Comments on: Personality disorders, the DSM, and the future of diagnosis http://blog.oup.com/2012/12/personality-disorders-the-dsm-and-the-future-of-diagnosis/ Academic insights for the thinking world. Wed, 22 May 2013 12:48:47 +0000 hourly 1 http://wordpress.org/?v=3.4.2 By: Patrick http://blog.oup.com/2012/12/personality-disorders-the-dsm-and-the-future-of-diagnosis/#comment-424093 Patrick Wed, 22 May 2013 05:33:05 +0000 http://blog.oup.com/?p=32284#comment-424093 Professor Shorter, Thanks for your work on the history of psychopathology. As a practicing psychotherapist of 16 years and a student of theory, I have reached the conclusion that much of the diagnosis that takes place these days is essentially a way of characterizing various aspects of the human condition as biologically determined medical conditions. Perhaps personality problems shouldn't be in a medical book (the DSM) but historically at least they have conveyed a different meaning to people about the nature of their suffering and, therefore, about what might be done about it. Our understanding of psychopathology seems to be in an early stage of development and it is epistemologically very messy. Why not simply acknowledge this and use our diagnostic system clinically as a work in progress? Professor Shorter, Thanks for your work on the history of psychopathology. As a practicing psychotherapist of 16 years and a student of theory, I have reached the conclusion that much of the diagnosis that takes place these days is essentially a way of characterizing various aspects of the human condition as biologically determined medical conditions. Perhaps personality problems shouldn’t be in a medical book (the DSM) but historically at least they have conveyed a different meaning to people about the nature of their suffering and, therefore, about what might be done about it. Our understanding of psychopathology seems to be in an early stage of development and it is epistemologically very messy. Why not simply acknowledge this and use our diagnostic system clinically as a work in progress?

]]> By: Liz http://blog.oup.com/2012/12/personality-disorders-the-dsm-and-the-future-of-diagnosis/#comment-322156 Liz Sun, 09 Dec 2012 14:24:14 +0000 http://blog.oup.com/?p=32284#comment-322156 I see it as a spectrum disorder. I have no professional background in treatment or diagnosis, but I was married in to a family where personality disorders are sprinkled thru in a distribution like eye color. I hadn't heard the asshole line before, but that's what my ex and his seven siblings called their dad. And there are manifestations of his personality down to one of my own children. What I gradually picked up on in my father in law and his sister was an innate narcissim, an inabilty to empathize. As very intelligent people they knew that acting empathetic was what society calls for, and they were successful to a point. I have found that when things are going well it's easy for personality disorders to blend in. When shit hits the fan, coping becomes more difficult. What I see in my daughter is what I saw in my husband, an inability to form strong bonds. My ex doesn't see that his daughter is like him he just sees that she has a difficult personality like his sister's. My other children both adore and are perplexed and angered by their sister (they are teens and young adults). I don't speak of my armchair diagnosis as I don't know what good it would do. My daughter has been in therapy before and now as an adult can make her own choices. She is not as strongly effected as the her two aunts that I've seen the same thing in, so I hope she will learn to deal with what's she's been dealt. She's not yet at an age when she'll listen tto her mother and a gentle warning (I thought) to watch for tendancies to 'fly off the handle' like her aunts was not well received. But it is fascinating at some level. About fifteen years ago when I first started noticing this trait there was a big family wedding on my ex's side, rare since there is such a fractious element. but they are an attractive and fairly well-off bunch and have reproduced widely so here we all were. And I spent the day quietly them out. And by nightfall, after a few drinks and the tensions that accompany any large gathering the PD people were not doing well. They were either leaving early or getting that last word in what would become the new relationship fault line down the road. I wish there was an easy answer for this; a pill to take. I think it's part of brain chemistry, almost (and maybe related to) a genetic disposition to having a bad temper. I see it as a spectrum disorder. I have no professional background in treatment or diagnosis, but I was married in to a family where personality disorders are sprinkled thru in a distribution like eye color. I hadn’t heard the asshole line before, but that’s what my ex and his seven siblings called their dad. And there are manifestations of his personality down to one of my own children.

