Dsm Quotes

Narcissistic personality disorder is named for Narcissus, from Greek mythology, who fell in love with his own reflection. Freud used the term to describe persons who were self-absorbed, and psychoanalysts have focused on the narcissist's need to bolster his or her self-esteem through grandiose fantasy, exaggerated ambition, exhibitionism, and feelings of entitlement.

The DSM-IV-TR is a 943-page textbook published by the American Psychiatric Association that sells for $99...There are currently 374 mental disorders. I bought the book...and leafed through it...I closed the manual. "I wonder if I've got any of the 374 mental disorders," I thought. I opened the manual again. And instantly diagnosed myself with twelve different ones.

If we could somehow end child abuse and neglect, the eight hundred pages of DSM (and the need for the easier explanations such as DSM-IV Made Easy: The Clinician's Guide to Diagnosis) would be shrunk to a pamphlet in two generations.

The power to label is the power to destroy.

Oddly enough, there’s no name in the DSM for the compulsion to diagnose people.

One day I would like to make up my own DSM-111 with a list of “disorders” I have seen in my practice. For example, I would want to include the diagnosis “psychological modernism,” an uncritical acceptance of the values of the modern world. It includes blind faith in technology, inordinate attachment to material gadgets and conveniences, uncritical acceptance of the march of scientific progress, devotion to the electronic media, and a life-style dictated by advertising.

Another consequence of C-PTSD not being in the DSM: This psychologist hasn’t been trained in treating it.

Dissociative symptoms—primarily depersonalization and derealization—are elements in other DSM-IV disorders, including schizophrenia and borderline personality disorder, and in the neurologic syndrome of temporal lobe epilepsy, also called complex partial seizures. In this latter disorder, there are often florid symptoms of depersonalization and realization, but most amnesia symptoms derive from difficulties with focused attention rather than forgetting previously learned information.

I was much crazier than I had imagined. Or maybe it was a bad idea to read DSM-IV when you're not a trained professional. Or maybe the American Psychiatric Association had a crazy desire to label all life a mental disorder.

narcissistic personality disorder, or NPD. According to DSM-IV, NPD is distinguished by a pervasive pattern of grandiosity (in fantasy or behavior), need for admiration, and lack of empathy

The forward to the landmark 1980 DSM III was appropriately modest and acknowledged that this diagnostic system was imprecise. So imprecise that it never should be used for forensic or insurance purposes. As we will see that modesty was tragically short lived.

For the diagnostic categories for which drugs are far and away the first-line form of treatment, such as the ‘mood disorders’, ‘eating disorders’, ‘psychotic disorders’ and ‘anxiety disorders’, an average of 88% of all DSM-IV panel members had drug company financial ties.

Dissociative Disorders have a high rate of responsiveness to therapy and that with proper treatment, their prognosis is quite good.

Dissociation is characterized by a disruption of usually integrated functions of memory, consciousness, identity, or perception of the environment.

John Briere, quip that if Cptsd were ever given its due, the DSM [The Diagnostic and Statistical Manual of Mental Disorders] used by all mental health professionals would shrink from its dictionary like size to the size of a thin pamphlet.

panic disorder with agoraphobia (DSM-V code 300.22): the condition, as Hippocrates described it, “usually attacks abroad, if a person is travelling a lonely road somewhere, and fear seizes him.

Loose diagnosis is causing a national drug overdose of medication. Six percent of our people are addicted to prescription drugs, and there are now more emergency room visits and deaths due to legal prescription drugs than to illegal street drugs.6

[Sociopaths] may have a history of many sexual partners… They may have associated disorders… substance use disorders… and other disorders of impulse control… [They] also often have personality features that meet criteria for other personality disorders, particularly borderline, histrionic, and narcissistic personality disorders. —DSM-V2 As

The great unspoken paradox of the arduous process of psychoanalysis is that the best patients are the ones who never really needed it in the first place. Abnormal

Finally, those who do not meet the SCID-D-R standard for "distinct identities or personality states," but who do meet the SCID-D-R's other four standards (for DSM-IV's Criterion A and Criterion B) for DID, receive a SCID-D-R diagnosis of DDNOS-1a.

While a 2013 study found that, over time, a very small percentage of children experienced such improvements in symptoms that they no longer fit the DSM autism diagnosis, the study found no way to predict which children would show such gains, or why.

Acts of psychological abuse include berating or humiliating the victim; interrogating the victim; restricting the victim's ability to come and go freely; obstructing the victim's access to assistance (e.g., law enforcement; legal, protective, or medical resources); threatening the victim with physical harm or sexual assault; harming, or threatening to harm, people or things that the victim cares about; unwarranted restriction of the victim's access to or use of economic resources; isolating the victim from family, friends, or social support resources; stalking the victim; and trying to make the victim think that he or she is crazy.

Give a name to suffering, perhaps the most immediate reminder of our insignificance and powerlessness, and suddenly it bears the trace of the human. It becomes part of our story. It is redeemed.

Even sleep offered no respite from my mental disorders. There was Nightmare Disorder, which is diagnosed when the sufferer dreams of being "pursued or declared a failure." All my nightmares involve someone chasing me down the street while yelling, "You're a failure!

