Personality Change Due to Another Medical Condition

Personality Change Due to Another Medical Condition is a DSM-5 diagnosis used to identify a persistent personality change caused by a medical condition. Common signs and symptoms personality change include affective instability, lack of impulse control, aggressive outbursts or rage, apathy, suspiciousness, or paranoid ideation.

A persistent personality disturbance that represents a change from the individual's previous characteristic personality pattern.

There is evidence from the history, physical examination, or laboratory findings that the disturbance is the direct pathophysiological consequence of another medical condition.

The disturbance is not better explained by another mental disorder (including another mental disorder due to another medical condition).

The disturbance does not occur exclusively during the course of a delirium.

The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.

• The essential feature of this diagnosis is that the personality disturbance that is judged by the clinician to be due to the direct pathophysiological effects of a medical condition. Various etiologies can cause personality changes, including central nervous system neoplasms, traumatic brain injury, cerebrovascular disease, Huntington's disease, epilepsy, infectious conditions involving the central nervous system (e.g. - HIV), endocrine conditions (e.g., hypothyroidism, hypo- and hyperadrenocorticism), and autoimmune conditions with central nervous system involvement (e.g. - systemic lupus erythematosus).

• Chronic medical conditions associated with pain and disability
  • Chronic medical conditions associated with pain and disability be associated with personality change. Thus, the diagnosis of personality change due to another medical condition is given only if a direct pathophysiological mechanism can be established. This diagnosis is not given if the change is due to a psychological or behavioural adjustment, or a response to another medical condition (e.g. - dependent behaviors that result from a need for the assistance of others following a traumatic brain injury, cardiovascular disease, or dementia).
• Delirium or major neurocognitive disorder
  • Personality change is a frequently associated feature of a delirium or major neurocognitive disorder. A separate diagnosis of personality change due to another medical condition is not given if the change occurs exclusively during the course of a delirium. However, the diagnosis of personality change due to an other medical condition may be given in addition to the diagnosis of major neurocognitive disorder if the personality change is a prominent part of the clinical presentation.
• Another mental disorder due to another medical condition
  • The diagnosis of personality change due to another medical condition is not given if the disturbance is better explained by another mental disorder due to another medical condition (e.g. - depressive disorder due to brain tumor).
• Substance use disorders
  • Personality changes may also occur in the context of substance use disorders, especially if the disorder is long-standing. The clinician should inquire carefully about the nature and extent of substance use. If the clinician wishes to indicate an etiological relationship between the personality change and substance use, the unspecified category for the specific substance (e.g. - unspecified stimulant-related disorder) can be used.
• Other mental disorders
  • Marked personality changes may also be an associated feature of other mental disorders (e.g. - schizophrenia; delusional disorder; depressive and bipolar disorders; other specified and unspecified disruptive behavior, impulse-control, and conduct disorders; panic disorder). However, in these disorders, no specific physiological factor is judged to be etiologically related to the personality change.
• Other personality disorders
  • Personality change due to another medical condition can be distinguished from a personality disorder by the requirement for a clinically significant change from baseline personality functioning and the presence of a specific etiological medical condition.

• Leppla, I., Fishman, D., Kalra, I., & Oldham, M. A. (2020). Clinical Approach to Personality Change Due to Another Medical Condition. Psychosomatics.