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 Post subject: Five personality disorders removed from the DSM-V
PostPosted: Sun Jan 02, 2011 2:18 pm 
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I found this quite interesting- it's a little old but I didn't find any other posts on the PPK. The DSM-5 (2013) will exclude five personality disorders that are currently recognized by the DSM-IV, including histrionic personality disorder, oppositional personality disorder, and narcissistic personality disorder (NPD).

I found it surprisingly difficult to find a lot of information on this online, but does anyone know the reasoning behind these changes? I know a lot of people who fit into all of those categories that are being removed and while I understand there is a huge difference between a personality 'trait' and a personality 'disorder,' it seems like there are people out there who would benefit from having such disorders recognized and diagnosed as an actual pathology.

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 Post subject: Re: Five personality disorders removed from the DSM-V
PostPosted: Sun Jan 02, 2011 2:21 pm 
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That is shocking.


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 Post subject: Re: Five personality disorders removed from the DSM-V
PostPosted: Sun Jan 02, 2011 2:28 pm 
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I wonder if they're going to be put under another name or characterized under other types? Narcissistic and Histrionic are both Cluster B personality disorders, so maybe they'll even combine them (!) and you can have one mega personality disorder with components both of both or just one. I hope so because that sounds exciting. To me.


I've never heard of oppositional personality disorder, but looking at stuff on Wikipedia makes me think that it's something similar - it's got high comorbidity with ADHD and other childhood disorders, so they might just be reordering and renaming these for better, more succinct diagnoses rather than diagnoising one child with three separate disorders at once.

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 Post subject: Re: Five personality disorders removed from the DSM-V
PostPosted: Sun Jan 02, 2011 2:42 pm 
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Erika Soyf*cker wrote:
...there is a huge difference between a personality 'trait' and a personality 'disorder,' it seems like there are people out there who would benefit from having such disorders recognized and diagnosed as an actual pathology.

Yeah, this befuddles me. My ex-husband is a textbook narcissist and has never been able to form healthy relationships as a result of it. If that's just a personality trait, then... what? He just hasn't found someone who likes that aspect of his personality yet?

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 Post subject: Re: Five personality disorders removed from the DSM-V
PostPosted: Sun Jan 02, 2011 2:47 pm 
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I haven't come across oppositional personality disorder. For children/adolescents, there's conduct disorder and oppositional defiant disorder, and those can be predictors for antisocial personality disorder, but I believe they get classed as developmental rather than personality disorders.

As for the five changing, I just googled and what came up for me was that the five they are changing are narcissistic, paranoid, schizoid, histrionic and dependent personality disorders. How confusing. I definitely know people who are textbook narcissists, and it certainly seems like a personality disorder.


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 Post subject: Re: Five personality disorders removed from the DSM-V
PostPosted: Sun Jan 02, 2011 2:48 pm 
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Wow. Well, I guess I'm not too shocked because there is quite a bit of controversy surrounding personality diagnosis for reasons listed above. As well as some sexual disorders like fetishes. However, I think, that if it is severely imparing quality of life and relationships, affecting or hurting yourself and others, then it should be considered a disorder.

The downside is now people who need therapy because of what WAS considered a disorder may not get covered by their insurance because it's non-diagnosable.


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 Post subject: Re: Five personality disorders removed from the DSM-V
PostPosted: Sun Jan 02, 2011 2:48 pm 
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monkeytoes wrote:
Erika Soyf*cker wrote:
...there is a huge difference between a personality 'trait' and a personality 'disorder,' it seems like there are people out there who would benefit from having such disorders recognized and diagnosed as an actual pathology.

Yeah, this befuddles me. My ex-husband is a textbook narcissist and has never been able to form healthy relationships as a result of it. If that's just a personality trait, then... what? He just hasn't found someone who likes that aspect of his personality yet?


Yeah, I am befuddled too. I either attract narcissists or clash with them on an epic level (making them stand out so much more in my mind), and I can't imagine that NPD will no longer be considered a disorder. Some of the worst narcissists I've known could most definitely benefit from psychological intervention. At the very least, the people around them could benefit from psychological intervention!

I never, ever read self-help books, but my mom lent me The Wizard of Oz and Other Narcissists and insisted I read it since some of the narcissists I know are also in her life/have ruined aspects of her life. Reading it is incredibly validating, especially the part where the author describes how narcissists can manipulate those in their orbit into thinking they're crazy/overreacting for having a problem with their narcissism.