Identity confusion is defined by the SCID-D as a subjective feeling of uncertainty, puzzlement, or conflict about one's own identity. Patients who report histories of childhood trauma characteristically describe themes of ongoing inner struggle regarding their identity; of inner battles for survival; or other images of anger, conflict, and violence. P13

Many people with Dissociative Disorders are very creative and used their creative capacities to help them cope with childhood trauma.p55

Taking a pill is passive. In contrast, psychotherapy puts the patient in charge by instilling new coping skills and attitudes toward life.

[W]e have far too much faith in pills, far too little trust in resilience, time, and homeostasis.

DSM largely lacks what in the world of science is known as “reliability”—the ability to produce consistent, replicable results. In other words, it lacks scientific validity.

Do not allow a child or an adult to become defined by a DSM label.

Many research psychiatrists I’ve interviewed liken DSM diagnoses to our understanding of headaches—we have symptoms with no knowledge of the underlying cause.

Great, so he was paranoid, too—which, along with his ambient anxiety and the narcissistic behavior he’d been popping lately, meant he had most of the DSM-IV covered tonight.

to have poor shame tolerance. They learned in childhood to manage feelings of inadequacy by adopting unhealthy coping mechanisms to forestall or avoid shaming experiences. Poor shame tolerance causes behaviors associated with the just-mentioned DSM disorders, including vindictive anger, lack of insight and accountability, dishonesty, impulsivity, entitlement, paranoia, lack of remorse and empathy, self-importance, and attention-seeking. Trump is an extreme example, but “subclinical” versions of this behavior exist in millions of people, including domestic abusers.

First documented in the late 1800s, then “codified as an independent diagnostic entity” a century later, though largely comorbid with panic disorder. You can read all about it, if you like, in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. DSM-5 for short. It’s always amused me, that title; it sounds like a movie franchise. Liked Mental Disorders 4? You’ll love the sequel!

Social anxiety disorder”—which essentially means pathological shyness—is now thought to afflict nearly one in five of us. The most recent version of the Diagnostic and Statistical Manual (DSM-IV), the psychiatrist’s bible of mental disorders, considers the fear of public speaking to be a pathology—not an annoyance, not a disadvantage, but a disease—if it interferes with the sufferer’s job performance.

Due to previous lack of systematic assessment of dissociative symptoms, many subjects experience the SCID-D as their first opportunity to describe their symptoms in their own words to a receptive listener.

Mental disorders should be diagnosed only when the presentation is clear-cut, severe, and clearly not going away on its own. The best way to deal with the everyday problems of living is to solve them directly or to wait them out, not to medicalize them with a psychiatric diagnosis or treat them with a pill.

DSM-5 is not 'the bible of psychiatry' but a practical manual for everyday work. Psychiatric diagnosis is primarily a way of communicating. That function is essential but pragmatic—categories of illness can be useful without necessarily being 'true.' The DSM system is a rough-and-ready classification that brings some degree of order to chaos. It describes categories of disorder that are poorly understood and that will be replaced with time. Moreover, current diagnoses are syndromes that mask the presence of true diseases. They are symptomatic variants of broader processes or arbitrary cut-off points on a continuum.

DSM definitions do not include personal and contextual factors such as whether the depressive symptoms are an understandable response to loss, a terrible life situation, psychological conflict or personality factors.

[W]ay too much treatment is given to the normal "worried well" who are harmed by it; far too little help is available for those who are really ill and desperately need it. Two thirds of people with severe depression don't get treated for it, and many suffering with schizophrenia wind up in prisons. The writing is on the wall.

When is posttraumatic stress pathological? The American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-IV23 or DSM-IV-TR24)b lays out specific criteria. Criterion A: Trauma. Yes, the event that created Batman (1) involved death or physical danger and (2) horrified the survivor. Criterion B: Persistent re-experiencing. Yes, Bruce re-experiences his parents’ murders through recurrent, vivid recollections and

You can read all about it, if you like, in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. DSM-5 for short. It’s always amused me, that title; it sounds like a movie franchise. Liked Mental Disorders

I was much crazier than I had imagined. Or maybe it was a bad idea to read the DSM-IV when you’re not a trained professional. Or maybe the American Psychiatric Association had a crazy desire to label all life a mental disorder.

I was much crazier than I had imagined. Or maybe it was a bad idea to read the DSM-IV when you're not a trained professional. Or maybe the American Psychiatric Association had a crazy desire to label all life a mental disorder.

I’d always wondered why there had been no mention of psychopaths in the DSM. It turned out, Spitzer told me, that there had indeed been a backstage schism—between Bob Hare and a sociologist named Lee Robins. She believed clinicians couldn’t reliably measure personality traits like empathy. She proposed dropping them from the DSM checklist and going only for overt symptoms. Bob vehemently disagreed, the DSM committee sided with Lee Robins, and Psychopathy was abandoned for Antisocial Personality Disorder.

Failure to conform to social norms with respect to lawful behaviors… deceitfulness, as indicated by repeated lying, use of aliases or conning others for personal [gain]… Deceit and manipulation are central features of antisocial personality disorder… —DSM-V7

The foreword to the landmark 1980 DSM-III was appropriately modest and acknowledged that this diagnostic system was imprecise—so imprecise that it never should be used for forensic or insurance purposes.8 As we will see, that modesty was tragically short-lived.

