The Diagnostic and Statistical Manual for Mental Disorders (DSM) serves as guidebook for much of the mental health community. It’s the go-to book of traits and symptoms and helps counselors and therapists use symptoms to identify what exactly it is a patient is dealing with. The DSM has never been without controversy. On a broad level, many therapists debate whether statistical diagnosis is an appropriate way to look at people. And on a specific level, decisions to add or remove a condition or change a condition’s diagnostic criteria are often highly debate. The fifth edition, DSM-V, is scheduled for publishing in 2013, and its proposed changes have already caused quite a stir.
Most prominent in the media have been changes proposed to the DSM-V section of personality disorders. Currently, there are ten different labels included within this section, and the 2013 update will cut that in half, eliminating five diagnoses from the DSM. Most well-known among those slated for removal is narcissism, officially called “narcissistic personality disorder” in the DSM. Generally, traits that fall under this label are not just self-absorption, but an extreme form of it: a very inflated sense of one’s own skills and value, the expectation that others share and express those views, and a lack of seeing things from another’s perspective.
The narcissism debate has raised discussion of larger issues, including how the DSM approaches people’s problems and labels people. After all, these traits will still be items that people struggle with and find a therapist to address. Is a label actually necessary, or even helpful? Saddled with a term so loaded as “narcissism, who would feel empowered to change? But this applies to the whole category of “personality disorders,” as well. The idea of personality disorder runs a high risk of pathologizing people rather than empowering them to heal and grow. If a person exhibits qualities that meet DSM standards for a certain diagnosis, why use those qualities to label the person as a whole? Why not simply use therapy and counseling to identify and address those qualities to help the person improve his or her life without the stigma of “personality disorder” attached? The debates triggered by the DSM and changes to it are sure to continue.
© Copyright 2010 by By Noah Rubinstein, LMFT, LMHC, therapist in Olympia, Washington. All Rights Reserved. Permission to publish granted to GoodTherapy.org.
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