Descriptive Psychopathology: The Signs and Symptoms of ...

391 Chapter 16: An evidence-based classificationConversion disorder is also a phenomenon associated with several conditions anddoes not warrant separate classification. 173 The category should be discarded.Dissociative conditions 174Dissociation is a symptom, not a syndrome. Depersonalization and derealizationare seen in anxiety disorders and epileptic conditions. Fugue states andmultiple personality can only be medically verified as expressions of seizuredisorder. Dissociative amnesia is best explained as a syndrome representingseveral conditions. The category should be discarded.Impulse control conditionsThe category should be eliminated. Impulsiveness is a behavior, not a disease.Kleptomania, pyromania, pathological gambling, and trichotillomania are OCDvariants. Intermittent explosive behavior is a symptom, not a syndrome, and isassociated with seizure disorder, traumatic brain injury, delirium and dementia,substance abuse, and antisocial personality disorder. It is like fever in infectiousdisease and is an ill-defined criterion for classification.Personality disordersAxis considerationsData summarized in Chapters 14 and 15 show present personality disorderclassifications to be inconsistent with the evidence. Personality disorder reflectsdeviant trait behavior evolving from maturational factors, but much of thepresent formulation reflects disease (e.g. all of the DSM cluster A). The traitsyndromes that meet the definition (e.g. narcissistic personality) are poorlydefined categorically. The severity continuum of the three DSM clusters doesnot exist. The cluster system is unsupported and should be eliminated. Many ofthe present Axis II conditions are best placed within other syndromes or classifiedindependently (see below).The conditions reflecting maturational deviation should be delineated bydimensional criteria so that the number of features and their degree of strengthwould both be required to reach a rated score. Several dimensional modelscould replace the present approach, the “5-Factor” and Cloninger temperament–character systems providing opportunities to re-define the personality disorders. 175Cloninger’s terminology offers understandable descriptive terms: harm avoidance,novelty seeking, reward dependence, persistence, cooperativeness, self-directedness,and self-transcendence. The 5-factor terms are: extraversion, agreeableness, conscientiousness,neuroticism, openness to experience, social contact, curiosity, honor,