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Letter to British Journal of Psychiatry (1)

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The letter discusses the complexity of diagnosing personality disorders, emphasizing that existing definitions lack precision due to the distinctiveness of individuals with these disorders. It argues for categorizing certain personality disorders as overlapping with the neurodevelopmental disorder spectrum, particularly in light of shared behavioral traits with autism spectrum disorders (ASD). The author suggests that a clearer separation of these neurodevelopmental elements within personality disorders could lead to improvements in understanding and treatment.

Prof. Michael Fitzgerald M.D.FRC Psych, M. Inst. Psychoanal D. 15. GP., Ground Floor Unit 3 Main Street Blanchardstown Dublin 15 12th February 2020 Professor Kirakos Xenitidis & Professor Colin Campbell, Correspondence Editors, British Journal of Psychiatry, Dear Editors, Peter Tyrer Tyrer P. Why we need to take personality disorder out of the doghouse. Brit. J. Psych 220; 216: 65-66. is correct to point out that, “we must take personality disorder out of the doghouse”, but this assumes we have an accurate valid definition of what this is. While all diagnoses in psychiatry have validity problems - personality disorders are even more challenging. Every person with a personality disorder is unique because of a number of reasons, one of which is the many genetic factors of minor effect involved. Nevertheless, we have to try and establish what they have in common. Of course, they are on a spectrum but most diagnoses in psychiatry are on a spectrum or dimension and personality disorder spectrum overlaps to a greater or lesser extent with other disorders which leaves us with mild, moderate or severe psychopathology, which is very non-specific in diagnostic terms but nevertheless, true. Subtyping of personality disorder is very difficult, if not impossible, because most of the subtypes overlap and are not specific. Nevertheless, we have to try to separate out subtypes of personality disorder spectrum. Part of these personality disorder spectrums belong to the neurodevelopmental disorder spectrum, e.g., schizoid Wolf S. Diagnostic precision or confusion of terms: The example of schizoid disorders of childhood. Brit. J. of Clinical and Social Psychiatry. 1990; 7: 59-65., overlapping with higher functioning autism. Schizotypal needs to be taken out and attached to schizophrenia spectrum. Indeed, there’s a case for putting further personality disorders on the neurodevelopmental spectrum. Tyrer states, “they all have great difficulty in understanding how others feel and act”, or are, “eccentrics”. This is classical neurodevelopmental autism spectrum. Indeed, Asperger Asperger H. Das Psychisch Abnormale Kind. Wiener Klinische Wochenschrift 1938; 51: 1314-1317. (1938) first described autism as autistic psychopathy – a personality disorder. He was partially correct. There is overlap between personality disorder and ASD Fitzgerald M. Young, violent and dangerous to know. Nova Science, 2013. , Fitzgerald M. Psychopathy. Nova Science, 2015. in terms of fearful and anxious behaviour; avoidance behaviour; being a loner; being compulsive; being narcissistic; showing emotional indifference; anger; suspicion; have unusual beliefs and preoccupations; having identity diffusion; having empathy problems; not conforming; problems with emotional processing; poor self-awareness; egocentricity; rigidity; frontal lobe and amygdala problems and cortical tinning of temporal cortex in psychopathy and ASD. The line of research suggested here is separating out the neurodevelopmental portion of personality disorders from the rest. Then the, “doghouse”, might be closed. Yours sincerely, Professor Michael Fitzgerald, IMC 00004541 Department of Psychiatry, Trinity College Dublin (TCD) Dublin 2, Ireland Tel:+ 353 1 8211796 Mobile: + 353 86 8597547 Fax: + 353 1 8205924 E-mail: [email protected] Click on these links below or visit my website to avail of free literature and resources www.professormichaelfitzgerald.eu 10 free e-books about Psychiatry Pressure Points on Irish Families Recent advances in Autism Spectrum Disorders Volume I. Recent Advances in Autism Spectrum Disorders Volume II