There seems to be a gap between the DSM and the literature.

[lenfan]

To what extent do you think the DSM is lagging behind the actual consensus on what comprises this disorder? My own upwBPD is high functioning and would not seem to fit the DSM criteria. However, she so clearly fits the high functioning BPD Hermit as described in the leading books that it is uncanny. There seems to be a gap between the DSM and the literature.

"Walking on Eggshells" suggested we should not be so concerned with labels and diagnoses, but the behaviors and the best ways to respond. Still, it is helpful to have a name for things in order to let us know where to turn. 

[Skip]

Good question.

When you refer to a "consensus", who is included in that group?

[lenfan]

I didn't have any group particularly in mind when I said "consensus." I guess I mean the larger community that uses this site as well as the also the leading authors and experts.

It was a great relief in many respects when I read SWOE and the other book about BPD Mom's that described the Hermit, etc.  At least now I had a name for this, online community support and some strategies. However, those books go into much greater detail than what is described in the DSM.  If I had only read the DSM, I would have never been able to connect the dots.

I was also thinking historically about how the DSM once characterized homosexuality as a disorder, and how there is some controversy about grief and how it relates to depression in the DSM as well.  So, I'm wondering if the DSM is just lagging behind what is the latest understanding of this disorder.

[enlighten me]

I think one problem people face when referring the DSM is that it is for a pure PD whereas the majority cases have some form of co-morbidity with a different disorder. For example the BPD queen could be a mix of BPD and NPD (not saying it is).

[lenfan]

Yes, that's what I mean enlightenme. If the majority of people don't purely fit the diagnosis but it's pretty clear they all have most of the same kinds symptoms in common, then I think the powers that be should work on refining the diagnosis.

[enlighten me]

Hi Lenfan

The problem is where do you start? If there are 9 criteria for BPD and only 5 are needed to diagnose it then there are over 100 combinations for BPD alone. If you do this for every PD then there are thousands of combinations. If you then add co-morbidity then theres tens of thousands of combinations. Add to this that although some criteria are very similar across PDs the treatment for the particular PDs differ.

I'm personally a fan of the idea of mapping every trait on a scale of 1-10 in a 3d model which shows which areas are affected. Then separate the areas into different PDs/ fields i.e. emotional, antisocial etc. That way you can say they have an emotional disorder with strong antisocial traits.

[Skip]

I am not sure it is fair to say there is much of a gap between the scientific literature and the DSM. The DSM is a consensus of experts and it was just updated in 2013.

I think the question you are asking is why doesn't the DSM align with all the amateur self-help books and Internet blogs?

There are two reasons I can think of.

Most amateur self-help books and Internet blogs don't understand what personality disorders are and lump every ex relationship partner "from a relationship that ended badly" into the mix. This inflates the population by a factor of 300 - 400%

Less than 12% of the population has a clinically defined personality disorder. However, if you add the incidence of all 10 disorders, you get a much higher number. Why? The category of personality disorders greatly overlap.  Adding them is double, triple counting and this greatly inflates the population numbers.

Currently 29% of the population qualifies for either an addiction and/or a DSM mental illness label. This is a staggering number and many clinical experts believe it is already too high. I don't think there is much consensus to make the number higher.

Nina Brown PhD said it best. Most of us are dealing with personality traits of these diseases (not the disease) and that is enough to cause the problems we experience. Learning the tools and coping mechisms for dealing with these disorders apply. And that is why we are here.

I'm personally a fan of the idea of mapping every trait on a scale of 1-10 in a 3d model which shows which areas are affected. Then separate the areas into different PDs/ fields i.e. emotional, antisocial etc. That way you can say they have an emotional disorder with strong antisocial traits.

Not too practical in an inner city emergency room... .the data gathering alone would be prohibitive... .

There has been a much simpler mechanism in place for years - a person must first qualify as having a Personalty Disorder (generic) before it is sub-categorized. Most people miss hurdle/gatekeeper and jump to the trait lists like reading a cookbook.

[enlighten me]

Hi Skip

I'm on about when a person is assessed then it should be a more accurate assessment. As for emergency rooms if its a walk in with no history on record then most go on the persons behaviour rather than assigning a PD. Surely the behaviour is a more accurate diagnostic tool as the professional diagnosis is more or less guess work based on what the patient wishes to disclose and the assumptions of the mental health professional.

[Skip]

Your idea is good in theory, but not practical. How many axis would you have? 30? 35? And you would need 10 definitions for each scale point. That 300 criteria.

The DSM-5 committee proposed scaling 2 of 4 domains with a 5 point scale (10 criteria) and even that got some pushback.  The method didn't make the cut for DSM 5, but was included in the DSM 5 addendum for study.  It will be reconsidered in the next edition.

[enlighten me]

By a scale of 1-10 I mean the severity of the criteria from 1 not at all to 10 fully impairs day to day life.

Yes I agree that you would need definitions to be 100% accurate but if I were to ask you on a scale of 1-10 how would you rate your day would you need a scale to answer it? As we are not using physical evidence we can only go off the persons personal opinion of how they suffer so definitions may not be as accurate as the patients own opinion of how a particular criteria affects them.

PDs have already been divided into categories. Odd, bizarre, eccentric, dramatic, erratic, anxious and fearful. While the wording might need updating the basic idea is there. It shows the behaviour rather than naming a particular PD.

So maybe as a diagnostic tool it wouldn't be perfect but for a patient to do a self assessment it would give a good idea of where the disorder was and the intensity of it. If the therapist did their own of the patient then overlapped them it might be a useful indicator.

[Skip]

By a scale of 1-10 I mean the severity of the criteria from 1 not at all to 10 fully impairs day to day life.

Your presumption that all criteria can be put on this scale is probably not practical.

What is your personal score for "empathy" impairs day to day life?

Most importantly, we are not here music theory or mechanical engineering principles to psychology... .that takes us to the problem the OP described... .urban legend and pseudoscience having much greater visibility than the science itself.

[enlighten me]

The problem is the science itself. A diagnosis does not have any physical evidence. It is purely what professionals have decided fits. There is no xray to show the problem, no open wound, nothing physical to go on. How many here have partners who have seen a therapist and the therapist has said theres nothing wrong? It relies on the patient being honest, My ex wife saw several psychiatrists and around 50% said she was fine and it was just stress. The others told her something she didn't want to hear so she got rid of them.

I'm not saying the system we have now isn't functional but I do think it can be improved. For one thing family members are hardly ever spoken to. We can paint a picture that the rest of the world never sees. There was an interesting post on another site yesterday where a woman with BPD said about her husband beating her up. The husband also posted his side of the story. At first she received all the support but once his side was posted things changed. One member even stated how their behaviour can cause such pain in their partners that they end up sending them to the edge.

As for empathy about a 2.

[Skip]

I would have said 3.2.