Overcoming problems on your own normalizes the situation, teaches new skills, and brings you closer to the people who were helpful. Taking a pill labels you as different and sick, even if you really aren't. Medication is essential when needed to reestablish homeostasis for those who are suffering from real psychiatric disorder. Medication interferes with homeostasis for those who are suffering from the problems of everyday life.

For millennia, we’ve recognized the difference between “normal” sadness and crippling despair. But we’ve never been good at delineating between the two. So the American Psychiatric Association’s Diagnostic and Statistical Manual (DSM) defines depression by a list of symptoms rather than how it’s caused.

Anyone who is truly crazy, in my book, wouldn't be able to understand the dialectic of crazy and not-crazy. Listen, I've worked for the pharmaceutical companies, they have a vested belief in making you believe that if you have a chemical imbalance you need them to be 'cured' of your current issues and personality. Indefinitely. Imagine diagnosing personality only in terms of its negative aspects. Does this strike you as a strategy designed for health? The only way to deal with a problem is to fucking deal with it. Get inside what positive motivation, what intention, makes you behave in the way you are... and how you could maybe satisfy that need in a healthier or at least more agreeable manner. America wants quick, easy and painless; being a real person is slow, difficult and very messy.

The outcome of this revelation was that the APA scrubbed homosexuality from the new edition of the DSM—though traces remained in the diagnosis “Sexual Orientation Disturbance,” which described people distressed by their sexuality (which, frankly, was probably anyone who was gay during a time when it was considered criminal and ill).

the essential feature of the Dissociative Disorders is a disruption in the usually integrated functions of consciousness, memory, identity,or perception

Patienthood can become a way of life and rationale for people who are struggling for other reasons.

Time heals so well because many of our ills are short-term, situational, and self-limited - our bodies and our minds are programmed to be resilient without any active effort on our part.

Partner psychological abuse encompasses nonaccidental verbal or symbolic acts by one partner that result, or have reasonable potential to result, in significant harm to the other partner.

As we have learned more and more about the brain and how it generates complex behaviours, U.S. psychiatry remains wedded to a diagnostic and treatment system over 60 years old: identify a few clinical features that match a diagnostic label in the DSM and then apply the treatments that are said to work for the category of the patient. It Is a cookbook diagnosis and treatment. Without thought, labels are applied and drugs with significant side effects but with only the modest efficiency are prescribed. Various brands of psychotherapy are offered with little consideration of what actually helps and which patients are best suited to a particular brand. This is twenty-first century U.S. psychiatry. As a field in my view ignored the oath to first, do no harm.

It is not unusual for subjects diagnosed with a Dissociative Disorder on the SCID-D to be surprised at having their symptoms validated by a clinician who understands the nature of their disorder.

It is equally dangerous at either extreme - to have either an expanding concept of mental disorder that eliminates normal or to have an expanding concept of normal that eliminates mental disorder.

The DSMs have a mixed record. They have served an extremely valuable function in improving the reliability of psychiatric diagnosis and in encouraging a revolution in psychiatric research. But they have also had the very harmful unintended consequence of triggering and helping to maintain a runaway diagnostic inflation that threatens normal and results in massive overtreatment with psychiatric medication.

Quando alguns psiquiatras dizem que as perturbações da personalidade não são doenças, não estão apenas a constatar o que está contemplado no DSM. Estão também a assumir uma posição. Estão, por palavras diferentes, a dizer que elas não têm categoria ou estatuto para serem consideradas verdadeiras doenças. E se não o têm, então são o parente pobre da psiquiatria porque a missão tradicional desta especialidade médica é tratar doenças.

their lack of empathy imposes no brake on the punishment they mete out to real or imagined opponents. Nor does it allow any consideration of the human costs of another of their DSM symptoms: their “fantasies of unlimited success, power, brilliance, beauty, or ideal love,” which may be realized in rapacious conquest, pharaonic construction projects, or utopian master plans. And we have already seen what overconfidence can do in the waging of war.

Kendler himself is the researcher who reported that when Walter Cassidy, the psychiatrist who first proposed diagnostic criteria for depression, was asked why he set the threshold at six out of ten symptoms, he responded, “It sounded about right

Stigma takes many forms, comes from all directions, is sometimes blatantly overt, but can also be remarkably subtle. It is the cruel comment, the unkind smirk, the extrusion from the group, the lost job opportunity, the rejected marriage proposal, the ineligibility for life insurance, the inability to adopt a child or pilot a plane. But it is also the reduced expectation, the helping hand when none is needed or wanted, the solicitous sympathy that one cannot really be expected to measure up. And the secondary psychological and practical harms of having a mental disorder come only partly from how others see you. A great deal of the trouble comes from the change in how you see yourself: the sense of being damaged goods, feeling not normal or worthy, not a full fledged member of the group. It is bad enough that stigma is so often associated with having a mental disorder, but the stigma that comes from being mislabeled with a fake diagnosis is a dead loss with absolutely no redeeming features.

