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FranzOren
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25 Dec 2021, 5:15 pm

Why is the age 18 the minimum age to be diagnosed with personality disorders?

The problem is that young adults are still adolescents until mid 20s. The frontal lobe does not finish developing until age 25. The personalities in young adults still changes in very similar ways as in teenagers, It means that personalities does not become stable, because the frontal lobe is not developed until age 25, as I explained before.

It would be better to diagnose personality disorders at the age of 26, when the personalities are completely stable.


https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3621648/



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26 Dec 2021, 6:29 am

To get disability help when youngsters are still growing, diagnosis is needed. By saying diagnosis should not happen until age 25 does not admit to struggles before that. Diagnoses are revised frequently as a child grows up, but there is a real need to define struggles long before we reach the age of 25. Diagnoses are not inflexible, and can and do change frequently.


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14 Mar 2022, 12:16 pm

Actually, many PDs should probably be diagnosed much younger, not older.

Borderline PD is detectable by early adolescence and relatively stable from adolescence until adulthood, so it'd actually make more sense to put the minimum age for diagnosis around 10 or so.

Antisocial PD is even more distinct, and can be detected as young as 3 or 4 years old. In children it's often renamed "callous-unemotional" personality, but it's basically the same thing, and relatively stable from preschool to adulthood.

However, since both of those conditions carry a lot of stigma, there's concerns about whether it'd actually be beneficial for a child to be diagnosed with either condition, even if the diagnosis is accurate.



FranzOren
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14 Mar 2022, 2:52 pm

It makes sense.



funeralxempire
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14 Mar 2022, 3:14 pm

Ettina wrote:
Actually, many PDs should probably be diagnosed much younger, not older.

Borderline PD is detectable by early adolescence and relatively stable from adolescence until adulthood, so it'd actually make more sense to put the minimum age for diagnosis around 10 or so.

Antisocial PD is even more distinct, and can be detected as young as 3 or 4 years old. In children it's often renamed "callous-unemotional" personality, but it's basically the same thing, and relatively stable from preschool to adulthood.

However, since both of those conditions carry a lot of stigma, there's concerns about whether it'd actually be beneficial for a child to be diagnosed with either condition, even if the diagnosis is accurate.


My understanding has always been that ASPD can't be diagnosed in young children even if there will sometimes be warning signs that emerge early on. CU traits are a strong potential indicator that a child may develop conduct disorder or oppositional defiant disorder but not a guarantee. Not every kid who gets diagnosed with one or both of those goes on to meet diagnostic criteria for ASPD as an adult.

CU traits on their own aren't synonymous with ASPD and it would require a substantial redefinition of ASPD in order for that to change.


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FranzOren
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14 Mar 2022, 3:26 pm

That is another point to consider.



Ettina
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15 Mar 2022, 6:58 am

funeralxempire wrote:
Ettina wrote:
Actually, many PDs should probably be diagnosed much younger, not older.

Borderline PD is detectable by early adolescence and relatively stable from adolescence until adulthood, so it'd actually make more sense to put the minimum age for diagnosis around 10 or so.

Antisocial PD is even more distinct, and can be detected as young as 3 or 4 years old. In children it's often renamed "callous-unemotional" personality, but it's basically the same thing, and relatively stable from preschool to adulthood.

However, since both of those conditions carry a lot of stigma, there's concerns about whether it'd actually be beneficial for a child to be diagnosed with either condition, even if the diagnosis is accurate.


My understanding has always been that ASPD can't be diagnosed in young children even if there will sometimes be warning signs that emerge early on. CU traits are a strong potential indicator that a child may develop conduct disorder or oppositional defiant disorder but not a guarantee. Not every kid who gets diagnosed with one or both of those goes on to meet diagnostic criteria for ASPD as an adult.

CU traits on their own aren't synonymous with ASPD and it would require a substantial redefinition of ASPD in order for that to change.


The redefinition of ASPD you're talking about has already occurred. DSM-V ASPD is essentially synonymous with CU, and is very distinct from DSM-IV ASPD.



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15 Mar 2022, 9:26 am

Ettina wrote:
funeralxempire wrote:
Ettina wrote:
Actually, many PDs should probably be diagnosed much younger, not older.

Borderline PD is detectable by early adolescence and relatively stable from adolescence until adulthood, so it'd actually make more sense to put the minimum age for diagnosis around 10 or so.

