The Diagnostic and Statistical Manual (DSM) - Pros and Cons
2569
Reference & Education > Psychology
Mar 1, 2007
Sam Vaknin
The Diagnostic and Statistical Manual (DSM) - Pros and Cons
The Diagnostic and Statistical Manual, fourth edition, text revision [American Psychiatric Association. DSM-IV-TR, Washington, 2000] - or the DSM-IV-TR for short - describes Axis II personality disorders as "deeply ingrained, maladaptive, lifelong behavior patterns". But the classificatory model the DSM has been using since 1952 is harshly criticized as woefully inadequate by many scholars and practitioners.
The DSM is categorical. It states that personality disorders are "qualitatively distinct clinical syndromes" (p. 689). But this is by no means widely accepted. As we saw in my previous article and blog entry, the professionals cannot even agree on what constitutes "normal" and how to distinguish it from the "disordered" and the "abnormal". The DSM does not provide a clear "threshold" or "critical mass" beyond which the subject should be considered mentally ill.
Moreover, the DSM's diagnostic criteria are ploythetic. In other words, suffice it to satisfy only a subset of the criteria to diagnose a personality disorder. Thus, people diagnosed with the same personality disorder may share only one criterion or none. This diagnostic heterogeneity (great variance) is unacceptable and non-scientific.
In another article we deal with the five diagnostic axes employed by the DSM to capture the way clinical syndromes (such as anxiety, mood, and eating disorders), general medical conditions, psychosocial and environmental problems, chronic childhood and developmental problems, and functional issues interact with personality disorders.
Yet, the DSM's "laundry lists" obscure rather than clarify the interactions between the various axes. As a result, the differential diagnoses that are supposed to help us distinguish one personality disorder from all others, are vague. In psych-parlance: the personality disorders are insufficiently demarcated. This unfortunate state of affairs leads to excessive co-morbidity: multiple personality disorders diagnosed in the same subject. Thus, psychopaths (Antisocial Personality Disorder) are often also diagnosed as narcissists (Narcissistic Personality Disorder) or borderlines (Borderline Personality Disorder).
The DSM also fails to distinguish between personality, personality traits, character, temperament, personality styles (Theodore Millon's contribution) and full-fledged personality disorders. It does not accommodate personality disorders induced by circumstances (reactive personality disorders, such as Milman's proposed "Acquired Situational Narcissism"). Nor does it efficaciously cope with personality disorders that are the result of medical conditions (such as brain injuries, metabolic conditions, or protracted poisoning). The DSM had to resort to classifying some personality disorders as NOS "not otherwise specified", a catchall, meaningless, unhelpful, and dangerously vague diagnostic "category".
One of the reasons for this dismal taxonomy is the dearth of research and rigorously documented clinical experience regarding both the disorders and various treatment modalities. Read this week's article to learn about the DSM's other great failing: many of the personality disorders are "culture-bound". They reflect social and contemporary biases, values, and prejudices rather than authentic and invariable psychological constructs and entities.
The DSM-IV-TR distances itself from the categorical model and hints at the emergence of an alternative: the dimensional approach:
?An alternative to the categorical approach is the dimensional perspective that Personality Disorders represent maladaptive variants of personality traits that merge imperceptibly into normality and into one another? (p.689)
According to the deliberations of the DSM V Committee, the next edition of this work of reference (due to be published in 2010) will tackle these long neglected issues:
The longitudinal course of the disorder(s) and their temporal stability from early childhood onwards;
The genetic and biological underpinnings of personality disorder(s);
The development of personality psychopathology during childhood and its emergence in adolescence;
The interactions between physical health and disease and personality disorders;
The effectiveness of various treatments - talk therapies as well as psychopharmacology. Sam Vaknin ( samvak.tripod.com ) is the author of Malignant Self Love - Narcissism Revisited and After the Rain - How the West Lost the East. He served as a columnist for Global Politician, Central Europe Review, PopMatters, Bellaonline, and eBookWeb, a United Press International (UPI) Senior Business Correspondent, and the editor of mental health and Central East Europe categories in The Open Directory and Suite101. Until recently, he served as the Economic Advisor to the Government of Macedonia. Visit Sam's Web site at samvak.tripod.com
The DSM is categorical. It states that personality disorders are "qualitatively distinct clinical syndromes" (p. 689). But this is by no means widely accepted. As we saw in my previous article and blog entry, the professionals cannot even agree on what constitutes "normal" and how to distinguish it from the "disordered" and the "abnormal". The DSM does not provide a clear "threshold" or "critical mass" beyond which the subject should be considered mentally ill.
