A new proposal to clarify diagnoses of recognized personality disorders and better integrate them into clinical practice, to extend and improve treatment, is meeting resistance.
This weekend the Board of Trustees of the American Psychiatric Association will vote on whether to adopt a new diagnostic system for some of the most serious, and striking, syndromes in medicine:personality disorders.
Personality disorders occupy a troublesome niche in psychiatry. The 10 recognized syndromes are fairly well represented on the self-help shelves of bookstores and include such well-known types as narcissistic personality disorder, avoidant personality disorder, as well as dependent and histrionic personalities.
But when full-blown, the disorders are difficult to characterize and treat, and doctors seldom do careful evaluations, missing or downplaying behavior patterns that underlie problems like depression and anxiety in millions of people.
The new proposal — part of the psychiatric association’s effort of many years to update its influential diagnostic manual — is intended to clarify these diagnoses and better integrate them into clinical practice, to extend and improve treatment. But the effort has run into so much opposition that it will probably be relegated to the back of the manual, if it’s allowed in at all.
These days, as never before, therapists are struggling with concerns about the accessibility made possible by technology.
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The idea to study reparative therapy at all was pure Spitzer, say those who know him, an effort to stick a finger in the eye of an orthodoxy that he himself had helped establish.
In the late 1990s as today, the psychiatric establishment considered the therapy to be a nonstarter. Few therapists thought of homosexuality as a disorder.
It was not always so. Up into the 1970s, the field’s diagnostic manual classified homosexuality as an illness, calling it a “sociopathic personality disturbance.” Many therapists offered treatment, including Freudian analysts who dominated the field at the time.
Advocates for gay people objected furiously, and in 1970, one year after the landmark Stonewall protests to stop police raids at a New York bar, a team of gay rights protesters heckled a meeting of behavioral therapists in New York to discuss the topic. The meeting broke up, but not before a young Columbia University professor sat down with the protesters to hear their case.
“I’ve always been drawn to controversy, and what I was hearing made sense,” said Dr. Spitzer, in an interview at his Princeton home last week. “And I began to think, well, if it is a mental disorder, then what makes it one?”
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