May 12th, 2012

Dimensionality in the proposed DSM-V

I decided to take a closer look at the revamp of Personality Disorders in DSM-V. I have a long-ish standing interest in Borderline Personality Disorder, because I've run across people (_not_ friends of mine, but friends-of-friends) with this diagnosis and they really stand out as Trouble. I've never been able to make much sense out of the diagnostic criteria in DSM-IV, and quite a lot of my shorthand understanding of who winds up with this diagnosis isn't even in the criteria (the shortest of my short forms is, "cutter = BPD" -- and yes, I'm not a pro and yes, I understand this is actually not entirely accurate).

DSM-V has made a really big change to the way Personality Disorders are handled. They've moved from a set of criteria (must have n/2 or more of n items on a list to get the diagnosis and if you are on the edge, you'll lose eligibility for the diagnosis if you lose a single item on the list even tho the diagnosis is supposedly life-long or at least chronic) to a hybrid model of traits and types. The idea is to capture elements of who-the-person-is (think five factor model of personality) to describe better how the personality disorder will manifest as well as what-in-particular-is-broken to capture pathological behaviors/approaches/thought-patterns/etc. For some of the PDs, they've done a detailed match-up of the traits and types, but quite a few PDs went away. The rationale is that a lot of people clearly had a PD but didn't qualify for one in particular -- and some people qualified for more than one, when that's not supposed to happen either. The new approach is, like everything else in DSM-V, supposed to lead to better consistency of diagnosis over time and practitioner AND to reduce dependency on X-NOS coding.

I had to puzzle over this for a while to understand what they were doing and why, and then my brain kinda farted and I went, hey, this is like my modules theory! Instead of coming up with One Name to describe what a person has or is, try an analytical description and then address the pieces that are problematic. So I think I wholeheartedly approve, altho I'm now curious to read more of the diagnostic descriptions to see what I think of the implementation.

I'm really impressed by what's happening with DSM-V. The people running this round are being extremely diligent and careful and professional. Nor does it hurt that the way they think about mental health appears to run along very similar ideas to the way I think about it. ;-)

What I really like, however, is their minimalist approach is driven by an effort to find the parts that disparate theories hold in common. This is where I would expect to find stable ground.

From the Rationale section for Borderline Personality Disorder:

"Impairment in self and interpersonal functioning is consistent with multiple theories of PD and their research bases, including cognitive/behavioral, interpersonal, psychodynamic, attachment, developmental, social cognitive, and evolutionary theories, and has been viewed as a key aspect of personality pathology in need of clinical attention (e.g., Clarkin & Huprich, 2011, Luyten & Blatt, 2011, Pincus, 2011)."

That is just fucking brilliant.

If you have the time, go explore the proposed revision.

Wikipedia will help you out with the jargon.