Personality disorders in the workplace.

Editorial Personality disorders in the workplace Personality disorders are probably the most common form of mental disorder. The reason for 'probably' is that the classification of personality disorder has been defective for many years and, as one of the consequences of this, it has been relatively under-diagnosed. Currently, the two official classification systems in psychiatry (the Diagnostic and Statistical Manual of Mental Disorders in the USA, and the International Classification of Diseases (the official world classification led by the World Health Organisation) describe personality disorders in two stages; a general definition , followed by categorization into 10 further categories: antisocial (dissocial), borderline (emotionally unstable), impulsive, obsessive-compulsive (anankastic), histrionic, narcissistic, schizoid, schizotypal and anxious (avoidant) personality disorders, with a very common additional category, personality disorder—not otherwise specified (PD-NOS). This is unsatisfactory for many reasons, including a very great overlap between the different disorders, the tendency for clinicians to ignore general definition and go straight into categorical diagnosis and the absence of any levels of severity of each disorder. The current definitions of personality disorder are also pejorative, as they refer to the persistence and pervasiveness of disorder from the time of late adolescence until middle or late life, and this has been shown to be clearly wrong [1]. There has also been a tendency for many psychiatrists to regard personality disorders as untreatable and so when patients demonstrate the features of the disorder, they are commonly rejected from treatment. Research studies consistently find that people with personality disorder are diagnosed in clinical practice much less frequently than formal research assessments suggest and the main reason for this appears to be the stigma attached to the diagnosis [2]. There will be a new classification of personality disorder in the next edition of the International Classification of Diseases, which will be published in 2015. This is a much simpler classification in which personality dysfunction is assessed on a single dimension—no personality dys-function, personality difficulty, mild personality disorder, moderate personality disorder and severe personality disorder [3]. At each level of diagnosis, there are a series of domain traits that describe the main features manifest by the disorder. These can be summarized as the 5 Ds—dis-social, detached, doggedness (obsessional), dependent and disinhibited domains. This editorial is written with this new classification in mind. The overall prevalence of personality disorder is in the order of 10% in the community, but if you also include personality difficulty …