National field trial of the DSM-III-R diagnostic criteria for self-defeating personality disorder

Article Abstract:

Self-defeating personality disorder is a new diagnostic category listed in the DSM-III-R (Diagnostic and Statistical Manual of Mental Disorders, third edition, revised). The criteria for diagnosing the disorder have been questioned, in that they may also indicate transient coping responses to abuse from others or transitory depressive symptoms. A national field trial of these criteria was conducted among psychiatrists in 1986 to detect any problems inherent in the criteria and diagnosis. The first study elicited 620 responses, of which 51 percent thought the diagnostic category was needed. Women clinicians were expected to be less likely to endorse the category because of an earlier concern over sexist prejudice in use of the diagnosis. Those who used primarily psychotherapy, as opposed to drug therapy, were expected to be more likely to favor the category, as were clinicians trained many years ago, as their training would have included the concept of "masochistic personality." The results unexpectedly showed no relationship between support for the diagnosis and the respondent's sex, type of practice, or years in practice. The questionnaire revealed that the criteria were able to "correctly" diagnose a case of self-defeating personality disorder 83 percent of the time, when applied by 222 clinicians. A second study questioned a group of 1,391 psychiatrists with a special interest in personality disorders on relationships between 32 diagnostic criteria, never mentioning the personality disorders the criteria represented. There was a high degree of overlap between all the personality disorders. Both studies found the diagnosis was applied more frequently to women. It is concluded that the diagnostic category has limited descriptive validity.

Criticism and interpretation, Self-destructive behavior, Self injurious behavior, Personality disorders

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Psychotic disorders in DSM-III-R

Article Abstract:

Changes in the classification of psychotic disorders that were made in three sections of the DSM-III-R (Diagnostic and Statistical Manual of Mental Disorders, third edition, revised) are reviewed. Areas that were affected include schizophrenia, delusional disorder, and psychotic disorders that do not appear in other categories. Three major types of changes are identified: changes lacking empirical support; changes backed by some empirical support; and changes that are fully supported by empirical data. In the authors' opinion the first type of change is not advisable and it is hoped that the forthcoming fourth edition of the manual, DSM-IV, will include only changes in diagnostic criteria that are based, at least in part, upon empirical evidence. The authors also propose two other changes, a reorganization of the category for schizophrenia to include related (schizoaffective) disorders, and a reduction in the required duration in criteria for schizophrenia. The authors stress that the new edition should be created with two main objectives: to increase the scientific basis for the systematic classification of mental disorders and to provide a foundation to enhance the stability of the diagnostic process. They also suggest that a database could be used to support proposed revisions.

Analysis, Evaluation, Schizophrenia, Psychoses, Psychotic disorders

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