The Diagnostic and Statistical Manual of Mental Disorders IV (DSM IV), a book that defines and describes the symptoms of emotional problems, has been in the revision process for years. Health professionals (and insurance companies) routinely use the manual to guide diagnosis and treatment. Recently, considerable attention has been given to the proposed changes in preparation for the fifth edition of the book (to be released in 2013). The possible changes to the section on personality disorders will certainly generate much discussion and controversy.
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Bonnie B.
8:40 pm on
March 1st, 2010Great! Do the symptoms disappear along with the diagnosis? What a cure!
I wonder how long it will be before insurance companies start demanding reimbursement for paying to treat those non-existent disorders.
Ok, I have an idea but keep in mind that it’s coming from a disordered mind. How about this? Since the problem with these disorders was that they tended to switch over time and people were diagnosed with more than one at a time, I say let’s make it real simple. We can resurrect the old Multiple Personality Disorder and redefine it by changing the emphasis. Instead of “Multiple Personality” Disorder, it can be Multiple “Personality Disorder.”
Could it ever occur to an intelligent thinking person that the entire DSM series have been, and ever increasingly are a farce and a fraud?
http://familyrights.us/educate/pop/index.html
hmm. I interpreted the draft a bit differently, but there is some ambiguity in how it was presented.
The disorders that are being removed won’t be represented by a type, but the draft also lists clusters of traits that are representative of the previous diagnosis. I was under the impression that instead of the type diagnosis clinicians could instead use the cluster of traits for the diagnosis was sort of an NOS category for those who don’t fit into a specific type. So in that sense I didn’t really get the impression that the ones being eliminated are really being eliminated, just described in a new way.
In other words, it looks like the new goal for all personality disorders is to look at the traits and for some better researched clusters of traits a type name has been given, but for those less researched the type has been shelved pending further empirical validation.
Chris
10:47 am on
March 3rd, 2010Personality disorders disappearing?
I think not.
As someone with a Histrionic mother and narcissistic father, the Reality of these disorders not only disrupts but destroys lives.
Of course, PDs are less-likely to seek help so maybe psych professionals have had difficulty recognizing certain PDs when they see them. Esp. if they don’t fit neat-and-tidy.
“Switching” to other diagnosis over time is a problem. Well, yes, co-occurrences do occur, however, when a PD is in a state of decomposition under Stress, they can appear “as if” they have another disorder. But that is looking at the symptoms, and the surface, not the core issue.
This revamping of cluster A & B is a huge mistake.
Why not just taking care of cognitive competence? The categories seem artificial altogether. If the medical community would acknowledge that breaches in logic are the only “illness” there is, they would hand over the most cases to philosophers. And if you are still worried about the moral implications of mental illness, one can acknowledge too, that wisdom (and therefore benevolence) is an important component of a logical mindset!
I like that idea…if only disorders were so easily cured, we’d get rid of the whole DSM and all be healthy!
Marty
6:19 pm on
March 3rd, 2010I think Paranoid PD has been removed because the military industrial-pharmaceutical complex want conspiracy theorists to be seen as mentally healthy & therefore within the clandestine jurisdiction of international freelance intelligence via the illicit drug trade.
Seriously such exclusions seems a little hard to take seriously, I think the internet may have turned everyone into a narcissist, they probably feel you can’t say everyone is nuts, even though it is entirely possible.
Bridgette
7:56 pm on
March 3rd, 2010It’s interesting that the article said the so many times, or should I say, too many times, clinicians, or the dr’s have given out the diagnosis
of, Borderline Personality Disorder, Not Otherwise Specified, which I must
say is in my Social Sec. file I once saw (but definitely was NOT supposed to!) b/c the people over at Social Security mistakenly mailed me my file
with so many original pieces of importants papers in there! Anyway that is exactly how I found out that
my second dx (diagnosis) indeed was Borderline Personality Disorder, Not Otherwise Specified! Do I think that was a coincidence for me to receive my own folder from Social Security? Hell no. Someone who works there, likes me and is always sending me so many more check than I’m supposed to get! lol.. Ssssshhhhhhhhhhh
marie faith
4:15 pm on
March 4th, 2010I was diagnosed as “unstable personality, type A, passive aggressive when I was honorably discharged from the Navy in 1965 for that disorder. I was not afforded any treatment before or after discharge and have struggled with this for a lifetime. My military medical records say it did not exist prior to service and it was not due to my own conduct.
What exactly, in contemporary terms is this disorder? I fit all of the symptoms of Borderline personality except for a fear of being alone … and I cannot seem to find any information about it because it was a term used back in the 60′s.
