Immature personality disorder
SpecialtyPsychiatry
Symptoms
  • Lack of stamina[1]
  • Poor adaptation capabilities[1]
Diagnostic methodBased on reported symptoms
Differential diagnosisBipolar[2], anxiety disorder, phobia, conversion disorder[3]

Immature personality disorder was a type of personality disorder diagnosis. It is characterized by lack of emotional development, low tolerance of stress and anxiety, inability to accept personal responsibility, and reliance on age-inappropriate defense mechanisms.[4] The disorder has been "gaining prominence" in the 21st century.[5] A study in Denmark found that together, these 6 "Other" types constituted 2.4% of all personality disorder diagnoses.[6]

It has been noted for displaying "an absence of mental disability",[4] and demonstrating "ineffectual responses to social, psychological and physical demands."[7]

History

The definition borrowed by the first edition of the DSM (see Diagnosis) was originally published in the Army Service Forces's Medical 203 in 1945 under Immaturity Reactions. It had five subtypes:

  • Emotional instability reaction (later histrionic personality disorder[8]: 78 ): excitability, ineffectiveness, undependable judgement, poorly controlled hostility, guilt and anxiety;
  • Passive-dependency reaction (later dependent personality disorder[9]: 379 ): helplessness, indecisiveness, tendency to cling to others;
  • Passive-aggressive reaction (later passive-aggressive personality disorder[9]: 379 ): pouting, stubbornness, procrastination, inefficiency, passive obstructionism;
  • Aggressive reaction: irritability, temper tantrums, destructive behavior;
  • Immaturity with symptomatic "habit" reaction: e.g. speech disorder brought on by stress.[10]

Diagnosis

DSM

Immature personality (321), as "Personality trait disturbance", only appeared in the first edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM), separately from personality disorders. The DSM defines the condition as follows:[3]

"This category applies to individuals who are unable to maintain their emotional equilibrium and independence under minor or major stress because of disturbances in emotional development. [...] This classification will be applied only to cases of personality disorder in which the neurotic features (such as anxiety, conversion, phobia, etc.) are relatively insignificant, and the basic personality maldevelopment is the crucial distinguishing factor. Evidence of physical immaturity may or may not be present."

Some of its subtypes became separate conditions (see History). In DSM-II "immature" became a type specifier for Other personality disorder (301.89),[8]: 44  and remained unchanged in the DSM-III.[9]: 330 [lower-alpha 1] The condition does not appear in later editions.

ICD

The International Classification of Diseases (ICD) also listed the condition as Immature personality (321) in the ICD-6[11] and ICD-7.[12] The ICD-8 introduced Other personality disorder (301.8)[13] which became the main diagnosis adding "immature" as a type specifier. This classification was shared by the ICD-9 (301.89) and ICD-10 (F60.8). The specifier was removed in ICD-11.

Mechanics

Early explanations

The underlying mechanism of the disorder was originally explained either as fixation (certain character patterns persisting from childhood to adult life), or as a regressive reaction due to severe stress (reversion to an earlier stage of development).[10]

Poor emotional control "require[s] quick mobilization of defense, usually explosive in nature, for the protection of the ego." In case of dependency "there is a predominant child-parent relationship." The "morbid resentment" of the aggressive type is the result of a "deep dependency" hidden by reaction formation.[10]

Later developments

IPD involves a weakness of the ego, which limits the ability to restrain impulses or properly model anxiety.[4] They fail to integrate the aggressive and libidinal factors at play in other people, and thus are not able to parse their own experiences.[4]

It can be caused by a neurobiological immaturity of brain functioning, or through a childhood trauma, or other means.[4]

In law and custom

In the 1980s, it was noted that immature personality disorder was one of the most common illnesses invoked by the Roman Catholic Church in order to facilitate annulment of undesired marriages.[14]

In 1978, David Augustine Walton was tried in Barbados for killing two passersby who had offered his mother and girlfriend a ride following an argument, and pleaded diminished capacity resulting from his immature personality disorder; he was nevertheless convicted of murder.[15]

In 1989, a former employee of the Wisconsin Department of Transportation had his claim of discrimination dismissed, after alleging that his employment had been terminated due to his Immature Personality Disorder alongside a sexual fetish in which he placed chocolate bars under the posteriors of women whose driving capabilities he was testing.[16]

A 1994 Australian case regarding unemployment benefits noted that while "mere personal distaste for certain work is not relevant, but a condition (such as immature personality disorder) may foreclose otherwise suitable prospects".[17]

