Posted by Larry Hoover on June 1, 2003, at 9:57:36
In reply to Re: DSM and labels » Larry Hoover, posted by Dinah on May 31, 2003, at 23:51:48
> It's a sorry state of affairs, isn't it? And the new DSM V is due out in 2010, the political maneuvering has already begun, and I don't expect much better than the IV version. Sigh.
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> At the very very least, they should try to correlate the "personality disorders" with the biological underpinnings that most of them probably have. Axis II should be hmmmm.... a manifestation of Axis I? whenever possible. I don't know if I'm expressing it well, but Axis II disorders ought to come with a list of Axis I disorders to rule out. Borderline personality with some form of affective instability. Avoidant with an anxiety disorder. Schizoid and schizotypal with Asperger's or some related neurological condition. That would take some of the stigma away from personality "disorders", and suggest additional biological treatments, as well as therapy treatments.
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> So maybe if they used the axis system to say something like "BPII with borderline coping mechanisms" "Sensory Integration neurological deficits with borderline coping mechanisms" "Post Traumatic Stress disorder with antisocial coping mechanisms" "Generalized Anxiety Disorder with avoidant coping mechanisms" "Generalized Anxiety Disorder with obssessive compulsive coping mechanisms"
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> I don't know if I'm expressing the idea well. It's in my head, but I'm not sure if it's making it out in a coherent manner.I think you've done well expressing your ideas.
The current philosophy of diagnosis is that organic brain disease is Axis I, which is the first focus of the diagnostician in interpreting symptoms/behaviour. When that fails, or if it's apparent there's more to consider, you go to Axis II. The problem is that you can certainly get "false negatives" with respect to organic brain disease; i.e. there really is a pathology of some sort, but you erroneously exclude that concept from consideration.
The reason for that failing lies in the symptom checklists. Schizotypal disorder is "organic" under ICD-10, but PD under DSM-IV. Is European schizotypy different from the American form? Not.
The whole format, e.g. "four of these ten symptoms", "persisting for greater than two weeks", and so on, presumes that people are going to fit reasonably well into these "constructed pigeonholes" of conceptualization. What do you do with those who straddle these arbitrary definitions? Mother Nature doesn't draw lines.
If you think about it, the fact that drugs are even tried as therapy for personality disorders suggests that doctors believe that there are biological underpinnings.
Lar
poster:Larry Hoover
thread:230170
URL: http://www.dr-bob.org/babble/psycho/20030529/msgs/230551.html