Social Theory & Health

, Volume 15, Issue 4, pp 388–406 | Cite as

Incorrigible conduct and incorrigible diagnoses: the case of personality disorder

Original Article

Abstract

A critical realist analysis is offered of a particular unresolved contention in modern psychiatric knowledge about the diagnosis of personality disorder (PD). With the publication of the most recent edition of the Diagnostic and Statistical Manual from the American Psychiatric Association in 2013, this diagnosis stood out as a point of reticence in a document, noted by its critics, for its diagnostic expansionism. Resources from critical realism are used to examine the weakness of the diagnosis and the real enough conduct that the medical codification subsumes. It is concluded that the psychiatric jurisdiction over those with a PD diagnosis now lacks credibility. However, the socio-ethical challenges that lay beneath the diagnosis and beyond its associated medical jurisdiction are not only real but are thrown into sharp relief by the critique offered, raising socio-ethical questions for all citizens.

Keywords

personality disorder critical realism 

References

  1. American Psychiatric Association (APA). (2013) Diagnostic and Statistical Manual of Mental Disorders (5th ed.). Washington, DC: APA.CrossRefGoogle Scholar
  2. Angell, M. (2011) The illusions of psychiatry. New York Review of Books 58(12): 20–22.Google Scholar
  3. Babiak, P. and Hare, R.D. (2007) Snakes in Suits: When Psychopaths go to Work. New York: HarperCollins.Google Scholar
  4. Berrios, G.E. (1985) Obsessional disorders during the nineteenth century: Terminological and classificatory issues. In: W.F. Bynum, R. Porter and M. Shepherd (eds.) The Anatomy of Madness. Vol. 1, London: Tavistock.Google Scholar
  5. Bhaskar, R. (1986) Scientific Realism and Human Emancipation. London: Verso.Google Scholar
  6. Bierer, L.M., Yehuda, R., Schmeidler, J., Mitropoulou, V., New, A.S., Silverman, J.M. and Siever, L.J. (2003) Abuse and neglect in childhood: relationship to personality disorder diagnoses. CNS Spectrums 8: 737–754.CrossRefGoogle Scholar
  7. Black, D.W. (2013) Bad Boys, Bad Men: Confronting Anti-Social Behavior. New York: Oxford University Press.Google Scholar
  8. Board, B.J. and Fritzon, K. (2005) Disordered personalities at work. Psychology, Crime and Law 11(1): 17–32.CrossRefGoogle Scholar
  9. Boddy, R.P., Ladysjewsky, R. and Galvin, P.L (2010) Leaders without ethics in global business: Corporate psychopaths. Journal of Public Affairs 10(1): 131–138.Google Scholar
  10. Bolton, D. (2008) What Is Mental Disorder? Oxford: Oxford University Press.CrossRefGoogle Scholar
  11. Cacciola, J.S., Rutherford, M.J., Alterman, A.I., McKay, J.R. and Mulvaney, F.D. (1998) Long-term test-retest reliability of personality disorder diagnoses in opiate dependent patients. Journal of Personality Disorders 12(4): 32–37.CrossRefGoogle Scholar
  12. Cleckley, H. (1941) The Mask of Sanity. St Louis: C. V. Mosby.Google Scholar
  13. Corbett, K. and Westwood, T. (2005) ‘Dangerous and Severe Personality Disorder’: A psychiatric manifestation of the risk society. Critical Public Health 15(2): 121–133.CrossRefGoogle Scholar
  14. D’Silva, K., Duggan, C. and McCarthy, L. (2004) Does treatment really make psychopaths worse? A review of the evidence. Journal of Personality Disorders 18(2): 163–177.CrossRefGoogle Scholar
  15. De Girolamo, G.G. and Dotto, P. (2000) Epidemiology of personality disorders. In: M.G. Gelder, J.J. Lopez-Ibor Jr. and N.C. Andreasen (eds.) The Oxford Textbook of Psychiatry. Oxford: Oxford University Press.Google Scholar
  16. DH. (2000) Managing Dangerous People with Severe and Dangerous Personality Disorder. London: DH.Google Scholar
  17. Dolan, B. and Coid, J. (1993) Psychopathic and Anti-social Personality Disorders: Treatment and Research Issues. London: Gaskell.Google Scholar
  18. Gergen, K.J. (1992) The decline and fall of personality. Psychology Today 25(6): 58–63.Google Scholar
  19. Greenberg, G. (2013) The Book of Woe: The DSM and the Unmaking of Psychiatry. New York: Blue Rider Press.Google Scholar
  20. Hare, R.D. and Neumann, C.S. (2008) Psychopathy as a clinical and empirical construct. Annual Review of Clinical Psychology 4: 217–246.CrossRefGoogle Scholar
  21. Henderson, D.K. (1939) Psychopathic States. London: Chapman and Hall.Google Scholar
