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Real 'Sybil' Admits Multiple Personalities Were Fake (NPR Books)

October 20, 2011

Courtesy Simon & Schuster

Shirley Mason was the psychiatric patient whose life was portrayed in the 1973 book Sybil. The book and subsequent film caused an enormous spike in reported cases of multiple personality disorder. Mason later admitted she had faked her multiple personalities.

When Sybil first came out in 1973, not only did it shoot to the top of the best-seller lists — it manufactured a psychiatric phenomenon. The book was billed as the true story of a woman who suffered from multiple personality disorder. Within a few years of its publication, reported cases of multiple personality disorder — now known as dissociative identity disorder — leapt from fewer than 100 to thousands. But in a new book, Sybil Exposed, writer Debbie Nathan argues that most of the story is based on a lie.

Shirley Mason, the real Sybil, grew up in the Midwest in a strict Seventh-day Adventist family. As a young woman she was emotionally unstable, and she decided to seek psychiatric help. Mason became unusually attached to her psychiatrist, Dr. Connie Wilbur, and she knew that Wilbur had a special interest in multiple personality disorder.

"Shirley feels after a short time, that she is not really getting the attention she needs from Dr. Wilbur," Nathan explains. "One day, she walks into Dr. Wilbur's office and she says, 'I'm not Shirley. I'm Peggy.' ... And she says this in a childish voice. ... Shirley started acting like she had a lot of people inside her."

Wilbur believed that she had stumbled on a remarkable case. She began seeing Mason frequently and eventually teamed up with the writer Flora Rheta Schreiber to work on a book about her patient. The two women taped a series of interviews. In one of those interviews, Wilbur describes the moment that Peggy first appeared. She uses the pseudonym "Sylvia" to protect Mason's identity:

Sybil Exposed

Mason became increasingly dependent on Wilbur for emotional and even financial support. She was eager to give her psychiatrist what she wanted.

"Once she got this diagnosis she started generating more and more personalities," Nathan says. "She had babies, she had little boys, she had teenage girls. She wasn't faking. I think a better way to talk about what Shirley was doing was that she was acceding to a demand that she have this problem."

Wilbur began injecting Mason regularly with sodium pentothal, which was then being used to help people remember traumatic events that they had repressed. Under the influence of drugs and hypnosis, the very suggestible Mason uncovered her many personalities.

Reading through Schreiber's papers, Nathan says it becomes obvious that the writer knew that Mason's story was not entirely true. Memories of a traumatic tonsillectomy, for instance, morphed into a lurid story of abuse. And Schreiber seemed eager to pump up or even create drama where none existed. But if Schreiber had doubts, she suppressed them.

"She already had a contract and she already had a deadline," Nathan says. "She was in the middle of writing the book. So she had the dilemma all journalists have nightmares about — what if my thesis turns out to be wrong as I do my research but it's too late?"

At one point, Mason tried to set things straight. She wrote a letter to Wilbur admitting that she had been lying: "I do not really have any multiple personalities," she wrote. "I do not even have a 'double.' ... I am all of them. I have been lying in my pretense of them." Wilbur dismissed the letter as Mason's attempt to avoid going deeper in her therapy. By now, says Nathan, Wilbur was too heavily invested in her patient to let her go.

I do not really have any multiple personalities. ... I do not even have a 'double.' ... I am all of them. I have been lying in my pretense of them.

In 1973, Flora Rheta Schreiber published Sybil: The True Story of a Woman Possessed by 16 Separate Personalities. The book sold 6 million copies and, in 1976, was made into a TV movie.

"She had already started giving presentations about this case," Nathan says. "She was planning a book. ... She was very, very attached to the case emotionally and professionally and I don't think she could give it up. But she had a very nice little piece of psychoanalytic theory to rationalize not giving it up."

As for Mason, she quickly got the message that if she raised questions about the veracity of her multiple personalities, she'd quickly lose her support network.

"She got the very, very strong impression when she went in and brought this letter of recantation to Dr. Wilbur that if she didn't go with the program she was not going to have Dr. Wilbur anymore," Nathan says. "Dr. Wilbur was giving her 14 to 18 hours of therapy a week. Dr. Wilbur was coming to her house and eating with her, giving her clothes, paying her rent ... so, how could you give up Dr. Wilbur?"

