Reading between Philosophy and Clinical Social Work

This is my third and for now final entry on Tyrer and Mulder’s recent book on personality disorder. In previous entries, I looked at the problems with the old categorical way of classifying personality disorders and the arguments for a dimensional approach, such as is found in ICD-11 or the DSM-5 Alternative Model. I want to step back now and examine some of the larger implications of this book. First, I will consider what the authors have to say about stigma. This will lead naturally to my underlying working thesis: that there are underlying philosophical problems with concept of personality disorder, philosophical problems connected to how we think about selfhood and moral character. These problems do not disappear simply by operationalizing the term “personality” in more sophisticated ways. There is no doubt that, at present, personality disorders are heavily stigmatized diagnoses. The authors cite extensive empirical evidence of this in Chapter 9 (pp. 98-111). They also reprise...

In my previous post, I focused on Tyrer and Mulder's critique of the construct of borderline personality disorder (BPD). In this post, I would like to cover Tyrer and Mulder’s critique of the categorical approach to personality disorder classification. They call for its replacement with a dimensional system, such as is found in the Alternative DSM-5 Model for Personality Disorders (AMPD) found in the back of the DSM-5 or in ICD-11.  Categorical classification schemes divide the world up into discrete, non-overlapping categories. An ideal categorical system is comprehensive, so that it covers the entirety of what is to be classified—there is no “other specified” or “unspecified” (DSM-5) or “not otherwise specified” (DSM-IV) category. The categories are mutually exclusive. In the standard 52-card deck (as long as we exclude the jokers), for example, the four suits function like categories; a card either is a heart, spade, diamond, or club, and no card is sort of one suit or belongs t...

 Tyrer, P. J., & Mulder, R. (2022). Personality disorder: From evidence to understanding . Cambridge University Press. At just over 100 pages, Personality Disorder: From Evidence to Understanding is a slim volume with a strong punch. The authors, psychiatry professors in the UK and New Zealand respectively, are leading experts in personality disorder research, and, from what I can tell (although I need to look into this more), they were deeply involved in the major changes in personality disorder classification and diagnosis introduced by ICD-11, which was released in 2022. In many ways, this book is a compact exposition and defense of those changes. Although the authors cite heavily and wade into some of the more technical debates in the field, the book succeeds in its stated aim of being accessible to a non-specialist audience. Indeed, one of the greatest strengths of this book, from my perspective, is that the authors always have in mind the overworked non-specialist mental...