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 Post subject: Re: Five personality disorders removed from the DSM-V
PostPosted: Sun Jan 02, 2011 3:04 pm 
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I participated in some of the DSM feedback last year. They're also going to be changing the wording for some of the personality disorders (specifically Borderline) that makes it sound more palatable and less... harsh?

This new DSM is going to be very different, I think, if the changes go through that I saw over the summer. They still have a lot of time to tweak it and do whatever they want to do with it (take the feedback or not), but there were a lot of changes over all, not just with the personality disorders.

It's exciting!

graffitipassion wrote:
The downside is now people who need therapy because of what WAS considered a disorder may not get covered by their insurance because it's non-diagnosable.
On the same token, many insurance companies will not cover personality disorders because the treatment for them is too long; they are seen as not "curable."

Here are the proposed changes:
http://www.dsm5.org/ProposedRevisions/Pages/PersonalityandPersonalityDisorders.aspx


Last edited by Meggs on Sun Jan 02, 2011 3:08 pm, edited 1 time in total.

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 Post subject: Re: Five personality disorders removed from the DSM-V
PostPosted: Sun Jan 02, 2011 3:05 pm 
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This brings to mind a discussion we had in class about personality disorders and problems putting a personality diagnosis on people. For example, if someone has what is considered schizoid personality disorder. They are aloof and detached. They have little or no relationships with other people.

Maybe a guy works as a librarian his whole life because he has no interest in other people. He's happy that way and he's able to function. Who are we to tell him he's messed up just because it doesn't fit into our "norm". Who is he hurting other than maybe family members?

That's the problem. Sometimes personality disorders hurt others, sometimes they don't. Sometimes their actions are not considered socially acceptable, sometimes it is (especially in context or culturally). Sometimes their own actions bother the person with the disorder, sometimes they could care less. So I can understand why they may want to remove them from the DSM.

But again, some people might want therapy or treatment, and then it becomes more difficult to get them that.


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 Post subject: Re: Five personality disorders removed from the DSM-V
PostPosted: Sun Jan 02, 2011 3:08 pm 
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Meggs wrote:
graffitipassion wrote:
The downside is now people who need therapy because of what WAS considered a disorder may not get covered by their insurance because it's non-diagnosable.
On the same token, many insurance companies will not cover personality disorders because the treatment for them is too long; they are seen as not "curable."


This is true, but on another note, personality disorders are commonly comorbid with other disorders. So if a doctor gets a new patient and is given the okay to treat them for depression, then they see a comorbid personality disorder, they can possibly provide them with better treatment because they immediately have more information about the patient.


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 Post subject: Re: Five personality disorders removed from the DSM-V
PostPosted: Sun Jan 02, 2011 3:15 pm 
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graffitipassion wrote:
Meggs wrote:
graffitipassion wrote:
The downside is now people who need therapy because of what WAS considered a disorder may not get covered by their insurance because it's non-diagnosable.
On the same token, many insurance companies will not cover personality disorders because the treatment for them is too long; they are seen as not "curable."

This is true, but on another note, personality disorders are commonly comorbid with other disorders. So if a doctor gets a new patient and is given the okay to treat them for depression, then they see a comorbid personality disorder, they can possibly provide them with better treatment because they immediately have more information about the patient.

I absolutely agree with this statement. I'm just saying that I don't think that removing personality disorders from the DSM will negatively impact insurance/treatment because of what you just said. We'll still be able to charge for, say, depression, and will recognize the personality disorder and be able to treat for it regardless of whether it is mentioned for insurance purposes or not. I'd always rather go conservative and not mention personality disorder in a diagnosis to insurance if it doesn't have to be mentioned, because that label follows that person for the rest of their lives.


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 Post subject: Re: Five personality disorders removed from the DSM-V
PostPosted: Sun Jan 02, 2011 3:21 pm 
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Aww. Avoidant is still there.

As someone who was diagnosed with a personality disorder, I find the whole idea of labeling someones personality as "disordered" troubling. Sadly, without a diagnosis people often don't get access to services. I only got assessed for a personality disorder to see if I could apply for an inpatient program, and it required the diagnosis of borderline personality disorder. So I went and got the "avoidant" badge instead and no treatment program.