The book succeeded beyond anyone's expectations — it sold some 6 million copies around the world, and in 1976, it was made into a television movie starring Sally Field and Joanne Woodward.

As for the real Sybil, people began to recognize Mason as the patient portrayed in the book and the film. She fled her life and moved into a home near Wilbur. Mason lived in the shadows until her death in 1998.

Read an excerpt of Sybil Exposed

How to Spot Psychopaths: Speech Patterns Give Them Away

reposted from MSNBC

Psychopaths are known to be wily and manipulative, but even so, they unconsciously betray themselves, according to scientists who have looked for patterns in convicted murderers' speech as they described their crimes.

The researchers interviewed 52 convicted murderers, 14 of them ranked as psychopaths according to the Psychopathy Checklist-Revised, a 20-item assessment, and asked them to describe their crimes in detail. Using computer programs to analyze what the men said, the researchers found that those with psychopathic scores showed a lack of emotion, spoke in terms of cause-and-effect when describing their crimes, and focused their attention on basic needs, such as food, drink and money.

While we all have conscious control over some words we use, particularly nouns and verbs, this is not the case for the majority of the words we use, including little, functional words like "to" and "the" or the tense we use for our verbs, according to Jeffrey Hancock, the lead researcher and an associate professor in communications at Cornell University, who discussed the work on Monday (Oct. 17) in Midtown Manhattan at Cornell's ILR Conference Center.

"The beautiful thing about them is they are unconsciously produced," Hancock said.

These unconscious actions can reveal the psychological dynamics in a speaker's mind even though he or she is unaware of it, Hancock said.

What it means to be a psychopath

Psychopaths make up about 1 percent of the general population and as much as 25 percent of male offenders in federal correctional settings, according to the researchers. Psychopaths are typically profoundly selfish and lack emotion. "In lay terms, psychopaths seem to have little or no 'conscience,'" write the researchers in a study published online in the journal Legal and Criminological Psychology.

Psychopaths are also known for being cunning and manipulative, and they make for perilous interview subjects, according to Michael Woodworth, one of the authors and a psychologist who studies psychopathy at the University of British Columbia, who joined the discussion by phone.

"It is unbelievable," Woodworth said. "You can spend two or three hours and come out feeling like you are hypnotized."

While there are reasons to suspect that psychopaths' speech patterns might have distinctive characteristics, there has been little study of it, the team writes.  

How words give them away

To examine the emotional content of the murderers' speech, Hancock and his colleagues looked at a number of factors, including how frequently they described their crimes using the past tense. The use of the past tense can be an indicator of psychological detachment, and the researchers found that the psychopaths used it more than the present tense when compared with the nonpsychopaths. They also found more dysfluencies — the "uhs" and "ums" that interrupt speech — among psychopaths. Nearly universal in speech, dysfluencies indicate that the speaker needs some time to think about what they are saying.

With regard to psychopaths, "We think the 'uhs' and 'ums' are about putting the mask of sanity on," Hancock told LiveScience.

Psychopaths appear to view the world and others instrumentally, as theirs for the taking, the team, which also included Stephen Porter from the University of British Columbia, wrote.

As they expected, the psychopaths' language contained more words known as subordinating conjunctions. These words, including "because" and "so that," are associated with cause-and-effect statements.

"This pattern suggested that psychopaths were more likely to view the crime as the logical outcome of a plan (something that 'had' to be done to achieve a goal)," the authors write.

And finally, while most of us respond to higher-level needs, such as family, religion or spirituality, and self-esteem, psychopaths remain occupied with those needs associated with a more basic existence.

Their analysis revealed that psychopaths used about twice as many words related to basic physiological needs and self-preservation, including eating, drinking and monetary resources than the nonpsychopaths, they write.

By comparison, the nonpsychopathic murderers talked more about spirituality and religion and family, reflecting what nonpsychopathic people would think about when they just committed a murder, Hancock said.

The researchers are interested in analyzing what people write on Facebook or in other social media, since our unconscious mind also holds sway over what we write. By analyzing stories written by students from Cornell and the University of British Columbia, and looking at how the text people generate using social media relates to scores on the Self-Report Psychopathy scale. Unlike the checklist, which is based on an extensive review of the case file and an interview, the self report is completed by the person in question.

This sort of tool could be very useful for law enforcement investigations, such as in the case of the Long Island serial killer, who is being sought for the murders of at least four prostitutes and possibly others, since this killer used the online classified site Craigslist to contact victims, according to Hancock.      

