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.
Personality (oversimplified) refers to the patterns of behavior, emotional responses, and characteristics that tend to be stable for a long period of time. Personality disorders, as previously defined in the DSM IV, were patterns of behavior and experience that were inflexible, pervasive, stable, and led to distress and impairment. Ten personality disorders were identified. Since the DSM IV was first published in 1994, the diagnosis of personality disorders has been fraught with problems. For example, personality by definition was supposed to be stable, yet people diagnosed with one personality disorder tended to lose that diagnosis or switch to another diagnosis over time. That didn’t make sense.
Another problem with the diagnosis was that if someone had one personality disorder it was quite likely that he or she would also have another personality disorder. And finally, the DSM IV suggested that personality disorders were all or none—for example, someone with Borderline Personality Disorder had five out of nine symptoms. So, if a person only had 4, she wouldn’t “qualify” for the diagnosis. Perhaps it’s not surprising that the most common diagnosis given by mental health practitioners is Personality Disorder Not Otherwise Specified (301.9 Personality Disorder NOS).
The revision of the DSM hopes to address these problems by eliminating a number of diagnoses that were not strongly supported as reliable and valid. The current plan is to eliminate simple symptom checklists and provide a narrative description of traits for each personality disorder. The diagnosis will be made by assigning ratings indicating degree of severity.
We look forward to these developments and especially appreciate the emphasis on severity ratings as opposed to the previous all or none approach to assigning such diagnoses. (In other words, you either had one or you didn’t rather than having a small to a large amount of it.) See our earlier blog post What’s the Difference between Swine Flu, Depression, and Pregnancy?
The categories that were retained include:
- Borderline Personality Disorder (emotionally volatile, fearful of abandonment, and impulsive)
- Schizotypal (eccentric, odd, and detached)
- Antisocial/psychopathic (disregard for others, lack empathy, and break rules)
- Avoidant (hypersensitive to evaluation, fearful, and feelings of inadequacy)
- Obsessive Compulsive Personality Disorder (cold, rule bound, perfectionistic, orderly)
In the meantime, we can all say goodbye to the following personality disorders as they will no longer appear in DSM V:
- Paranoid Personality Disorder (highly distrusting and suspicious)
- Schizoid Personality Disorder (detached and emotionless)
- Histrionic Personality Disorder (dramatic and attention seeking)
- Narcissistic Personality Disorder (self aggrandizing and lack of empathy)
- Dependent Personality Disorder (clingy and submissively helpless)
Does anyone know where they went?