AAPEL
Borderline personality disorder.
What is the DSM?
Is the DSM useful, even indispensable or is it "dangerous"?
In the year 2000, can a psychiatrist be a good doctor if he doesn't use the DSM?
The French psychiatric association against the DSM ?!
Can one speak of a French exception in psychiatry?

 Introduction

Beyond the controversial aspect of the title lies a much more serious problem, i.e. the differences in working practices among psychiatric doctors. In some cases one might even eliminate the word "doctor" in connection with the word "psychiatrist.
Why is the DSM rejected by so many French psychiatric doctors, is it legitimate ? Is it possible nowadays for a psychiatric doctor to totally deny the DSM? What alternative(s) are there to the DSM?
Meme page en Francais / Same page in french
Main title summary
What is the DSM ?
What is the role of a doctor ?
Can the DSM be ignored ?
But can one be a good practitioner without using the DSM?!
Doctor Christian Vasseur view, President of the French Psychiatric Association (AFP)
Doctor J Cottraux view, Anxiety Disorder Unit, neurological hospital of Lyon
AXIS
Asked questions to the conseil national de l'ordre des médecins français
Is it possible to respect the Madrid Declaration... without using the DSM (or ICD) ?
What about Switzerland ? D. Page's view, responsible for the service de psychiatrie adulte, Hôpital de Prangins (Suisse)
But why so much "hatred"?

What is the DSM?

In simple terms, the DSM is the world's "bible" for psychiatric disorders. Its purpose is to offer help in diagnosing and to enable specialists, throughout the world, to have a common language in which to share the progress made in their experiences in this field.
The DSM came into being in 1952, followed by the DSM II in 1968, the DSM III in 1980 and the DSM IV in 1994 and the latest revision of the DSM IV TR in 2000.
The DSM IV according to the author.
* "The American Psychiatric Association published a Fourth Edition of its Diagnostic and Statistical Manual of Mental Disorders in 1994.
DSM-IV ’s Importance to Psychiatric Diagnosis. The importance of the DSM IV in psychiatric diagnosis.
Diagnosis is the foundation in any medical practice, and the twentieth century has seen a revolution in the doctor's capacity to identify and treat certain illnesses which have been poisoning the existence of mankind. (aapel "one only needs to look at the improved life expectancy in rich countries")
Apart from its usefulness as an aid in diagnosis, the DSM IV codification of mental illnesses facilitates the process of collecting and recuperating research data, and helps researchers to compile information for statistical studies.
The DSM IV codes are in accordance with the international classification of illnesses, ninth edition, clinical modification (icd-9-cm). The icd-9-cm is based on the WHO (world health organization's) publication icd-9, which is used throughout the world to facilitate the emergence of coherent medical diagnosis. ("Psychiatric Diagnosis and the Diagnostic and Statistical Manual of Mental Disorders Fourth Edition", http://www.psych.org/public_info/dsm.pdf)

 
Q: What's so "Statistical" about the Diagnostic and Statistical Manual of Mental Disorders?
R: The word "statistical" in the name of the manual is a throwback to one of the original uses of the DSM-to facilitate the collection of hospital statistics in the early 1950's and 1960's. Although psychiatric diagnoses are still an important part of record keeping, the primary use of the DSM is "diagnostic." For historical reasons, we have kept the name "DSM."