Text analysis software could be used to conduct a "first pass," focusing the work for human investigators, he said. "A lot of time analysts tell you they feel they are drinking from a fire hose."

Knowing a suspect is a psychopath can affect how law enforcement conducts investigations and interrogations, Hancock said.

A FIRST-RATE MADNESS book review reprinted from the NYT

Are All of Our Leaders Mad?

George Tames/The New York Times

By THOMAS MALLON

Published: August 19, 2011

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After examining the psychological histories of a few living leaders and a whole little power necropolis, Nassir Ghaemi, director of the Mood Disorders Program at Tufts University Medical Center, is ready to proclaim a link between madness and achievement that is usually reserved for poets, not prime ministers: “Depression makes leaders more realistic and empathic, and mania makes them more creative and resilient.” It may be fine to like Ike during periods of smooth sailing, but Lincoln and a little lunacy are the ticket when seas get rough: “For abnormal challenges,” Ghaemi insists, “abnormal leaders are needed.” The text makes only one reference to the current president, warning us that while “ ‘No drama’ Obama might be considered the epitome of mental health,” we must remember that “psychological moderation” is not the prescription for greatness.

A FIRST-RATE MADNESS

Uncovering the Links Between Leadership and Mental Illness

By Nassir Ghaemi

340 pp. The Penguin Press. $27.95.

Related

Excerpt: 'A First-Rate Madness' (pdf)

·         Books of The Times: ‘A First-Rate Madness’ by Nassir Ghaemi (August 11, 2011)

Abraham Lincoln’s “depressive episodes” are well known, and their political implications have been the subject of thoughtful extended treatment, most recently by Joshua Wolf Shenk in “Lincoln’s Melancholy.” By contrast, Ghaemi’s assertion that Lincoln’s “depression conferred upon him . . . realism and empathy that helped make him a superb crisis leader” is unaccompanied by the least bit of proof or persuasiveness. The 16th president is on and off the couch in the space of nine pages that whiz by like a single 50-­minute session. Ghaemi has to get to two other empathic depressives — Mahatma Gandhi and Martin Luther King — who are out there in his waiting room.

Using the “four indicators” he likes to apply to the dead — the available records of “symptoms, genetics, course of illness and treatment” — he sees Gandhi as having a “dysthymic personality” that involved “chronic mild depression and anxiety.” The Mahatma’s practice of nonviolent resistance may well have derived from his psychology, but Ghaemi tends to misunderstand what he calls Gandhi’s “radical empathy,” seeing it as little more than kind feelings toward his enemies rather than a mental capacity to walk in their shoes. In the case of King, the author observes genuine “mental illness” at work, including clinical depression toward the end of King’s brief life. But Ghaemi’s analysis is not helped by the way one of his chief sources, Dr. Alvin Poussaint, a civil-rights comrade of King’s as well as a professor of psychiatry, doesn’t regard depression as a major factor in King’s behavior. And it is weak indeed to take an offhand remark by the Rev. Joseph Lowery — about how civil-rights protesters, facing huge dangers, needed to be “a little crazy” — and offer it as a piece of medical evidence. One wonders if, in his exploration of empathy, Ghaemi might have done better with less transcendent figures than Gandhi and King. The juicy, earthbound Bill Clinton, with his trademark ability to feel one’s pain, comes immediately to mind, but he scarcely enters the author’s consulting room.

If depression did help Gandhi and King to engage with their visions, Ghaemi believes that Churchill’s experience of the “black dog” taught him “political realism.” Alcoholic and perhaps bipolar, the British prime minister had the churning, multiple moods of the “cyclothymic personality.” Churchill, Ghaemi argues, was “never ‘himself,’ because his ‘self’ kept changing,” in an exhausting series of alternations and adaptations. There was a reason Churchill saw through Hitler after his predecessor failed to. “Chamberlain was mentally healthy,” Ghaemi concludes, “while Churchill was clearly not.”

One problem with “A First-Rate Madness” is the way it seems to indicate that almost any mental illness, within limits, will do the trick. The decidedly undepressed Franklin Roosevelt helped win the same war Churchill was fighting, and he did it, Ghaemi explains, with a non-neurotic but “hyperthymic” personality. He was eager to be liked, loath to be alone and interested in everything; he once put down “None” on a questionnaire that asked for a list of “aversions.” But how much sense does it make to attribute Roosevelt’s flexibility to his “mentally abnormal” condition? More than six decades after his death, a doctor can pronounce him “hyperthymic”; the voters on the scene thought he was tiptop.

