Tag Archives: American College of Psychiatrists

Narcissists Get “Ignored” in DSM-5

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.

Photo courtesy of flickr user dbking (Creative Commons license).

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)

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Social Media Lack Privacy, a Problem for Psychiatrists

Many psychiatrists of, ahem, a certain age (say, over 30) have been caught by surprise by the reach of online and social media. With the explosion in use of the Internet, e-mail, Google, Facebook, Twitter, LinkedIn, and many other ways to find out information about someone, there’s no such thing as privacy any more. That creates a new set of modern problems for psychiatrists who walk a fine line between building a therapeutic alliance with patients and keeping a professional distance.

Image captured by flickr user smemom87.

I sat in on a fascinating group discussion at the annual meeting of the American College of Psychiatrists to hear how professionals are grappling with these issues. Look for a more detailed report soon in Clinical Psychiatry News. What surprised me is that even some very young psychiatrists who grew up so immersed in online and social media that they seem like part of the natural environment have been surprised by the professional ramifications of the long reach that these tools give to patients.

Some of the challenges are old problems in a new form, it seems. Setting limits on patients’ e-mail contact with psychiatrists is similar to setting limits on phone contact in some ways, but magnified. The Internet and e-mail can be both helpful and problematic in their work, psychiatrists said. The biggest potential land mines are in the social media. What happens when a patient wants to “Friend” a psychiatrist who is on Facebook? No matter how the psychiatrist responds, there’s grist for the psychoanalytic mill. Transference becomes a bigger issue. Even using the highest privacy settings, non-Friend visitors to your page can glean information about you, your “Friends,” and potentially your family. Perhaps not surprisingly, only a handful of psychiatrists in the room said they were on Facebook. And Internet dating? Look out.

Does that mean psychiatrists must be technological hermits, never to enjoy the interconnectedness that social media supply to everyone else in society?

These are all weighty questions that usually have no right or wrong answer. The American Association of Directors of Psychiatry Residency Training (AADPRT) just released new curricula to guide psychiatrists-in-training in discussing these issues, so that they can anticipate the potential consequences of the decisions they make about use of online tools and social media. See my full story for details.

The curricula are available only to AADPRT members, though some of the resources in them may be made available to the general public in the future, said AADPRT President Dr. Sheldon Benjamin. Meanwhile, you can hear him discuss these topics in an AADPRT podcast interview with Dr. Sandra M. DeJong, chair of the Association’s Task Force on Professionalism and the Internet.

I’d love to hear from clinicians of any specialty who are reading this (but especially psychiatrists) — do you use social media? Are they worth the potential professional problems? And will you Friend me? Leave a comment, and let us know.

— Sherry Boschert

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