Subject: Replacing “Personality Disorder” with “Syndrome.”
Whereas:
1] DSM-5 has a chapter on "Personality Disorders"
2] "Personality Disorder" is pejorative and more uncomfortable for
patients than most diagnoses. See “9]” as to “disorder” being
more pejorative than “syndrome.”
3] The APA should not advocate diagnostic terms that are painful
for patients when less pejorative are available.
4] Being pejorative, the “personality disorder” decreases the
patient's willingness to accept that label and, thus, accept
treatment for that condition.
5] Insurance companies have been reluctant to pay for treatment of
“personality disorders,” not eager to conceptualizing them as a
medical condition.
6] When a patient has the signs and symptoms of a "personality"
disorder, it is not uncommon for clinicians to select another
diagnosis, e.g., Bipolar II, instead of a personality disorder
diagnosis to avoid problems listed supra. That is often
unfortunate because guides to the treatment of personality
disorders stress the need for psychotherapy and without that
diagnosis, the patient may not receive the psychotherapy they
need, may only be given a prescription.
7] The DSM-5 version of personality disorders is not tied to the
science of personality. This motion would leave the door open for
DSM entities tied to the science of personalities.
8] “Syndrome” is a medical term* that implies a grouping of
symptoms and is less pejorative than “disorder.” For example,
alternative terms could be:
Paranoid syndrome
Schizoid syndrome
Schizotypal syndrome
Antisocial syndrome
Borderline syndrome
Histrionic syndrome
Narcissistic syndrome
Obsessive-compulsive syndrome
Avoidant syndrome
Dependent syndrome
Other syndromes of untoward interpersonal functioning
Unclassified conditions of untoward interpersonal
functioning
9] *”Syndrome” is more medical than “disorder.” In the Random
House Dictionary of the English Language:
Disorder 1. Lack of order or regular arrangement; confusion:
your room is in utter disorder. 2. an irregularity: a disorder in legal
proceedings. 3. breach of order; disorderly conduct; public
disturbance. 4. a disturbance in physical or mental health or
function; malady or dysfunction: a mild stomach disorder.
Syndrome 1. Pathol., Psychiatry. A group of symptoms that
together are characteristic of a specific disorder, disease, or the
like. 2. a group of related or coincident things, events, action, etc. 3.
the pattern of symptoms that characterize or indicate a particular
social condition. 4. a predictable, characteristic pattern of behavior,
action, etc., that tends to occur under certain circumstances: the
retirement syndrome of endless golf and bridge games; the feastor-famine syndrome of big business
“Syndrome” appears in ICD-9-CM more than twice as
frequently as “disorder.”
10] The author of ICDs is the National Center of Health Statistics
[NCHS].
Resolved
1] That the Assembly propose to the APA's newly formed DSM
component that the APA recommend to the National Center of
Health Statistics [NCHS] that for all of DSM-5’s “Personality
Disorders,” the names of the conditions use "syndrome" rather
than "personality disorder."
2]
Once approved by NCHS, that these additions be reflected in
the subsequent printing of DSM-5.
Author:
Roger Peele, MD, DLFAPA, Washington Psychiatric Society
Assembly Representative.
Approved by Suburban Maryland Psychiatric Society, Summer,
2014.
Approved by Washington Psychiatric Society, 8 September 2014
Estimated Costs: None, This AP can be processed in meetings
of components routinely schedule.
APA:
Estimated Saving: None
Estimated Revenue Generated: None
Endorsed by: Washington Psychiatric Society
Key Words:
DSM
APA Strategic Goal: Enhancing the Scientific Basis of
Psychiatric Care
Reviewed by Relevant APA Component:
Sent to Chair, DSM component