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Re-classifying Personality Disorder

The Diagnostic and Statistical Manual of Mental Disorders (DSM), published by the American Psychiatric

Association, provides clinicians with specific standards for evaluating and diagnosing patients with mental

disorders, in this case personality disorders. There have been four versions released, with the next one scheduled

to be published in 2013. The latest, the DSM-IV, utilizes a multi axial system of classification. Each axis

represents criteria that the clinician will use as a guide to their diagnosis of personality disorders. But this

method of establishing a patient’s illness has drawn intense criticism.

The DSM-IV breaks down personality disorders into 10 categories, along with their associated symptoms. How

many symptoms a patient reports will define the severity of the illness. Unlike other fields of medicine that can

run a multitude of concrete tests to find the source of the problem, mental health professionals rely almost

exclusively on the patient’s own report of experiences. Since many personality disorders share similar symptom

evaluation can be subjective, producing a more or less favorable outcome. Exhibiting symptoms and behaviors

that are closely related can produce a specific diagnosis, but have very different causes, and consequently, a

different course of treatment.

There have been many efforts to test the accuracy of psychiatric diagnosis. One example comes from

psychologist David Rosenhan, who conducted a well-known experiment in 1973. Known as the Rosenhan

experiment, mentally healthy individuals feigned auditory hallucinations to become admitted into a mental

hospital. Once admitted, they informed staff they were feeling better, and no longer suffering from the

hallucinations. The staff believed all of the “pseudopatients” were showing signs of mental illness, and would n

release them until they admitted they had a problem, and were on medication.

A new study, conducted by psychologist Christopher Hopwood and his team at Michigan State University, is

calling for a more scientific and realistic system of categorizing personality disorders. Looking to be included in

the DSM-5, the study suggests a 3-stage approach.

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• Stage One: Understand a patient’s normal personality traits. The clinician would be better equipped to play in

the patient’s strengths, improving their participation in treatment.

• Stage Two: Instead of needing to fulfill a minimum number of criteria to judge the severity of a patient’s

disorder, a clinician would use a numerical score to convey that information.

• Stage Three: Break down the list of  10 personality disorders into five dimensional ratings. These dimensionswould serve to more efficiently and accurately diagnose the patient’s disorder. The clinician would then make a

 judgment based on how many symptoms the patient exhibits within each of the following dimensions:

• Peculiarity

• Withdrawal

• Fearfulness

• Unstable

• Deliberate

A new approach to diagnosing personality disorders is widely favored among those within the profession. The

current approach offers too many variables, allowing for multiple possibilities for diagnosis. It lacks the ability

appropriately take into account a patient’s sociological, physical and emotional background. A more scientific

approach could provide a specific formula, removing some of the discretionary power of the clinician. A more

accurate diagnosis leads to the most beneficial treatment plan for the patient, which is the ultimate goal of all

involved.