Personality Disorders: Current Thoughts

Personality Disorders: Current Thoughts

Personality disorders are associated with ways of thinking and feeling about oneself and others that significantly and adversely affect how an individual functions in many aspects of life. They fall within
10 distinct types: paranoid personality disorder, schizoid personality disorder, schizotypal personality disorder, antisocial personality disorder, borderline personality disorder, histrionic personality, narcis- sistic personality disorder, avoidant personality disorder, dependent personality disorder and obsessive- compulsive personality disorder.

During the development process of the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), several proposed revisions were drafted that would have significantly changed the method by which individuals with these disorders are diagnosed. Based on feedback from a multilevel review of proposed revisions, the American Psychiatric Association Board of Trustees ultimately decid- ed to retain the DSM-IV categorical approach with the same 10 personality disorders.

The proposed revisions that were not accepted for the main body of the manual were approved as an alternative hybrid dimensional-categorical model that will be included in a separate chapter in Section III of DSM-5. This alternative model is included to encourage further study on how this new methodol- ogy could be used to assess personality and diagnose personality disorders in clinical practice.

DSM-5 moves from the multiaxial system to a new assessment that removes the arbitrary boundaries between personality disorders and other mental disorders.

Assessing on a Single Axis
Until now, DSM has organized clinical assessment into five areas, or axes, addressing the different aspects and impact of disorders. This multiaxial system was introduced in part to solve a problem that no longer exists: Certain disorders, like personality disorders, received inadequate clinical and research focus. As a consequence, these disorders were designated to Axis II to ensure they received greater attention. However, the axis system was seen by some clinicians as burdensome and time consuming. Given that there is no fundamental difference between disorders described on DSM-IV’s Axis I and Axis II, DSM-5 has shifted to a single axis system.
This system combines the first three axes outlined in past editions of DSM into one axis with all mental and other medical diagnoses. Doing so removes artificial distinctions among conditions, benefitting both clinical practice and research use.

Evolving the Diagnosis of Personality Disorders

The Personality Disorders Work Group began its efforts on DSM-5 by reviewing recent research on these disorders and considering general feedback from the field about the categorical approach.
The Work Group’s first revision represented a significantly different approach to diagnosis. It attempted to break down the concise models of personality disorders, which sometimes are too rigid to fit pa- tients’ symptoms, and replaced them with a trait-specific method. Using this model, clinicians would have determined if their patients had a personality disorder by looking at the traits suggested by their symptoms and ranking each trait by severity.

As evidenced by the field’s reaction, this new model was too complex for clinical practice. After consid- ering that response and additional research, the Work Group evolved the diagnostic criteria for person- ality disorders to marry the most useful aspects of DSM-IV criteria with features from the first revision’s trait-based approach.

The result was reflected in a second proposal, a hybrid model that included evaluation of impairments in personality functioning (how an individual typically experiences himself or herself as well as others) plus five broad areas of pathological personality traits.

Although this hybrid proposal was not accepted for DSM-5’s main manual, it is included in Section III for further study. Using this alternate methodology, clinicians would assess personality and diagnose a personality disorder based on an individual’s particular difficulties in personality functioning and on specific patterns of those pathological traits.

The hybrid methodology retains six personality disorder types: 
• Borderline Personality Disorder
• Obsessive-Compulsive Personality Disorder
• Avoidant Personality Disorder
• Schizotypal Personality Disorder 
• Antisocial Personality Disorder 
• Narcissistic Personality Disorder

Each type is defined by a specific pattern of impairments and traits. This approach also includes a diag- nosis of Personality Disorder—Trait Specified (PD-TS) that could be made when a Personality Disorder is considered present, but the criteria for a specific personality disorder are not fully met. For this diagno- sis, the clinician would note the severity of impairment in personality functioning and the problematic personality trait(s).

This hybrid dimensional-categorical model and its components seek to address existing issues with the categorical approach to personality disorders. APA hopes that inclusion of the new methodology in Section III of DSM-5 will encourage research that might support this model in the diagnosis and care of patients, as well as contribute to greater understanding of the causes and treatments of personality disorders.

DSM is the manual used by clinicians and researchers to diagnose and classify mental disorders. The American Psychiatric Association (APA) will publish DSM-5 in 2013, culminating a 14-year revision process. For more information, go to www. DSM5.org.

APA is a national medical specialty society whose more than 36,000 physician members specialize in the diagnosis, treat- ment, prevention and research of mental illnesses, including substance use disorders. Visit the APA at www.psychiatry.org. For more information, please contact Eve Herold at 703-907-8640 or press@psych.org.
© 2013 American Psychiatric Association 

George Zimmerman: Please donate your body to science

George Zimmerman: Please donate your body to science.

