Harvard Mental Health Letter

Commentary: Diagnosing personality disorders


Diagnosing personality disorders

The Austrian-Jewish philosopher Martin Buber once wrote, "Every person born into this world represents something new, something that never existed before, something original and unique." This attractive sentiment seems to make the notion of a personality diagnosis pointless. Why typecast people, if everyone is different?

Individualists are especially troubled by a cookbook approach to codifying personality, and many mental health professionals believe that's what the American Psychiatric Association's Diagnostic and Statistical Manual (DSM) does. In its third edition, published in 1980, that volume introduced diagnostic criteria for all psychiatric disorders. It provided researchers and clinicians with reliable definitions to replace the previously vague descriptions.

The DSM system favors categories (like subtypes of depression or schizophrenia) over dimensions of illness (such as the intensity of sadness or the degree of isolation a person feels). Symptoms can be found in multiple categories, and a person may end up carrying multiple diagnoses. Of course, there are no sharp divisions between any of the mental disorders, but personality disorders are hardest to reduce to a defining checklist. Many researchers have therefore advocated a dimensional approach to diagnosing personality disorders, focusing on the extent to which various traits are expressed and abandoning categories altogether.

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