What I gradually picked up on in my father in law and his sister was an innate narcissim, an inabilty to empathize. As very intelligent people they knew that acting empathetic was what society calls for, and they were successful to a point. I have found that when things are going well it’s easy for personality disorders to blend in. When shit hits the fan, coping becomes more difficult.

What I see in my daughter is what I saw in my husband, an inability to form strong bonds. My ex doesn’t see that his daughter is like him he just sees that she has a difficult personality like his sister’s. My other children both adore and are perplexed and angered by their sister (they are teens and young adults). I don’t speak of my armchair diagnosis as I don’t know what good it would do. My daughter has been in therapy before and now as an adult can make her own choices. She is not as strongly effected as the her two aunts that I’ve seen the same thing in, so I hope she will learn to deal with what’s she’s been dealt. She’s not yet at an age when she’ll listen tto her mother and a gentle warning (I thought) to watch for tendancies to ‘fly off the handle’ like her aunts was not well received.

But it is fascinating at some level. About fifteen years ago when I first started noticing this trait there was a big family wedding on my ex’s side, rare since there is such a fractious element. but they are an attractive and fairly well-off bunch and have reproduced widely so here we all were. And I spent the day quietly them out. And by nightfall, after a few drinks and the tensions that accompany any large gathering the PD people were not doing well. They were either leaving early or getting that last word in what would become the new relationship fault line down the road. I wish there was an easy answer for this; a pill to take. I think it’s part of brain chemistry, almost (and maybe related to) a genetic disposition to having a bad temper.

]]> By: Mike http://blog.oup.com/2012/12/personality-disorders-the-dsm-and-the-future-of-diagnosis/#comment-322022 Mike Sun, 09 Dec 2012 10:17:06 +0000 http://blog.oup.com/?p=32284#comment-322022 "[Kraepelin's] list is interesting because it is very different from our own: the “excitable”; the irresolute; those driven by pleasure to seek out alochol, gambling, and who generally become wastrels; the eccentric; the liars and swindlers; and the quarrelsome, sometimes called the querulants" Is this list really so different from our own? "excitable" = mood disorders; 'those driven by pleasure to seek out alcohol, gambling etc.' = addictive personality; 'liars and swindlers' = sociopathic tendencies, etc.etc. "And what kind of disorder was this anyway, an illness in which the identified patient thinks he personally is fine but is making everyone around him unhappy? This is not like psychosis." In my experience this is quite common with psychosis. “[Kraepelin's] list is interesting because it is very different from our own: the “excitable”; the irresolute; those driven by pleasure to seek out alochol, gambling, and who generally become wastrels; the eccentric; the liars and swindlers; and the quarrelsome, sometimes called the querulants”

Is this list really so different from our own? “excitable” = mood disorders; ‘those driven by pleasure to seek out alcohol, gambling etc.’ = addictive personality; ‘liars and swindlers’ = sociopathic tendencies, etc.etc.

“And what kind of disorder was this anyway, an illness in which the identified patient thinks he personally is fine but is making everyone around him unhappy? This is not like psychosis.”

In my experience this is quite common with psychosis.