Antisocial PD is even more distinct, and can be detected as young as 3 or 4 years old. In children it's often renamed "callous-unemotional" personality, but it's basically the same thing, and relatively stable from preschool to adulthood.

However, since both of those conditions carry a lot of stigma, there's concerns about whether it'd actually be beneficial for a child to be diagnosed with either condition, even if the diagnosis is accurate.


My understanding has always been that ASPD can't be diagnosed in young children even if there will sometimes be warning signs that emerge early on. CU traits are a strong potential indicator that a child may develop conduct disorder or oppositional defiant disorder but not a guarantee. Not every kid who gets diagnosed with one or both of those goes on to meet diagnostic criteria for ASPD as an adult.

CU traits on their own aren't synonymous with ASPD and it would require a substantial redefinition of ASPD in order for that to change.


The redefinition of ASPD you're talking about has already occurred. DSM-V ASPD is essentially synonymous with CU, and is very distinct from DSM-IV ASPD.


Funny you say that when I was using DSM 5 as a resource.

I've included the relevant portion from DSM 5, pay attention to portions B and C since they're what I mentioned in my first post and they're what you seemed to claim was no longer part of the criteria despite clearly being within the DSM 5 criteria.

Quote:
Symptoms & Criteria for Antisocial Personality Disorder

According to the DSM-5, there are four diagnostic criterion, of which Criterion A has seven sub-features.

A. Disregard for and violation of others rights since age 15, as indicated by one of the seven sub features:

Failure to obey laws and norms by engaging in behavior which results in criminal arrest, or would warrant criminal arrest
Lying, deception, and manipulation, for profit or self-amusement,
Impulsive behavior
Irritability and aggression, manifested as frequently assaults others, or engages in fighting
Blatantly disregards safety of self and others,
A pattern of irresponsibility and
Lack of remorse for actions (American Psychiatric Association, 2013)

The other diagnostic Criterion are:

B. The person is at least age 18,

C. Conduct disorder was present by history before age 15


D. and the antisocial behavior does not occur in the context of schizophrenia or bipolar disorder (American Psychiatric Association, 2013)
Onset

The DSM-5 notes that Antisocial Personality Disorder cannot be diagnosed before age 18, so while an adolescent may display antisocial features, prior to age 18, if diagnostic criteria are met, the appropriate diagnosis would be Conduct Disorder (American Psychiatric Association, 2013).


Further, scholarly articles regarding ASPD consistently include phrases like:

Quote:
The DSM-5 definition of ASPD requires a history of childhood CD, the diagnosis used for persistent and serious childhood behaviour problems. Once the child passes age 18 years, if the behavioural problems have persisted the diagnosis changes to ASPD. An estimated 25% of girls and 40% of boys with CD will later meet criteria for ASPD.


It really doesn't seem as though Callous and unemotional traits = ASPD, at least not according to DSM-5.


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FranzOren
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15 Mar 2022, 7:41 pm

But can it be possible for an adult to be diagnosed with adult onset conduct disorder?

Like, an adult started to have symptoms of conduct disorder in adulthood, I heard that it is possible, but unusual.



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16 Mar 2022, 12:54 pm

funeralxempire wrote:
Ettina wrote:
funeralxempire wrote:
Ettina wrote:
Actually, many PDs should probably be diagnosed much younger, not older.

Borderline PD is detectable by early adolescence and relatively stable from adolescence until adulthood, so it'd actually make more sense to put the minimum age for diagnosis around 10 or so.

Antisocial PD is even more distinct, and can be detected as young as 3 or 4 years old. In children it's often renamed "callous-unemotional" personality, but it's basically the same thing, and relatively stable from preschool to adulthood.

However, since both of those conditions carry a lot of stigma, there's concerns about whether it'd actually be beneficial for a child to be diagnosed with either condition, even if the diagnosis is accurate.


My understanding has always been that ASPD can't be diagnosed in young children even if there will sometimes be warning signs that emerge early on. CU traits are a strong potential indicator that a child may develop conduct disorder or oppositional defiant disorder but not a guarantee. Not every kid who gets diagnosed with one or both of those goes on to meet diagnostic criteria for ASPD as an adult.

CU traits on their own aren't synonymous with ASPD and it would require a substantial redefinition of ASPD in order for that to change.


The redefinition of ASPD you're talking about has already occurred. DSM-V ASPD is essentially synonymous with CU, and is very distinct from DSM-IV ASPD.


Funny you say that when I was using DSM 5 as a resource.