The VA has denied my request for compensation for this disorder even though my life record demonstrates that this disorder has compromised my ability to keep a job and has contributed to the failure of relationships with other people.
My solution has been to isolate myself and avoid interaction as much as possible because I always seem to get myself in trouble with others if I don’t. I have lived well below the poverty line and have had very little contact with the medical community, first because I was taught as a child that a person is expected to “carry their own load.” Second I always believed there were others who had difficulties much greater than mine and because I was able to manage, it would be “wrong” for me to take advantage of the social services third, I did not know it, but I was very, very poor, never earning enough to even reach the poverty line. At the age of 54, I took an informal test and was told that I have an IQ in the top 2-3 percentile (if they were being truthful) but I did not really know if I can trust doctors. I did at one time trust doctors to a limited extent, but after my experience with the doctors at the VA, I no longer trust the medical community at all.
I am 65 now and because of my problems I am no longer interested in life. Neither do I hope for an afterlife. I hope for complete oblivion … absolute non-existence, anywhere.
Lastly, and for this I hold the medical community, religion, the educational system and society at large, accountable for my suffering because I have endured abuse as the direct result of being a person who was born with gender dysphoria.(male to female pre-op transsexual) Probably, this was also the cause of my difficulties in the Navy, since the military is a tolerated and endorsed homophobic organization, allowed to act in direct violation to constitutional guarantee.
I have also been diagnosed with ADD, ADHD, bipolar disorder, and depression.
My short term memory (not age related) has, since childhood, prevented me from reading much because I forget what it is I am reading before I finish the sentence. My education has been largely the result of educational TV, audio tapes, and thankfully, a creative nature which allowed me to learn through experience and exploration.
Please tell me what unstable personality is, what type A, passive aggressive is, and tell me, if you can, what the hell should I do next? I am bored, depressed and sick of life on this planet where the majority cannot seem to get the sense of equality … I did not ask for life, yet I am forced to endure it.
love marie
Artie
2:02 am on
March 5th, 2010According to a favorite author Narcissistic PD is rampant in management & other positions of power. It may be that narcissists are the most powerful group in western society, that would likely include plenty of the medical elite.
It’s amazing it was ever considered a disorder in the first place & shouldn’t be surprising it’s gone.
Darick
9:36 am on
March 5th, 2010“•Avoidant (hypersensitive to evaluation, fearful, and feelings of inadequacy)”
Isn’t that what we call shy,introvert and uncertain in normal language? Since when is that a “disorder”?
Interesting comments! The whole issue of “disorder” versus normal variations in personality or mood has treatment, legal, and financial implications. When people have an official diagnosis does that label influence the way they are treated? And does the label itself cause some to suffer more?
Artie
6:48 pm on
March 5th, 2010I sometimes have the feeling it is wishful thinking to label say anti-social or narissistic behavior sick rather than simply immoral.
In terms of labels causing suffering, I sometime wonder if I am interested in PDs because I have been labelled “bipolar” I sometimes think being able to label basically anyone with some degree of PD is my way of getting revenge against the world for being labelled negatively (I’ve given up doing it to their faces by the way), or at least making myself feel less inferior.
Then again having vitually no choice but to accept a bipolar label (& also experience enormous benefits by doing this) may have opened my mind to the benefits of self-understanding. Something the “healthy” majority apear very keen & able to avoid, perhaps to their disadvantage in some ways.
x
9:34 pm on
March 5th, 2010That’s an interesting point, Dr. Smith. In thinking about some people who I work with or have known, or have even dated, who are not so well adjusted, sometimes I think those who seek help and strive to improve are at a disadvantage being labeled with a diagnosis that forever haunts them, while those who don’t ever seek mental health treatment can sometimes be abusive and never carry around the label or the consequences of having a mental disorder forever imprinted on their records – the legal, social and employment.
Employment with the federal government, and other places that do background checks, comes to mind. Also divorce and child custody cases. It’s sad to think about the consequences of seeking professional help while those left to abuse have their credibility intact.
Good point. Of coure, there are no specific answers to these questions. Some who seek help from a professional benefit incredibly from the treatment and lose the diagnosis. Hopefully, we can all keep in mind that people are not “disorders.”
