ICD-10 and Hare's PCL-R

Odysseus

For those who use the terms regularly and treat people like this I'm wondering what do people think of dissocial personality disorder and a true psychopath as defined by Hare's PCL-R. What would you see as the main distinguishing features? I mention it in another thread that going by the ICD-10 addiction and Dissocial PD often accompany each other, and we certainly get a few "smiling psychopaths" regularly enough.

It just that I don't use those nosological categories and I was just thinking about it today after a brief encounter with a person who would fall into Hare's system. So guys any thoughts?

Gibs

Odysseus wrote: »

For those who use the terms regularly and treat people like this I'm wondering what do people think of dissocial personality disorder and a true psychopath as defined by Hare's PCL-R. What would you see as the main distinguishing features? I mention it in another thread that going by the ICD-10 addiction and Dissocial PD often accompany each other, and we certainly get a few "smiling psychopaths" regularly enough.

It just that I don't use those nosological categories and I was just thinking about it today after a brief encounter with a person who would fall into Hare's system. So guys any thoughts?

This month's edition of Scientific American Mind has a great article about the subject. The authors talk about the fact that while Antisocial Personality Disorder is included in DSM-IV-TR, psychopathy is not included. They also emphasize the point that the two terms are not interchangeable and that only about 1 in 5 people with antisocial personality disorder is a psychopath, contrary to the common belief among many psychiatrists and other mental health professionals.

Odysseus

Gibs wrote: »

This month's edition of Scientific American Mind has a great article about the subject. The authors talk about the fact that while Antisocial Personality Disorder is included in DSM-IV-TR, psychopathy is not included. They also emphasize the point that the two terms are not interchangeable and that only about 1 in 5 people with antisocial personality disorder is a psychopath, contrary to the common belief among many psychiatrists and other mental health professionals.

Cheers, I will have a look at the link, yeah, that's my point it is not named and commonly misdiagnosed. I'm not fully aware of the distinction, but I'm aware there is one. I have recently developed an interest into the forensic side of things. Though getting time to read is difficult, does any know where you would situate psychopath, if it’s not in the DSM/ICD. It would go beyond a personality disorder I think, but in term of severity I would think it’s less that a psychosis.

Though I know the above description is far from ideal and flawed, by it helps highlight the question.

metrovelvet

Does APD have a scale? Like can you have a cold version of APD or is it always pneumonia?

I hope that makes sense.

hotspur

metrovelvet wrote: »

Does APD have a scale? Like can you have a cold version of APD or is it always pneumonia?

I hope that makes sense.

When the DSM V comes out all of the personality disorders will be dimensional in nature.

Odysseus

hotspur wrote: »

When the DSM V comes out all of the personality disorders will be dimensional in nature.

Could you expand on that Hotspur? The only thing I have heard about the DSM V is that it will contain a description of patholgical/complicated grief, its a topic that they are talking a lot about on my course.

Gibs

[URL="[url]http://www.psychologytoday.com/blog/the-shrink-tank/201002/dsm-v-offers-new-criteria-personality-disorders[/url]"]Here's[/URL] an explanation of the proposed changes and here's the official DSM-V site that outlines the proposed structures for personality disorders

hotspur

Odysseus wrote: »

The only thing I have heard about the DSM V is that it will contain a description of patholgical/complicated grief, its a topic that they are talking a lot about on my course.

Gib's post should answer that question.

This is OT but what are you reading atm related to your new course? I'm reading grief and bereavement material myself right now. I have Machin's "Working with Loss and Grief", Worden's "Grief Counselling and Grief Therapy", Kubler-Ross and Kessler's "On Grief and Grieving", and I might read Boss's "Loss, Trauma, and Resilience: Therapeutic Work with Ambiguous Loss".

Odysseus

hotspur wrote: »

Gib's post should answer that question.

This is OT but what are you reading atm related to your new course? I'm reading grief and bereavement material myself right now. I have Machin's "Working with Loss and Grief", Worden's "Grief Counselling and Grief Therapy", Kubler-Ross and Kessler's "On Grief and Grieving", and I might read Boss's "Loss, Trauma, and Resilience: Therapeutic Work with Ambiguous Loss".

