DSM Finally Acknowledges Matters of the Heart

Most therapists are pretty unhappy with the American Psychiatric Association’s Diagnostic and Statistical Manual. We don’t like to be pigeonholed into pathologizing our clients with disorders that meet DSM criteria for insurance purposes. We also find that the DSM omits huge problems such as sexual addiction and the use of pornography while including arcane and relatively inconsequential diagnoses such as trichotillomania—hair-pulling disorder—admittedly a behavior that the DSM itself may provoke in many of us. In our work with men, we certainly treat conventional diagnoses, but find that these diagnoses frequently fail to address men’s core issues: matters of the heart.

I recently wandered around the pages of DSM-5 in preparation for my presentation on treating men at the annual American Men’s Studies Association later this month. I discovered something that finally seemed to touch on the core issues of men—and, for that matter, women. One can only imagine what happens in the boardrooms of APA, but it appears that perhaps somebody—or a group of somebodies—revolted against the traditional DSM model. Perhaps you already know about it. Anyway, on page 761, not entirely buried in the back of the book, there’s an Alternative DSM-5 Model for Personality Disorders which, surprise, upends the single-minded pathologizing of human beings by offering qualities of healthy human functioning. Here’s a sample from the list:

  • The experience of oneself as unique, with clear boundaries between self and others.
  • Stability of self-esteem and accuracy of self-appraisal.
  • Capacity for, and ability to regulate a range of emotional experience.
  • Utilization of pro-social internal standards for behavior.
  • Empathy: the comprehension and appreciation of others’ experiences and motivations, tolerance of different perspectives.
  • Intimacy: Depth and duration of connection with others. Desire and capacity for closeness. Mutuality of regard reflected in interpersonal behavior.

Wow. Among other desired attributes are the characteristics of empathy and intimacy, elsewhere absent from the almost 1000 pages of DSM-5. Here is a proposal that the descriptions of personality disorders use empathy and intimacy as categories for diagnostic criteria. Could it be that APA has found heart?

In its appendage of empathy and intimacy, APA is finally getting with the program, elucidating what we want so badly for men, and what’s so hard for many to achieve. The addition of empathy and intimacy to the DSM vision of human beings could promote new treatment goals and correspondingly novel interventions for men.

Maybe the Alternative DSM-5 Model could even become the new standard. Or, maybe that’s a fantasy: there’s still an overwhelming conventionally masculine culture at the APA. If only some of these guys who still dominate the DSM process would join a men’s group. Probably an even bigger fantasy.