# DSM IV axis II personality disorders



## clavichorder (May 2, 2011)

http://en.wikipedia.org/wiki/Personality_disorder

I haven't done a lot of very methodical research on the topic, but on the personal side of things, I had a fear for a long time that I possessed an incurable disorder of my personality. For a while I hated the DSM(diagnostic and statistical manual of mental disorders) because once you are diagnosed, you have it on your medical record and it has an effect on how you are treated by medical professionals.

Most therapists and psychiatrists with varied backgrounds know that personality disorders and the like are merely a tool, and not a description of who you are, and therefore they do not diagnose them, but address symptoms. It can be very harmful to have a label on you like Borderline personality disorder, Avoidant, Narcissistic, Schizotypal ect. I've been on a forum where people rail about their disorder and seem to view their personality through a lens of disorder descriptions. But the disorders can't easily be written off as fun pop psychology like personality tests, they are serious business in the eyes of many psychiatrists. What do you think of them? I've talked to some people that have said just about everyone could be diagnosed with several of these...


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## Almaviva (Aug 13, 2010)

Just about everyone can have personality _traits _that exist in these _disorders_, but to qualify for a _disorder_ you have to have functional impairment. What many lay people misunderstand when they read the DSM is that they focus on the list of symptoms, forgetting to keep reading down until the criterion that says that for these symptoms to be called a disorder, functional impairment is needed. So people may have obsessional traits for example - they may like to be organized, they may feel compelled to check if a door has been locked, and even have some rituals of their own - but they won't have the disorder if this does not impair their functioning. However if they can't work because they are constantly worrying about checking and they're performing rituals endlessly and they need to go to restroom over and over to wash their hands until their skin is cracked and peeling off, then they have a _disorder. _Regardless of what lay people say trying to invalidate the existence of these disorders, they do exist and are well documented. Most of these opinions in boards come from people who haven't really seen the real severe cases. Yes, they are serious business, and if you encounter the real cases you'll see that they can't be written off.

As for avoiding to write down a diagnosis because of stigma, it's a silly thing to do. If the diagnosis is well established, it is in the patient's interest to have it written down so that the person can have access to appropriate treatments. Avoiding the acknowledgment of the diagnosis is akin to saying: "Well if I burn a red light I get a traffic ticket, so I'll just close my eyes when I'm approaching a red light and push on the gas anyway, as long as I don't see the red light I'll be fine."

Now, wrongly diagnosing someone with a personality disorder may indeed be detrimental. But if the disorder indeed exists, it should be diagnosed and treated.


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## graaf (Dec 12, 2009)

I don't think clavichorder is denying the existence of conditions, I'd say that he might be worried about getting into a kind of a Kafkian labyrinth of health system once one is diagnosed even with milder case of something. Or at least that's how I read it.

After I saw a documentary by Stephen Fry about bipolar disorder and how some doctors are arguing usage of prescription drugs on kids only 3 years old, I can certainly understand the concern.


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## Almaviva (Aug 13, 2010)

graaf said:


> I don't think clavichorder is denying the existence of conditions, I'd say that he might be worried about getting into a kind of a Kafkian labyrinth of health system once one is diagnosed even with milder case of something. Or at least that's how I read it.
> 
> After I saw a documentary by Stephen Fry about bipolar disorder and how some doctors are arguing usage of prescription drugs on kids only 3 years old, I can certainly understand the concern.


I wasn't saying that *clavichorder* was denying the existence of these disorders, I was addressing what he said certain members of other fora were doing, and certain doctors who according to him refuse to make the diagnosis. He even said "most" therapists and psychiatrists do not make the diagnosis, and this in my opinion is certainly not true. They may avoid addressing the patient as if the patient had a big label stuck to his/her face, but it's not like when they write down their clinical notes they don't name a diagnosis. Maybe some refrain from writing down a diagnosis (which in my opinion is poor practice) but most professionals certainly do write it down.

About Bipolar Disorder, yes, there is controversy about the use of the concept of Bipolar "spectrum" and there are groups for and against broadening the criteria, for the next edition (DSM V), exactly because broadening the criteria might encourage excessive treatment of potentially normal or not fully developed conditions, and childhood bipolar is right in the middle of this controversy.

My take is, when a disorder is *correctly* diagnosed by an experienced professional, it should be treated. But available treatments for Bipolar Disorder are not benign and do have long term side-effects and consequences, therefore only those who truly have the disorder should be treated. It's a question of risks versus benefits. One who truly had the disorder would be better off incurring some risks to reap off the benefits, because untreated Bipolar Disorder is a scourge. But over-treating a situation that doesn't warrant treatment is definitely detrimental, because then you have meager or unclear benefits, which don't justify the risks.


