Controversies surrounding personality disorder

There are a number of controversies which are often cited within the field of personality disorder.

  • Firstly, there has been considerable criticism levelled at the categorical nature of personality disorder diagnoses, as there is considerable overlap between the different disorders. In response to this, future revisions of the DSM 5 are likely to include a proposal to reduce the number of types of personality disorder from ten to five, with greater consideration given to the individual traits which are present in each case and the overall severity of personality dysfunction along a continuum.
  • It is also frequently observed that personality disorder diagnosis is particularly unreliable, with differing diagnoses being provided by different clinicians and obtained by different assessment methods.
  • Lastly, although recent clinical guidelines suggest that psychological treatments should be provided to PD individuals, the reality is that many mental health services are still reluctant to engage with a group who are often perceived as ‘untreatable’ and ‘difficult’. It is indeed the case that treatment approaches for the more severe forms of PD are still in their infancy. The term personality disorder has sometimes been used as a pejorative label and the diagnosis given as a means of excluding sufferers from mental health services.