Ladies and Gentlemen of America, George Zimmerman has been called many things. He has been called a racist, a wanna-be cop, a pathological liar, a dutiful neighborhood watchman and he has been called a hero.  I do believe that he is a hero and though he may not be “Super-man,” he is indeed what I would like to call “Zimmer-Man,” a unique type of human able to defy odds and logic all at the same time. Given his humanitarian aspirations, I, as a citizen of the United States, respectfully request that he donate his body to science to remedy the imbalance his case has created.

Allow me to explain: First off, he has a “Super-head.” Who else but Zimmer-Man would be able to sustain 25-30 daggering blows and multiple whacks aggressively into a concrete slab and walk away with two Band-Aids and a slightly mashed nose? Who else could expect to experience damage to all cerebral lobes and yet their mind remain so astute they remember to place invisible handcuffs on the listless body of Trayvon, just in case he planned to get away? Who else has skin so Teflon-like that Martin’s fists slid off and left acne-scarred teens crying in envy? Who else could courageously hold off on what should have been critical medical care, and with the fine tuned precision of a student carrying cheat sheets, articulate events in alignment with the law? Only Zimmer-Man, for the rest of us soft headed slacks would be unconscious, bleeding, and frankly traumatized from the life passing before our eyes moment. So let’s put racial issues aside. Should he accept my challenge, we could study a true superhero with true superpowers that can benefit everyone.  Within Zimmer-Man’s skull and skin we are being given an opportunity to no longer subject our football heroes to traumatic brain injury studies because Zimmer-Man’s head isn’t just resilient, it has healing powers too. If you hold it, slam it’s twisting sphere into concrete, even though your knuckles and fingers should rip to bloody bone, Zimmer-Man’s head will magically remove all signs of injury as well as DNA - long before the police arrive at the scene. How’s that for magical! If Zimmer-Man donates his body to science, we can create our own super skulls so average softies like the rest of us can equally engage in mortal combat in our own suburban communities!

Zimmer-Man’s value to science is limitless. By any assessment he has Super-Perception. Who else by sheer will alone (and a few classes in criminology), would be able to detect nefarious criminal potential just by monitoring the way Trayvon Martin strolled and subtly gazed into windows? No more Ph.D. programs in Psychology - researchers will be able to analyze his keen perception skills ensuring mere mortals like ourselves are able to consistently differentiate between true drugged-out up-to-no-good burglars from those of lazy teens chatting on their cell phones lost in unfamiliar neighborhoods.

Zimmer-Man also has Super-Vision. His Nikon-like corneas are able to see in the dark (without his flashlight pointed at freaked out suspects). As a result, he is able to identify not only skin color hidden within hoodies, but also evil intentions with just a glance.  His depth of field is extraordinary - able to zero in on devious movements such as reaching into a pocket for “God Knows What” from hundreds of yards away. Please George, if you care about America, as I know you do, I beg you at least to sign that donor card right away and insure that at least one lucky lad receives those baby browns.

Zimmer-Man displays Super-Natural feats of agility and dexterity. Who else could have his arms locked in a hold, wiggle one limb loose and shove his hand deep into the back of his pants while a body is smashed on top of him? His magical laser fingers can unhook holsters and hold guns firmly (enough to ensure that dual action trigger takes), then perfectly hit the chambers of a suspect’s heart. Wow! But wait - there’s more; To recognize that he could successfully achieve this one-handed feat in less time than it would take to whack a suspect with his knee and throw their skinny ass off, surely demands the attention of America’s top scientists.

Zimmer-Man’s ability to enhance the world of Psychology is equally astounding. While Piaget (the famous Psychologist who studied object permanence in infants) probably would insist that by age two he should have outgrown this, Zimmer-Man has been able to maintain the concept that even though he is physically present, he does not exist.  Why else would he believe that if he follows people in his car and later on foot, that they would not see him and perceive him as a threat? He must believe he is invisible. Who else but Zimmer-Man could perceive danger, acknowledge his own racing heart and not see these issues as warning sign to retreat?  And there is an issue with empathy. Who else but Zimmer-man could, only seconds after realizing he killed a teenager armed only with snacks, fail to collapse into genuine sadness, doubt or experience even mild anxiety? Who else would call out for a neighbor to help restrain a boy shot in the heart instead of calling out for help to try to save his life? Is he ignorant or just lack concern, for who else would be able to look at a young teen, his lanky bones sealed in a body bag, and feel utter entitlement for all of his actions? Who else but Zimmer-Man, the Super-Hero of all heroes, could callously omit all elements of personal reflection about ones’ own responsibilities for causing the teen’s death? No one, I tell you, but Zimmer-Man.