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## graaf (Dec 12, 2009)

In a health system that is not "for profit", I could easily buy most of what "experienced professionals" tell me. In a health system that is "for profit", I would certainly be wary of obvious "conflict of interest". But I will stop right there, before it gets political.

best regards,
graaf


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## Almaviva (Aug 13, 2010)

graaf said:


> In a health system that is not "for profit", I could easily buy most of what "experienced professionals" tell me. In a health system that is "for profit", I would certainly be wary of obvious "conflict of interest". But I will stop right there, before it gets political.
> 
> best regards,
> graaf


Even in health systems that are for profit, there are ethical professionals.
It is possible to make decent money while practicing good medicine; there is no need for corrupt practices and false diagnoses to milk more money out of a patient or a patient's health insurance. As a matter of fact I believe that the vast majority of medical professionals see it this way and mean well - all that they want is to make a honest living while helping the patients to the best of their abilities. Of course, as in any other field of human activity, there are bad apples.

There is nothing wrong with profit.
Every worker on this planet expects to be paid for his/her work. 
But many people make the choice of being paid for honest work, instead of aiming for corrupt or unethical work.

Your premise would imply that a doctor would have a vested interest in making a false diagnosis in order to earn the patient's business and make more money.

This is just not the case, at least not in my country. I can't speak for other countries, but doctors here are not scrambling for patients and trying desperate measures to get more business. Much the opposite, doctors here are overwhelmed with the existing business coming from real patients, work long hours, and if anything, would like less business. They have enough real patients to treat without any need to be falsifying diagnoses to get more patients.

Of course I'm speaking about the vast majority of doctors. Like I said, there are exceptions and bad apples and it is not impossible to find someone with this kind of modus operandis. But it is certainly not the rule.


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## Klavierspieler (Jul 16, 2011)

I'm tempted to go into rant mode, so tempted...


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## Lenfer (Aug 15, 2011)

I'm not sure how things work here in the *UK* or in *Europe* but I to have a condition listed in the "DSM". In fact that was the reason I was unable to post here for a bit. I know my doctors are given the "other" book the one from the *WHO* but they still read the *DSM* and think it's far superior.

I have never felt bad about "being in" the book in fact I was thrilled as for many years no one knew what was wrong. I take great comfort in the fact that other people are like me and the that I am not the only here with this sort of "quirk" thanks for posting.


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## graaf (Dec 12, 2009)

Almaviva said:


> Even in health systems that are for profit, there are ethical professionals.
> It is possible to make decent money while practicing good medicine; there is no need for corrupt practices and false diagnoses to milk more money out of a patient or a patient's health insurance. As a matter of fact I believe that the vast majority of medical professionals see it this way and mean well - all that they want is to make a honest living while helping the patients to the best of their abilities. Of course, as in any other field of human activity, there are bad apples.
> 
> There is nothing wrong with profit.
> ...


Whether doctors want more or less patients will, obviously enough, depend on the way they are paid. It's not actually rocket science. On the other hand, To say that there are good people on the planet takes far less words. And far less emotions too. There's something going on here that I'm not quite interested to find out.


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## Almaviva (Aug 13, 2010)

graaf said:


> Whether doctors want more or less patients will, obviously enough, depend on the way they are paid. It's not actually rocket science. On the other hand, To say that there are good people on the planet takes far less words. And far less emotions too. There's something going on here that I'm not quite interested to find out.


Huh... what emotions?
Yes, I'm verbose. So?
Doctors may want more patients if they're compensated by the number of patients they see, sure.
But from there to believe that then they engage in making false diagnoses so that they have more patients is a big, big leap.
Like I said, most people are honest, hardworking, ethical folks who try to only diagnose what they believe, rightly or wrongly, that is there in reality to be diagnosed, and needs to be diagnosed so that appropriate and helpful treatment is provided.


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## graaf (Dec 12, 2009)

Almaviva said:


> Like I said, most people are honest, hardworking, ethical folks who try to only diagnose what they believe, rightly or wrongly, that is there in reality to be diagnosed, and needs to be diagnosed so that appropriate and helpful treatment is provided.


 I'm sure they also strive to extend visionary support with internal impact for the benefit of their patients as well as general public, because their vision is to provide critical patients with better outcomes for their benefit, given that their one true aim is to enable hospital networks to have increased productivity in the interest of all parts of society, as well as to strive to synergistically create emerging technology so that they may professionally supply every ambulance with latest hi-tech gear while striving for both technical and ethical perfection - to which they are fully committed.


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## Almaviva (Aug 13, 2010)

graaf said:


> I'm sure they also strive to extend visionary support with internal impact for the benefit of their patients as well as general public, because their vision is to provide critical patients with better outcomes for their benefit, given that their one true aim is to enable hospital networks to have increased productivity in the interest of all parts of society, as well as to strive to synergistically create emerging technology so that they may professionally supply every ambulance with latest hi-tech gear while striving for both technical and ethical perfection - to which they are fully committed.