 
Q: What is the status of the ICD-10?
R: ICD-10, the tenth revision of the International Classification of Diseases, was published by the World Health Organization in 1993. Although DSM-IV and DSM-IV-TR were developed with the explicit goal of ICD-10 compatibility
What is the role of a doctor?
If one refers to  the French medical code of ethics: "reaching a diagnosis is the first stage in patient care".
Also "medicine requires that  the nature and the origin of an illness must be recognized in order to treat it correctly". (please note the "conseil de l'ordre" is very clear on this point)
Is a psychiatric doctor a doctor?
Generally this is not a question that a patient asks himself when consulting a psychiatric doctor.
Many choose to consult a psychiatric doctor because he is a doctor, rather than a psychologist, a psycho-therapist or a psycho-analyst who is not
So why ask this question?
Quite simply because there are still many psychiatric doctors (in France) who refuse to diagnose even when their patient request it of them.
Why do many psychiatric doctors not diagnose and do they have the right not to do it?
Clearly not if one refers to the medical code of ethics.
Concerning the first part of the question, the problem is to know whether the doctor doesn't reach a diagnosis or whether he chooses not to inform his patient.
Regarding their motivation I can summarize as follows; "the human brain cannot be considered like any other organ and a psychiatric diagnosis is too simplistic".
To state that, by refusing the very principle of a diagnosis, one is respecting a human being is praiseworthy, isn't it?
Certainly it is and I'm not going to dispute the fact. But setting aside these "humanist" and necessary considerations, is it possible to heal a person's suffering from a medical point of view, without first reaching a diagnosis?
I believe that it is not, and I will develop my reasons further on.
Does a psychiatric doctor have the right not to diagnose for purely philosophical reasons?
The problem is to know if he is a "psychoanalyst" or a "doctor".
I don't see how a psychiatric doctor can believe that he has a right not to diagnose and still call himself a "psychiatric doctor".
If, as some people believe, there cannot exist a diagnosis in psychiatry, a totally respectable theory (the debate is not on this point), then there is no such thing as a "psychiatric doctor"!
If you, patient, share the "humanistic" viewpoint of the psychoanalytic theory, and if you consult a psychoanalyst, then that is an "honest" contract. You will not be seeking a diagnosis and you will not be given one.
I believe it is a "fraud", i.e. non-respect of the medical code of ethics (like it is confirmed buy the "conseil de l'ordre") and therefore non-respect of the human being), when a psychiatric doctor refuses to give a diagnosis on the pretext that he is also a psychoanalyst.

 
In this case, why see a doctor if it's not with the aim of consulting "a doctor"!
Can we use the DSM all as subscribe with psychoanalytical theories or are they both "incompatible"?
The DSM is a diagnosis tool and not a treatment's tool, I thus do not see why it would not be possible to diagnose a patient on DSM criteria then to treat him/her by a form or other of analytical therapy. Many studies were published by psychoanalysts of reputation and who diagnosed the concerned patients on DSM criteria.
Some doctors believe, sometimes rightly, that a psychiatric diagnosis is stigmatizing and even "counter productive".
It is true that the medical code of ethics authorizes concealing a diagnosis from a patient for a certain time, but that should only be in exceptional cases.
Many (too many) psychiatric doctors refuse to diagnose on "ethical" grounds. Well I'm sorry to have to say this, but it is their sole duty to resign, because this attitude, though morally respectable, is in fact "illegal". Allow me to explain myself.
Normally, a doctor is under an obligation to diagnose and inform a patient. Anything else should remain an exception.
Even if this refusal is morally respectable in the absolute, it becomes morally reprehensible if a patient believes he is consulting a doctor when in fact, the person who refuses to diagnose cannot be qualified as such. (In France medical insurance cover medical treatment and not others)
But my doctor may be trained and competent to relieve me without necessarily make a diagnosis or give it to me?
I don't care, debate is not here.
Whether or not a doctor has the "ability" to relieve a patient is not an issue. The fact is, that as a member of a professional body, he has certain moral obligations
If a doctor relieves a patient without diagnosing or informing him about the diagnosis, then he is not acting as a medical practitioner but as a psychotherapist or psychoanalyst.
Worse still, he will be in contradiction with "article 33 if he prescribes "psychotrope" substances without first establishing a diagnosis.

