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Not Otherwise Specified (NOS) Personality Disorder

by Sam Vaknin

The NOS diagnosis is a laundry list of all personality-related dysfunctions, signs, symptoms, and complaints that do not fit a specific personality disorder.

It is a sign of the inadequacy of our current knowledge of personality disorders that both the American Diagnostic and Statistical Manual (DSM) and its international counterpart, the ICD, maintain a "Personality Disorders Not Otherwise Specified (NOS)" diagnostic category. It is a catch-all, meaningless, "diagnosis", a testament to the diagnostician's helplessness and ignorance in the face of human complexity which often defies neat classification.

Even the rudiments of this diagnostic category are in dispute. There is no agreement as to what traits and behaviors it applies to. The ICD, for instance, includes the Narcissistic Personality Disorder in the NOS category, insisting that it is not a full-fledged personality disorder.

The NOS diagnosis is a laundry list of all personality-related dysfunctions, signs, symptoms, and complaints that do not fit a specific personality disorder. Some people satisfy one or more diagnostic criteria of a few personality disorders ("mixed personality"), but do not run the full gamut of any of them. The only requirement is that the personality be somehow impaired and cause distress and dysfunctions in one or more important areas of life: social, occupational, sexual, interpersonal, and so on.

Personality disorders not yet recognized by the DSM Committee - e.g., depressive, negativistic, or passive-aggressive - are also NOS.

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