Moreover, the DSM's diagnostic criteria are ploythetic. In other words, suffice it to satisfy only a subset of the criteria to diagnose a personality disorder. Thus, people diagnosed with the same personality disorder may share only one criterion or none. This diagnostic heterogeneity (great variance) is unacceptable and non-scientific.
In another article we deal with the five diagnostic axes employed by the DSM to capture the way clinical syndromes (such as anxiety, mood, and eating disorders), general medical conditions, psychosocial and environmental problems, chronic childhood and developmental problems, and functional issues interact with personality disorders.
Yet, the DSM's "laundry lists" obscure rather than clarify the interactions between the various axes. As a result, the differential diagnoses that are supposed to help us distinguish one personality disorder from all others, are vague. In psych-parlance: the personality disorders are insufficiently demarcated. This unfortunate state of affairs leads to excessive co-morbidity: multiple personality disorders diagnosed in the same subject. Thus, psychopaths (Antisocial Personality Disorder) are often also diagnosed as narcissists (Narcissistic Personality Disorder) or borderlines (Borderline Personality Disorder).
The DSM also fails to distinguish between personality, personality traits, character, temperament, personality styles (Theodore Millon's contribution) and full-fledged personality disorders. It does not accommodate personality disorders induced by circumstances (reactive personality disorders, such as Milman's proposed "Acquired Situational Narcissism"). Nor does it efficaciously cope with personality disorders that are the result of medical conditions (such as brain injuries, metabolic conditions, or protracted poisoning). The DSM had to resort to classifying some personality disorders as NOS "not otherwise specified", a catchall, meaningless, unhelpful, and dangerously vague diagnostic "category".
One of the reasons for this dismal taxonomy is the dearth of research and rigorously documented clinical experience regarding both the disorders and various treatment modalities. Read this week's article to learn about the DSM's other great failing: many of the personality disorders are "culture-bound". They reflect social and contemporary biases, values, and prejudices rather than authentic and invariable psychological constructs and entities.
The DSM-IV-TR distances itself from the categorical model and hints at the emergence of an alternative: the dimensional approach:
?An alternative to the categorical approach is the dimensional perspective that Personality Disorders represent maladaptive variants of personality traits that merge imperceptibly into normality and into one another? (p.689)
According to the deliberations of the DSM V Committee, the next edition of this work of reference (due to be published in 2010) will tackle these long neglected issues:
The longitudinal course of the disorder(s) and their temporal stability from early childhood onwards;
The genetic and biological underpinnings of personality disorder(s);
The development of personality psychopathology during childhood and its emergence in adolescence;
The interactions between physical health and disease and personality disorders;
The effectiveness of various treatments - talk therapies as well as psychopharmacology. Sam Vaknin ( samvak.tripod.com ) is the author of Malignant Self Love - Narcissism Revisited and After the Rain - How the West Lost the East. He served as a columnist for Global Politician, Central Europe Review, PopMatters, Bellaonline, and eBookWeb, a United Press International (UPI) Senior Business Correspondent, and the editor of mental health and Central East Europe categories in The Open Directory and Suite101. Until recently, he served as the Economic Advisor to the Government of Macedonia. Visit Sam's Web site at samvak.tripod.com
Write a Review
Add to My Favorite
Refer it to Friend
Report Article
Other links owned by this user
Most politicians bend the laws of the land and steal money or solicit bribes because they need the funds to support networks of patronage. Others do it in order to reward their nearest and dearest or to maintain a lavish lifestyle when their political
Category:
(The author was among the first contributors to Nupedia, the Wikipedia's peer-reviewed predecessor, and spent six years, on and off, studying the Wikipedia) It is a question of time before the Wikipedia self-destructs and
Category:
I use words as others use algebraic signs: with meticulousness, with caution, with the precision of the artis. I sculpt in words. I stop. I tilt my head. I listen to the echoes. The tables of emotional resonce. The fine tuned reverberations of pain
Category:
Are we human because of unique traits and attributes not shared with either animal or machine? The n of "human" is circular: we are human by virtue of the properties that make us human (i.e., distinct from animal and machine). It is a
Category:
In their opus magnum "Personality Disorders in Modern Life", Theodore Millon and Roger Davis define personality as: "(A) complex pattern of deeply embedded ychological characteristics that are expressed automatically in almost every area of
Category:
The father in the Roman family (paterfamilias) exercised absolute and lifelong power over all other family members (patria potestas): his wife, children, and slaves. If the father's father was alive - then he was the supreme authority in the household.