The most chronic and complex of the dissociative disorders, multiple personality disorder, was renamed multiple personality disorder, was renamed 'dissociative identity disorder' in 1994 in DSM-IV (American Psychiatric Association). The rationale for the name change, was among other things, to clarify that there are not literally separate personalities in a person with dissociative identity disorder; 'personalities' was a historical term for the fragmented identity states that characterize the condition.

Oddly, the lack of reliability and validity did not keep the DSM-V from meeting its deadline for publication, despite the near-universal consensus that it represented no improvement over the previous diagnostic system.29 Could the fact that the APA had earned $100 million on the DSM-IV and is slated to take in a similar amount with the DSM-V (because all mental health practitioners, many lawyers, and other professionals will be obliged to purchase the latest edition) be the reason we have this new diagnostic system?

The implication that the change in nomenclature from “Multiple Personality Disorder” to “Dissociative Identity Disorder” means the condition has been repudiated and “dropped” from the Diagnostic and Statistical Manual (DSM) of the American Psychiatric Association is false and misleading. Many if not most diagnostic entities have been renamed or have had their names modified as psychiatry changes in its conceptualizations and classifications of mental illnesses. When the DSM decided to go with “Dissociative Identity Disorder” it put “(formerly multiple personality disorder)” right after the new name to signify that it was the same condition. It’s right there on page 526 of DSM-IV-R. There have been four different names for this condition in the DSMs over the course of my career. I was part of the group that developed and wrote successive descriptions and diagnostic criteria for this condition for DSM-III-R, DSM–IV, and DSM-IV-TR. While some patients have been hurt by the impact of material that proves to be inaccurate, there is no evidence that scientifically demonstrates the prevalence of such events. Most material alleged to be false has been disputed by someone, but has not been proven false. Finally, however intriguing the idea of encouraging forgetting troubling material may seem, there is no evidence that it is either effective or safe as a general approach to treatment. There is considerable belief that when such material is put out of mind, it creates symptoms indirectly, from “behind the scenes.” Ironically, such efforts purport to cure some dissociative phenomena by encouraging others, such as Dissociative Amnesia.

The genius of Peterson and Seligman’s classification is to get the conversation going, to propose a specific list of strengths and virtues, and then let the scientific and therapeutic communities work out the details. Just as the DSM is thoroughly revised every ten or fifteen years, the classification of strengths and virtues (known among positive psychologists as the “un-DSM”) is sure to be revised and improved in a few years. In daring to be specific, in daring to be wrong, Peterson and Seligman have demonstrated ingenuity, leadership, and hope.

DSM-5 pathologized those who hold on to their stuff for too long, who clutter their homes too much, who do not clean that often, and who harbor too many things. The manual labeled these activities “hoarding disorder” (HD, as it is sometimes called) and gave them an International Classification of Diseases (ICD-9-CM, to be precise) code of 300.3. Legitimized as a psychiatric disease and categorized under Obsessive-Compulsive and Related Disorders, this diagnosis rendered unsound certain relations to certain personal property. Hoarding, it seems, had arrived.

Like the DSM-V, the RDoC framework conceptualizes mental illnesses solely as brain disorders. This means that future research funding will explore the brain circuits “and other neurobiological measures” that underlie mental problems. Insel sees this as a first step toward the sort of “precision medicine that has transformed cancer diagnosis and treatment.” Mental illness, however, is not at all like cancer: Humans are social animals, and mental problems involve not being able to get along with other people, not fitting in, not belonging, and in general not being able to get on the same wavelength.

The lifetime prevalence of dissociative disorders among women in a general urban Turkish community was 18.3%, with 1.1% having DID (ar, Akyüz, & Doan, 2007). In a study of an Ethiopian rural community, the prevalence of dissociative rural community, the prevalence of dissociative disorders was 6.3%, and these disorders were as prevalent as mood disorders (6.2%), somatoform disorders (5.9%), and anxiety disorders (5.7%) (Awas, Kebede, & Alem, 1999). A similar prevalence of ICD-10 dissociative disorders (7.3%) was reported for a sample of psychiatric patients from Saudi Arabia (AbuMadini & Rahim, 2002).

In the Judeo-Christian view--and thus, the dominant Western view--to die by suicide is a sinful, selfish act. This perception has been slow to fade, though the science is clear that suicide has root causes in diagnosable mental disorders and substance abuse. ("Sin" does not qualify for the DSM-5.) The cultural meaning of suicide in Japan is different. It's viewed as a selfless, even honorable act... Outsiders say that the Japanese romanticize suicide, and that Japan has a "suicide culture." But the reality is more complicated. The Japanese view of self-inflicted death as altruistic is more about wanting not to be a burden, rather than fascination with mortality itself.

ADHD is spreading like wildfire. It used to be confined to a small percentage of kids who had clear-cut problems that started at a very early age and caused them unmistakable difficulties in many situations. Then all manner of classroom disruption was medicalized and ADHD was applied so promiscuously that an amazing 10 percent of kids now qualify.