Roosevelt’s hypersociability became, in John F. Kennedy’s case, “hypersexuality.” The recklessness displayed by the 35th president was, Ghaemi argues — by toting up plane crashes and drug overdoses and accidents on the ski slopes — a family trait: “There is no Kennedy curse. There is a Kennedy gene — for hyperthymia — that is both a curse and a blessing.” The president misused anabolic steroids as well as amphetamines until a “medical coup d’état,” headed by a White House doctor, George Burkley, and carried out some time before the Cuban missile crisis, got Kennedy on the proper regimen of prescription drugs. The result, Ghaemi believes, paraphrasing Kennedy’s urologist, was “a spectacular psychochemical success.” From it the author seems to derive a kind of contact high, one that sends him on a fanciful flight of alternate history: “The military presence in Vietnam, later disastrous, was a mistake made in 1961, when Kennedy was medically ill and psychiatrically erratic. By 1963, Kennedy expressed reservations about further involvement in that conflict. Had he lived, he probably would not have responded the way Lyndon Johnson did.” Or he would have.

Ghaemi does nothing by halves. Admitting that his next psychological autopsy is a “delicate” matter, he moves on from Kennedy’s case to Hitler’s. “Up to 1937, I think his moderate bipolar disorder influenced his political career for the better — fueling his charisma, resilience and political creativity.” Later, though, Hitler’s personal physician, Theodor Morell, began injecting the Führer with amphetamines, thereby lighting “a fuse that exploded the entire world.” Ghaemi would have rendered a malpractice judgment at Nuremberg.

“A First-Rate Madness” goes most seriously wrong when Ghaemi explores a “corollary” of his main proposition, offering examples of how “mental health can hamper leadership.” Using a term from Roy Grinker’s half-­century-­old study of the “normal American male,” the author puts George W. Bush, Tony Blair and Richard Nixon (a “healthy failure” who “had his quirks”) into the category of “homoclites,” men better equipped to follow than to lead. Ghaemi even argues that the successes of “levelheaded” Harry Truman don’t refute this part of his thesis, since Truman wasn’t “handling major crises” during what Ghaemi seems to regard as an eight-year cakewalk from Hiroshima through Korea.

By this point, a reader begins to feel that the author is practicing history without a license, a sensation not diminished by the way Ghaemi puts Wendell Willkie on the ballot in 1944 instead of 1940; puts Kennedy there in 1945 instead of 1946; and has a famous 1960 election-­night anecdote involving Kennedy and Johnson exactly backward. He says that Nixon was “the first president to invite” Kennedy’s widow and her two children “for a White House visit” — never mind that Johnson can be heard, on recordings of his phone conversations, practically begging Mrs. Kennedy to drop by.

“We are far from accepting severe depression or mania in our leaders,” Ghaemi concedes. “But there is reason for hope.” He points to voters’ willingness to elect Senator Lawton Chiles and Rep. Patrick Kennedy after each of these lawmakers disclosed his mental-­health problems and course of treatment. The further electoral leap that Ghaemi prescribes, one that would turn psychological afflictions into positive credentials, remains far off. In the meantime, “A First-Rate Madness” will make a thoughtful present for any politician going through rehab and feeling a little discouraged.

Study: Wealthy Stockbrokers More Dangerous Than Psychopaths

By David Sirota (best-selling author of the new book "Back to Our Future: How the 1980s Explain the World We Live In Now." He hosts the morning show on AM760 in Colorado. Email him at ds@davidsirota.com, follow him on Twitter @davidsirota or visit his website at DavidSirota.com)

The findings are a reminder of why now -- more than ever -- we must refuse to succumb to political apathy and laissez-faire demagoguery.

October 6, 2011  |  

  

Like most people living through this jarring age of economic turbulence and political dysfunction, you can probably recall a moment in the last few months when you thought to yourself that our lawmakers and corporate leaders are all crazy. And not just run-of-the-mill crazy, a la George Costanza's parents, but the kind of crazy that makes films like "Silence of the Lambs" and "One Flew Over the Cuckoo's Nest" so frightening.

