The Personality Follies Keep Marching On

The personality proposals are certainly not the most dangerous part of DSM-5—but they do win the prize for being absolutely the silliest. They offer a riot of impossibly intricate detail with a level of complexity that could never be of any use in any real world setting. This excess reflects the personalities of the well meaning but extremely compulsive researchers who developed it—they simply have no feel whatever for the needs and realities of clinical practice or the appropriate role of psychiatric diagnosis. The system is so fantastically byzantine and cumbersome it seems unlikely anyone outside the narrow circle of its creators can fully understand it. A small group of research scientists have retreated to the laboratory to concoct a Frankenstein monster that will mangle personality disorder research and practice, give dimensional diagnosis an undeserved bad name, and make DSM-5 a laughing stock.

Not surprisingly, the opposition to the proposal has been universal, intense, and sustained. Heated and pained outcries have come both from within the workgroup and from the field at large. One of the work group members, John Livesley, has written a brilliant dissent illustrating in detail that the proposals are ad hoc, unsupported, and display an untested impracticality. It is rare to get unanimity on anything, but this proposal has managed to unite the entire field of personality researchers. They worry that its unusable suggestions will downgrade the field and have a devastating effect on research and clinical work. The proposal has elicited no visible support outside the tiny group who developed it.

The DSM-5 personality work group realized they had to somehow respond to the chorus of criticisms. They attempted to simplify their original suggestions—but doing anything simple is just not within their gift. The revision seems just as unworkably complex and obscure as the original. And recently, they have supported the proposal with a remarkably long, detailed, but totally off point apologia that meets none of concerns raised by the field. The entire process seems like an unintentional parody of academic scholasticism—how many personality traits on the head of a pill. It would be funny if it weren't so sad for the field of personality disorders and for the patients who will be affected.

How can a tiny group succeed in promoting such a foolish and idiosyncratic proposal in opposition to the entire universe of their colleagues? Even I am stunned by the persistence of this white elephant. Skeptical as I am of the fatally flawed DSM-5 governance process, I never could have imagined that such a laughable nonstarter would keep evading adult supervision. But the proposal seems have its own crazy momentum—blithely rolling right along unimpeded by common sense, universal opposition, and the fact that it will have a devastating impact on the field. I guess this proves that just about anything is possible in the weird, looking glass world of DSM-5 decision-making.