Though diagnosis is unquestionably critical in treatment considerations for many severe conditions with a biological substrate (for example, schizophrenia, bipolar disorders, major affective disorders, temporal lobe epilepsy, drug toxicity, organic or brain disease from toxins, degenerative causes, or infectious agents), diagnosis is often counterproductive in the everyday psychotherapy of less severely impaired patients. Why? For one thing, psychotherapy consists of a gradual unfolding process wherein the therapist attempts to know the patient as fully as possible. A diagnosis limits vision; it diminishes ability to relate to the other as a person. Once we make a diagnosis, we tend to selectively inattend to aspects of the patient that do not fit into that particular diagnosis, and correspondingly overattend to subtle features that appear to confirm an initial diagnosis. What’s more, a diagnosis may act as a self-fulfilling prophecy. Relating to a patient as a “borderline” or a “hysteric” may serve to stimulate and perpetuate those very traits. Indeed, there is a long history of iatrogenic influence on the shape of clinical entities, including the current controversy about multiple-personality disorder and repressed memories of sexual abuse. And keep in mind, too, the low reliability of the DSM personality disorder category (the very patients often engaging in longer-term psychotherapy).

Because DID requires the presence of amnesia, DID patients are, by DSM-5 definition (American Psychiatric Association, 2013), unaware of some of their behavior in different states. Progress in treatment includes helping patients become more aware of, and in better control of, their behavior across all states. To those who have not had training in treating DID, this increased awareness may make it seem as if patients are creating new self-states, and “getting worse,” when in fact they are becoming aware of aspects of themselves for which they previously had limited or no awareness or control. Although some DID patients create new self-states in adulthood, clinicians strongly advise patients against so doing (Fine, 1989; ISSTD, 2011; Kluft, 1989).

Disruption of identity characterized by two or more distinct personality states, which may be described in some cultures as an experience of possession. The disruption in identity involves marked discontinuity in sense of self and sense of agency, accompanied by related alterations in affect, behavior, consciousness, memory, perception, cognition, and/or sensory-motor functioning.

Let’s take a quick look at what a psychopath is. Although the American Psychiatric Association (APA) no longer uses this term, much of the rest of the world does. The APA has incorporated the term psychopath and sociopath within a broader definition designated as antisocial personality disorder. Even within the APA, there is wide disagreement as to what these terms actually mean. The most recent Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR) is an American handbook for mental health professionals. It lists different categories of mental disorders and the criteria for diagnosing them, according to the publishing organization, the American Psychiatric Association. The APA defines antisocial personality disorder, which would include Lobaczewski’s psychopathic personality disorder, as a pervasive pattern of disregard for the violation of the rights of others occurring since age fifteen years, as indicated by three or more of the following:   1.     Failure to conform to social norms with respect to lawful behaviors as indicated by repeatedly performing acts that are grounds for arrest. 2.     Deceitfulness, as indicated by repeated lying, use of aliases, or conning others for personal profit or pleasure. 3.     Impulsivity or failure to plan ahead. 4.     Aggressiveness, as indicated by repeated physical fights or assaults. 5.     Reckless disregard for the safety of self or others. 6.     Consistent irresponsibility. 7.     Lack of remorse, as indicated by being indifferent to or rationalizing having hurt, mistreated, or stolen from another.

We feel so superior to the dead. For example, if Michelangelo was so damn smart, why'd he die? How I feel reading the DSM is, I may be a fat stupid dummy, but I'm still alive. The caseworker's still dead, and here's proof that everything she studied and believed in all her life is already wrong. In the back of this edition of the DSM are the revisions from the last edition. Already, the rules have changed. Here are the new definitions of what's acceptable, what's normal, what's sane. Inhibited Male Orgasm is now Male Orgasmic Disorder. What was Psychogenic Amnesia is now Dissociative Amnesia. Dream Anxiety Disorder is now Nightmare Disorder. Edition to edition, the symptoms change. Sane people are insane by a new standard. People who used to be called insane are the picture of mental health.

Grassley ordered the APA to disclose how much of its income was drug money. The answer turned out to be a lot—according to the Times, nearly one-third of the organization’s $62.5 million annual revenue41 in 2006. Some of it came from advertising, but much of it went to educational programs in which drug companies tutored doctors attending APA conferences in the fine points of prescribing their drugs.

The thesis that DID is merely a North American phenomenon has been refuted in the past decade by research reports based on standardized assessment from diverse countries, such as from The Netherlands, Turkey, and Germany (Boon & Draijer, 1993; Gast, Rodewald, Nickel, & Emrich, 2001; S ̧ar et al, 1996). Clinicians and researchers should be careful to avoid categorizing a universal human condition as culture-bound.

000-x02 Dissociative reaction This reaction represents a type of gross personality disorganization, the basis of which is a neurotic disturbance, although the diffuse dissociation seen in some casts may occasionally appear psychotic. The personality disorganization may result in aimless running or "freezing." The repressed impulse giving rise to the anxiety may be discharged by, or deflected into, various symptomatic expressions, such as depersonalization, dissociated personality, stupor, fugue, amnesia, dream state, somnambulism, etc. The diagnosis will specify symptomatic manifestations. These reactions must be differentiated from schizoid personality, from schizophrenic reaction, and from analogous symptoms in some other types of neurotic reactions. Formerly, this reaction has been classified as a type of "conversion hysteria.