It looks like your idea of the medical community is negative and suspicious. Fair enough.
I am a member of the profession so my view is a lot more favorable, and as an insider, I do know that *most* people (not all people, of course) are just like I said, hardworking ethical folks. Maybe now you'll understand better why I was defending the profession - but rest assured, there weren't any strong emotions in my defense. I'm just speaking of the realities that I encounter in my everyday professional life. I've been in positions of assessing the quality of the work and the ethical stance of peers (or lack thereof) and what I find is adequate in the overwhelming majority of cases. I've been also in the position of mentoring and teaching young professionals and I see a lot of commitment to patient care and idealism. Greed does exist as well (like I said, what field of human activity doesn't have bad apples) but it is definitely not the rule, at least among the samples I've been exposed to (and I've been exposed to a huge sample of medical students, residents, and peers, in my several decades of professional activity).


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## clavichorder (May 2, 2011)

I just think its better, especially in younger people, to treat individual symptoms rather than being diagnosed, either via medication or therapy or any other methods that stand a chance of working. I do agree with you Almaviva in that it helps to label a condition if its a severe impairment but like graaf said, the consequences of having it on your medical record can be troublesome, so diagnoses should not be made lightly and the symptomatic approach should be taken first unless there is some urgency to the matter. 

I also have noticed in this forum I used to frequent a tendency to self diagnose with the DSM personality disorders and this in my opinion can be a very bad thing, or to readily diagnose others who have been problematic in your life. I don't know how I feel about the personality disorder stuff anyway. But there is no disputing labels like OCD, anxiety, or depression. If anyone reading this has been diagnosed with a personality disorder, to make myself clear, I will say that I wouldn't dispute a professional diagnoses were I to get one, but I don't like amateur diagnoses.

However like you almaviva, I really believe and when feeling cynical, hope there aren't many professionals who are in it for the "buisiness" as opposed to actually helping people.


To add to this: 

Anyway, this is my personal obsessional issue. If it triggers anyone, I'm sorry for having brought it up.


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## Almaviva (Aug 13, 2010)

Treating individual symptoms may or may not make sense. It is often helpful to have a clear idea of what exactly the underlying problem is.

An analogy: If someone has tuberculosis which causes fever and cough, giving Tylenol for the fever and cough supressants for the cough is not effective treatment. You can do that, but the patient won't get any fundamentally better (will just have less symptoms for a period of time while the underlying process will continue to get worse) unless you also give the proper combination of antibiotics to kill the tuberculosis bacillum. So by failing to diagnose tuberculosis and just treating the symptoms of fever and cough as if it's a common upper respiratory infection, you actually make the problem worse.

In mental health: if someone is depressed, you need to be careful about just treating the symptom (depression) because in certain cases, the disorder (e.g., Bipolar Disorder during the depressive pole or phase) can be made worse by antidepressant treatment such as an SSRI (the class of medications such as Prozac), resulting in the patient flipping into mania which is often more detrimental than the depression, and resulting in the long run in more frequent and more severe crises of Bipolar illness. By knowing what the diagnosis is rather than just the symptoms, the doctor will be able to give a mood stabilizer with antidepressant properties such as Lamictal which does not flip Bipolar patients into mania and does not worsen the long-term course of illness.

When you say you wouldn't dispute a professional diagnosis but wouldn't like an amateur one, I agree with you. What I've been saying is that as long as a disorder does exist (is real, that is, not something poorly diagnosed by someone who is not experienced or knowledgeable enough), causes functional impairment, and requires treatment, it is a *good* thing to have it diagnosed so that the correct treatment is provided (like in the example above). This is even more true for severe conditions. Mild symptoms involving multiple personality traits that don't even qualify for a full diagnosis (The DSM calls those, personality disorder _not otherwise specified_) are better treated by targetting symptoms, but complex and serious situations do require a carefully considered full diagnosis.


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## Head_case (Feb 5, 2010)

Just reading this up on the internet now that you've brought this up (no! not wikipedia lol) I suppose I'm taking the stance in reiterating that if a person's finding that his relationships are exhausting for him, or that others are exhausted by his person; then surely yes, we do see some scope for recognising that the functional impairment, which Almaviva reiterates as the DSMIV criteria, entails that there is a usefulness for making such diagnoses. 

I suppose though...the example in your original post is indicating, that living with the issue of 'stigma' from a diagnosis is indeed terrible. 

Like being the modern sufferer of leprosy; or what having HIV or AIDS was like back in the 1980's. 

But this is the social stigma...of a the diagnosis, is it not? 

If it is, then I wonder whether the problem is not actually with the clinical therapies which recognise these diagnoses, in order to help those who suffer from disordered personalities....the problem is.... the lack of empathy (compassion) in society, in reaching out to help those who suffer beyond their means to change their ways.


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## clavichorder (May 2, 2011)

Head_case said:


> Just reading this up on the internet now that you've brought this up (no! not wikipedia lol) I suppose I'm taking the stance in reiterating that if a person's finding that his relationships are exhausting for him, or that others are exhausted by his person; then surely yes, we do see some scope for recognising that the functional impairment, which Almaviva reiterates as the DSMIV criteria, entails that there is a usefulness for making such diagnoses.
> 
> I suppose though...the example in your original post is indicating, that living with the issue of 'stigma' from a diagnosis is indeed terrible.
> 
> ...


I suppose that(societies misunderstanding) is what irks me the most, thanks for the refined thought on the matter.


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