PERSONALITY DISORDERS – LEC 02
TheAPA(American PsychiatricAssociation) Formalizes the DSM. Even though it is a
psychiatric manual, both psychiatrist and psychologist contribute to the DSM. The DSM-5 will
partly be online. They are now using “5” over “V” as a symbol to how much changes will
happen in the new diagnostic manual. PTSD use to be an anxiety disorder and now it will
probably be it’s own name “trauma and stressor-related disorders”.
Field trials – trying out the new methods in assessing the new DSM. With DSM-IV we use the
SCIDD to do formalized interviews for assessment. However, with the new DSM, there is no
such interview system. Structured interviews provide more reliable results. In the real world
psychiatrist don’t often use the SCID. So does this make the field trials more like the real world?
The KAPPAvalues were generally low for most disorders. Should we be lowering our
expectations? Medical diagnoses tend to be .3-.5. However, it is possible that lower values are
probably a projection of how unreliable the techniques were in order to diagnose.
Problems with DSM-5 mentioned by article: (1) The classification is too complex, incoherent,
and inconsistent, and (2) it disregards a lot of evidence in regards to which disorder should
remain and which should stay.
• Diagnostic unreliability: The criteria represent abstract constructs. Without structure
interviews you are leaving out a lot of information.
• Pejorative connotations: Misperception that some personality disorders are untreatable. It
is hard to get coverage for the treatment of personality disorders.
• Heterogeneity Within Diagnosis: Most of the personality disorder diagnostic criteria sets
in DSM-III were monothetic (all of the criteria were required in order to provide a
diagnosis). In DSM-IV (polythetic criterion set) you can have only subset of the
symptoms and still be diagnosed, meaning that two different patients could have different
symptoms and still be diagnosed with the same disorder, but