Changes to diagnostic guide for personality disorders
By Liz Lockhart
Earlier this week Mental Healthy reported on proposed changes to the Diagnostic and Statistical Manual of Mental Disorders (DSM) with regard to the 
diagnostic criteria for autism. We can now report that a new storm appears to be brewing over proposed changes to the personality disorder diagnostic criteria.
There are several controversies raging regarding the upcoming revisions to the DSM but a new paper is of the opinion that the proposed removal of five personality disorders could actually result in harming patients.
The DSM is used around the world by psychiatrists and other mental health workers to diagnose mental health disorders and now several fierce debates have erupted by those who use the manual over the draft changes proposed for the new version – DSM(V).
Researchers from Rhode Island Hospital believe that, based on their study, the changes could result in false-negative diagnose for patients with personality disorders. This will result in individuals not being diagnosed with the disorder when, in fact, they meet the current criteria.
Several recommendations have been made to change the approach toward diagnosing personality disorder. One such recommendation is the deletion of five personality disorders in order to reduce the level of comorbidity among disorders. Comorbidity implies that a disorder with a similar yet different disorder may occur at the same time but independently of the other.
The five disorders proposed to be eliminated as a diagnostic definition are:
- Paranoid personality disorder
- Schizoid personality disorder
- Histrionic personality disorder
- Narcissistic personality disorder
- Dependent personality disorder
Recently the Work Group has recommended that narcissistic personality disorder be kept in DSM(V).
Lead author, Mark Zimmerman, M.D., says that no data were cited describing the impact this deletion had, or might have, on the overall prevalence of personality disorders. Similarly, no research was cited for the Work Group’s reversal when deciding to keep narcissistic personality disorder.
Zimmerman said ‘When it comes to revising the official diagnostic classification system, the guiding principle should be that criteria should not be changed in the absence of research demonstrating that the new approach is superior to the old validity or clinical utility, preferably both.’
He added ‘Despite assurances that only data-driven modification would be made, with each new edition of the DSM, we have witnessed repeated instances of changes being made in the absence of sufficient date demonstrating the new criteria is superior.’
Zimmerman and his colleagues evaluated 2,150 psychiatric outpatients to assess the proposed changes of deleting five personality disorders. More than a quarter of the participants were diagnosed with one of the ten current DSM(IV) personality disorders.
59 patients who were diagnosed with a personality disorder according to the DSM(IV) criteria would no longer be so diagnosed if the proposed changes are made.
‘The findings of the present study highlight our concerns about adopting changes in the diagnostic manual without adequate empirical evaluation beforehand. To be sure, there are problems with the classification of personality disorders, however, the identification of a problem is only the first step of a process resulting in a change to diagnostic criteria,’ Zimmerman said.
‘The classification of personality disorders would not be improved if the new criteria or diagnostic material were more clinically useful but less reliable and valid,’ he concluded.
Source: Lifespan