If you are reading this George, I hope you fully appreciate the value you bring, understand that we need you and are willing to commit to the most intensive of studies.  For in the end, after scientists have analyzed your superpowers, what they will ultimately want to know most is how the brain of such a moron could be housed in such a Super-man. We need you; to help us understand you, because for all your Super-Powers, the ones that allowed you to come through your alleged horrific beating relatively unscathed and not guilty in a court of law, it is clear that surely you must be “The Dumbest Man in America” and if we could just understand how you personally formulate decisions, we can cure stupidity in all Americans. For who else but you would desperately search for a definitive address that the suspect wasn’t remotely standing at?  Who else but you would fail to recall the name of a street in a three street community? Who else but you can’t recall if they are left or right handed? Is your super-sonic memory not as great as I hope or is it more? Please George - to solve the problems, we need to know the issues.

Mostly, and don’t let your empty feelings be offended, who else but you would enter a darkened rainy maze of homes where a criminal lurked and decide it wasn’t necessary to take your loaded gun into your hand to protect yourself from attack? Most of us soft heads grab at least a candlestick in the dark of the night when we hear an intruder in our home, but not you. Instead, you decide to ignore the perceptions you’ve formed, the adrenaline in your body, as well as the hard metal of a pistol whacking around your back and groin. You had plenty of time to discuss your concerns about the suspect with the dispatcher, but it never dawned on you to take that gun out, place it in your hand and walk onto that little doggy path with a little confidence? Instead of a gun, you placed flashlights in your hands, one broken, making your walk in the dark nefarious and even more invisible. Let’s face facts - you must be incredibly stupid to risk your safety, risk your wife losing a husband, your parents losing a son, and don’t forget about all the loving cousins who would miss you should you perish in the night by the hands of the suspected burglar.

So we are worried George. By all accounts you seemed to fully utilize your Super-Zimmer-Man powers with Trayvon, but failed to use those super skills on yourself, because let’s face it, only “The Dumbest Man in America” wouldn’t contemplate the sheer luck of having a registered handgun, well “handy,” during this rare opportunity to detain “the” criminal that’s been robbing your community. You’ve simply got to help us George. If we could understand your stupidity - at what clearly was one of the most coveted moments in your life, we could potentially cure Alzheimer’s.

And I am telling you now George - your case, more than any others, has illuminated just how desperate a need we have for understanding stupidity in America.  Seemingly intelligent people have thrown out an entire prosecution’s case stating that, “that black kid was a total violent druggie criminal, skipping school and making magical Kool-Aid.” People have come to believe if someone sees a “moment” of a fight that reliably represents the “entire fight” forever altering the outcomes of playground altercations everywhere. In your case, top experts in medicine and defensive use of force, couldn’t recall that when evaluating a reported fight, they actually had to factor in whether the “other person” (you know the dead guy) had injuries congruent with the supposed victim’s claims.

And don’t get me started on your attorney’s! Glaring with stupidity they were unable to comprehend what Rachel Jeantel said in her attitude-filled deposition about who was screaming. Were your Superhero ears working that day? She was saying there were two people out there - so of course the screams “could’ve been Trayvon’s!”  My God, what a bunch of idiots you hired! And we know what your attorneys thought of the jury.  They thought your jury was just a bunch of dumb women who needed to be told the same thing over and over again. And maybe they were right. In spite of your attorney’s sophomoric poster board cheat sheet, one juror said the jury instructions were “totally confusing” but insisted they based their verdict of the Good Samaritan - on the law.  One just announced, “He got away with murder!” Good lord George, the respect and salvation of the judicial system are frighteningly contained in your “Zimmer-Man” slippery hands.

More than anything, I suppose, you represent the average man; living in the shadows of his successful father, jilted out of being the chosen son.  We get it. You are a man who wants to be more but doesn’t know how. We understand.  We know you long to be a good boy and do good things.  This was most evident when you showed up at trial willing to have that 12 year-old boy hair cut and those 100 extra pounds of innocence. We’ve been there. You didn’t want to kill Trayvon Martin; you aren’t filled with paranoid delusional hate.  You didn’t even want to detain him, you just wanted to be a good boy and do whatever necessary to keep your neighborhood safe. We are with you. You are America’s Mr. Roger’s and Frank Taffee just one of the people that we meet in the neighborhood. But there is more to you George. Zimmer-Man represents the type of man worthy of study, a true warrior, an anomaly of the mind-boggling intersection where good citizen and moron merge.  You can’t slip away into oblivion, rescue the occasional flipped car and not fulfill your duty to society. You can’t give up on all your dreams of being important and making a difference to the world as a whole. When OJ was found Not Guilty in a court of law, did he give up? No! With the blessing of his attorney Johnny Cochran, he wrote us stupid Americans a book and to help us - IF he had killed them, THIS is how it would’ve been done, in case we didn’t understand. Are you going to show up, make a mess and then leave us to solve it alone? Please George, be the American Superhero we know you can be and run yourself to the nearest Medical Laboratory. And if you can’t do it for America, do it, well… for…. Johnny!