Sam Vaknin

Changes in the Diagnostic and Statistical Manual (DSM) IV

The DSM-IV considerably expanded and updated the introductory text while emphasizing dimensional models of personality and listing for the first time some of the dimensions espoused by the more important models.

The DSM-IV dropped two diagnoses that made an appearance in the DSM-III: the masochistic and the sadistic personality disorders. But these are not the only differences between the two editions as far as Axis II (personality disorders) goes.The DSM-IV considerably expanded and updated the introductory text while emphasizing dimensional models of personality and listing for the first time some of the dimensions espoused by the more important models.The long running dispute regarding the Antisocial Personality Disorder (is it tantamount to the traditional understanding of psychopathy or is it a completely different and new diagnosis?) has surfaced. The DSM-IV allows that tests like the Psychopathy Check List (PCL) that rely on the original perception and definition of what it is to be a psychopath better predict recidivism in "settings where criminals acts are likely to be nonspecific" (in other words, in prisons).

The DSM-IV flatly contradicts the misconception widely held among clinicians and therapists that the prognosis for patients with the Borderline Personality Disorder is bad. Borderline Personality Disorder can frequently be successfully cured, insists the DSM-IV.The DSM-IV Committee accepted that the definition of codependence in the DSM-III was gender-biased and, therefore, that gender differences are artifactual. The text pertaining to the Dependent Personality Disorder has been amended to remove culture-bound prejudices.Finally, the DSM-IV is much clearer on the comorbidity of the Obsessive-Compulsive Personality Disorder with Anxiety Disorders, and especially with the Obsessive-Compulsive Disorder.

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