Sure we go off topic here all the time, just completed the first module which was theories and perspectives on grief. All of the above was on the reading list, Strobe et al Dual Process Model as well. Personally I'm focusing on Bowlby for my assessment, not that much of a surprise is it;) I never covered Bowlby in my degree or masters, even his early stuff was considered psychoanalytic enough. Anyway as I never got the chance and there is a loose association to psychoanalysis I'm using this as my chance to get up to speed on an old theory, we have to apply a theory to a published personal account of bereavement/grief.

I know you have an interest in this area, I can keep you updated as to reading lists if you want. Another useful thing to know is the Irish Hospice Foundation has an excellent bereavement library and membership is open to professionals for only 20e a year, DBS where looking for 80e+ a year as an alumni

metrovelvet

Ok. Can you guys translate into layspeak? I read the blog linked above and I also read the readers comments, which were extremely interesting.

1.Is the DSM V eliminating Axis II altogether? And what are the implications of that?

2. A question about diagnosis: Is diagnosis basically a psychiatrists interpretation of a patient's narrative? And does the patient have the right to deny consent or do they get stuck with a label for the rest of their lives?

3. Introversion. Introversion is a personality disorder? I find that very hard to believe?

hotspur

Odysseus wrote: »

Personally I'm focusing on Bowlby for my assessment, not that much of a surprise is it;)

I'm reading a wonderful book atm called Attachment in Psychotherapy by David Wallin and I recommend it highly.
http://www.amazon.com/Attachment-Psychotherapy-David-Wallin-PhD/dp/1593854560

I like the neuroscience behind modern attachment orientated therapy. This is a wonderful Google talk by Dan Siegel on the issue:
http://www.youtube.com/watch?v=Gr4Od7kqDT8

Odysseus wrote: »

Another useful thing to know is the Irish Hospice Foundation has an excellent bereavement library and membership is open to professionals for only 20e a year, DBS where looking for 80e+ a year as an alumni

DBS charge €80+ for alumni library access? I have an alumnus reader card for free from TCD, but don't use it. The fact that so many books can be obtained in pdf form for free these days helps a lot. It's pirating, but meh.

metrovelvet

hotspur wrote: »

The fact that so many books can be obtained in pdf form for free these days helps a lot. It's pirating, but meh.

Glad to see ethics are alive and well in the psych professions.

Odysseus

hotspur wrote: »

I'm reading a wonderful book atm called Attachment in Psychotherapy by David Wallin and I recommend it highly.
http://www.amazon.com/Attachment-Psychotherapy-David-Wallin-PhD/dp/1593854560

I like the neuroscience behind modern attachment orientated therapy. This is a wonderful Google talk by Dan Siegel on the issue:
http://www.youtube.com/watch?v=Gr4Od7kqDT8



DBS charge €80+ for alumni library access? I have an alumnus reader card for free from TCD, but don't use it. The fact that so many books can be obtained in pdf form for free these days helps a lot. It's pirating, but meh.

Cheers, I'll check them out. As much as I like them the fees are typical of DBS. I never really got into the PDF thing, I a bit of a bibliophile. I do love having the text to hand and I'm quite proud of my personal library, then again I would have saved myself a small fortune over the years. Amazon and Karnac made a killing off me when I was doing my masters. Of course my standard edition and my Arden Shakespeare collection have a special place of their own:)

Odysseus

metrovelvet wrote: »

Ok. Can you guys translate into layspeak? I read the blog linked above and I also read the readers comments, which were extremely interesting.

1.Is the DSM V eliminating Axis II altogether? And what are the implications of that?

2. A question about diagnosis: Is diagnosis basically a psychiatrists interpretation of a patient's narrative? And does the patient have the right to deny consent or do they get stuck with a label for the rest of their lives?

3. Introversion. Introversion is a personality disorder? I find that very hard to believe?

I'm still working out your first question myself, I’m much more familiar with the ICD-10.

For number 2 a psych diagnosis is made up of the patient’s symptom as expressed through their language and behaviour, the observations of the psychiatrist and evidence from significant others. A psych diagnosis will follow the person in their medical notes the same way a diagnosis of cancer would. As further evidence is presented a diagnosis will reflect that. A psych diagnosis is only a label if it is used for anything else apart from treatment. In and of itself a diagnosis is not a label.

