blithe assumptions

So, I did a little perusing of the personality disorders section of the DSM, and I was amazed by some of the language that I found there. Linehan's article ought to have tipped me off, but it wasn't just the description of borderline personality disorder that used pejorative language and descriptions that were "confound[ed] [by] motivational hypothes[es]" (p. 14). Here's a sampling (all italics mine):

Histrionic Personality Disorder-

"they commandeer the role of 'the life of the party'"

"their emotions often seem to be turned on and off too quickly to be deeply felt"

"they often act out a role (e.g., "victim" or "princess") in their relationships"

"seek to control their partner through emotional manipulation or seductiveness"

"at increased risk for suicidal gestures and threats to get attention and coerce better caregiving"

Narcissistic Personality Disorder--

"they may blithely assume that others attribute the same value to their efforts..."

"sense of entitlement"

"contemptuous and impatient"

"Arrogant, haughty behaviors characterize these individuals. They often display snobbish, disdainful, or patronizing attitudes"

"very sensitive to "injury" from criticism or defeat"

"overweening ambition"

"[differs from] Histrionic, Antisocial, and Borderline Personality Disorders, whose interactive styles are respectively coquettish, callous, and needy..."

Obsessive-Compulsive Personality Disorder

"oblivious to the fact that other people tend to become very annoyed"

"stubbornly and unreasonably insist that everything be done their way"

"Individuals with this disorder may be miserly and stingy"

The language used to describe these individuals is certainly not scientific or objective; rather, it's the kind of subjective, emotional language you might use to describe anyone you didn't like. The diagnostic criteria seem more to be criteria for unlikeableness (if that's even a word) than impaired functioning and clinically significant distress. If this is the best we can do, it's no wonder a large portion of the world describes us as "quacks" and "shrinks." No meaningful therapeutic progress can be made if the clinician conceives of their client in such pejorative terms and ascribes motives to their behaviors (i.e., rapid fluctuations in expressed emotion) that may, in fact, have more to do with our cultural "common sense" about what such behaviors mean (i.e., "turned on and off too quickly to be felt"), and less about their actual origin and function (perhaps limbic dysregulation?).

Frankly, this section of the DSM seems like a holdover from the dark ages, and I'm horrified by the pseudoscientific veneer it lays over highly subjective diagnostic categories. After all, how is a clinician to operationally define, say, "fishing for compliments" (a behavior described in both the Histrionic and the Narcissistic sections)? Or, taking a look at the actual criteria , how is one to pinpoint which emotions are "shallow" (Histrionic)? How can different clinicians all arrive at the same definition of what is "theatrical" (Histrionic) or "haughty" (Narcissistic) or "perfectionis[tic]" (Obsessive-Compulsive)?

Furthermore, is a category of personality disorders even helpful? Defining these diagnoses as disorders of the personality suggests disorders of intrinsic, relatively stable traits; it implies resistance to treatment. If a clinician diagnoses a client as having avoidant personality disorder, it seems that there's little that can be done--her very personality is disordered! Yet give the same individual a label of social phobia, and it seems, instead, that change can be effected--the phobia can be tackled.

So, in all, this whole category has me steamed.