Statement of Principles concerning personality disorder No. 143 of 1995

Statement of Principles

concerning

PERSONALITY DISORDER

Instrument No. 143 of 1995 as amended

made under section 196B(2) of the

Veterans’ Entitlements Act 1986

This compilation was prepared on 7 August 2008 taking into account Amendment of Statement of Principles concerning personality disorder (Instrument No. 13 of 1997)

Prepared by the Repatriation Medical Authority Secretariat, Brisbane.

Statement of Principles

concerning

PERSONALITY DISORDER

ICD CODE: 301.0, 301.10, 301.11, 301.12, 301.2 – 301.9

Veterans’ Entitlements Act 1986
subsection 196B(2)

1. Being of the view that there is sound medical-scientific evidence that indicates that personality disorder and death from personality disorder can be related to operational service rendered by veterans, peacekeeping service rendered by members of Peacekeeping forces and hazardous service rendered by members of the Forces, the Repatriation Medical Authority determines, under subsection 196B(2) of the Veterans’ Entitlements Act 1986 (the Act), that the factors that must as a minimum exist before it can be said that a reasonable hypothesis has been raised connecting personality disorder or death from personality disorder with the circumstances of that service, are:

(a) suffering a catastrophic experience that immediately preceded an enduring personality change to the level of disorder; or

(b) inability to obtain appropriate clinical management for personality disorder.

2. Subject to clause 3 (below) at least one of the factors set out in paragraphs 1(a) to 1(b) must be related to any service rendered by a person.

3. The factor set out in paragraph 1(b) applies only where:

(a) the person’s personality disorder developed before a period, or part of a period, of service to which the factor is related; and

(b) the relationship suggested between the personality disorder and the particular service of a person is a relationship set out in paragraph 8(1)(e), 9(1)(e), 70(5)(d), or 70(5A)(d) of the Act.

4. For the purposes of this Statement of Principles:

“DSM-IV” means the fourth edition of the American Psychiatric Associations Diagnostic and Statistical Manual of Mental Disorders;

“enduring personality change” means a psychiatric condition that is present for at least two years immediately following exposure to catastrophic stress; where

(a) the catastrophic stress must be so extreme that it is not necessary to consider personal vulnerability in order to explain its profound effect on the personality; and

(b) the personality change is characterised by a hostile or distrustful attitude towards the world, social withdrawal, feelings of emptiness or hopelessness, a chronic feeling of “being on edge” as if constantly threatened, and estrangement;

Note:  Post-traumatic stress disorder may precede this type of personality change.

“'ICD code' means a number assigned to a particular kind of injury or disease in the Australian Version of The International Classification of Diseases, 9th revision, Clinical Modification (ICD-9-CM), effective date of 1 July 1996, copyrighted by the National Coding Centre, Faculty of Health Sciences, University of Sydney, NSW, and having ISBN 0 642 24447 2;

‘personality disorder’ means a psychiatric condition, attracting ICD code 301.0, 301.10, 301.11, 301.12 or a code in the range 301.2 to 301.9, derived from DSM-IV, meeting the following criteria,

(a) an enduring pattern of inner experience and behaviour that deviates markedly from the expectations of the individual's culture, manifested in at least two of the following areas:

(i) cognition (ie. ways of perceiving and interpreting self, other people and events);

(ii) affectivity (ie. the range, intensity, lability, and appropriateness of emotional response);

(iii) interpersonal functioning;

(iv) impulse control; and

(b) the enduring pattern is inflexible and operative across a broad range of personal and social situations; and

(c) the enduring pattern leads to clinically significant distress or impairment in social, occupational, or other important areas eg. functioning; and

(d) the pattern is stable and of long duration and its onset can be traced back at least to adolescence or early adulthood; and

(e) the enduring pattern is not better accounted for as a manifestation or consequence of another mental disorder; and

(f) the enduring pattern is not due to the direct physiological effects of a substance (eg. a drug of abuse, a medication) or a general medical condition (eg. head trauma), and may be identified as any of the following:

(i) paranoid personality disorder attracting ICD code 301.0;

(ii) schizoid personality disorder attracting ICD code 301.2;

(iii) schizo typal personality disorder attracting ICD code 301.22;

(iv) antisocial personality disorder attracting ICD code 301.7;

(v) borderline personality disorder attracting ICD code 301.83;

(vi) histrionic personality disorder attracting ICD code 301.50;

(vii) narcissistic personality disorder attracting ICD code 301.81;

(viii) avoidant personality disorder attracting ICD code 301.82;

(ix) dependent personality disorder attracting ICD code 301.6;

(x) obsessive-compulsive personality disorder attracting ICD code 301.4;

(xi) personality disorder not otherwise specified attracting ICD code 301.9.

Note: The above criteria are derived from DSM-IV.”.

Notes to Statement of Principles concerning personality disorder (Instrument No. 143 of 1995)

The Statement of Principles concerning personality disorder (Instrument No. 143 of 1995) in force under section 196B(2) of the Veterans’ Entitlements Act 1986, as shown in this compilation is amended as indicated in the Tables below.

Table of Instruments

Table of Amendments