The New York Times’ Science Times Podcast moderated by Science editor David Corcoran Wednesday, related that “psychiatrists rewrite their diagnostic bible, but still have problems with the personality disorder entries.” The The Diagnostic and Statistical Manual of Mental Disorders (DSM) published by the American Psychiatric Association (APA) is the most prolific psychiatric manual used in the profession today. The most recently updated version is scheduled for publication in May of 2013. This weekend, the APA Board of Trustees will vote on whether to adopt a new diagnostic system for personality disorders.
The current DSM (IV) defines 10 personality disorders, organized in three groups of related and commonly co-occurring disorders: they are defined a Custer [group] A (the “odd, eccentric” cluster), Cluster B (the “dramatic, emotional, erratic” cluster), and Cluster C (the “anxious, fearful” cluster). The following cluster characteristics braise the surface of these complicated disorders.
Cluster A includes (1. Paranoid Personality Disorder : characterized by extreme distrust overshadowing thought processes, relationships, and interactions with other people. The person will seek to confirm fears and suspicions, and experiences oversensitivity to perceived failures. He or she may withdraw from relationships; (2. Schizoid Personality Disorder: characterized by an avoidance of the external world, including indifference to social norms, and inward contraction coupled with lack of emotional range; 3.) Schizotypal Personality Disorder: characterized by abnormalities in appearance, speech and behavior, and of anomalies in the thought process that resemble those of patients with schizophrenia.
Cluster B includes (1. Antisocial Personality Disorder: characterized by unsympathetic relation to the feelings of others. This person pays no attention to social norms or responsibilities, acts impulsively without remorse and does not learn from experience. (2. Borderline Personality Disorder: characterized by the lack of a sense of self coupled with feelings of void and fears of abandonment. He or she has trouble with relationships, experiencing emotional volatility, impulsive behavior and poor response (usually anger) to criticism; (3. Histrionic Personality Disorder: characterized by a lack of sense of self-worth coupled with constant vying for approval and dramatizing or ‘playing a part’ in order to (often inappropriately) attract and manipulate attention; (4. Narcissistic Personality Disorder: characterized by the person having a lavish sense of self-importance, self-entitlement, and a strong need to be admired.
Cluster C includes (1. Avoidant Personality Disorder: characterized by pervasive tension rooted the person’s belief that he or she is socially inadequate, unattractive, or inferior. The person consequently fears being embarrassed, criticized, or rejected; (2. Dependent Personality Disorder: characterized by an extreme lack of self-confidence coupled with an excessive need to be taken care of; (4. Obsessive-compulsive (anankastic) Personality Disorder : characterized by excessive preoccupation with details, lists, order, organization, rules, or schedules. Persons with this disorder experience such an extreme perfectionism that prevents tasks from being completed and interferes with productivity while sacrificing leisure and relationships.
A committee working on this section of the DSM-5 for over a year has had trouble agreeing on what to include and what to exclude from the manual. Despite the agreement amongst committee members that many of the diagnoses need to change, the lack of consensus means that the main diagnoses most likely remain the same in the new edition (DSM-5). In this case, the current proposal of revisions for personality disorders would be relegated to an appendix at the back of the manual.
Benedict Carey, who reports on behavior and brain science for the New York Times, wrote Monday in an article entitled, Thinking Clearly About Personality Disorders, the “the entire exercise has forced psychiatrists to confront one of the field’s most elementary, yet still unresolved, questions: What, exactly, is a personality problem?”
From the Podcast
David Corcoran: It seems we know these conditions when we see them, but precise definitions are proving to be maddeningly elusive. I asked Ben just what constitutes a personality disorder.
Benedict Carey: (from the podcast) “Well, a personality disorder is kind of an extreme personality type. It’s the kind of thing we recognize out in the world – you know, narcissism, or antisocial behavior, avoidant personalities, those kinds of things that we see pretty often in people we know and perhaps work with… but the personality disorder… what it means to psychiatrists is an extreme form that sort of describes an extremely disabling personality. Though, they aren’t [just] annoying traits of an otherwise functional person, but they are defining traits that get the person into serious trouble.”
Why all the commotion?
As Carey writes, For years they [those with personality disorders] have lived as orphans and outliers, a colony of misfit characters on their own island: the bizarre one and the needy one, the untrusting and the crooked, the grandiose and the cowardly.” The APA should have a real motivation to do what it takes to define the personality disorders as they are the definitive expert on the subject. Without their effort, psychiatry will continue to “fail the sort of patients that no other field could possibly help [in the same way].”
The most pervasive disorder and effective therapy
Borderline Personality Disorder (BPD) is the most common personality disorder, occurring in about 2% of the adult population. Typically, treatment includes psychotherapy. Persons with (BPD) need to learn emotion management, coping and life skills that go beyond a medication regimen. Marsha Linehan’s Dialectical Behavior Therapy is the most successful and effective psychotherapeutic approach to date. Research on this treatment method has proven it more effective than most alternative methods. The therapy is a comprehensive approach that teaches the client how to educate him or herself to more adequately take control of life situations, emotional states, and their person personal experience through self-knowledge, emotion regulation, and cognitive restructuring.
Carey, Benedict. “Thinking Clearly About Personality Disorders.” New York Times <http://www.nytimes.com/2012/11/27/health/clearing-the-fog-around-persona… 28 Nov. 2012
New York Times. Science Times podcast, November 27, 2012. 28 Nov. 2012
Psychology Today. “The 10 Personality Disorders.” < http://www.psychologytoday.com/blog/hide-and-seek/201205/the-10-personal… 28 Nov. 2012