narcissistic personality disorder, or NPD. According to DSM-IV, NPD is distinguished by a pervasive pattern of grandiosity (in fantasy or behavior), need for admiration, and lack of empathy . . . , indicated by five (or more) of the following: 1. An exaggerated sense of self-importance . . . 2. Preoccupation with fantasies of unlimited success, power, brilliance, beauty, or ideal love 3. Believes that he or she is “special” and can only be understood by, or should associate with, other special or high-status people . . . 4. Requires excessive admiration 5. Has a sense of entitlement . . . 6. Selfishly takes advantage of others to achieve his or her own ends 7. Lacks empathy 8. Is often envious of others or believes that others are envious of him or her 9. Shows arrogant, haughty, patronizing, or contemptuous behaviors or attitudes

Despite the growing clinical and research interest in dissociative symptoms and disorders, it is also true that the substantial prevalence rates for dissociative disorders are still disproportional to the number of studies addressing these conditions. For example, schizophrenia has a reported rate of 0.55% to 1% of the normal population (Goldner, Hus, Waraich, & Somers, more or less similar to the prevalence of DID. Yet a PubMed search generated 25,421 papers on research related to schizophrenia, whereas only 73 publications were found for DID-related research.

The SCID-D-R's standard for "distinct identities or personality states" (DSM-IV, p. 487) is: "Persistent manifestations of the presence of different personalities, as indicated by at least four of the following: a) ongoing dialogues between different people; b) acting or feeling that the different people inside of him/her take control of his/her behavior or speech; c) characteristic visual image that is associated with the other person, distinct from the subject; d) characteristic age associated with the different people inside of him/her; e) feeling that the different people inside of him/her have different memories, behaviors, and feelings; f) feeling that the different people inside of him/her are separate from his/her personality and have lives of their own" (Steinberg, 1994, p. 106). [The author believes that it is of considerable importance that none of the SCID-D-R's six criteria for "distinct personalities or personality states" are observable signs; each of the six is a subjective symptom or experience that must be reported to the test administrator. This striking fact supports the contention that assessment of dissociation should be based on subjective symptoms rather than signs (Dell, 2006b. 2009b).]

I began to see that the stronger a therapy emphasized feelings, self-esteem, and self-confidence, the more dependent the therapist was upon his providing for the patient ongoing, unconditional, positive regard. The more self-esteem was the end, the more the means, in the form of the patient’s efforts, had to appear blameless in the face of failure. In this paradigm, accuracy and comparison must continually be sacrificed to acceptance and compassion; which often results in the escalation of bizarre behavior and bizarre diagnoses. The bizarre behavior results from us taking credit for everything that is positive and assigning blame elsewhere for anything negative. Because of this skewed positive-feedback loop between our judged actions and our beliefs, we systematically become more and more adapted to ourselves, our feelings, and our inaccurate solitary thinking; and less and less adapted to the environment that we share with our fellows. The resultant behavior, such as crying, depression, displays of temper, high-risk behavior, or romantic ventures, or abandonment of personal responsibilities, which seem either compulsory, necessary, or intelligent to us, will begin to appear more and more irrational to others. The bizarre diagnoses occur because, in some cases, if a ‘cause disease’ (excuse from blame) does not exist, it has to be 'discovered’ (invented). Psychiatry has expanded its diagnoses of mental disease every year to include 'illnesses’ like kleptomania and frotteurism [now frotteuristic disorder in the DSM-V]. (Do you know what frotteurism is? It is a mental disorder that causes people, usually men, to surreptitiously fondle women’s breasts or genitals in crowded situations such as elevators and subways.) The problem with the escalation of these kinds of diagnoses is that either we can become so adapted to our thinking and feelings instead of our environment that we will become dissociated from the whole idea that we have a problem at all; or at least, the more we become blameless, the more we become helpless in the face of our problems, thinking our problems need to be 'fixed’ by outside help before we can move forward on our own. For 2,000 years of Western culture our problems existed in the human power struggle constantly being waged between our principles and our primal impulses. In the last fifty years we have unprincipled ourselves and become what I call 'psychologized.’ Now the power struggle is between the 'expert’ and the 'disorder.’ Since the rise of psychiatry and psychology as the moral compass, we don’t talk about moral imperatives anymore, we talk about coping mechanisms. We are not living our lives by principles so much as we are living our lives by mental health diagnoses. This is not working because it very subtly undermines our solid sense of self.

Fast-forward nearly a hundred years, and Prufrock’s protest is enshrined in high school syllabi, where it’s dutifully memorized, then quickly forgotten, by teens increasingly skilled at shaping their own online and offline personae. These students inhabit a world in which status, income, and self-esteem depend more than ever on the ability to meet the demands of the Culture of Personality. The pressure to entertain, to sell ourselves, and never to be visibly anxious keeps ratcheting up. The number of Americans who considered themselves shy increased from 40 percent in the 1970s to 50 percent in the 1990s, probably because we measured ourselves against ever higher standards of fearless self-presentation. “Social anxiety disorder”—which essentially means pathological shyness—is now thought to afflict nearly one in five of us. The most recent version of the Diagnostic and Statistical Manual (DSM-IV), the psychiatrist’s bible of mental disorders, considers the fear of public speaking to be a pathology—not an annoyance, not a disadvantage, but a disease—if it interferes with the sufferer’s job performance. “It’s not enough,” one senior manager at Eastman Kodak told the author Daniel Goleman, “to be able to sit at your computer excited about a fantastic regression analysis if you’re squeamish about presenting those results to an executive group.” (Apparently it’s OK to be squeamish about doing a regression analysis if you’re excited about giving speeches.)