The good news for you is that you aren't insane for thinking this. The bad news for all of us, though, is that according to two new scientific analyses, you are more correct in your assessment than you may know.
The first revelation came from Dr. Nassir Ghaemi of Tufts University. In his recent book, "A First-Rate Madness," he went beyond merely restating the old adage that anyone crazy enough to run for public office probably shouldn't occupy that office. Instead, the book sheds light on what Ghaemi calls an "inverse law of sanity," whereby tumultuous times like these actually reward and promote political figures who are "mentally abnormal (or) even ill."
Now comes a new study from Switzerland's University of St. Gallen showing that the most successful of the global financial elite probably pose more of a menace to society than known psychopaths.
As the website Newser reported, the researchers "pitted a group of stockbrokers against a group of actual psychopaths in various computer simulations and intelligence tests and found that the money men were significantly more reckless, competitive, and manipulative." Even more striking, the researchers note that achieving overall success was less important to the stock speculators than the sadistic drive "to damage their opponents."
The findings build on similar research in the recent past. In 1996, investigators at Glasgow Caledonian University discovered connections between psychopathy and successful financial speculation, concluding that "with the right parenting, (psychopaths) can become successful stockbrokers instead of serial killers." Likewise, in 2004, researchers at the University of British Columbia reacted to similar findings and created a test to help firms detect "corporate psychopaths" within their ranks. That same year, the award winning-documentary "The Corporation" used World Health Organization metrics to show that if companies really are "people," as our Supreme Court insists, then many of them are mentally ill.
Obviously, these results reflect the not-so-surprising fact that the extreme nature of the modern political process and of today's casino economy inherently self-select for certain kinds of traits. And no doubt, wholly changing that dynamic may be impossible or undesirable -- or both.
However, the findings are a reminder of why now -- more than ever -- we must refuse to succumb to political apathy and laissez-faire demagoguery. Indeed, it’s time to redouble our commitment to strengthening checks on political and corporate power because that power is often being wielded by the most unstable among us.
So what does that mean in practice? It means that when we see a wild-eyed White House ignore the constitution and claim the despotic right to assassinate American citizens without criminal charge, we demand that Congress stop the madness -- rather than quietly acquiesce. It means that when we see a spontaneous grassroots movement physically occupy Lower Manhattan and challenge banks' deranged rapaciousness, we applaud the effort as long overdue -- rather than scoff at it as unrealistic. It means, in short, that we refuse to stay silent in the face of insanity.
And frankly, if we have scientific proof that the inmates are running the Wall Street and Washington asylums, this is the least we should do -- and we really should do a whole lot more.
 

My Turn: Wall Street Protesters Have It Right by Joe Randazzo

(reprinted from the Burlington Free Press)

The concept of solidarity is marvelous. It means supporting people of a kindred spirit in their struggle. Labor union members throughout history have shown solidarity with one another. We should now give the same support to those brave young people who are protesting Wall Street.

This protest movement has come together as a result of a failed financial system. In his article "Laissez-Faire Capitalism Has Failed," by Nouriel Roubini in Forbes, the author writes: "The Financial Crisis has shown the failure of a particular model of capitalism. Namely, the laissez-faire, unregulated (or aggressively deregulated), Wild West model of free market capitalism with lack of prudential regulation, supervision of financial markets and proper provision of public goods by governments."

I like the W.C. Fields quote, "I like thieves. Some of my best friends are thieves. Why, just last week we had the president of the bank over for dinner."

The recent meltdown by companies like Bear Stearns, Fannie Mae and Freddie Mac, Lehman, Washington Mutual, and AIG, proves that thieves are alive and well on Wall Street. They had to turn to the U.S government, to bail them out. This was our money, and it was recycled by the power brokers to spearhead more abuses that are raging full-force as I write this. There's no money for public welfare or health, but plenty of money for Wall Street. This is a complete outrage. These banks have proven to be, as Warren Buffet has stated, "Financial weapons of mass destruction."

I'm delighted that the American people have finally begun to lay the blame where it rightfully belongs, at the heart of our financial power structure. Presidential candidate Mitt Romney was quoted as saying, at the Iowa State Fair, "Corporations are people, my friend." He has the nerve to make a statement like this in front of the people he intends to govern. What is his agenda, return to the era of serfs and vassals?