A 2017 study indicated that an individual with immature personality disorder (among other people with personality disorders) was allowed to die through Belgian euthanasia laws that require a medical diagnosis of a life-long condition that could impair well-being.[18]

A 2019 Russian study of military age persons in the Tomsk region reported that mental and behavioral disorders were detected in 93 out of 685 recruits. "Among personality pathology, immature personality disorder (43.8%) and emotionally unstable personality disorder (38.6%) prevailed."[19]

Notes

  1. ↑ "Other Personality Disorder should be used when the clinician judges that a specific Personality Disorder not included in this classification is appropriate, such as Masochistic, Impulsive, or Immature Personality Disorder. In such instances the clinician should record the specific Other personality Disorder, using the 301.89 code."

References

  1. 1 2 "Personality disorders". medicineworld.org. Retrieved November 26, 2020.
  2. ↑ Department of Veterans Affairs Regional Office in Winston-Salem, NC, Docket No 04-12 158A
  3. 1 2 Diagnostic and Statistical Manual of Mental Disorders. American Psychiatric Association. 1952. p. 98,36.
  4. 1 2 3 4 5 Almeida F, Ribeiro P, Moreira D (September 27, 2019). "Immature Personality Disorder: Contribution to the Definition of this Personality" (PDF). Clinical Neuroscience and Neurological Research International Journal. Troy, Michigan: Academic Strive. 2 (2).
  5. ↑ Ostrow R (May 18, 2017). "Forever young: immature personality disorder". The Australian. Retrieved December 28, 2020.
  6. ↑ Pedersen L, Simonsen E (November 17, 2014). "Incidence and prevalence rates of personality disorders in Denmark—A register study". Nordic Journal of Psychiatry. Abingdon, England: Taylor & Francis. 68 (8): 543–548. doi:10.3109/08039488.2014.884630. ISSN 0803-9488. PMID 24520919. S2CID 207472992.
  7. ↑ "Personality disorders :From MedicineWorld.Org". medicineworld.org.
  8. 1 2 Diagnostic and Statistical Manual of Mental Disorders (2nd ed.). American Psychiatric Association. 1968.
  9. 1 2 3 Diagnostic and Statistical Manual of Mental Disorders (3rd ed.). American Psychiatric Association. 1980.
  10. 1 2 3 "Nomenclature of Psychiatric Disorders and Reactions". War Department Technical Bulletin, Medical 203. Army Service Forces. 1945.
  11. ↑ "International Classification of Diseases, Revision 6". 1948.
  12. ↑ "International Classification of Diseases, Revision 7". 1955.
  13. ↑ "Conversion Tables between ICD-8, ICD-9, ICD-10" (PDF). 1994. p. 14.
  14. ↑ Severino SK, Mcnutt ER (March 1984). "The Psychiatrist as Expert Witness: The Roman Catholic Church Marriage Tribunal". Journal of the American Academy of Psychiatry and the Law. Bloomfield, Illinois: American Academy of Psychiatry and the Law. 12 (1): 49–66. doi:10.1177/009318538401200106. S2CID 158806167.
  15. ↑ Kok LP, Cheang M, Chee KT (1990). Diminished Responsibility: With Special Reference to Singapore. Kent Ridge, Singapore: NUS Press. pp. 157–158. ISBN 9789971691387.
  16. ↑ "Decision order" (PDF). werc.wi.gov. 1989. Retrieved November 26, 2020.
  17. ↑ Carney T (2003). "Disability and Social Security: Compatible or Not?". Australian Journal of Human Rights. Abingdon, England: Taylor & Francis. 9 (2): 139–172. doi:10.1080/1323238X.2003.11911110. S2CID 158299198.
  18. ↑ Dierickx S, Deliens L, Cohen J, Chambaere K (December 2017). "Euthanasia for people with psychiatric disorders or dementia in Belgium: analysis of officially reported cases". BMC Psychiatry. London, England: BioMed Central. 17 (1): 203. doi:10.1186/s12888-017-1369-0. ISSN 1471-244X. PMC 5481967. PMID 28641576. S2CID 3237745.
  19. ↑ Bokhan NA, Evseev VD, Mandel AI (2019). "Structure and prevalence of mental and behavioral disorders in persons of military age in the Tomsk Region in 2016-2018". Siberian Herald of Psychiatry and Addiction Psychiatry. 4 (105): 26–33.
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