Proposed revisions to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), which gives clinicians criteria for diagnosing a mental disorder in someone, have generated much discussion. Perhaps none more so than the elimination of narcissistic personality disorder.
The mainstream media had fun playing with this. “A Fate That Narcissists Will Hate: Being Ignored,” said The New York Times headline. “For decades (if not centuries), a cure for narcissistic personality disorder has been elusive. Now we have one: simply take the diagnosis out” of DSM-5, said a Psychology Today blogger.
The real story, not surprisingly, is more complicated and nuanced than that. Revisions to the whole category of personality disorders will be a test case in DSM-5 for using a dimensional model for diagnosis rather than the categorical approach that has been used for decades. If it’s a helpful switch, the dimensional model might be employed in other parts of future DSMs.
Narcissistic personalities aren’t going away, nor is recognition of this particular collection of problematic mental characteristics. But in DSM-5 it would be represented as a trait, not as a personality disorder type. Nor is narcissistic personality disorder the only one generating controversy. Dr. John G. Gunderson of Harvard University, Boston, worries that changes proposed for the definition of borderline personality disorder could undermine research in this disorder and any confidence that clinicians and patients have in the diagnosis, he said at the annual meeting of the American College of Psychiatrists.
Dr. Andrew E. Skodol of the University of Arizona, Tucson and chair of the DSM-5 Personality and Personality Disorders Work Group, countered at the meeting, “I think we really haven’t changed the content of the construct as much as the format.”
See my full story in Clinical Psychiatry News for more info. I think there will be more news on these topics for years to come. Will that make the narcissistic types happy? Silly question.
–Sherry Boschert (@sherryboschert on Twitter)