 
Why is it that, at a time when measures are being taken to regulate the practice of psychotherapy, the title of "doctor" is still granted to those who, for this reason, no longer exert the profession of "medical practitioner"?
On the one hand and on the orher hand, Mr. Vasseur, president of the AFP, is scandalized that there exist psychotherapists who are not qualified "doctors", while at the same time implying that a psychiatric doctor should not behave as a fully fledged "doctor" as it is stipulated in the medical code of ethics. "Logical"? "Interesting" to say the least, but rather "baffling".
At the risk of repeating myself; a psychiatric doctor is under an obligation to behave as a doctor. Not because it is my opinion but because it is laid down in the regulations.
If a psychiatric doctor was not a doctor, there would be no need for his profession to exist as he would have the same role as others professions, such as a psychologist.
The very existence of the term "psychiatric medical specialist" implies the recognition of a medical specificity i.e. professional doctors who are there to treat "mental disorders"!
Can the DSM be ignored in this day and age?
Whether one considers the DSM useful, or "harmful" and even "dangerous", one would have to be blind to ignore that it has become the reference guide worldwide.
Those who think they can go against it are incredibly naïve.
The truth is that if one wishes to "fight" against the DSM it can only be done from the inside. The general tendency is for the DSM to hold a more and more important role; therefore it is up to its "opponents" to make themselves heard  and to make things evolve in a direction which they consider "favorable".
(bis) Would it be possible to do without the DSM in the 21th century ? (or the icd)
The answer is "yes". The proof is that (too) many French psychiatric doctors take on a disdainful, amused or scornful expression when someone mentions the DSM. "As if this guide could be of benefit to anyone." (One only has to read the remarks of Dr. Vasseur, president of the French association for psychiatry, to be convinced)
But you have to admit that  the DSM is far from being perfect and it does have certain disadvantages ?
Nobody's denying the fact.
Of course a misuse of the DSM can be dangerous if it's only use is to put a label on someone without giving them the opportunity to change.
Nobody's saying that the diagnosis is the be-all and end-all.
The question to ask is not "is the use of DSM dangerous", but rather "is the NON USE of DSM even more dangerous"
So what, in your opinion, are the advantages of the DSM?
Many specialists see the DSM as something too arbitrary.
E.g. "You have only 5 points out of 9 therefore you do not have such & such an illness" or inversely, "you have 6 points out of 9 therefore you have such & such an illness."
In my opinion it's just the opposite, because the DSM makes it possible to eliminate the arbitrary and to give some sort of power and an existence to the patient.
The DSM would be not reliable?
If that is the case, then why do so many published studies claim the opposite?
For example, many studies concerning borderline personality disorder prove the  "reproducibility" of the results. Could it be that France, a great defender of human  rights, is one of the only countries which has not been blinded by the emergence of  one "DSM totalitarianism"?
Why do so many people recognize themselves in our description of the disorder?  Couldn't it be because they all have many points in common?
Be that as it may. Supposing, therefore, that the DSM is not reliable. OK. Then what "reliable" tool would you suggest in its place, None? Then we are coming close to being knowing everything.
Is the DSM only useful for research and statistics?
Many detractors of the DSM base their judgement on the fact that it was originally a statistical tool. However, many of these same detractors recognize that the DSM is useful for everything connected with research, namely because it is necessary to have a common base.
If in one country "influenza" is called "throat infection", it will become "complicated" to analyse the effects of the "influenza" on "my" population and to use the results of the study.
But can one be a good practitioner without using the DSM?!
That's an interesting question. Can one be a good practitioner in the year 2000 without using the DSM in medical practice (with the patients)?
(I have a feeling that I'm going to make myself a few new "friends")
Once again, I have never said that the DSM was "wonderful" or "perfect". The proof can be seen in the definitions of borderline personality disorder which we give on the website and which are modeled from the DSM. I repeat "modeled"! But let's get back to the question in hand.

 
Starting with the hypothesis that "I can be a good practitioner without using the DSM". I therefore consider myself to be a psychiatric doctor (which of course I'm not).
.
Is all this possible without using the DSM?
It seems to me that things are clear; crystal clear.
Even though the DSM may seem to be, or is, a bad tool (a belief I do not share), it is a tool which is used by hundreds of thousands of practitioners.
No researcher in the world, who wishes to be published, can manage without it today !
By deciding to ignore the DSM on "moral" grounds, I prevent my patient from benefiting from the treatment which is the most capable of curing him.
How then could I not be "blameworthy" in the eyes of my ethical code when I voluntarily exclude myself from the international scientific community!

 
It would be nevertheless at least very strange to claim that progress exists (before Freud, no neurosis and psychosis or pervert) but that this one would have then stopped a few years ago.

 
It is true that I have a right, and even a duty, to act this way if I believe that the DSM is "harmful". However, in such a case, it would also be my duty to resign as a "doctor in medicine" because I would have made the decision to go against the code of ethics of my order and against the code of public health, which obliges me to respect my code and to integrate the results of scientific studies.
Of course, I do have the possibility to deny the studies carried out by the international community in the last twenty years… but then how can I manage to convince anyone that I'm not entering in communautarism and the sectarian attitude?
In the year 2000, is it possible to be a "competent" psychiatric doctor whilst ignoring the DSM?
 (You'll notice that, a)I said "psychiatric doctor" and didn't mention another profession beginning with "psy" and, b)I use the word "ignoring" and not "criticizing")

 
If one refers to the surprising remarks made by the president of the French psychiatric association, it's rather through using the DSM that a psychiatric doctor becomes "incompetent"

 
Allow me to answer this question with another question.
How (this is my opinion) can a psychiatric doctor, who does not (advisedly) use the DSM with his patient in his daily work, be "competent" (trained) in a domain which is perpetually evolving, when he voluntarily deprives himself of the majority of the world's scientific studies (studies which he would denounces as being "non" scientific)!

