In Chapters 2, 3, and 4, we examined the 10 standard personality disorders in the DSM-IV-TR. In this chapter, we discuss several other patterns of personality disorder pathology that were described in previous versions of the DSM. As in the earlier chapters, we provide a clinical description, discuss possible problems with the diagnostic criteria for older people, and describe how the disorders might be manifested in later life. It would be a mistake to conclude that these disorders are not as important or relevant simply because they are not part of the official classification system. In fact, most of the disorders we describe in this chapter have a long and rich clinical tradition, and patients with these patterns do present for help in clinical practice. The debates about official classification usually center around whether these other personality disorders are discrete diagnostic entities (not variations of the standard personality disorders) and disagreements about how to define and opera-tionalize the criteria for these personality disorders.
Whereas the DSM-III contained elaborate appendixes, none were devoted to additional or speculative personality disorders. In 1987, the publication of DSM-III-R began a new tradition—the use of the appendixes to introduce new or speculative syndromes and personality disorders for study and perhaps validation. DSM-III-R's Appendix A: Proposed Diagnostic Categories Needing Further Study included two (the Sadistic Personality Disorder and Self-Defeating Personality Disorder). DSM-IV and DSM-IV-TR continued this tradition in Appendix B: Criteria Sets and Axes Provided for Further Study in which two personality disorders were added (one new [Depressive Personality Disorder] and one [Passive-Aggressive Personality Disorder] that was previously listed on Axis II in DSM-III-R). In the current manual, both Sadistic Personality Disorder and Self-Defeating Personality Disorder were dropped from the appendix. The diagnostic criteria for the four personality disorders discussed in this chapter are provided separately in the following sections.
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