Most Republican and Democratic lawmakers are merely shills for business interests. We have pleaded with them to end the abuses on Wall Street. Unregulated commodity trading has brought about spiraling food and gasoline prices. Wall Street abuses have caused food riots, hunger, and death from malnutrition throughout the world. We are not talking about some mindless manipulation of paper transactions. The results are catastrophic in the real world. People will not have enough food, or oil to heat their homes. Why? Because Wall Street puts profits ahead of human welfare. The only sane voice in the U.S. Senate is Bernie Sanders. He is wise enough to recognize these abuses and recommend solutions.

The American people do not control the market. The market controls us. We are now subservient to the collective energy of the corporate oligarchy. All the precious resources that many generations of citizens have worked and sweated to save and preserve, are being siphoned off by greedy CEOs who enrich themselves while taking our jobs overseas. They are protected by tax loopholes that are sanctioned by our lawmakers.

The mad, frenetic trading of money on Wall Street just shifts wealth upward to more savvy investors. It produces no goods and no real wealth. The greatest assets in America are the men and women who do real work. They make products, teach our children, and cook our meals. The lowest forms of labor are those people who handle other people's money for the sole purpose of exploiting their honest efforts for the moneymen's own enrichment.

When will the next financial meltdown occur? What will be its cause -- default by a major European country, or perhaps a natural or manmade disaster in this country? How many people will be thrown into poverty as a result? It's not sane or rational for the foundation of our financial future to be based on the whims and fantasies of gamblers on Wall Street.

I totally support the protesters.

Joe Randazzo lives in South Burlington.

Once again...

You heard it from me first on this blog a long time ago, and it is now confirmed - Palin won't run for president. Big surprise. Who can blame her? She's making too much money. And I wouldn't want the scrutiny of the press and others that she would endure. Not if I was her. And let me tell you, they would have a field day. And besides, while she can't suggest any specific ways to fix our financial problems, she sure knows how to push the buttons of a frustrated populace, her cash cow. Now I predict she will say soon  that she is more valuable in her current role - as a self-appointed leader - so that not running for office is in everyone else's interest. Please tell me you know the translation of that. That's right, it's in her best interests to not run.

I am having some folks over to my house. This time, it's professors with whom I share a special bond: we spent a year together in what's called Teaching in Community, a program that allows professors to collaboratively learn best teaching practices. I really like these folks.

I am tired. I am not sleeping well. I am choosing strange words to use in substitution of appropriate ones that are bizarre at best. Last night I asked if there was any "ass" coffee left. I don't wish to inquire beyond the superficial as to the source of this question. An error of commission brought on by sleep deprivation. Yeah, that's it.

Truth is illusive. The truth is that our economy is so tied to the world now that we cannot unilaterally fix our financial problems. Isn't that what we were hoping for at first - a global economy? Well, for eternity we are inextricably linked through the best, and worst, of times.

DSM-V Offers New Criteria for Personality Disorders

The DSM-V is due to be published in May of 2013. Here's a look at the proposed changes in Personality Disorders (hyperlinks have been preserved):

A roadmap to the proposed changes to personality disorder diagnosis in DSM-V

Published on February 10, 2010 by Jared DeFife, Ph.D. in The Shrink Tank

The American Psychiatric Association is in the middle of a historical revision to its diagnostic "Bible", the Diagnostic and Statistical Manual of Mental Disorders (or DSM). This book is used by clinicians, insurance companies, and even the legal system to define and identify the types and thresholds of mental illness that become the focus of treatment and research.

Following a very secretive process of review and revision that has been marked by criticism, the APA has created a website, www.DSM5.org and officially released its first draft of the new system to the public.

Below is a quick roadmap to the section on personality disorders (also known as "Axis II"), the section with perhaps the most considerable changes in the entire manual.

Diagnosing disorders in the current edition of the DSM-IV involves two aspects. The first is defining what a personality disorder is. Currently, a personality disorder is defined as a pervasive pattern of "inner experience and behavior" that is deviant from a person's cultural norms. These may be deviations in thoughts, emotionality, interpersonal relatedness, and impulse control. Deviations in any of the above aspects need to be pervasive, stable, present at least since adolescence, and not due to substances or another mental disorder. Importantly, these ways of thinking, feeling, or behaving need to be significantly distressful and problematic.