Number three, I think the DSM is the same in this, for PDs there is a general criteria for a PD and then a specific one for the type. So both criteria’s will need to be fulfilled. It is about much more than just being introverted.

metrovelvet

Odysseus wrote: »

For number 2 a psych diagnosis is made up of the patient’s symptom as expressed through their language and behaviour, the observations of the psychiatrist and evidence from significant others. A psych diagnosis will follow the person in their medical notes the same way a diagnosis of cancer would. As further evidence is presented a diagnosis will reflect that. A psych diagnosis is only a label if it is used for anything else apart from treatment. In and of itself a diagnosis is not a label.

.

I'll just complicate this a little here. From what I have read, it seems to me that mental health industry still does not fully understand mental illness. And who could blame them. But isn't there a danger of a patient internalising their diagnosis and making them worse. In a "I AM MY ILLNESS" kind of way. Illness can give you an identity. I remember when I was misdiagnosed with chronic ulcerative colitis and for over a year I was an "IBD sufferrer" and this took over my life. [Iwas later undiagnosed and kicked out of an identity so to speak.]

The other thing too is of the stigma attached to certain diagnosis. You could internalise the stigma too. For example, borderline PD. I know there is feminist criticism of 'borderline' as it seems to be handed out to women, and films like Fatal Attraction and Single White Female buttress the stigma. Feminist criticism argues that PTSD should be used more than borderline for this reason alone. Isn't there a danger in that? Borderline is used as a put down in common parlance. Cancer isnt. Cancer gets the sympathy, borderline, APD, etc gets funny looks, jokes, and repulsion.

Odysseus

metrovelvet wrote: »

I'll just complicate this a little here. From what I have read, it seems to me that mental health industry still does not fully understand mental illness. And who could blame them. But isn't there a danger of a patient internalising their diagnosis and making them worse. In a "I AM MY ILLNESS" kind of way. Illness can give you an identity. I remember when I was misdiagnosed with chronic ulcerative colitis and for over a year I was an "IBD sufferrer" and this took over my life. [Iwas later undiagnosed and kicked out of an identity so to speak.]

The other thing too is of the stigma attached to certain diagnosis. You could internalise the stigma too. For example, borderline PD. I know there is feminist criticism of 'borderline' as it seems to be handed out to women, and films like Fatal Attraction and Single White Female buttress the stigma. Feminist criticism argues that PTSD should be used more than borderline for this reason alone. Isn't there a danger in that? Borderline is used as a put down in common parlance. Cancer isnt. Cancer gets the sympathy, borderline, APD, etc gets funny looks, jokes, and repulsion.

Sometimes the treatment involves that have a look at the threads on the treatment of addiction and 12 step fellowships; my name is Odysseus an I'm a ... As I said all diagnosis is description of the symptoms given a classification, its primary goal is the formulation of a treatment plan. If all a subject can see is themselves as the diagnosis this should be dealt with as part of the treatment.

The stigma associated with the illness is another issue and more of a social one than a therapeutic one, tbh I have enough on my plate trying to deal with my clients.

I'm not the best to speak about PDs, my research maters was on Dual Diagnosis, an addictive disorder and another psych diagnosis. I avoided PDs as the area is so big. A psychoanalytic viewpoint would be that PDs became the waste bin of psycho-diagnostics; all that was too difficult to diagnose was placed there. I only dealt with addiction and psychoses, depressive disorders and anxiety disorders. I looked at the difference in psycho-diagnostics between psychoanalysis and the ICD-10 and DSM; though I focused more on the ICD-10 as it's used more in St Vincent's where I was training. I wrote 55,000 and only touched on the topic, so you’re right it’s a vast area.

Lots of diagnoses are used as put downs, psychoses, depression, addiction, "sure they are only a junkie".

However, I will add that you are only getting my opinions, some of the other Lads and Ladies here may not agree with what I'm saying.

Edit: As you are asking a lot of questions here recently, are you going to take the leap and study the area?