I've included the relevant portion from DSM 5, pay attention to portions B and C since they're what I mentioned in my first post and they're what you seemed to claim was no longer part of the criteria despite clearly being within the DSM 5 criteria.

Quote:
Symptoms & Criteria for Antisocial Personality Disorder

According to the DSM-5, there are four diagnostic criterion, of which Criterion A has seven sub-features.

A. Disregard for and violation of others rights since age 15, as indicated by one of the seven sub features:

Failure to obey laws and norms by engaging in behavior which results in criminal arrest, or would warrant criminal arrest
Lying, deception, and manipulation, for profit or self-amusement,
Impulsive behavior
Irritability and aggression, manifested as frequently assaults others, or engages in fighting
Blatantly disregards safety of self and others,
A pattern of irresponsibility and
Lack of remorse for actions (American Psychiatric Association, 2013)

The other diagnostic Criterion are:

B. The person is at least age 18,

C. Conduct disorder was present by history before age 15


D. and the antisocial behavior does not occur in the context of schizophrenia or bipolar disorder (American Psychiatric Association, 2013)
Onset

The DSM-5 notes that Antisocial Personality Disorder cannot be diagnosed before age 18, so while an adolescent may display antisocial features, prior to age 18, if diagnostic criteria are met, the appropriate diagnosis would be Conduct Disorder (American Psychiatric Association, 2013).




Where did you find that? This document lists very different criteria:

Quote:
The essential features of a personality disorder are impairments in personality (self and interpersonal) functioning and the presence of pathological personality traits. To diagnose antisocial personality disorder, the following criteria must be met:
A. Significant impairments in personality functioning manifest by:
1. Impairments in self functioning (a or b):
a.Identity: Ego-centrism; self-esteem derived from personal gain, power, or pleasure.
b.Self-direction: Goal-setting based on personal gratification; absence of prosocial internal standards associated with failure to conform to lawful or culturally normative ethical behavior.
AND
2. Impairments in interpersonal functioning (a or b):
a.Empathy: Lack of concern for feelings, needs, or suffering of others; lack of remorse after hurting or mistreating another.
b.Intimacy: Incapacity for mutually intimate relationships, as exploitation is a primary means of relating to others, including by deceit and coercion; use of dominance or intimidation to control others.
B. Pathological personality traits in the following domains:
1. Antagonism, characterized by:
a.Manipulativeness: Frequent use of subterfuge to influence or control others; use of seduction, charm, glibness, or ingratiation to achieve one's ends.
b.Deceitfulness: Dishonesty and fraudulence; misrepresentation of self; embellishment or fabrication when relating events.
c. Callousness: Lack of concern for feelings or problems of others; lack of guilt or remorse about the negative or harmful effects of one's actions on others; aggression; sadism.
d. Hostility: Persistent or frequent angry feelings; anger or irritability in response to minor slights and insults; mean, nasty, or vengeful behavior.
2. Disinhibition, characterized by:
a. Irresponsibility: Disregard for – and failure to honor – financial and other obligations or commitments; lack of respect for – and lack of follow through on – agreements and promises.
b. Impulsivity: Acting on the spur of the moment in response to immediate stimuli; acting on a momentary basis without a plan or consideration of outcomes; difficulty establishing and following plans.
c.Risk taking: Engagement in dangerous, risky, and potentially self-damaging activities, unnecessarily and without regard for consequences; boredom proneness and thoughtless initiation of activities to counter boredom; lack of concern for one's limitations and denial of the reality of personal danger.
C. The impairments in personality functioning and the individual's personality trait expression are relatively stable across time and consistent across situations.
D. The impairments in personality functioning and the individual's personality trait expression are not better understood as normative for the individual's developmental stage or sociocultural environment.
E. The impairments in personality functioning and the individual's personality trait expression are not solely due to the direct physiological effects of a substance (e.g., a drug of abuse, medication) or a general medical condition (e.g., severe head trauma).
F. The individual is at least age 18 years.



