Challenge for the Entry of Psychoanalytic Concepts in Personality Disorders in DSM-5

Choi, Eunkyung; Ha, Jee Hyun

Abstract

Diagnostic and Statistical Manual of Mental Disorder (DSM) is the most widely used diagnosis classification system in mental health area. DSM-5 personality disorder work group developed a brand new classification system remarkably changed from DSM-IV-TR system. But American Psychiatric Association board committee turned down and it could not be included in DSM-5. However it contained numerous radical changes especially reintroducing psychoanalytic concepts. It would be meaningful to explore the proposed new definition of personality disorders and classifications. DSM-5 proposal defined personality disorder as dysfunction in 'self' and 'interpersonal'. The concept of self and interpersonal resembled psychoanalytic 'ego and self integration' and 'object representation'. DSM-5 personality disorder proposal presented 'severity' rating, and it was similar with the level system proposed by Gunderson in 'Borderline personality disorder'. Remaining 6 personality disorders in DSM-5 proposal were antisocial, borderline, narcissistic, avoidant, schizotypal and obsessive-compulsive. The known treatment of choice for most of them was psychotherapy, which implied that psychoanalytic concepts might be the core theoretical and clinical methods to evaluate and treat personality disorder patients. It is true that psychoanalysis has been isolated from main psychiatric field because of few evidence based medical knowledge or scientific research results. The new proposed DSM-5 personality disorders showed that psychoanalytic theory and concepts could have sufficient power to be the central core of personality disorder.