I am not sure I would want to call it more appropriate. But there were elements in the presentation of the patient that matched elements of patients in my clinical experience who had significant pathology that was more bordeline/narcissistic than it was antisocial.
Look, the research that supposedly supports the existence of well-defined, distinct personality disorders that can be distinguished from other personality disorders can't fight its way out of a paper bag. If you are diagnosed with one personality disorder, you will de facto satisfy criteria for several others. Moreover, in practice, in the front lines of behavioral healthcare, personality disorders are used pejoratively.
Does this mean they don't have value? No; many years ago I made a decision to not diagnose personality disoders, precisely because of the reasons you have presented. However, I will retain the presence of characterological/personality features in patients presentation in my own personaly clinical formulation because it serves as an initial model against which I can measure and test future information from the patient. This formulation, I should add, doesn't see the light of the third party payor day.
As far as treatment is concerned, if the focus of my treatment is the personality disorder then I am not doing behavioral medicine treatment, I am doing long term psychotherapy.
The challenge for behavioral medicine practitioners is how to manage longstanding patterns of behavior, that persist even to the disadvantage of the individual, in the context of time-limited symptom focussed treatment.
IMHO
John
Replies:
|
| Behavior OnLine Home Page | Disclaimer |
Copyright © 1996-2004 Behavior OnLine, Inc. All rights reserved.