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16 Mar 2022, 1:24 pm

Ettina wrote:

Where did you find that? This document lists very different criteria:

Quote:
The essential features of a personality disorder are impairments in personality (self and interpersonal) functioning and the presence of pathological personality traits. To diagnose antisocial personality disorder, the following criteria must be met:
A. Significant impairments in personality functioning manifest by:
1. Impairments in self functioning (a or b):
a.Identity: Ego-centrism; self-esteem derived from personal gain, power, or pleasure.
b.Self-direction: Goal-setting based on personal gratification; absence of prosocial internal standards associated with failure to conform to lawful or culturally normative ethical behavior.
AND
2. Impairments in interpersonal functioning (a or b):
a.Empathy: Lack of concern for feelings, needs, or suffering of others; lack of remorse after hurting or mistreating another.
b.Intimacy: Incapacity for mutually intimate relationships, as exploitation is a primary means of relating to others, including by deceit and coercion; use of dominance or intimidation to control others.
B. Pathological personality traits in the following domains:
1. Antagonism, characterized by:
a.Manipulativeness: Frequent use of subterfuge to influence or control others; use of seduction, charm, glibness, or ingratiation to achieve one's ends.
b.Deceitfulness: Dishonesty and fraudulence; misrepresentation of self; embellishment or fabrication when relating events.
c. Callousness: Lack of concern for feelings or problems of others; lack of guilt or remorse about the negative or harmful effects of one's actions on others; aggression; sadism.
d. Hostility: Persistent or frequent angry feelings; anger or irritability in response to minor slights and insults; mean, nasty, or vengeful behavior.
2. Disinhibition, characterized by:
a. Irresponsibility: Disregard for – and failure to honor – financial and other obligations or commitments; lack of respect for – and lack of follow through on – agreements and promises.
b. Impulsivity: Acting on the spur of the moment in response to immediate stimuli; acting on a momentary basis without a plan or consideration of outcomes; difficulty establishing and following plans.
c.Risk taking: Engagement in dangerous, risky, and potentially self-damaging activities, unnecessarily and without regard for consequences; boredom proneness and thoughtless initiation of activities to counter boredom; lack of concern for one's limitations and denial of the reality of personal danger.
C. The impairments in personality functioning and the individual's personality trait expression are relatively stable across time and consistent across situations.
D. The impairments in personality functioning and the individual's personality trait expression are not better understood as normative for the individual's developmental stage or sociocultural environment.
E. The impairments in personality functioning and the individual's personality trait expression are not solely due to the direct physiological effects of a substance (e.g., a drug of abuse, medication) or a general medical condition (e.g., severe head trauma).
F. The individual is at least age 18 years.


I recognize your source because it was the only one with that criteria listed. I checked a number of sources to ensure the wording I was referring to was consistent.

https://www.theravive.com/therapedia/an ... 1.7-(f60.2)
https://www.psychdb.com/personality/antisocial
https://www.merckmanuals.com/en-ca/prof ... order-aspd

I also consulted with the hard copy at my psychiatrist's office.

I've only ever encountered the criteria you've pasted on that one specific Argentinian page.


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16 Mar 2022, 1:35 pm

I am very frustrated when I get falsely accused of stigmatizing mental illness when I explain that certain mental disorders highten the risk for criminal behavior, but the problem is that the blanket term "Mental illness" is too broad.

To be honest with you, people who committed serial criminal activities have severe personality disorder that causes antisocial traits, and delusions.

I even got accused of being more afraid of Schizophrenics, but that is not true. I am only afraid of people who have specific types of delusions that hightens the risk for criminal behavior. It's very frustrating. I am more afraid of people who have unhealthy twisted delusions that hightens the risk for criminal behavior, and those are personality disorders with antisocial traits and delusions, not Schizophrenia.

I was even accused of discriminating Antisocial Personality Disorder, and to people with Antisocial Personality Disorder that don't commit serious felonies, I am sorry, but the diagnostic criteria for Antisocial Personality Disorder includes elements of criminal behavior.

If most articles point out that mental illness is not a product of mental illness, and they really need to be specific about what mental disorders they are talking about, then it's ironic, because specific paraphilic disorders, Disruptive, Impulse Control and Conduct Disorders, especially Antisocial Personality Disorder includes elements of criminal behavior.

I was even accused of discriminating personality disorders as a whole, and that is not true, I was only talking about specific types of mental disorders that hightens the risk for criminal behavior.

Is there a stigma against mental disorders? The long answer is yes and no, it depends on what types of mental disorders we are talking about.

To say that mental health and neurodevelopmental disorders is not the cause for criminal behaviors is too broad.

Short answer is that most mental health and neurodevelopmental disorders is not the cause for criminal behaviors, but long answer is that mental health and neurodevelopmental disorders is the cause for criminal behaviors, but it depends on what mental health and neurodevelopmental disorders we are talking about.

