Psychiatr News February 2, 2007
Volume 42, Number 3, page 29
© 2007 American Psychiatric Association
DSM Recommendation
Roger Peele, M.D.
Rockville, Md.
Maryam Razavi, M.D.
Washington, D.C.
The recent headlines about someone being discharged from the Army with a
"personality disorder" is a reminder that in 2002 the Washington
Psychiatric Society and the Maryland Psychiatric Society voted to ask APA to
remove the word "personality" from the titles of present disorders
(e.g., "histrionic disorder" rather than "histrionic
personality disorder"). There is no reason to label some of the
psychiatrically ill with DSM-IV's "personality"
disorders."
The 10 aggregations of signs that constitute DSM-IV's 10
"personality" disorders do not reflect the total
"personality" of patients any more than does autism, Asperger's,
mental retardation, schizophrenia, and so forth. Nor are the so-called
"personality" conditions any more permanent or pervasive than many
other psychiatric disorders. Both borderline "personality"
disorder and antisocial "personality" disorder, for example, often
remit spontaneously by their fifth decade, some far sooner.
The label "personality" disorder misleads patients, family
members, employers, insurance companies, and even some clinicians to think of
these patients as having pervasive and permanent psychiatric conditions, i.e.,
untreatable. APA should take steps to remove misleading diagnostic labels.
Labeling people with these disorders as having a "personality"
disorder is hurtful. They may have very positive personalities in many
respects, yet suffer from an aggregation of signs that historically APA has
labeled a "personality" disorder. APA should remove unnecessarily
hurtful diagnostic terms.
The concept of "personality" disorder contributes to
misdiagnosing the patient's problems because of clinicians' reluctance to
apply the "personality disorder" label to patients, particularly
to children and adolescents. This barrier leads to postponing, if not
precluding, correct treatment. APA should take steps to change the diagnostic
categories when the change will encourage appropriate care and treatment.
The so-called "personality" disorders incorrectly imply a
relationship to the basic science on personality. These 10 aggregations are
inadequate, if not misleading, in facilitating communication between
clinicians treating patients and researchers studying personality. Leaving the
word "personality" out of these 10 aggregations and focusing on
the impact of personality traits that science is studying places psychiatry
closer to the rest of medicine's use of "personality," e.g.,
specific personality traits impact on the immune system.
(Two of the 10 "personality" disorders have names whose
problems go beyond the term "personality." The term
"obsessive-compulsive personality disorder" is confusing, as these
patients don't necessarily have obsessions or compulsions. Further, that label
is confusingly close to "obsessive-compulsive disorder." The
international community (ICD-10) uses "anankastic" for
these patients, a term that doesn't confuse these patients with those who have
"obsessive-compulsive disorder." The term "borderline"
is inappropriate as it fails to summarize the patient's condition. APA should
take steps to encourage an exploration of alternative terms that accurately
reflect a patient's condition. Explorations already taking place in some
clinical settings include "emotional dysregulation disorder,"
"dysregulation disorder," and "regulation
disorder."
In summary, the proposal from the Washington and Maryland psychiatric
societies to remove the word "personality" from the label of these
10 disorders would be a humane step that would facilitate communication and
increase access to treatment.
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American Psychiatric Association.
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