Remarks made in December 2OO2, by  doctor Christian Vasseur, President of the French Psychiatric Association (AFP)
«Today it’s a matter of classifications. As it is, we, AFP, are in a position to speak on this subject since we denounced the abusive use of the DSM and of the CIM 10 which may have been made in the past ten years. We have organized meetings and symposiums; we have regularly made publications and during the “Jubilee de l’Association  Mondiale de Psychiatrie” held in Paris in June 2000, the main part of the French speeches focused on this matter...
It so happens that in France, contrary to in other countries, we are fortunate to have a psychopathological corpus already set up which has been added to over time and regularly questioned in order to alter the relevance according to the evolution of society and to medical knowledge. This has protected us from the attraction of Anglo Saxon classifications which are based on statistics and which are even challenged by the Anglo Saxons themselves.
Our practice is that of scientific and medical humanism in which the patient is central. It is true that this attitude is often frowned upon by the pharmaceutical industry and by the authorities who, either through misunderstanding or concern for management and rational expenditure, are tempted to impose classifications on psychiatrists which, although benefiting from international consensus, are not necessarily acceptable scientific references for our practice.
Once again, we have denounced any abuse as soon as it appeared and, at the moment, it is only the authorities, the statisticians and the research units together with the pharmaceutical industry who continue to refer to these classifications which have been rejected by every practitioner» (C. Vasseur, «Disqualification de la PSYCHIATRIE», Association Française de Psychiatrie December 2OO2)

 
AAPEL: Things couldn’t be clearer, could they? What did the AFP do?
From what I understand, it would seem that the French psychiatric doctors are “humanists” (contrary to the Anglo Saxons) and “protected” (the term used by C. Vasseur) from  Anglo Saxon classifications, clearly and mainly the DSM.
It would seem therefore that the members of the French psychiatric association (AFP) are  ”scientific” whereas the rest of the planet is not since; “their scientific references are not acceptable”. The objective is clear, the DSM is not to be taken into consideration in France!
This answers an earlier question…a reality is that a patient who consults a psychiatric doctor has absolutely no idea who he is dealing with!
The point of view of Doctor J Cottraux, Anxiety Disorder Unit, neurological hospital of Lyon
"I read, with interest, your document on the DSM. (AAPEL, the 16 February edition, before inclusion of this present account)
I think it evokes several questions
1) The nature of the DSM
One often forgets that the DSM is a multi-axial classification which takes into account five dimensions.
 
Axis 1- Clinical Disorders (AAPEL:  Roughly mental disorders like depression, schizophrenia, etc)
Axis 2- Personality (AAPEL:  Personality disorders, like "borderline", etc)
Axis 3- General Medical Condition (AAPEL: If the person has some illnesses that could have an influence on the mental, like diabetes, cancer, etc)
Axis 4- Psychosocial and stressors Factors (AAPEL: Example educational, economic, legal, etc)
Axe 5- Global Assessment of Functioning (AAPEL: Scale from 1 to 100 ex between 80 and 100 the person is "functional", lower 50 serious problems , lower 30 delirious hospitalization may be necessary, etc)
2) The absence of a simplistic view
Far from being simplistic, it makes it possible to envisage the presence of several syndromes at the same time; that of several personality disorders and the overall functioning of the person in the face of his illness and of the events which take place in his life (axis 4). It is therefore less simplistic than a nosography, such as: psychosis or neurosis; perversions with which we often satisfy ourselves in France.
.
3) The clinical aspect of the DSM
As you emphasized, the DSM is compatible with the ICD-10 which was drawn up in Geneva by the WHO and there is a "key" which makes it possible to pass from one to the other.
The DSM is not solely a manual for researchers. it is used daily in its abridged version by dozens of clinicians or those studying psychiatry or psychology. It was not drawn up exclusively by partisans of neurobiology, but by a group of experts who understood psychiatrists and psychologists.
Finally, it is an evolutionary tool which is revised periodically and brought up to date as a result of studies carried out in medical institutions as well as in clinical research and in more fundamental research.
.
4) The European and "integrative" aspect of the DSM
It is worth noting that in France the DSM was an unexpected, great success in book shops for Masson editions. It is the reference for psychopathology, despite (or maybe because of) its critics who are opposed to nothing in particular.
In fact, the DSM is not especially American in its description of syndromes: It has just integrated the data coming from French, German and, occasionally, Anglo Saxon psychiatry in the 19th and 20th century, and systemized it. Its description of personality disorders takes into account the data coming from classical psycho-analysis. The ICD-10 has even criticized
the DSM for focusing too much on a psycho-analytical description of obsessive-compulsive personality disorder in contrast with existing data.  (anankastique) In: Féline A, Guelfi J., Hardy P. : Les troubles de la personnalité, Flammarion, 2OO2).