The problem is that there are a lot of mental health and neurodevelopental disorders and each mental health and neurodevelopmental disorders are not the same to each other.

Statistically, most people with mental health and neurodevelopmental disorders are more likely to be victims than being perpetrators. There are however small-subgroup of people with mental health and neurodevelopmental disorders that commit crimes.

There are however some mental disorders that is related to criminal behaviors, it includes specific command hallucinations, specific delusions of paranoid and grandiose themes, and Erotomania, specific pathological jealousy , but criminal behaviors is more related to Distributive, Impulsive Control and Conduct Disorders, especially Antisocial Personality Disorder, Narcissistic Personality Disorder and specific Paraphilic Disorders. About Bipolar Disorder, criminal behaviors is more associated with Distributive, Impulsive Control and Conduct Disorders, and specific Paraphilic Disorders. Symptoms of Bipolar Disorder includes impulsively and risky behaviors.

About Communication Disorders and Autism Spectrum Disorder, criminal behaviors in Communication Disorders and Autism Spectrum Disorder is mostly related to lack of social skills, not out of maliciousness or sadism.



Sources:

https://www.mentalhealth.gov/basics/men ... yths-facts

https://www.ncbi.nlm.nih.gov/books/NBK396481/

https://www.ncbi.nlm.nih.gov/books/NBK537064/

https://pubmed.ncbi.nlm.nih.gov/16485220/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5742412/

https://www.ncbi.nlm.nih.gov/books/NBK562279/

https://www.ncbi.nlm.nih.gov/books/NBK470238/

https://www.ncbi.nlm.nih.gov/books/NBK546673/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5819598/

https://pubmed.ncbi.nlm.nih.gov/17032961/

https://www.ncbi.nlm.nih.gov/books/NBK554425/



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16 Mar 2022, 1:50 pm

FranzOren wrote:
I am very frustrated when I get falsely accused of stigmatizing mental illness when I explain that certain mental disorders highten the risk for criminal behavior, but the problem is that the blanket term "Mental illness" is too broad.


I think some of the problem also comes from people not really applying nuance when they hear of an elevated risk for whatever the concern might be. Instead of thinking increased likelihood it gets misunderstood as guaranteed that all individuals will.

Often the difference between average and increased risk isn't huge (even if significant) and the overall likelihood will often be quite low as well so even with all risk factors presenting the likelihood is still pretty minimal.


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16 Mar 2022, 1:53 pm

The problem is that symptoms of Antisocial Personality Disorder includes elements of criminal behavior, and lets say there is stigma and discrimination on Antisocial Personality Disorder, it's based on reality of some of the traits of Antisocial Personality Disorder. When I looked at the diagnostic criteria for Antisocial Personality Disorder, it's looks bad. I am sorry to say.



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16 Mar 2022, 1:57 pm

FranzOren wrote:
The problem is that symptoms of Antisocial Personality Disorder includes elements of criminal behavior, and lets say there is stigma and discrimination on Antisocial Personality Disorder, it's based on reality of some of the traits of Antisocial Personality Disorder. When I looked at the diagnostic criteria for Antisocial Personality Disorder, it's looks bad. I am sorry to say.


I meant the problem in general with trying to discuss stigmatized conditions, not the problems associated with that specific one. Sorry if I was unclear.


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16 Mar 2022, 2:10 pm

It makes sense.

There are certain mental disorders that hightens the risk for criminal behavior, those command hallucinations (It depends on the context of the hallucinations, and how a person handles it), specific delusional disorders, especially paraphilic disorders Erotomania, pathological jealousy (In rare situation, that can turn into very serious anger problems to the point of legal issues), about prosecutory delusions (It depends on the context of that delusion, in rare causes, it can cause you to fermly believe that you were defending yourself). Grandiose delusions, mainly also Meglonania, Egomania and Narcissistic Personality Disorder is also associated with Grandiose Delusional Disorder (In rare situations, it can turn into legal risky behavior, just to proof how much power you have). But, what I said is a small-subgroup of people with mental health and neurodevelopental disorders. The vast of majority of people with Schizophrenia Spectrum and Other Psychotic Disorders are more likely to be victims than being perpetrators. And I explained that most people with mental health and neurodevelopmental disorders are more likely to be victims than being perpetrators.

Criminal behaviors is more related to specific Paraphilic Disorders, Disruptive, Impulse Control and Conduct Disorders, especially Antisocial Personality Disorder.