]]> By: Mark http://blog.oup.com/2012/12/personality-disorders-the-dsm-and-the-future-of-diagnosis/#comment-321639 Mark Sat, 08 Dec 2012 21:19:30 +0000 http://blog.oup.com/?p=32284#comment-321639 Working in community mental healh and having had a relationshiip with a guy wih Borderline PD I've seen this, and other conditions, up close, too close at some times. BPD has a pretty loose definition but the range of behaviours are surprisingly consistent. Charismatic, superficial, a complete inability to regulate their emotions, a terror of being abandoned, and not because they will be alone but because they will cease to exist. This terror motivates highly manipulative and extreme behaviour usually exacerbated by drug use. The aim? A relationship that is alternatively, clung to with the same intensity as a drowning man, and destroyed through controlling behaviour, threats of suicide, violence and degrading acts, with no acceptance of personal responsibility. A nightmare in a relationship, chaotic and time consuming in a work environment. I have seen this set of behaviours change, most consistently through an acceptance of personal responsibility and learning techniques, such as mindfullness meditation to lessen the overwhelming emotional ride. It would be a bitch of a condition to have so I sympathise but they cannot be "saved", supported, yes.....at a distance Working in community mental healh and having had a relationshiip with a guy wih Borderline PD I’ve seen this, and other conditions, up close, too close at some times.
BPD has a pretty loose definition but the range of behaviours are surprisingly consistent.
Charismatic, superficial, a complete inability to regulate their emotions, a terror of being abandoned, and not because they will be alone but because they will cease to exist.
This terror motivates highly manipulative and extreme behaviour usually exacerbated by drug use. The aim? A relationship that is alternatively, clung to with the same intensity as a drowning man, and destroyed through controlling behaviour, threats of suicide, violence and degrading acts, with no acceptance of personal responsibility.
A nightmare in a relationship, chaotic and time consuming in a work environment.
I have seen this set of behaviours change, most consistently through an acceptance of personal responsibility and learning techniques, such as mindfullness meditation to lessen the overwhelming emotional ride.
It would be a bitch of a condition to have so I sympathise but they cannot be “saved”, supported, yes…..at a distance

]]> By: Rob http://blog.oup.com/2012/12/personality-disorders-the-dsm-and-the-future-of-diagnosis/#comment-321524 Rob Sat, 08 Dec 2012 18:02:58 +0000 http://blog.oup.com/?p=32284#comment-321524 The last paragraph seems to imply that drugs are the only way for psychiatrists to treat mental illnesses. Was this implication intended? The last paragraph seems to imply that drugs are the only way for psychiatrists to treat mental illnesses. Was this implication intended?

]]> By: Picking Apart Personalities | The Penn Ave Post http://blog.oup.com/2012/12/personality-disorders-the-dsm-and-the-future-of-diagnosis/#comment-321423 Picking Apart Personalities | The Penn Ave Post Sat, 08 Dec 2012 14:45:23 +0000 http://blog.oup.com/?p=32284#comment-321423 [...] Apart Personalities Posted at 10:45 on December 8, 2012 by Andrew Sullivan Edward Shorter spotlights the difficulty in diagnosing personality disorders: Psychiatrists had a seat-of-the pants [...] [...] Apart Personalities Posted at 10:45 on December 8, 2012 by Andrew Sullivan Edward Shorter spotlights the difficulty in diagnosing personality disorders: Psychiatrists had a seat-of-the pants [...]

]]> By: Clare http://blog.oup.com/2012/12/personality-disorders-the-dsm-and-the-future-of-diagnosis/#comment-318401 Clare Tue, 04 Dec 2012 13:04:24 +0000 http://blog.oup.com/?p=32284#comment-318401 I felt compelled to respond to your article, as someone with a diagnosed personality disorder I feel that the uninformed prejudice of your piece adds to the stigma that I and others like me have to endure on a daily basis. I was born with an inability to regulate my emotions, research is being conducted in order to ascertain the cause of this problem but just because neurology hasn't quite got there yet, does not mean that it isn't real. Just because medicine hasn't found a pill that eases my symptoms it does not mean they don't actually exist. I understand the argument that psychiatric conditions are quite often a social construct, but your article only looks at personality disorders from one point of view: that the disordered are quite happy being "assholes", it's the rest of the world that has to suffer, because we "can’t quite get it all together". My personality disorder materialised from a desperate need to make people like me so that they would stop hurting me, the emotional disregulation meant that I could not cope with the mistreatment I suffered as a child. I am therefore the most considerate, caring person you could meet, the suffering is internal. And considerable. I have made many sincere attempts to end my life because of it. How do you suggest I receive treatment for my condition? I am not entirely convinced that my personality disorder is an illness but I do need help and support to overcome the difficulties it has presented to me. In our culture that process is medicalised, whether that is right or wrong it is a fact. Where else would you like us to go or would you prefer if we suffered in silence? I felt compelled to respond to your article, as someone with a diagnosed personality disorder I feel that the uninformed prejudice of your piece adds to the stigma that I and others like me have to endure on a daily basis.