When a high IQ-test score is accompanied by subpar performance in some other domain, this is thought "surprising," and a new disability category is coined to name the surprise. So, similarly, the diagnostic criterion for mathematics disorder (sometimes termed dyscalculia) in DSM IV is that "Mathematical ability that falls substantially below that expected for the individual's chronological age, measured intelligence, and age-appropriate education" (p. 50)- The logic of discrepancy-based classification based on IQ-test performance has created a clear precedent whereby we are almost obligated to create a new disability category when an important skill domain is found to be somewhat dissociated from intelligence. It is just this logic that I exploited in creating a new category of disability- dysrationalia.T he proposed definition of the disability was as follows: Dysrationalia is the inability to think and behave rationally despite adequate intelligence. It is a general term that refers to a heterogeneous group of disorders manifested by significant difficulties in belief formation, in the assessment of belief consistency, and/or in the determination of action to achieve one's goals. Although dysrationalia may occur concomitantly with other handicapping conditions (e.g., sensory impairment), dysrationalia is not the result of those conditions. The key diagnostic criterion for dysrationalia is a level of rationality, as demonstrated in thinking and behavior, that is significantly below the level of the individual's intellectual capacity (as determined by an individually administered IQ test).

Prior to the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), the diagnosis of Dissociative Identity Disorder had been referred to as Multiple Personality Disorder. The renaming of this diagnosis has caused quite a bit of confusion among professionals and those who live with DID. Because dissociation describes the process by which DID begins to develop, rather than the actual outcome of this process (the formation of various personalities), this new term may be a bit unclear. We know that the diagnosis is DID and that DID is what people say we have. We’d just like to point out that words sometimes do not describe what we live with. For people like us, DID is just a step on the way to where we live—a place with many of us inside! We just want people who have little ones and bigger ones living inside to know that the title Dissociative Identity Disorder sounds like something other than how we see ourselves—we think it is about us having different personalities. Regardless of the term, it is clear that, in general, the different personalities develop as a reaction to severe trauma. When the person dissociates, they leave their body to get away from the pain or trauma. When this defense is not strong enough to protect the person, different personalities emerge to handle the experience. These personalities allow the child to survive: when the child is being harmed or experiencing traumatic episodes, the other personalities take the pain and/ or watch the bad things. This allows these children to return to their body after the bad things have happened without any awareness of what has occurred. They do this to create different ways to make sense of the harm inflicted upon them; it is their survival mechanism.

There presently exist three recognized conceptualizations of the antisocial construct: antisocial personality disorder (ASPD) as outlined in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5; American Psychiatric Association, 2013), dissocial personality disorder in the International Classification of Diseases (ICD-10; World Health Organization, 1992), and psychopathy as formalized by Hare with the Psychopathy Checklist—Revised (PCL-R; Hare, 2003). A conundrum for therapists is that these conceptualizations are overlapping but not identical, emphasizing different symptom clusters. The DSM-5 emphasizes the overt conduct of the patient through a criteria set that includes criminal behavior, lying, reckless and impulsive behavior, aggression, and irresponsibility in the areas of work and finances. In contrast, the criteria set for dissocial personality disorder is less focused on conduct and includes a mixture of cognitive signs (e.g., a tendency to blame others, an attitude of irresponsibility), affective signs (e.g., callousness, inability to feel guilt, low frustration tolerance), and interpersonal signs (e.g., tendency to form relationships but not maintain them). The signs and symptoms of psychopathy are more complex and are an almost equal blend of the conduct and interpersonal/affective aspects of functioning. The two higher-order factors of the PCL-R reflect this blend. Factor 1, Interpersonal/Affective, includes signs such as superficial charm, pathological lying, manipulation, grandiosity, lack of remorse and empathy, and shallow affect. Factor 2, Lifestyle/Antisocial, includes thrill seeking, impulsivity, irresponsibility, varied criminal activity, and disinhibited behavior (Hare & Neumann, 2008). Psychopathy can be regarded as the most severe of the three disorders. Patients with psychopathy would be expected to also meet criteria for ASPD or dissocial personality disorder, but not everyone diagnosed with ASPD or dissocial personality disorder will have psychopathy (Hare, 1996; Ogloff, 2006). As noted by Ogloff (2006), the distinctions among the three antisocial conceptualizations are such that findings based on one diagnostic group are not necessarily applicable to the others and produce different prevalence rates in justice-involved populations. Adding a further layer of complexity, therapists will encounter patients who possess a mixture of features from all three diagnostic systems rather than a prototypical presentation of any one disorder.

Morrison, J. (2014). Diagnosis made easier (2nd ed.). New York: Guilford Press. [Step by step, this book helps the reader make sense of the interview material. Newly revised to reflect DSM-5 changes.]

