A critique on the use of standard psychopathological classifications in understanding human distress: The example of ‘schizoid personality disorder’

Abstract

Content and FocusThere is an ongoing debate about how practitioners understand ‘mental disorders’ in terms of assessment, formulation and treatment. The current diagnostic procedures are defined by rule-based classifications that largely rely on symptom clusters, such as the Diagnostic and Statistical Manual of mental disorders (DSM) and the International Classification of Diseases (ICD), and are influenced by the medical model which supports the concept of nosology. Under this notion, psychological difficulties are seen as pathological and, therefore, questions are raised about what is ‘normal’ and ‘abnormal’. The aim of this paper is to make a critique on the use of standard psychopathological classifications in understanding human distress and the example of so-called schizoid personality disorder will be discussed in non-conventional psychiatric terms. Additionally, a formulation-driven approach which derives from the basic tenets of attachment theory will be utilised to understand schizoid personality disorder. Considerations for counselling psychology practice are also discussed in light of an integrative therapeutic framework, which brings together concepts from Cognitive Behavioural Therapy (CBT) and psychodynamic therapy.ConclusionsThe current psychopathological classifications provide a descriptive guidance on labelling symptoms but the limited attention paid on the aetiology of disorders raises important questions. A need for revision of what constitutes a psychiatric ‘illness’ is apparent and furthermore the inclusion of a formulationdriven approach in the psychopathological manuals can be invaluable as it can offer a heuristic focus in understanding human psychological distress.