  22. Herman, J.L., Perry, C.J. and Van der Kolk, B.A. (1989) Childhood trauma in borderline personality disorder. American Journal of Psychiatry 146(4): 490–495.CrossRefGoogle Scholar
  23. Kendell, R.E. (2002) The distinction between personality disorder and mental illness. British Journal of Psychiatry 180: 110–115.CrossRefGoogle Scholar
  24. Kernberg, O.F. (1984) Severe Personality Disorders: Psychotherapeutic Strategies. New Haven: Yale University Press.Google Scholar
  25. Kliem, S., Kröger, C. and Kossfelder, J. (2010) Dialectical behavior therapy for borderline personality disorder: A meta-analysis using mixed-effects modeling. Journal of Consulting and Clinical Psychology 78: 936–951.CrossRefGoogle Scholar
  26. Linehan, M.M., Comtois, K.A., Murray, A.M., et al. (2006) Two-year randomized controlled trial and follow-up of dialectical behavior therapy vs therapy by experts for suicidal behaviors and borderline personality disorder. Archives of General Psychiatry 63(7): 757–766.CrossRefGoogle Scholar
  27. Luntz, B.K. (1994) Antisocial personality disorder in abused and neglected children grown up. American Journal of Psychiatry 151: 670–674.CrossRefGoogle Scholar
  28. Lynch, T.R., Trost, W.T., Salsman, N. and Linehan, M.M. (2007) Dialectical behavior therapy for borderline personality disorder. Annual Review of Clinical Psychology 3: 181–205.CrossRefGoogle Scholar
  29. Manning, N. (2000) Psychiatric diagnosis under conditions of uncertainty: Personality disorder, science and professional legitimacy’. Sociology of Health and Illness 22: 621.CrossRefGoogle Scholar
  30. Manning, N. (2002) Actor networks, policy networks and personality disorder’. Sociology of Health and Illness 24: 644.CrossRefGoogle Scholar
  31. Mischel, W. (2004) Toward an integrative science of the person. Annual Review of Psychology 55: 1–22.CrossRefGoogle Scholar
  32. Moncrieff, J. (2010) Psychiatric diagnosis as a political device. Social Theory Health 8: 370.CrossRefGoogle Scholar
  33. NIMHE. (2003) Personality Disorder: No Longer a Diagnosis of Exclusion. London: NIMHE.Google Scholar
  34. Pilgrim, D. (2001) Disordered personalities and disordered concepts. Journal of Mental Health 10(3): 253–266.CrossRefGoogle Scholar
  35. Pilgrim, D. (2015) Understanding Mental Health: A Critical Realist Exploration. London: Routledge.Google Scholar
  36. Polusny, M. and Follette, V. (1995) Long-term correlates of child sexual abuse: Theory and review of the empirical literature. Applied and Preventive Psychology 4(14): 30–66.Google Scholar
  37. Quadrio, C. (2005). Axis one/axis two: A disordered borderline. Australian and New Zealand Journal of Psychiatry 39: A107.Google Scholar
  38. Read, J. and Bentall, R.P. (2012) Negative childhood experiences and mental health: Theoretical, clinical and primary prevention implications. British Journal of Psychiatry: 88–91.Google Scholar
  39. Roberts, R., O’Connor, T., Dunn, J. and Golding J. (2004) The effects of child sexual abuse in later family life mental health, parenting and adjustment of offspring. Child Abuse and Neglect 28(5): 535–545.CrossRefGoogle Scholar
  40. Salekin, R.T. (2002) Psychopathy and therapeutic pessimism: Clinical lore or clinical reality? Clinical Psychology Review 22(1): 79–112.CrossRefGoogle Scholar
  41. Scheff, T. (1966) Being Mentally Ill. Chicago: Aldine.Google Scholar
  42. Schilling, E.A., Aseltine, R.H. and Gore, S. (2008) The impact of cumulative childhood adversity on young adult mental health: measures, models, and interpretations. Social Science & Medicine 6(5): 1140–1151.CrossRefGoogle Scholar
  43. Soloff, P.H., Lynch, K.G. and Kelly, T.M. (2002) Childhood abuse as a risk factor for suicidal behavior in borderline personality disorder. Journal of Personality Disorders 16(3): 201–214.CrossRefGoogle Scholar
  44. Spataro, J., Mullen, P.E., Burgess, P.M., Wells, D.L. and Moss, S.A. (2004) Impact of child sexual abuse on mental health: Prospective study in males and females. British Journal of Psychiatry 184: 416–421.CrossRefGoogle Scholar
  45. Tyrer, P., Coombs, N., Ibrahimi, F., Mathilakath, A., Bajaj, P., Ranger, M., et al. (2007) Critical developments in the assessment of personality disorder. British Journal of Psychiatry 190: s51–s59.CrossRefGoogle Scholar

Copyright information

© Macmillan Publishers Ltd 2017

Authors and Affiliations

  1. 1.University of LiverpoolLiverpoolUK
  2. 2.University of SouthamptonSouthamptonUK

Personalised recommendations