Statement of Principles

concerning

PERSONALITY DISORDER
(Balance of Probabilities)

(No. 18 of 2018)

The Repatriation Medical Authority determines the following Statement of Principles under subsection 196B(3) of the Veterans' Entitlements Act 1986.

Dated 2 March 2018

Contents

1 Name

2 Commencement

3 Authority

4 Revocation

5 Application

6 Definitions

7 Kind of injury, disease or death to which this Statement of Principles relates

8 Basis for determining the factors

9 Factors that must exist

10 Relationship to service

11 Factors referring to an injury or disease covered by another Statement of Principles

Schedule 1 - Dictionary

1 Definitions

1               Name

This is the Statement of Principles concerning personality disorder (Balance of Probabilities) (No. 18 of 2018).

2               Commencement

              This instrument commences on 2 April 2018.

3               Authority

This instrument is made under subsection 196B(3) of the Veterans' Entitlements Act 1986.

4               Revocation

The Statement of Principles concerning personality disorder No. 71 of 2008, as amended, made under subsections 196B(3) and (8) of the VEA is revoked.

5               Application

This instrument applies to a claim to which section 120B of the VEA or section 339 of the Military Rehabilitation and Compensation Act 2004 applies.

6               Definitions

The terms defined in the Schedule 1 - Dictionary have the meaning given when used in this instrument.

7               Kind of injury, disease or death to which this Statement of Principles relates

(1)          This Statement of Principles is about personality disorder and death from personality disorder.

Meaning of personality disorder

(2)          For the purposes of this Statement of Principles, personality disorder means a disorder of mental health that meets the following diagnostic criteria (derived from DSM-5):

1. An enduring pattern of inner experience and behaviour that deviates markedly from the expectations of the individual's culture. This pattern is manifested in two (or more) of the following areas:

(i)            cognition (that is, ways of perceiving and interpreting self, other people and events);

(ii)         affectivity (that is, the range, intensity, lability and appropriateness of emotional response);

(iii)       interpersonal functioning; or

(iv)        impulse control.

B.            The enduring pattern is inflexible and pervasive across a broad range of personal and social situations.

C.            The enduring pattern leads to clinically significant distress or impairment in social, occupational or other important areas of functioning.

D.           The pattern is stable and of long duration, and its onset can be traced back at least to adolescence or early adulthood.

E.            The enduring pattern is not better explained as a manifestation or consequence of another mental disorder.

F.             The enduring pattern is not attributable to the physiological effects of a substance (for example, a drug of abuse, a medication) or another medical condition (for example, head trauma).

Note 1: The definition of personality disorder includes paranoid personality disorder, schizoid personality disorder, schizotypal personality disorder, antisocial personality disorder, borderline personality disorder, histrionic personality disorder, narcissistic personality disorder, avoidant personality disorder, dependent personality disorder, obsessive-compulsive personality disorder, other specified personality disorder and unspecified personality disorder.

Note 2: The definition of personality disorder excludes personality change due to another medical condition. 

Note 3: DSM-5 and personality change due to another medical condition are defined in the Schedule 1 - Dictionary.

(3)          While personality disorder attracts ICD‑10‑AM code:

(a)          F60.0 (paranoid personality disorder);

(b)          F60.1 (schizoid personality disorder);

(c)          F21 (schizotypal personality disorder);

(d)          F60.2 (antisocial personality disorder);

(e)          F60.31 (borderline personality disorder);

(f)           F60.4 (histrionic personality disorder);

(g)          F60.8 (narcissistic personality disorder);

(h)          F60.6 (avoidant personality disorder);

(i)            F60.7 (dependent personality disorder);

(j)            F60.5 (obsessive-compulsive personality disorder); or

(k)          F60.9 (other specified personality disorder and unspecified personality disorder);

in applying this Statement of Principles the meaning of personality disorder is that given in subsection (2).

(4)          For subsection (3), a reference to an ICD-10-AM code is a reference to the code assigned to a particular kind of injury or disease in The International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, Australian Modification (ICD-10-AM), Tenth Edition, effective date of 1 July 2017, copyrighted by the Independent Hospital Pricing Authority, ISBN 978-1-76007-296-4.

Death from personality disorder

(5)          For the purposes of this Statement of Principles, personality disorder, in relation to a person, includes death from a terminal event or condition that was contributed to by the person's personality disorder.

Note: terminal event is defined in the Schedule 1 – Dictionary.

8               Basis for determining the factors

On the sound medical‑scientific evidence available, the Repatriation Medical Authority is of the view that it is more probable than not that personality disorder and death from personality disorder can be related to relevant service rendered by veterans or members of the Forces under the VEA, or members under the MRCA.

Note: MRCA, relevant service and VEA are defined in the Schedule 1 – Dictionary.

9               Factors that must exist

At least one of the following factors must exist before it can be said that, on the balance of probabilities, personality disorder or death from personality disorder is connected with the circumstances of a person's relevant service:

(1)          experiencing a category 1A stressor within the one year before the clinical onset of personality disorder;

Note: category 1A stressor is defined in the Schedule 1 - Dictionary.               

(2)          experiencing a category 1B stressor within the six months before the clinical onset of personality disorder;

Note: category 1B stressor is defined in the Schedule 1 - Dictionary.               

(3)          experiencing severe childhood abuse before the clinical onset of personality disorder;

Note: severe childhood abuse is defined in the Schedule 1 - Dictionary.