I think that this instrument, although not perfect and in constant evolution, is the reference which is necessary for psychiatrists, psychologists and doctors. Also, when widely distributed in its abridged edition, it gives the patient access, in an intelligible form, to the diagnosis to which he has a right". (Dr J Cottraux, Anxiety Disorder Unit, Hopital Neurologique, Lyon) (author of numerous books)

Asked questions to the conseil national de l'ordre des médecins français
The following questions were put to the "conseil national de l'ordre français" mid-February 2OO4
- Is a psychiatric doctor, both and above all, a doctor? (I suppose that the answer is yes, otherwise he would lose his legitimacy with regard to a psychologist.)
- Does a psychiatric doctor, like any other doctor, have a duty to respect the medical code of ethics, especially articles 11, 33 and 35, in his daily tasks?
- For this reason, regardless of his personal opinion of the DSM IV, can a psychiatric doctor ignore it in his daily medical practice with his patients? ( There have been over 40,000 international, scientific and medical publications in the last 20 years).

Reply given by the "conseil de l'ordre" on 27 February 2OO4. - Dossier LJC/SB/PS/EDA/D.04.057.900
"In reply to your Email of 17 February 2OO4, I confirm that a psychiatrist, like any other doctor, must respect the medical code of ethics in every aspect.
As for the DSM IV, it is a classification for mental illnesses accompanied by specific diagnostic criteria to be used as a guide while diagnosing.
However, it does not cover every circumstance which could justify a treatment, nor even the nature of the treatment." (Dr. Louis-Jean Calloc'h, general Secretary of the "conseil national de l'ordre des médecins).

AAPEL: That couldn't be clearer. the reply is perfectly clear!

Is it possible to respect the Madrid Declaration On Ethical Standards For Psychiatric Practice without using psychiatric classification like the DSM (or ICD) ?
Please read the "madrid declaration" from the World Psychiatric Association (WPA)
We can read:
"...Psychiatrists serve patients by providing the best therapy available consistent with accepted scientific knowledge and ethical principles... It is the duty of psychiatrists to keep abreast scientific developments,of the specialty... It is the duty of psychiatrists to provide the patient with relevant information so as to empower the patient to come to a rational decision according to personal values and preferences..."

"Psychotherapy by psychiatrists is a form of treatment for mental and other illnesses and emotional problems...The approach employed should be specific to the disease and patient's needs ...Therefore, the psychiatrist or other delegated qualified clinician, should determine the indications for psychotherapy and follow its development . In this context the essential notion is that the treatment is the consequence of a diagnosis and both are medical acts performed to take care of an ill person..." (Guidelines concerning specific situations, chapter "ETHICS OF PSYCHOTHERAPY IN MEDICINE")

And if we add these facts:
"...A diagnosis that a person is mentally ill shall be determined in accordance with the internationally accepted medical standards. Physicians, in determining whether a person is suffering from mental illness, should do so in accordance with medical science..."  (WPA Statement and Viewpoints on the Rights and Legal Safeguards of the Mentally III - adopted by the WPA General Assembly in Athens, l7th October, 1989)
Last... the WPA web site include the "WPA Educational Programs (WPA EPs) ICD 10 Training Kit - (in collaboration with WHO)"

Is it then possible to comply with these ethical rules without using the DSM and the results of more than 40 000 studies ?
Another interesting point, is the fact that the "association française de psychiatrie" is a member of the WPA (http://www.wpanet.org/generalinfo/members3.html). How is it then possible to be, on the one hand a WPA member and on the other hand claims words like "... authorities who... are tempted to impose classifications on psychiatrists which, although benefiting from international consensus, are not necessarily acceptable scientific references for our practice" ?
Good question !

