Wednesday, December 08, 2010

Narcissists - an endangered species?

You should have a look at two interesting NYTimes articles by Zanor and Carey on proposed changes to the fifth edition of the psychologist's and psychiatrist's bible,  the Diagnostic and Statistical Manual of Mental Disorders (due out in 2013, and known as DSM-5), which eliminate five of the 10 personality disorders that are listed in the current edition: narcissistic, dependent, histrionic, schizoid and paranoid. Rather than defining a syndrome by a cluster of related traits, with the clinician matching patients to that profile, the new proposed approach chooses from a long list of personality traits that best describe a particular patient. The older approach treats the categories as if we know them to be scientifically accurate (which we don't), and while fitting with common sense and folk psychology, can have the nature of self fulfilling prophesy...not to mention making life easier for insurance companies and the courts. Zanor quotes psychologist Jonathan Shedler:
Clinicians are accustomed to thinking in terms of syndromes, not deconstructed trait ratings. Researchers think in terms of variables, and there’s just a huge schism.... the committee was stacked with a lot of academic researchers who really don’t do a lot of clinical work. We’re seeing yet another manifestation of what’s called in psychology the science-practice schism.”

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