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 Post subject: Re: Five personality disorders removed from the DSM-V
PostPosted: Sun Jan 02, 2011 3:23 pm 
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Meggs wrote:
I absolutely agree with this statement. I'm just saying that I don't think that removing personality disorders from the DSM will negatively impact insurance/treatment because of what you just said. We'll still be able to charge for, say, depression, and will recognize the personality disorder and be able to treat for it regardless of whether it is mentioned for insurance purposes or not. I'd always rather go conservative and not mention personality disorder in a diagnosis to insurance if it doesn't have to be mentioned, because that label follows that person for the rest of their lives.


True. And if you have an astute doctor or therapist, they will pick up on personality traits that are problematic without having to be told. Actually, it could be BETTER for a doctor or therapist to not have this information so they can come to their own conclusions about what is a problem and what is not. Woah, this is becoming super interesting and exciting.


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 Post subject: Re: Five personality disorders removed from the DSM-V
PostPosted: Sun Jan 02, 2011 3:31 pm 
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Apparently, personality disorders are not as stigmatizing in other countries. Or so I've heard. It was awful, though, to hear my own professors even talking poorly about Borderline Personality Disorder patients.

Also, we had a great discussion in a trauma course of mine about how personality disorders can form in childhood as a result of abuse/neglect/maltreatment. The personality disorder is really just a coping mechanism... a flawed one, but a coping mechanism. Children can have personality disorders even though we don't typically diagnose in the US until age 18.

It's all quite fascinating, really. (As well as sad, in the case of children, stigmatization, or people not receiving adequate care).


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 Post subject: Re: Five personality disorders removed from the DSM-V
PostPosted: Sun Jan 02, 2011 6:02 pm 
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I think it makes perfect sense for personality disorders to be removed and reclassified. All the personality disorders are vague and overlapping and I don't think many of them address actual problems people have functioning in society.
Did the childhood mood disorder one make it in? The one about irritability?

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 Post subject: Re: Five personality disorders removed from the DSM-V
PostPosted: Sun Jan 02, 2011 6:26 pm 
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Is it true that ADHD isn't a recognized disorder in the UK? I had this professor one semester who really harped on ADD and ADHD and I've never seen more frontline documentaries in my life, but he told us that I've never really heard anything else about it. He was a smart guy so I believed him, but sometimes genius and kook overlap and you can never really tell.

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 Post subject: Re: Five personality disorders removed from the DSM-V
PostPosted: Sun Jan 02, 2011 6:31 pm 
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Hapax Legomenon wrote:
I think it makes perfect sense for personality disorders to be removed and reclassified. All the personality disorders are vague and overlapping and I don't think many of them address actual problems people have functioning in society.
Did the childhood mood disorder one make it in? The one about irritability?

I agree with you about the personality disorders. If they reclassify abuse/addiction how they showcased it when they let us have a peek at it over the summer, it will be hugely beneficial compared to how one has to try to tease the two apart currently.

I'm not sure what childhood disorder you're referring to, but here are the "Disorders Usually First Diagnosed in Childhood and Adolescence:"
http://www.dsm5.org/ProposedRevisions/Pages/InfancyChildhoodAdolescence.aspx

They did not let one in that I think should be in there, Complex Trauma, which is hugely unfortunate.


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 Post subject: Re: Five personality disorders removed from the DSM-V
PostPosted: Sun Jan 02, 2011 6:44 pm 
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Meggs wrote:
This new DSM is going to be very different,

It's exciting!

On the same token, many insurance companies will not cover personality disorders because the treatment for them is too long; they are seen as not "curable."

Here are the proposed changes:
http://www.dsm5.org/ProposedRevisions/Pages/PersonalityandPersonalityDisorders.aspx


Some time ago I read that the proposed changes to the DSM were seen as quite controversial and if I remember correctly there were also comments that said it seemed to be changed so more things could be seen as a disease so more medication could be prescribed?


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 Post subject: Re: Five personality disorders removed from the DSM-V
PostPosted: Sun Jan 02, 2011 6:53 pm 
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Veg_Eric wrote:
Some time ago I read that the proposed changes to the DSM were seen as quite controversial and if I remember correctly there were also comments that said it seemed to be changed so more things could be seen as a disease so more medication could be prescribed?

