DSM V--Personality DO's

[Chimed]

http://www.nytimes.com/2010/11/30/health/views/30mind.html?_r=1

This is an interesting article about the change in personality disorder criteria in the DSM V. I'm still not sure what to think about the "dimensional approach" and am willing to keep open minded to both sides of the argument. However, I have to admit that I don't think it's such a bad idea. After all, think about how many patients we see that don't fit a cookie cutter description in the DSM, and yet you know they have an illness that is impairing function.

I'd be curious what others think.

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[dl2dp2]

I concur with you that this might be a really good idea for a few reasons.

(1) more quantifiable diagnoses gives more traction in research, evidence based therapy etc. One can say, this guy has 3 out of 7 criteria for "borderline traits", and DBT works 80% effectiveness, etc. Indeed, this kind of thing should be done on all diagnoses (as they are done in many of the more academic oriented practices, where instruments like HAM-D are used extensively).

(2) This will likely improve clinical care as well in improving intersubject rating reliability.

(3) Patients will feel less stigmatized, I think, if we handed them instead of a archio-prototype (or stereotype) of say "borderline personality disorder", we have a more detailed report of what are the PO dimensional analysis of this patient, almost like an echo report.

(4) specific therapy, especially pharmacology, may correct some aspects of personality disorders but not others, and this can be used to justify the use of pharma. Or for that matter psychoanalytic treatment.

(5) moving psychiatry further away from a narrative specialty to a scientific specialty (one might argue this is not a good thing.)

On the other hand, my optimism is guarded. There were a lot of attempts in classifying schizophrenia more carefully based on clinical phenomenology, and very few of them proved very useful in eventual management. It's questionable whether and how much nosology without understanding mechanism can yield significant progress.

 

[DrGachet]

The new system may be less attractive to therapists with BPD.

I honestly don't know which is better. I think a lot of it depends on insurance providers. That's why psychiatrists use DSM in the first place, right? I mean, seriously, why categorize mental illness by symptom cluster instead of physiological or psychological causes? I haven't looked at the research behind this new system to see if it's more valid (whatever that means) and more reliable.

But I'm really gonna miss NPD. It sounded very decisive. And I used it often to describe people who got on my nerves. But this new system definitely has the look of science, you know, with the percentages and numbers and all...it scares away pretenders.

 

[Cruzinman]

If NPD is eliminated from DSM V a lot of physicians will feel better about themselves. We will give them all more reasons to be ego syntonic about their abrassive personality styles.