I was born with an inability to regulate my emotions, research is being conducted in order to ascertain the cause of this problem but just because neurology hasn’t quite got there yet, does not mean that it isn’t real. Just because medicine hasn’t found a pill that eases my symptoms it does not mean they don’t actually exist.

I understand the argument that psychiatric conditions are quite often a social construct, but your article only looks at personality disorders from one point of view: that the disordered are quite happy being “assholes”, it’s the rest of the world that has to suffer, because we “can’t quite get it all together”. My personality disorder materialised from a desperate need to make people like me so that they would stop hurting me, the emotional disregulation meant that I could not cope with the mistreatment I suffered as a child. I am therefore the most considerate, caring person you could meet, the suffering is internal. And considerable. I have made many sincere attempts to end my life because of it.

How do you suggest I receive treatment for my condition? I am not entirely convinced that my personality disorder is an illness but I do need help and support to overcome the difficulties it has presented to me. In our culture that process is medicalised, whether that is right or wrong it is a fact. Where else would you like us to go or would you prefer if we suffered in silence?

]]> By: Debbie Corso http://blog.oup.com/2012/12/personality-disorders-the-dsm-and-the-future-of-diagnosis/#comment-317386 Debbie Corso Mon, 03 Dec 2012 04:51:45 +0000 http://blog.oup.com/?p=32284#comment-317386 My name is Debbie, and I have Borderline Personality Disorder. Although medication is not typically used to treat this disorder, there is an effective therapy called Dialectical Behavior Therapy (DBT) that focuses on behavior modification and changing the way one thinks and responds to intense distress and difficulty with regulating emotions. I get the sense from your article that, because personality disorders aren't treated with medication as some other mental (and most physical) illnesses are, that they are not "real." I can tell you that the manifestation of one "not having their lives together" is a culmination of a fractured sense of self and other symptoms commonly present with the disorder that I suffer from. There is help available. People with this particular type of personality disorder can and do get better with DBT. My name is Debbie, and I have Borderline Personality Disorder. Although medication is not typically used to treat this disorder, there is an effective therapy called Dialectical Behavior Therapy (DBT) that focuses on behavior modification and changing the way one thinks and responds to intense distress and difficulty with regulating emotions.

I get the sense from your article that, because personality disorders aren’t treated with medication as some other mental (and most physical) illnesses are, that they are not “real.”

I can tell you that the manifestation of one “not having their lives together” is a culmination of a fractured sense of self and other symptoms commonly present with the disorder that I suffer from.

There is help available. People with this particular type of personality disorder can and do get better with DBT.

]]> By: University Diaries » Edward Shorter, author of the forthcoming, wonderfully titled… http://blog.oup.com/2012/12/personality-disorders-the-dsm-and-the-future-of-diagnosis/#comment-317015 University Diaries » Edward Shorter, author of the forthcoming, wonderfully titled… Sun, 02 Dec 2012 15:36:03 +0000 http://blog.oup.com/?p=32284#comment-317015 [...] How Everyone Became Depressed: The Rise and Fall of the Nervous Breakdown, talks about how doctors diagnose personality disorders. The most recent edition of the DSM series, [...] [...] How Everyone Became Depressed: The Rise and Fall of the Nervous Breakdown, talks about how doctors diagnose personality disorders. The most recent edition of the DSM series, [...]

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