The Board of Trustees of the American Psychiatric Association is planning to vote on whether to adopt a new diagnostic system for personality disorders. The new proposal is intended to clarify the diagnoses for personality disorders and better integrate them into clinical practice. It is also intended to extend and improve treatment for these disorders.
Dr. David J. Kupfer, a professor of psychiatry at the University of Pittsburgh and chairman of the task force updating the manual, refused to speculate on which way the vote might go. He said, “All I can say is that personality disorders were one of the first things we tackled, but that doesn’t make it the easiest.”
Personality disorders are some of the most serious syndromes in medicine and occupy a troublesome niche in psychiatry. Every mental anthropologist who has examined them seems to walk away with a new model to explain the strange behaviors associated with personality disorders.
These disorders are notoriously difficult to characterize and treat. Doctors seldom do careful evaluations for these conditions and often miss or downplay the behavior patterns that underlie problems like depression and anxiety in millions of people.
Mark F. Lenzenweger, a professor of psychology at the State University of New York at Binghamton said, “These therapists saw people coming into treatment who looked well put-together on the surface but on the couch became very disorganized, very impaired. They had problems that were neither psychotic nor neurotic. They represented something else altogether.”
Ted Millon, scientific director of the Institute for Advanced Studies in Personology and Psychopathology, turned the work on personality disorders into a set of 10 standardized types for the American Psychiatric Association’s third diagnostic manual in the late 1970s. The 10 recognized syndromes include such well-known types as narcissistic personality disorder, avoidant personality disorder, and dependent and/or histrionic personalities.
Producing precise, lasting definitions of extreme behavior patterns has proved to be exhausting work. The psychiatric association has expended a lot of effort over many years to update its influential diagnostic manual. However, the effort to update the diagnostic system for personality disorders has run into so much opposition that it will probably be relegated to the back of the manual, if it is allowed in at all.