Category:
The most beautiful experience we can have is the mysterious. It is the fundamental emotion that stands at the cradle of true art and true science." Albert Einstein, The World as I See It, 1931 The debate between realism and
Category:
Thought experiments (Gedankenexperimenten) are "facts" in the sense that they have a "real life" correlate in the form of electrochemical activity in the brain. But it is quite obvious that they do not relate to facts "out there". They are not true
Category:
There are many kinds of narratives and organizing principles. Science is driven by evidence gathered in experiments, and by the falsification of extant theories and their replacement with newer, asymptotically truer, ones. Other systems - religion,
Category:
The DSM-IV-TR (2000) defines a personality disorder as: "An enduring pattern of inner experience and behavior that deviates markedly from the expectations the individuals culture (and is manifested in two or more of his or her areas of mental
Category:
Personality traits enduring, usually rigid patterns of behavior, thinking (cognition), and emoting expressed in a variety of circumstances and situations and throughout one's life (typically from early adolescence onward). Some personality traits
Category:
Psychology is more an art form than a science. There is no "Theory of Everything" from which one can derive all mental health phenomena and make falsifiable predictions. Still, as far as personality disorders are concerned, it is easy to discern common
Category:
13. Slush Funds
According to David McClintick ("Swordfish: A True Story of Ambition, Savagery, and Betrayal"), in the late 1980's, the FBI and DEA set up dummy corporations to deal in drugs. They funneled into these corporate fronts money from drug-related asset
Category:
There is an often missed distinction between Being the First, Being Original, and Being Innovative. To determine that someone (or something) has been the first, we need to apply a temporal test. It should answer at least three questions:
Category:
The history of the Cathoic Church reads ike the annas of a goba crime concern. It gave the word the inquisition, incestuous and murderous popes, reigious warfare, pedophiiac sex scandas, idoatry, and the gnawing guit that comes from embracing
Category:
The preservation of human life is the ultimate vue, a pillar of ethics and the foundation of l mority. This held true in most cultures and societies throughout history. On first impression, the last sentence sounds patently wrong. We
Category:
With the exception of Nietzsche, no other madman has contributed so much to human sanity as has Louis Althusser. He is mentioned twice in the Encyclopaedia Britannica as someone's teacher. There could be no greater lapse: for two important decades (the
Category:
Incrementally, but noticeably, the United States is shedding its democracy. Hard-won civil liberties are willingly sacrificed for the sake of illusory added security. Institutions are stacked with political, partisan appointees who do their
Category:
19. The New Politics
Politics, in all its forms, is bankrupt. The notion that we can safely and successfully hand over the management of our daily lives and the setting of priorities to a political class or elite is thoroughly discredited. Politicians cannot be trusted,
Category:
Personality disorders are dysfunctions of our whole identity, tears in the fabric of who we are. They are all-pervasive because our personality is ubiquitous and permeates each and every one of our mental cells. I just published the first article in this
Category:
Other links at Reference & Education > Psychology
The reasons for initially trying different socially acceptable legal drugs (e.g. alcohol, cigarettes, etc.), and/ or illegal drugs, or for that matter any addictive behavior involvement (e.g. gambling, binge-eating, etc.) are multi-factored (e.g.
Category:
So you?ve decided to go on a diet and shed those few extra pounds you put on to keep you warm through winter. You?ve filled yourself full of good intentions and are eating a healthy diet with none of those terribly unhealthy foods that you used to enjoy
Category:
Recent hedline: ?Rod Rge my be due to medicl condition clled Intermittent Explosive Disorder (IED)? WHAT IS THE SCIENCE BEHIND THIS? The study, reported in the June (2006) issue of the Archives of Generl Psychitry ws bsed on
Category:
How To Solve Persistent And Frustrating Problems "To exist is to change, to change is to mature, to mature is to go on creating oneself endlessly,? said Henri Bergson. Life is a creative act. It is a series of
Category:
This type of worker has an attachment to a perfect result. Before going on, let us make a clarification between three totally different things: First, there is the effort we make in a certain task we are doing. Next comes the result of that effort.
Category:
Site Sponsor
Directory Statistics
Articles: 68214
Categories: 501
Yahoo Entertainment