Teri
2:59 am on
March 10th, 2010I did read the DSMV proposal on PDs and found it confusing. Now there are scales for each trait, ranging from 0 to 4, with 0 being completely normal (don’t have the trait at all). So people would get a rating of 0-4 for a number of traits. So maybe the diagnosis then becomes numerical? Like, one might be classified as a 0-2-4-4-4? And maybe if the total is over a certain amount, you are judged to have a disorder? Who knows? I wish they had said we are doing away with 5 PD diagnoses, but in the new system, here is how those 5 should be specified, and then given an example for each one. Like maybe Dependent personality Disorder would now be classified as “Avoidant PD, dependent type” or something like that. Who knows. I did not think the explanation of the PD changes in the DSMV was clear at all.
No kidding. It is very confusing. Can you imagine the poor reliability if this goes through?
EF
11:56 pm on
March 28th, 2010Why isn’t the committee suggesting that Borderline Personality Disorder be re-labeled as an Axis 1 disorder? Classifying people with symptoms that best confirm to the current Borderline diagnosis as having a persistent “personality disorder” is just plain insulting and causes great stigma. It wasn’t too long ago that Borderline Personality Disorder was code for “difficult patient.” Also, many people diagnosed as Borderline get help from therapy or otherwise lose their diagnosis with time.
Also, they are making the Borderline Personality requirements even more negative by adding characteristics such as “lacks empathy.” What will happen to patients who have the current Borderline diagnosis but don’t meet the criteria for the new one? They still need help and insurance companies or the government won’t pay unless they have a disorder in the DSM.
The whole idea of personality “disorders” seems a bit shakey to me. Avoident Personality Disorder sounds exactly like extreme shyness or possibly Social Phobia. OCPD is a lot like OCD without insight or just someone who really like rules and order. And Antisocial Personality Disorder characterizes most career criminals and serial killers. Borderline should be re-classified as a mood disorder or in it’s own category but definitely as an Axis I disorder.
I think that the DSM should allow for the clinican to indicate a severe personality problem for the benefit of others working with the client, but I don’t think they should be labeled as “personality disorders.”
Hi EF,
Since I’m not on the committe, I don’t know their reasoning. You make several good points. There are many of us in the field that would like to see a way of describing individual symptoms without giving a label to justify treatment. Also, getting rid of Axis II has been talked about for decades. The problem remains there is no good way to stuff square pegs(people) into the round holes of the medical model.
anonymous
1:49 pm on
April 11th, 2010Dr. Smith, do you think the new DSM criteria for personality disorder traits will enable practitioners to label-diagnose-more people with PDs?
(Example) If someone doesn’t currently meet the criteria for Borderline because they have mild traits that don’t interfere with their life as much, say it’s emotional more than behavioral, would the new scales allow the therapist to now attach the Borderline dx to that person? Maybe I am looking at this incorrectly.
The stigma I often read about is sad. I read mental health blogs and forums where people state their diagnosis and talk about their personal issues. It seems like among Bipolar and Borderline communities, males state they were dx Bipolar, while females state their dx to be Borderline. Yet, to me, they often sound like they have the SAME issues.
I have read so many stories how women dx Borderline are treated by therapists-before the therapist even knows them, say when they are shopping for a therapist. I guess some people, regardless of PD classification, must be emotionally taxing to the therapist, and the therapist can only take on so many intense cases which may require more attention, but it saddens me to hear how women with Borderline are treated when so much is assumed a result of their “Borderlineness” when they are being totally honest about their feelings. I read with interest, as I am considering going back to school for psychology someday, or I might do advocacy work for mental health patients. (I am a patient myself, but I’m currently in a non-health related field of work.)
Thanks so much for your blog. It’s good to see clinicians discussing this openly. 
Anonymous
1:52 pm on
April 11th, 2010I should add – It seems the new criteria will not lead to a disappearance of PDs, but it may lead to more Personality Disorder diagnoses. Again, maybe I am looking at this incorrectly, but this is what it seems like to me. Thanks!
Anonymous: It’s pretty hard to say what will finally happen in 2013 (or later) when the new DSM comes out. The field of diagnosis is full of problems. Those of us who have practiced many years see “fads” of disorders that become popular for a while then decrease over time. I would personally like to see less time spent in diagnosing and more time spent in treating. Thanks for your comments! Take care.
Nyghtmaer13
10:09 pm on
September 24th, 2010DSM = fraud.
Matthew
9:35 pm on
January 28th, 2011My brother would be NPD in the DSMR4. We are trying to get him on SSDI, he has not worked in ten years, lived with my father until my dad died. Now we are struggling to get him treatment of anykind I wonder how this will effect our progress. NPD pegs him perfectly and probably has other disorders some serious delusions which could be considered schizophrenic but that seems inconsistent and occasional rather than the persistent NPD traits.
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