20 Apr Is it a Mood or Personality Disorder: A Challenge for Mental Health Providers
Mental health professionals are frequently challenged to make clinical differential diagnoses between personality and mood disorders. As the clinical presentation of these disorders share significant features and frequently co-occurs, it can be arduous to disentangle the cause of the individual’s psychopathological symptoms. While mood and personality disorders are mental health conditions, many etiological differences exist.
Mood disorders impact the patterns in emotions, while personality disorders impact how people relate to others. Mood disorders can have a disruptive effect on interpersonal relationships. Conversely, personality disorders can impact a person’s mood. Individuals with personality disorders are identified as suffering from a distorted perception of reality and abnormal affective responses to their environment. As a result, they manifest maladaptive means of coping with distress, often resulting in worsening emotional distress. How do psychologists diagnose these disorders when both can lead to disruptions in mood and interpersonal interactions?
The theoretical difference between the two types of disorders is typically challenging to uncover. Mental health professionals seek to differentiate the patterns within the individual’s symptomatology. Individuals with an enduring and challenging pattern of behavior within interpersonal relationships that do not improve with treatment can signify the presence of a personality disorder. Contrariwise, individuals with mood disorder symptoms will see an improvement in any disruption to their interpersonal relationships once treatment ameliorates the mood disruptions they were experiencing.
The etiology of personality disorders emerges during childhood when personality features develop. However, limited empirical research exists on the epidemiology of such disorders resulting in multiple theories, including genetics, disturbance in attachment formations, childhood trauma, chaotic familial life as a child, and cultural influences. A study in the Neuroscience Bulletin in 2016 investigated genetic and neuroimaging studies on personality disorders to explore how they can contribute to the etiopathology, diagnosis, and treatment of many mental disorders. The researchers concluded that personality disorders often overlap in some regions and share abnormal brain structures and functions. It is also emphasized in this report that additional research should focus on a comprehensive investigation into the diagnostic system for personality disorders and a focus on youth to investigate etiopathology across the lifespan to promote prevention and early intervention strategies.
In 2017, research in BMC Psychiatry identified that the prevalence of personality disorders is as high as 4 to 15%. The researchers identified that an elevated severity level of personality disturbance is associated with increased psychiatric morbidity and social dysfunction. The research supports the need for an enhanced understanding of the role of personality disorder features on mood to direct treatment interventions and support positive outcomes.
Differentiating between symptoms of a mood disorder and a personality disorder is critical in supporting the patient’s outcomes in treatment. Yet, limited empirically tested screenings or diagnostic tools exist. To further complicate accurate diagnosis, personality disorders are frequently comorbid with other disorders, such as mood and substance use disorders. In the 2007 Journal of Personality Disorders, researchers highlighted the nature of current screening tools for personality disorders relying heavily on self-reports. While somewhat effective in predicting the presence of symptoms consistent with a personality disorder, performance was best when predicting a more severe presentation of personality-disordered features. The Minnesota Multiphasic Personality Inventory (MMPI) is the best-known psychological test with reliability and validity in identifying some personality disorders, as identified in a 2018 Journal of Psychiatric Nursing study.
Ideally, clinicians should integrate the use of psychometric self-report scales as well as structured, semi-structured, and open-ended interviews to accurately distinguish between a mood disorder and symptoms of a personality disorder.