DSM-V: Personality disorder revamp ends in ‘horrible waste’

Rather than receiving intensive psychotherapy, which can be effective, patients with personality disorders often get treated for the anxiety and depression that can be triggered by their difficulties with social interaction.

Personality disorder revamp ends in ‘horrible waste’

11:00 03 December 2012 by Peter Aldhous

A planned overhaul of the way in which personality disorders are diagnosed will not now appear in the manual dubbed “the bible of psychiatry”.

The failure to agree a workable system for the next edition of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, known as DSM-5 is bad news for people with serious personality difficulties, who are frequently misdiagnosed.

“It’s a horrible wasted opportunity,” says Jonathan Shedler of the University of Colorado School of Medicine in Denver, one of the fiercest critics of the rejected new system.

Personality disorders revolve around difficulties in relating to other people, but can manifest in different ways. Experts agree that the system in the current DSM, which dates from 1994, is seriously flawed. It features a bewildering set of symptoms and checklists that attempts to match patients to one of 10 disorders.

Symptoms, not cause

The problem is that patients may end up being diagnosed with several disorders at the same time, while others with seriously disturbed personalities don’t clearly meet any of the diagnoses. Add this confusion to the commonly held but outdated view that personality disorders can’t be treated, and many patients never get the help they need.

Rather than receiving intensive psychotherapy, which can be effective, patients with personality disorders often get treated for the anxiety and depression that can be triggered by their difficulties with social interaction. Others get misdiagnosed as suffering from attention-deficit hyperactivity disorder or even post-traumatic stress disorder.

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