5 manual should experience that meet the active phase A symptom (Zandersen & Parnas, 2019). The symptoms may be inclusive of either prodromal or residual symptoms within the period. The prodromal symptoms often manifest with a set of specific negative symptoms. Also, with schizophrenia class, Symptoms may present in attenuated forms, for instance, unusual perception experiences and odd beliefs.

Alex presents with delusions symptoms, which is evidenced by the disclosure he makes that he possesses the ability to control other people’s behaviors. Similarly, he explains that he can read other people’s minds. Notably, hallucinations manifest with the notion of a perceived feeling of being threatened by multiple voices in his surroundings. The two symptoms certify the type A schizophrenia symptom in the DSM-5. The additional symptoms include reduced energy, reduced motivations, and loss of interest in previously pleasurable activities.   Therefore, an individual ought to have two or more of the identified symptoms within one month or less successfully treated to diagnose schizophrenia.

Differential Diagnosis

Diagnosis of schizotypal disorder personality disorder remains a challenge owing to the significant thought disorders such as schizophrenia, depressive, and delusional disorders. To rule out schizophrenia and other thought disorders necessitates an assessment of the severity of symptoms. Delusions and hallucinations also accompany them. As for Alex, we ought to rule out symptoms of schizoaffective disorders, depressive, and bipolar disorders that manifest concurrently with psychotic features. Often, there are no reported cases of major depressive disorder, as well as maniac symptoms that occur with the active phase symptoms of schizophrenia. In instances where mood episodes occur during the active phase of symptoms, it implies the manifestation for a minority period or in the residual periods of the illness. DSM-5 manual illustrates that the symptoms for schizophrenia are often not associated with physiological effects due to drug abuse or different medical conditions (Zandersen & Parnas, 2018). In case of the existence of a comprehensive history of communication, or autism spectrum disorders, the diagnosis for schizophrenia depends on the judgment of prominence in symptoms of delusions and hallucinations.

References

Bach, B., Sellbom, M., Bo, S., & Simonsen, E. (2016). The utility of DSM-5 section III personality traits in differentiating borderline personality disorder from comparison groups. European Psychiatry, 37, 22-27.

Zandersen, M., & Parnas, J. (2019). Exploring schizophrenia-spectrum psychopathology in borderline personality disorder. European archives of psychiatry and clinical neuroscience, 1-10.