(4)           having a clinically significant disorder of mental health as specified, within the five years before the clinical onset of personality disorder;

Note: clinically significant disorder of mental health as specified is defined in the Schedule 1 - Dictionary.

(5)          experiencing a category 1A stressor within the one year before the clinical worsening of personality disorder;

Note: category 1A stressor is defined in the Schedule 1 - Dictionary.               

(6)          experiencing a category 1B stressor within the six months before the clinical worsening of personality disorder;

Note: category 1B stressor is defined in the Schedule 1 - Dictionary.               

(7)          experiencing severe childhood abuse before the clinical worsening of personality disorder;

Note: severe childhood abuse is defined in the Schedule 1 - Dictionary.

(8)           having a clinically significant disorder of mental health as specified, within the five years before the clinical worsening of personality disorder;

Note: clinically significant disorder of mental health as specified is defined in the Schedule 1 - Dictionary.

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

10           Relationship to service

(1)          The existence in a person of any factor referred to in section 9, must be related to the relevant service rendered by the person.

(2)          The factors set out in subsections 9(5) to 9(9) apply only to material contribution to, or aggravation of, personality disorder where the person's personality disorder was suffered or contracted before or during (but did not arise out of) the person's relevant service.

11           Factors referring to an injury or disease covered by another Statement of Principles

In this Statement of Principles:

(1)          if a factor referred to in section 9 applies in relation to a person; and

(2)          that factor refers to an injury or disease in respect of which a Statement of Principles has been determined under subsection 196B(3) of the VEA;

then the factors in that Statement of Principles apply in accordance with the terms of that Statement of Principles as in force from time to time.

Schedule 1 - Dictionary  

Note:               See Section 6

1               Definitions

In this instrument:

                             category 1A stressor means one of the following severe traumatic events:

(a)          experiencing a life-threatening event;

(b)          being subject to a serious physical attack or assault including rape and sexual molestation; or

(c)          being threatened with a weapon, being held captive, being kidnapped or being tortured.

                             category 1B stressor means one of the following severe traumatic events:

(a)          being an eyewitness to a person being killed or critically injured;

(b)          viewing corpses or critically injured casualties as an eyewitness;

(c)          being an eyewitness to atrocities inflicted on another person or persons;

(d)          killing or maiming a person; or

(e)          being an eyewitness to or participating in, the clearance of critically injured casualties.

Note: eyewitness is also defined in the Schedule 1 - Dictionary.

                             clinically significant disorder of mental health as specified means one of the following conditions, which is of sufficient severity to warrant ongoing management:

(a)          acute stress disorder;

(b)          agoraphobia;

(c)          alcohol use disorder;

(d)          anxiety disorder;

(e)          attention-deficit/hyperactivity disorder (including other specified attention-deficit/hyperactivity disorder and unspecified attention-deficit/hyperactivity disorder);

(f)           bipolar disorder;

(g)          conduct disorder (including other specified disruptive, impulse-control, and conduct disorder and unspecified disruptive, impulse-control, and conduct disorder);

(h)          depressive disorder;

(i)            eating disorder;

(j)            gambling disorder;

(k)          gender dysphoria;

(l)            obsessive-compulsive disorder;

(m)        oppositional defiant disorder;

(n)          panic disorder;

(o)          posttraumatic stress disorder;

(p)          schizophrenia;

(q)          social anxiety disorder;

(r)           somatic symptom disorder;

(s)           specific phobia; or

(t)            substance use disorder.

Note 1:               "                                                                                    Management" of the condition may involve regular visits (for example, at least monthly) to a psychiatrist, counsellor or general practitioner.

Note 2: To "warrant ongoing management" does not require that any actual management was received or given for the condition.

                                DSM-5 means the American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition.  Arlington, VA, American Psychiatric Association, 2013.

                               eyewitness means a person who experiences an incident first hand and can give direct evidence of it.  This excludes persons exposed only to public broadcasting or mass media coverage of the incident.

                               MRCA means the Military Rehabilitation and Compensation Act 2004.

                               personality change due to another medical condition means a disorder of mental health (derived from DSM-5) which is characterised by a persistent personality disturbance that is due to the direct physiological effects of a medical condition (for example, frontal lobe lesion, ischaemic stroke or cerebral trauma).

Note: DSM-5 is also defined in the Schedule 1 - Dictionary.

                               personality disorder—see subsection 7(2).

                               relevant service means:

(a)          eligible war service (other than operational service) under the VEA;

(b)          defence service (other than hazardous service and British nuclear test defence service) under the VEA; or

(c)          peacetime service under the MRCA.

Note: MRCA and VEA are also defined in the Schedule 1 - Dictionary.

                             severe childhood abuse means:

(a)          serious physical, emotional, psychological or sexual harm whilst a child aged under 16 years; or

(b)          neglect involving a serious failure to provide the necessities for health, physical and emotional development, or wellbeing whilst a child aged under 16 years;

where such serious harm or neglect has been perpetrated by a parent, a care provider, an adult who works with or around that child, or any other adult in contact with that child.

                               terminal event means the proximate or ultimate cause of death and includes the following:

(a)           pneumonia;

(b)           respiratory failure;

(c)           cardiac arrest;

(d)           circulatory failure; or

(e)           cessation of brain function.

                               VEA means the Veterans' Entitlements Act 1986.