Deconstructing the personality disorder diagnosis

[firemonkey]

I have symptoms which get lumped together and called a personality disorder. The question is is personality disorder an apt and appropriate descriptor for such symptoms, or is it an excuse to heap further abuse on those who already may have been abused/ bullied to some degree?

Certainly trying to decide what constitutes an abnormal or normal personality is a very subjective thing.

Most psychiatric professionals ,either through incompetence or laziness, don't tend to look beyond the diagnostic manuals and fail to take a broad/holistic approach to the person they are supposed to help .

This no doubt accounts for the failure of many to make a significant recovery. This failure and the ability to challenge the psychiatric professional's faulty thinking often resulting in one being described as awkward or troublesome , and a personality disorder being attached.

[Mu.]

The existing categorical diagnoses for personality disorder are really bad, don't make any sense as diagnoses, are massively value-laden and stigmatising, and don't really tell you anything about a patient who receives such a diagnosis. Most professionals want to move towards dimensional diagnostic models instead, where instead of ticking off some number of behavioural symptoms on a bullet-pointed list, you just get scored across five different personality axes, probably very similar to the five factor model of personality.

It was expected that the DSM would switch to a dimensional model in the DSM-5, but they went back on the idea and stuck with the stupid categorical model instead, and slipped a hybrid model in the appendix to "stimulate research."

The ICD, however, is looking likely to move to an entirely dimensional model, meaning there probably wont be individual personality disorders (borderline, paranoid, etc.) in the ICD-11, there'll just be a single diagnosis of personality disorder, and your individual personality profile will then be scored across the five axes. So somebody with "avoidant personality disorder" might instead become a person who scores very high on negativistic and detached features. But such features are present in all people to some degree, so they'd represent a scale that leads from pathologically-low values, through some "normal" range, to pathologically-high values.

This will hopefully help to adjust a lot of the bad attitudes that surround the diagnosis, and will also undoubtedly be more accurate than the garbage we currently use, but it might not ultimately affect patients very much beyond that because: 1.) It relies on the dimensional models coming with tools that can be easily used by clinicians to make assessments, and currently most clinicians aren't even trained in how to make a personality disorder diagnosis using the categorical model, let alone an entirely new dimensional model, 2.) The best treatments for personality disorder are psychotherapeutic anyway, and psychotherapists use formulations not diagnoses, and 3.) it's 2016 and most parts of England still haven't bothered developing specialist services for personality disorder.