The second aspect involves defining what type of personality disorder is present. DSM-IV currently lists ten: paranoid, schizoid, schizotypal, narcissistic, antisocial, borderline, histrionic, avoidant, dependent, obsessive-compulsive, with a catch-all "not otherwise specified category". Each personality disorder had a certain number of criteria, to which you must meet an artificial cut-off. So to be Borderline, for example, you need to have five symptoms out of nine possible symptoms such as: self-harming, unstable relationships, fear of real/imagined abandonment, impulsivity, identity disturbance, etc.

The problems with the existing system are many. First, the different personality types were poorly defined. They weren't based on research-derived criteria, the individual symptoms were vague, and the idea of checking off abstract criteria such as "an exaggerated sense of self-importance" were difficult. Don't we all, at SOME point or another, have an exaggerated sense of self-importance? Another problem is that the criteria overlapped heavily. A person meeting criteria for one personality disorder usually met critieria for 3 or 4 others, as well.

The proposed revision:

The proposed revision on the DSM-V website appears quite complicated and has three major facets.

A new definition for personality disorder

First, the definition of what a personality disorder is, in general, has changed. The proposed revision suggests that instead of a pervasive pattern of thinking/emotionality/behaving, a personality disorder reflects "adaptive failure" involving: "Impaired sense of self-identity" or "Failure to develop effective interpersonal functioning".

There are a couple of things I actually really like about this new definition. The first is the use of the term "adaptive failure". Every one of us has a personality, it's just a matter of how you use it. Your personality features only become a disorder when there is a pervasive failure to adapt who you are as a person to the demands of everyday life. The second is the newly detailed descriptions of failure to develop effective interpersonal functioning. These are fairly straightforward: problems with empathy, intimacy, cooperativeness with others, and inability to formulate a good working understanding or conceptualization of who others are as people.

There are two drawbacks, it seems to me. "Impaired sense of self-identity" is not quite as easily understood as someone who has pervasive failure in their relationships. The proposed revision breaks down identity problems into: poorly integrated identity (e.g. shifting self-states), poor integrity of self-concept (e.g. difficulty identifying and describing parts of oneself), and low self-directedness. The last part is great, and can be easily understood and observed as someone having trouble setting and achieving goals in life, showing a lack of direction, and feeling little meaning or purpose in life. Identity integration and integrity seem a little more "jargony" and a bit more difficult to explain or quantify in the real world.

Five personality types

Instead of the old ten personality types, DSM-V has simplified the system by cutting them down to just five: Antisocial/Psychopathic, Avoidant, Borderline, Obsessive-Compulsive, and Schizotypal types. Each type comes with a narrative paragraph description.

Antisocial/Psychopathic types have inflated grandiosity and a pervasive pattern of taking advantage of other people. Avoidant types are inhibited from forming and maintaining relationships out of fears of humiliation and rejection. Borderline types show intense emotionality, impulsivity, internal feelings of emptiness, and fears of rejection. Obsessive-compulsive types are hyperfocused on details and are excessively stubborn, rigid, and moralistic. Schizotypal types are characterized by odd thinking and appearances or confused states.

Clinicians simply read each paragraph length narrative description and rate on a 1-5 scale how much a patient matches each one (with 4 or 5 being a threshold for diagnosis). Research studies have found that clinicians tend to find this the most useful and comprehensive method for personality diagnosis, improving clinical description and treatment planning from the current system.

Personality trait domains and facets

The third and final element of the proposed system is a series of six personality "trait domains". These domains are based on the widely used five-factor model of personality. The six domains include: Negative Emotionality, Introversion, Antagonism, Disinhibition, Compulsivity and Schizotypy. Clinicians would be asked to rate each of the six domains on a 0-3 scale depending on how descriptive each is of the patient.

To aid with this, each of the six domains comes with a subset of adjectives, or facets. Disinhibition, for example, encompasses: impulsivity, distractability, recklessness, irresponsibility. While there is a great deal of personality research on these factors, and they are useful for a variety of purposes, their greatest limitation is the sense of vagueness for clinical use.  To compare, it would be like rating someone's level of usual sadness, as opposed to having a coherent syndrome of depression.

 That's the roadmap to the new proposed system for personality disorder diagnosis. What do you think? Post your thoughts and opinions below!! For a limited time, you can check out the entire system and provide feedback to the American Psychiatric Association at www.dsm5.org.

 Jared DeFife, Ph.D.