Stop Walking on Eggshells

When someone in your life has borderline or narcissistic personality disorder

An End to Narcissistic Personality Disorder In DSM-5?

APA wants to do away with narcissistic personality disorder.

For decades (if not centuries), a cure for narcissistic personality disorder (NPD) has been elusive. Now we have one: simply take the diagnosis out of the next edition of the Diagnostic and Statistical Manual (DSM-5), the clinician "bible" published by the American Psychiatric Association.

I have more than a passing interest in the upcoming reformulation of personality disorders (PDs) in the DSM-5. In the 14 years that I have been studying and writing about borderline personality disorder, I have come to the realization perhaps most of the "high functioning" type of those with BPD may also have co-occuring NPD or NPD traits. My next book (more about that sometime in the future) will focus on that subset. So needless to say, this news was a bummer.

But it won't change my plans to write about it.

Cadres of clinicians are taking great exception to the reorganization, and they're being vocal about it. They see a number of problems with it, but the one I am going to focus on is the elimination of NPD--perhaps the best known of the personality disorders.

Thomas A. Widiger, Ph.D., Department of Psychology, University of Kentucky, is one of the many clinicians who are disputing the reorg. He has written a paper called, "A Shaky Future for Personality Disorders" to be published in an edition of the journal Personality Disorders: Theory, Research, and Treatment.

Essentially, his arguments come down to this:

• The American Psychiatric Association is eliminating half of the personality disorders (including NPD) because some of the symptoms overlap and people can have more than one PD at the same time.

• There is plenty of scientific evidence that NPD and some other PDs exists. So why put them on the chopping block?

Widiger writes:

Half of the diagnostic categories [for personality disorders in the DSM-5] are proposed for deletion (i.e., dependent, narcissistic, paranoid, schizoid, and histrionic). The rationale for cutting out half is to reduce diagnostic co-occurrence [comorbidity; people having both diagnoses] (Skodol, 2010).

Diagnostic co-occurrence has been a significant problem for the categorical diagnoses (Widiger & Trull, 2007), but sacrificing fully half of them would seem to be a rather draconian approach for addressing this problem...

It does not speak well for the credibility of the field of personality disorders to be so willing to sacrifice half of its coverage in order to address diagnostic co-occurrence, as if half of what we have been diagnosing and treating for the past thirty years was not worth the clinical attention.

Imagine if these were real illnesses with a problematic diagnostic co-occurrence and the American Medical Association decided to address the problem by simply denying the existence of half of them. Persons will still have dependent, schizoid, paranoid, histrionic, and narcissistic personality traits despite their diagnoses being deleted...

A few disparate studies are cited to justify the retention of the avoidant and obsessive-compulsive personality disorders, but no studies are provided to justify the deletion of the narcissistic, dependent, schizoid, histrionic, or paranoid. There does not appear to have been a review of the literature to determine whether these personality disorders lack clinical utility and/or construct validity deletion (Frances et al., 1989).

You can find other articles about the topic here:

http://www.nytimes.com/2010/11/30/health/views/30mind.html?_r=1

http://psychcentral.com/blog/archives/2010/11/30/personality-disorders-shakeup-in-dsm-5/

Whatever happens, you can bet that NPD will still be with us for awhile. While you can take NPD out of the DSM, you can't as easily take NPD out of the people who have it.

Also, the publishing industry takes a great deal of time to catch up to the DSM. Authors like me will still be writing about it (including the upcoming book Splitting: Protecting Yourself When Divorcing a Borderline or Narcissist by myself and William Eddy (2011, New Harbinger Publications)).

What do you think?

 

ADDITION 7/8/11

Looks like NPD won't be dropped: see http://www.therepublic.com/view/story/MED-PERSONALITY-DISORDERS_5528069/MED-PERSONALITY-DISORDERS_5528069

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Randi Kreger is the co-author of Stop Walking on Eggshells.

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