Most confused

The much anticipated 5th edition of the Diagnostic and Statistical Manual of Mental Disorders, otherwise known as the DSM-5, is due to be released in 2013. Since the last major revision was done more than 15 years ago, it is expected that there will be a lot of changes when the new version is released.

If you'd like to review the proposed revisions that are already in the pipeline you can do so here. And until April 20, 2010 you can register with the site and leave comments regarding the various changes.

I've been reading through the diagnoses and the possible revisions that might be made to them for the last several days. I have to say that I am most confused by the section regarding the "levels of personality functioning" and just how one would be assessed for impairment.

As I read through the three areas listed under "self" and under "interpersonal", I find that in each area I have different levels of impairment for the items listed. So for instance, the first one under "self" is Identity Integration:

"Regulation of self-states; coherence of sense of time and personal history; ability to experience a unique self and to identify clear boundaries between self and others; capacity for self-reflection"

According to their continuum, I would say I have a serious impairment when it comes to regulation of self-states, a moderate level of impairment concerning the ability to experience a unique self and to identify clear boundaries between self and others, but absolutely no impairment when it comes to coherence of sense of time and personal history and capacity for self-reflection.

For Integrity of Self-Concept:

"Regulation of self-esteem and self-respect; sense of autonomous agency; accuracy of self-appraisal; quality of self-representation (e.g., degrees of complexity, differentiation, and integration)"

I'd say I have extreme impairment when it comes to regulation of self-esteem and self-respect and also accuracy of self-appraisal. But I have only a mild impairment when it comes to sense of autonomous agency. For quality of self-representation, I'm somewhere between mild and moderate.

For Self-directedness:

"Establishment of internal standards for one’s behavior; coherence and meaningfulness of both short-term and life goals"

I'd say I have a mild impairment when it comes to establishment of internal standards for one's behaviour and extreme impairment when it comes to coherence and meaningfulness of both short-term and life goals.

On the "interpersonal" side of things, the first one is Empathy:

"Ability to mentalize (create an accurate model of another’s thoughts and emotions); capacity for appreciating others’ experiences; attention to range of others’ perspectives; understanding of social causality"

Out of all those, I would say I have a mild impairment when it comes to appreciating others' experiences and possibly also with understanding of social causality, but no impairment in the ability to mentalize or attention to range of others' perspectives.

For Intimacy and Cooperativeness:

"Depth and duration of connection with others; tolerance and desire for closeness; reciprocity of regard and support and its reflection in interpersonal/social behavior"

I'd say I have no impairment in the areas of depth and duration of connection with others and reciprocity of regard and support and its reflection in interpersonal/social behaviour. But I have a moderate to serious level of impairment when it comes to tolerance and desire for closeness.

For Complexity and Integration of Representations of Others:

"Cohesiveness, complexity and integration of mental representations of others; use of other-representations to regulate self"

I'll say no impairment for cohesiveness, complexity and integration of mental representations of others and a mild impairment when it comes to use of other-representations to regulate self.

In other words....I don't fit neatly into any one of the defined levels of impairment in either self or interpersonal functioning. Most of my impairments do lie in the area of self, but even within that, I have absolutely no impairment when it comes to certain areas of functioning. When there's so much inconsistency, how would my level of overall impairment be determined?

Personally, I don't think there's a person alive that falls into the no impairment category, for self or interpersonal. Every single person on this planet has some disturbance in the way they think about themselves and others. It's a part of being human. If anyone believes they have no impairment in any level of personality functioning, I think they should be referred to a psychiatrist for their delusional thinking.