Do not routinely give the diagnosis of Panic Disorder solely because patients complain of nervous, anxious, panicky, or fearful emotions—the criteria for Panic Disorder are mainly physical symptoms that are also associated with increased blood levels of adrenaline (epinephrine), lactic acid, and increased blood pH. Even the “psychological” symptoms of derealization, depersonalization, and fears of dying, losing control, and going crazy can be reproduced by artificially altering blood adrenaline levels and acid/base balance.

20 years, we have experienced three unanticipated fads partly precipitated by DSM-IV: a 20-fold increase in Autism Spectrum Disorder,7 a tripling of Attention-Deficit/Hyperactivity Disorder (ADHD),8 and a doubling of Bipolar Disorders.9 The most dangerous fad is a 40-fold increase in childhood Bipolar Disorders,10 stimulated, not by DSM-IV, but instead by reckless and misleading drug company marketing. Twenty percent of the U.S. population11 is taking a psychotropic drug; 7% is addicted to one; and overdoses with legal drugs now cause more emergency room visits than overdoses with illegal drugs.

There were two main reasons that the name of this condition was changed from multiple was changed from multiple personality disorder to DID in the DSM-IV. The first was that the older term emphasized the concept of various personalities (as though different people inhabited the same body), whereas the current view is that DID patients experience a failure in the integration of aspects of their personality into a complex and multifaceted integrated identity. The International Society for the Study of Dissociation (1997) states it this way: "The DID patient is a single person who experiences himself/herself as having separate parts of the mind that function with some autonomy. The patient is not a collection of separate people sharing the same body." ͏

Another reason for the name change is that the term personality refers to characteristic pattern of thoughts, feelings, moods, and behaviors of the whole individual. The fact that patients with DID consistently switch between different identities, behavior styles, and so on is a feature of the individual's overall personality. Our phrasing changes in diagnostic criteria clarified that although alters may be personalized by the individual, they are not to be considered as having an objective, independent existence.

The DSM concept of pathological dissociation has evolved from the early inclusive concept of a dissociative reaction in DSM-I to five distinct dissociative disorders in DSM-IV: dissociative amnesia, dissociative fugue, depersonalization disorder, DDNOS, and MPD/DID [Dissociative Identity Disorder]. The first four disorders are rarely challenged, but the existence of MPD/DID has been more or less continually under attack for more than a century. I perceive many of these attacks as misdirected at a mass media stereotype that does not resemble the actual clinical condition.

Mithoefer completed an FDA- and DEA-approved trial of MDMA for the treatment of severe PTSD, with stunning results. In 2011, with the support of MAPS, he and his team created a double-blind design in which twelve severely traumatized patients were given MDMA and psychotherapy, and eight patients were given an active placebo and psychotherapy. The researchers used the Clinician Administered PTSD Scale (CAPS) as a means of measuring symptom reduction after intervention. In the placebo group, only two out of the eight subjects had a significantly lowered CAPS score post-intervention, whereas in the MDMA group, ten out of the twelve subjects had significantly lowered CAPS scores and were able to maintain those scores at a two-month follow-up. Furthermore, in the MDMA group, ten of the twelve patients were so improved that they no longer met the DSM criteria for PTSD. The second phase of the study allowed seven subjects who had previously taken the placebo (six of whom had failed to respond to the placebo and one of whom had relapsed after the placebo) to now try MDMA. They found a clinical response rate of 100 percent, and the three people who had previously said they weren’t able to perform their jobs on account of their PTSD were now able to work once again.

[T]he disorder currently known as dissociative identity disorder (where an individual has more than one distinct personality) was called multiple personality disorder in DSM-III-R. Even though the diagnosis ended in the words personality disorder, it was not classified as a personality disorder. It always has been and remains a clinical disorder to be coded on Axis I. To avoid confusion, the name of the disorder was changed in the DSM-IV. Now all mental disorders listed in the DSM-IV-TR that end in the words personality disorder, represent personality disorders and need to be coded on Axis II.

Dissociative disorders (DDs) were first recognized as official psychiatric disorders in 1980 with the publication of the Diagnostic and Statistical Manual of Mental Disorders, Third Edition (DSM III) in 1980. Prior to this, the related symptoms were listed under ‘hysterical neuroses’ in the second edition of the DSM.[1,2] Interestingly, all of the current DDs that have been described were discovered prior to 1900 but decades passed with little study or research of this spectrum of psychiatric pathology.

Nature abhors homogeneity and simply adores eccentric diversity.

Can the splitting of representations explain multiplicity? Not at all, for two reasons.20 First, a split is into two, not many. The splitting of self and object representations manifest polarity: self-object, good-bad, male-female, friend-foe, and so on, whereas alters generally don't (though they may). Second, hosts and alters are intentional subjects or agents, entities capable of uttering "I." Indeed, one may profitably regard alter as short for alter ego, literally "other I." A given "I" has intentional objects that are its respective self and object representations. In other words, a split representation, even of the self, is an object of thought, not a thinker, not a subject or agent or "I.

The second thing, which is even better from where I sit, is that a science of mental illness developed such that we found that we could measure fuzzy states like sadness, alcoholism, and schizophrenia with psychometric precision. We developed a classification, a DSM, so that people in London and in Philadelphia can agree that they’re both seeing a bipolar depressive.