From personality disorders to the fact-value distinction

Philosophy, Psychiatry, & Psychology, 2010

Current Opinion in Psychiatry, 2010

To review recent literature around the controversial diagnosis of personality disorder, and to assess the ethical aspects of its status as a medical disorder. The diagnostic currency of personality disorder as a psychiatric/medical disorder has a longstanding history of ethical and social challenges through critiques of the medicalization of deviance. More recently controversies by reflexive physicians around the inclusion of the category in the forthcoming revisions of International Classification of Diseases and Diagnostic and Statistical Manual of Mental Disorders classifications reflect the problems of value-laden criteria, with the diagnostic category being severely challenged from within psychiatry as well as from without. The clinical diagnostic criteria for extremely value-laden psychiatric conditions such as personality disorder need to be analyzed through the lens of values-based medicine, as well as through clinical evidence, as the propensity for political and sociolegal appropriation of the categories can render their clinical and diagnostic value meaningless.

The rupture between psychology and ethics has led to an oversimplification of the study of personality disorders (PD). We claim that an integrated view could enrich and widen the study of PD. This article is an attempt to reconceptualize PD from a psycho-ethical perspective, which includes the dimension of volitionality, to clarify how moral decisions can undermine psychological capacities and contribute, to a greater or lesser degree, to a progressive depersonalization. It is proposed that behaviors with a strong similarity with types of classical vicious character can be categorized into different typical PDs. Using the contributions of theorists who have described types of cognitive biases, in light of virtue epistemology and the underling motivation, we present an understanding of how vicious cognition develops, which is a step in the crystallization of vicious character. This approach, also, offers a distinction between disharmonic and fragmented personality that allows establishing different levels of severity from the psychological and ethical perspective.

Roczniki Psychologiczne, 2017

In this paper we aim to portray the evolution of the understanding, classification and diagnosis of personality disorders. We analyze the characteristics of normal and abnormal personality in the light of the debate about the nature of mental disorders. A brief historical outline of the conceptualization of personality disorders is followed by a description of the evolution of contemporary diagnostic systems. The limitations and problems of these systems are analyzed.

1991

For more than a decade, research studies on the various personality disorders have been carried out at an ever-expanding pace (Blashfield and McElroy, 1987; Gorton and Akhar, 1990). Factors promoting this research have included the establishment within the Diagnostic and Statistical Manual of Mental Disorders (DSM-III) of a separate axis for the diagnosis of personality disorders, the enumeration within DSM-III of diagnostic criteria for these conditions, and the development of standardized interviews for the assessment of personality disorders. Innovations such as these are expected to advance the scientific stature of personality disorder research.

Personality and Mental Health, 2011

This paper considers the proposed revisions to the DSM revision 5. The article discusses the process of classification in general and its application to the DSM. The argument in part is that classification schemes are judged by their usefulness in advancing social practices. The DSM serves a number of different such practices-most obviously research and treatment-and these may make different demands on any scheme. The paper goes on to consider the ethical issues involved in classifying mental disorders and in changing existing classifications. A preliminary scheme of ethical issues in relation to false negatives, false positives and social issues is offered. Finally, the paper considers the wider implications of the proposed changes to the classification of personality disorders and whether these changes may have a ripple effect on our understanding of ourselves and others.

Different studies have questioned tha capacity of the categorical diagnostics to establish a clear distinction between the existence or not of a determined personality disorder. The dimensional perspective would approach more to reality, in the measure that it tries to measure the different intensity degrees in which these disorders are present in the patients. But its application is very laborious and besides, presupposes that those categories whose nuances it pretends to measure really exist. The foresaid leads us to appeal to phenomenological perspective, which seems to be more adequate for the study of complex realities, as it is the case of the personality and its disorders. The essential features of the phenomenological method in the sense of Husserl are described, as well as his contribution to the study of personality disorders. This can be summarized in three fundamental points: the ideal types, introduced in psychiatry by Karl jaspers, the existential types, by Ludwig Binswanger, and the dialectic typologies and polarities, by Wolfgang Blankenburg and the undersigned. This author defines and develops each one of these concepts, aiming to show their advantages with respect to the categorical and dimensional systems.

Current Issues in Personality Psychology, 2013

Actas españolas de psiquiatría

Different studies have questioned the capacity of the categorical diagnostics to establish a clear distinction between the existence or not of a determined personality disorder. The dimensional perspective would approach more to reality, in the measure that it tries to measure the different intensity degrees in which these disorders are present in the patients. But its application is very laborious and besides, presupposes that those categories whose nuances it pretends to measure really exist. The foresaid leads us to appeal to phenomenological perspective, which seems to be more adequate for the study of complex realities, as it is the case of the personality and its disorders. The essential features of the phenomenological method in the sense of Husserl are described, as well as his contribution to the study of personality disorders. This can be summarized in three fundamental points: the ideal types, introduced in psychiatry by Karl Jaspers, the existential types, by Ludwig Bins...