Very astute observation. The DSM is put out by the American Psychiatric Association. Psychiatrists prescribe drugs. Some time ago, it was revealed (I think there was a thread on the old boards) that some of the doctors on the panels for the DSM-IV (the one currently in use) were receiving kickbacks from drug companies for supporting use of their meds. Or they were in cahoots, whatever.

Some people think that certain diagnoses remain in the DSM (alternately, other diagnoses will not be allowed in) because it will negatively impact medication prescriptions/sales.


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 Post subject: Re: Five personality disorders removed from the DSM-V
PostPosted: Sun Jan 02, 2011 6:57 pm 
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My very cynical side tells me that these since these disorders can't be treated or "cured" with medication that they will be reclassified into a disorder that is "successfully medicated"

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 Post subject: Re: Five personality disorders removed from the DSM-V
PostPosted: Sun Jan 02, 2011 7:16 pm 
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Meggs wrote:
I'm not sure what childhood disorder you're referring to, but here are the "Disorders Usually First Diagnosed in Childhood and Adolescence:"
http://www.dsm5.org/ProposedRevisions/Pages/InfancyChildhoodAdolescence.aspx

They did not let one in that I think should be in there, Complex Trauma, which is hugely unfortunate.

Found it! It was Temper Dysregulation Disorder; I think it might've had a name change along the way, but that's definitely the one I was thinking of. My teacher described it as one way of identifying a lot of childhood depression, because in children and adolescents a lot of those who are eventually diagnosed with a mood disorder would fit that criteria in younger years. So the things in the first section are proposed additions that are going to be in the DSM-V, or are they still under review and could be taken out?

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 Post subject: Re: Five personality disorders removed from the DSM-V
PostPosted: Sun Jan 02, 2011 7:19 pm 
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Fee wrote:
Is it true that ADHD isn't a recognized disorder in the UK? I had this professor one semester who really harped on ADD and ADHD and I've never seen more frontline documentaries in my life, but he told us that I've never really heard anything else about it. He was a smart guy so I believed him, but sometimes genius and kook overlap and you can never really tell.


Here is something I learned this year: 80% of the world usage of Ritalin is in the US.

Also, there was a really interesting article about the Americanization of mental health in the NYT last year. It was very enlightening to read about the influence American academia and the pharmaceutical industry and globalization.


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 Post subject: Re: Five personality disorders removed from the DSM-V
PostPosted: Sun Jan 02, 2011 7:28 pm 
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Hapax Legomenon wrote:
Found it! It was Temper Dysregulation Disorder; I think it might've had a name change along the way, but that's definitely the one I was thinking of. My teacher described it as one way of identifying a lot of childhood depression, because in children and adolescents a lot of those who are eventually diagnosed with a mood disorder would fit that criteria in younger years. So the things in the first section are proposed additions that are going to be in the DSM-V, or are they still under review and could be taken out?

That one is under "not currently listed," so I believe that means they could either put it in or not. It's up for review. I don't know that they have confirmed much of anything yet. Rather, they're slowly confirming things, like the personality disorder bit that came out in the NYTimes article. Over the summer, they let people review the proposed revisions, additions, changes, etc. and comment on them, and then they closed that off. Now it's just reviewing the comments, more peer review, more data/statistical review... and we wait? I'm not exactly sure how these things work.

I only know that in order to get something into the DSM you have to have a LOT of data and support to back it up. Meds to fix it probably wouldn't hurt, either.


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 Post subject: Re: Five personality disorders removed from the DSM-V
PostPosted: Sun Jan 02, 2011 7:30 pm 
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The DSM-V changes collapse several personality disorders into one category, with descriptors to classify narcissistic, borderline, etc. It's not a declaration that these personality disorders don't exist, and more of a technical change in classification.

For example, a narcissist will still be diagnosed as a narcissist, but instead of being diagnosed with "Narcissistic Personality Disorder" he/she will be diagnosed with "Personality Disorder, Narcissistic Features" or something like that.

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 Post subject: Re: Five personality disorders removed from the DSM-V
PostPosted: Sun Jan 02, 2011 7:34 pm 
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Fee wrote:
Is it true that ADHD isn't a recognized disorder in the UK? I had this professor one semester who really harped on ADD and ADHD and I've never seen more frontline documentaries in my life, but he told us that I've never really heard anything else about it. He was a smart guy so I believed him, but sometimes genius and kook overlap and you can never really tell.


I don't think that's true, my nephew was tested for it recently.


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