Personality Disorders as a Basis for Discharge and Denial of Benefits in the Military

Abstract

The US Department of Defense specifically states that intellectual disability and personality disorders are not diseases for compensation purposes, and disabilities from them may not be service connected absent a superimposed mental disorder. In addition, the diagnosis of a personality disorder led to the discharge of 31,000 troops during the years 2001 to 2010. I review the history of these developments, and how the Diagnostic and Statistical Manual of Mental Disorders enabled these actions. In contrast, the United Kingdom and Canada do not allow such actions. Whether our approach is logical seems highly questionable, especially given the significant problems with the DSM’s definitions of personality disorders, definitions at odds with the literature.

Veterans affairs serious mental illness patients: Differences in high-intensity service use by personality disorder status.

“…As much of this previous work utilized gold-standard diagnostic methods (e.g., structured diagnostic interviews), this discrepancy may suggest issues with clinician approaches to identify and treat PDs within the VHA patient population. This may be especially relevant in veteran samples as it has been speculated that clinicians may be hesitant to provide PD diagnoses within the VHA system for several reasons, including that PDs are not conditions which make VHA patients eligible for service-connected disability benefits and the lack of appropriate treatment referral options available (Dean, 2021, Nelson et al, 2021). Differences in access to treatment or the quality of diagnostic assessment were not evaluated in terms of their potential impact on diagnosis, treatment, or outcomes.…”

Personality disorder and suicide risk among patients in the veterans affairs health system.

“…Further work is needed to explore why there are lower rates of PDs found within the VHA system. As PD diagnoses are grounds for dismissal from the military, and are not eligible for service connection (Dean, 2021;Leroux, 2015), these diagnoses likely carry a greater stigma within the VHA system, and VA providers PERSONALITY DISORDER AND SUICIDE RISK 5 may be more hesitant to provide these diagnoses out of fear of disqualifying veterans from benefits. In addition, if the VHA system does not have adequate treatment programs that are PD-specific, providers may be hesitant to provide a diagnosis for a condition that they are unable to provide specific treatment for within the VHA system.…”