I use Kurt Schneider's "psychopathic personalities" to describe the condition and Otto Kernberg for "guidelines" to 'handle" the case and using the mechanism of projective identification to explain or "understand" specific traits or details of the overall behaviour of the patient.

Isn't use of ICD or DSM dictated "from above", according to health ministries or bodies funding medical care, and not a matter of personal preference?

There is also a tendency to use ICD in clinical practive and DSM in scientific research: https://www.karger.com/Article/Abstract/65122

Dear Joachim,

a good number of years ago, we used the term : Manic-depressive psychosis to describe this very specific condition, and this was effective for decades. Suddenly we had to use the term "bipolar" for our better understanding!!!

The fact that DSM (useful to defend american psychiatrists in american courts -Spitzer said so) could be a satisfactory tool for research doesn't make it panacea.

So, if we prefer to treat effectively our patients and to understand better their condition we need to go back to Schneider, Kleist, Mayer-Gross, Jaspers.

Thank you

I was just answering Lisa's question: "how do you choose which diagnostic system to use?" ;)

To my understanding there is personality conflict which is kind of like a promiscuous union aspect between the sufferer and many other individuals, some good some bad. Than there is disorder where the sufferer takes on the id (Freud), of another personality unknowingly as their own. Here the personalities clash affecting behavior. Their behavior in observation, assessment and the use of tools can give you the DSM criteria and insurance code for reporting and insurance coverage. Mind you that whether the sufferer is in conflict or disorder symptomology, they may not know the 'other' personality characteristics and this is the dilemma.

Michael S.

Thank you for your responses. Your points are relevant. If you are a practising psychologist or psychiatrist, please consider completing the survey, which you can find through the link above, where the question sits. I would like to capture your views in the survey if you are happy to complete it. Also I will post the results or where to access them, once this is complete if you are interested.

Personality diagnosis under the aegis of DSM 5 (or IV TR) provides one mechanism for the communication of personality dysfunction. Being categorical it tends to be less than satisfying as many people manifest many different traits and the "unspecified" or "NOS" specifier gets used as a result (eg dependent and borderline traits). Dimensional models seem more satisfying (eg 5 factor model) but fall outside of the accepted nosology making it difficult to use in the standard clinical setting in which I work.

I completed the survey, but wanted to point out there’s no explicit option to indicate use of a diagnostic model to obtain insurance reimbursement. (In a sense it’s a workplace requirement, and that’s the way I filled out the survey. But as a private practitioner I’m free to omit diagnoses, if I don’t care about being paid.) A U.S. thing?

I’ve always favored dimensional models over categorical, and psychodynamic formulation over both, but I use categories when the paperwork requires it.

Steven your decision to rate workplace requirement was perfect in relation to obtaining insurance reimbursement. The options are based on a qualitative study I have done exploring decision making for personality diagnosis, which is currently being submitted for publication. I will post the information about this study on Research Gate if it is accepted.

Thank you everyone for your support and for sharing your opinions. Please recommend this question and survey to other psychologists and psychiatrists you know or alternatively cut and paste the question in an email to forward on.

As a BHC clinician of 40+ years, a biopsychosocial evaluation and the MMPI or MCMI are quite reliable ways to differentiate disordered personalities from normative personality orientations.

Rich

We are forced to use the ICD, and even in a literal translation to the national language. I agree with colleagues - for better treatment we need to go back to Schneider, Kleist, Mayer-Gross, Jaspers (in my country P. Gannushkin, A.Lichko).