Thursday, December 9, 2010

Narcissistic Personality Disorder on the Endangered Species List?

The NY Times posted an article revealing that the new manual - Diagnostic and Statistical Manual of Mental Disorders (DSM-5) - which is due out in 2013 has eliminated five of the ten personality disorders which are currently listed in DSM-4, including narcissistic personality disorder.  Aw... Come on!  Can these professionals on the DSM committee honestly say with a straight face that there are absolutely no more individuals who qualify as being diagnosed with narcissistic personality disorder?  Or the other disorders?  Do you think that this is political?  Mmmm... Who constantly focuses on me, me, me?  They wouldn't want you-know-who to look bad and be labeled as a narcissist in our society.  And, yes there have been disorders removed from the DSM in the past, purely for political reasons.   There are many psychiatrists and other experts in the field who are fuming mad about the DSM committee's decision to give the axe to five of the ten personality disorders.  The DSM committee says that our everyday picture of a narcissist is too broad. 

After searching the internet I came to find out that the DSM committee's new standard of diangnosis for these five personality disorders is based on "a combination of core impairment in personality functioning and specific pathological personality traits, rather than as a specific type.” 
From PsychCentral: "The intended hybrid replacement model has not been extensively tested in clinical practice or in practical research. A handful of studies are used to suggest this model is ready for primetime, yet it appears that the Workgroup used a mish-mash of various theories to justify the change."

See how incoherent this is?       

The DSM committee seems like they're experimenting with peoples' lives like Frankenstein.

The NY Times points out the requirements for being diagnosed with narcissistic personaility disorder:

"The central requirement for N.P.D. is a special kind of self-absorption: a grandiose sense of self, a serious miscalculation of one’s abilities and potential that is often accompanied by fantasies of greatness. It is the difference between two high school baseball players of moderate ability: one is absolutely convinced he’ll be a major-league player, the other is hoping for a college scholarship.

Of course, it would be premature to call the major-league hopeful a narcissist at such an early age, but imagine that same kind of unstoppable, unrealistic attitude 10 or 20 years later.

The second requirement for N.P.D.: since the narcissist is so convinced of his high station (most are men), he automatically expects that others will recognize his superior qualities and will tell him so. This is often referred to as “mirroring.” It’s not enough that he knows he’s great. Others must confirm it as well, and they must do so in the spirit of “vote early, and vote often.”

Finally, the narcissist, who longs for the approval and admiration of others, is often clueless about how things look from someone else’s perspective. Narcissists are very sensitive to being overlooked or slighted in the smallest fashion, but they often fail to recognize when they are doing it to others.

Most of us would agree that this is an easily recognizable profile, and it is a puzzle why the manual’s committee on personality disorders has decided to throw N.P.D. off the bus. Many experts in the field are not happy about it."
One of the unhappy campers and a sharp critic of the DSM commmittee's decision, named Dr. John Gunderson, who is in the professional psyco babble camp said this showed how “unenlightened” the DSM committee is.  He continued:

“They have little appreciation for the damage they could be doing.” He said the diagnosis is important in terms of organizing and planning treatment.

“It’s draconian,” he said of the decision, “and the first of its kind, I think, that half of a group of disorders are eliminated by committee.”
He favors the prototype approach over what he called the dimensional appraoch. 

He also blamed a so-called dimensional approach, which is a method of diagnosing personality disorders that is new to the DSM. It consists of making an overall, general diagnosis of personality disorder for a given patient, and then selecting particular traits from a long list in order to best describe that specific patient.

This is in contrast to the prototype approach that has been used for the past 30 years: "the narcissistic syndrome is defined by a cluster of related traits, and the clinician matches patients to that profile."

The dimensional approach has the appeal of ordering à la carte — you get what you want, no more and no less. But it is precisely because of this narrow focus that it has never gained much traction with clinicians.
It is one thing to call someone a neat and careful dresser. It is another to call that person a dandy, or a clotheshorse, or a boulevardier. Each of these terms has slightly different meanings and conjures up a type.
And clinicians like types. The idea of replacing the prototypic diagnosis of narcissistic personality disorder with a dimensional diagnosis like “personality disorder with narcissistic and manipulative traits” just doesn’t cut it.
Jonathan Shedler, a psychologist at the University of Colorado Medical School, said: “Clinicians are accustomed to thinking in terms of syndromes, not deconstructed trait ratings. Researchers think in terms of variables, and there’s just a huge schism.” He said the committee was stacked “with a lot of academic researchers who really don’t do a lot of clinical work. We’re seeing yet another manifestation of what’s called in psychology the science-practice schism.”
Schism is probably not an overstatement. For 30 years the DSM has been the undisputed standard that clinicians consult when diagnosing mental disorders. When a new diagnosis is introduced, or an established diagnosis is substantially modified or deleted, it is not a small deal. As Dr. Gunderson said, it will affect the way professionals think about and treat patients.

Narcissism personality disorder - you can't live with it and you can't live without it.

I officially say even professional psycho babble doesn't make sense.


The Watcher said...

When does a 'disorder' become normal? When enough people start expressing the symptoms. Considering the number of people I come in contact with every day who act as though they're the greatest thing since sliced white bread and flush toilets, it doesn't surprise me that Narcissistic Personality is no longer considered a 'disorder', but is considered normal.

Quite Rightly said...

As long as the term "narcissist" cannot be clinically applied to the Narcissist-in-Chief, all will be well at the APA.

Amusing Bunni said...

Hi Teresa, what an interesting post. The dr.'s that think up these things are mostly all nuts themselves. They probably are eliminating this because they can't sell a drug to "cure" it. Also, they don't want to offend "dear leader" who is a text book narcissist if ever there was one.

I hope you've having a good week, and have a fun and restful night yourself. I'm gonna watch a red box movie and relax in a little bit, it was a cold & busy day.

Most Rev. Gregori said...

I wonder if these are the same folks who claimed that homosexuality was no-longer a disorder, but a normal condition. "Just saying"