Self-defeating personality disorder and DSM-III-R: development of the diagnostic criteria

Article Abstract:

A major controversy arising from the publication of the Diagnostic and Statistical Manual of Mental Disorders, third edition-revised (DSM-III-R) is the omission of the criteria for self-defeating personality disorder. However, the category was included in an appendix entitled 'Proposed Diagnostic Categories Needing Further Study'. This article examines the arguments for and against its inclusion and reviews the supportive clinical literature. The concept of the self-defeating personality disorder can be traced back to masochism, which was originally a psychosexual disorder, but the term has been expanded considerably in recent times so that it shares some similarities with self-defeating personality disorder. Some general criteria for self-defeating personality disorder that are tentatively included in the appendix include a pervasive pattern of self-defeating behavior. This behavior does not occur in response or anticipation of abuse, and the behavior is not manifested only during depression. The authors felt that arguments can be made for the inclusion of this category, observing that the empirical support for this disorder is comparable to the degree of support existing for other conditions that have been included in the DSM. Those favoring inclusion of self-defeating personality disorder have argued that there exists a potential for constructive clinical use. Many unanswered questions still remain, including the stability of the diagnosis over time versus periodic occurrence of the condition induced by severe stress or other factors; the consideration of developmental factors leading to the disorder such as child abuse; or the independence of this disorder from other conditions. Answers to these and other questions are required before a proper judgment can be made regarding the inclusion of this condition in the forthcoming fourth edition, DSM-IV.

Evaluation, Diagnostic and Statistical Manual of Mental Disorders (Book)

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Results of a survey of forensic psychiatrists on the validity of the sadistic personality disorder diagnosis

Article Abstract:

Forensic psychiatrists have recommended that 'sadistic personality disorder' be added to formal psychiatric diagnostic guides to diagnose individuals who have a long-standing history of maladaptive behavior and who do not easily fit into other diagnostic categories for personality disorders. The characteristics of the proposed sadistic personality disorder include cruel, demeaning, and aggressive behaviors. There has been little systematic study of the proposed category. Forensic psychiatrists nationwide were surveyed to determine their views on the usefulness of the diagnosis and the validity of the proposed diagnostic criteria. Of the 279 questionnaires that were analyzed, 50 percent of the respondents said that they had evaluated someone who would have fit the criteria. Four percent of the cases seen in the preceding year would have been diagnosed as sadistic personality disorder, had the diagnosis been available. The respondents believed that the diagnosis would be useful clinically, but they also feared that it could be misused in legal situations. Most potential cases for this diagnosis were male, 79 percent were white, and 90 percent reported a childhood history of emotional abuse. Sexual abuse was reported in 41 percent of the cases and physical abuse in 76 percent. It is recommended that the diagnosis of sadistic personality disorder be studied further because it is descriptive and would be useful for forensic psychiatrists and other clinicians. (Consumer Summary produced by Reliance Medical Information, Inc.)

Psychological aspects, Diagnosis, Surveys, Personality disorders, Sadism, Forensic psychiatrists

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