And switzerland ? D. Page's point of view , doctor in psychology and psychotherapist director of the psychiatric adult service, Hôpital de Prangins (Suisse)
"At the moment, Switzerland favors the use of the ICD-10 (AAPEL: That's only natural, since the ICD is the classification of the WHO, whose headquarters are in Switzerland) in conformity with the decision taken by the head doctors, psychiatrists and psychotherapists FMH- whereby it has been established as the official classification for mental illnesses; numerous professionals also work with the DSM IV (TR), sometimes simultaneously with the ICD-10.

All health professionals receive basic training in diagnostics; only doctors and psychotherapists (a title which is protected by Swiss law and attributed to people who have completed a university cycle in psychiatry, followed by 1,200 hours of specialized training in a psychotherapeutic branch of their choice) can pronounce a diagnosis which is medically legal. in this context, the use of international classifications such as the ICD-10 or the DSM- IV is clearly generalized.

This use offers various advantages :

  • The international classifications (DSM-10 or ICD-10) make it possible to use common denominators to describe complex and "multi-axiales" illnesses
  • The international classifications describe, on a phenomenological basis, symptoms of suffering presented in an objective manner. This considerably limits the subjectivity of the medical team in their perception of the problem.
  • The characteristics proposed for the different types of suffering make it possible to establish a base from which facilitates the putting into place of the most adequate treatment and the measuring of its effects.
  • The descriptions in the international classifications enable patients to identify and put a name to their suffering. This has the effect of relieving him of the feeling that he is alone in the face of his illness and enabling him to build up an alliance with his therapist for the work he will have to do.

  • .
    What are the risks connected with the use of the DSM-IV or with the ICD- 10? To be honest I can't see any!
    However, if there is a risk of any kind, it seems to me that it would come from the therapist's use of them... or rather "misuse"! One example would be to use such classifications without the patient's approval and without checking their exactness with regard to the patient's life and experience. Another example would be to consider that the difficulties and suffering described in the classification are rigid and unchanging. Using these diagnostic categories without considering if they are appropriate to the suffering and real life of a particular patient, is another example of misuse.

    The international classifications are, and should be, a tool at the disposal of both the therapist and the patient in order to help them to define, as objectively as possible, the real suffering of a particular person in a particular context at a given time. "They are clinical and therapeutic tool which can also be used to asses the evolution of the patient and the effectiveness of his treatment" (Dominique Page, Psychologic HPP Service Director - Prangins Switzerland)
    (D. Page has translated in french and in collaboration with the Dr. Wehrlé both book of Marsha Linehan on dialectical behavioral therapy for borderline personality disorders)

    But why so much "hatred" towards this famous worldwide DSM on the part of a fringe group in French psychiatry?
    I think that the French are holding an ideological war (I am over simplifying, of course. There are very many French psychiatric doctors who, without renouncing the past, do not reject the DSM).
    France is the birthplace of psycho-analysis which brought a "humanistic" view to psychological problems. The basis being the "neurosis" and "psychosis" of Freud.
    The Americans (I'm over simplifying again) from the beginning tried to erase the "psychological" aspect and concentrated more on the "biological and neurological" aspect of psychological disorders.
    The ideologists on both sides claim "you are denying the human spirit" against "you are denying science".
    Any person with a minimum of common sense is forced to admit that a human being is composed of both body and spirit. In my opinion, anyone who denies the notion of spirit, as well as anyone who denies the notion of body is, in fact, denying the human.
    From the moment the French considered the American attitude as "haughty" and "arrogant" (let's admit that they are strong in this field), many in the profession totally rejected the DSM in its entirety.
    I fear that many French patients have not yet finished paying the exorbitant price for this, and that, on the pretext of protecting des acquis, many psychiatric doctors are plunging us into an infernal spiral.
    The actual truth is that the DSM doesn't seem to be welcome in France. (One only has to read the remarks of the French psychiatric association to see this).
    The problem is that it is impossible to reject the DSM without depriving oneself of the tens of thousands of scientific studies which were based upon it!

     
    Each person is free to either put his trust in a doctor who uses the DSM as a diagnostic tool or to put it in one who totally rejects it.


    Alain Tortosa
    Psychotherapist and Founder of the AAPEL association.

    See also the pages
    Declaration of madrid, psychiatry and ethics
    The right to be sick and dignity,(in french)
    Talking to his/her shrink about BPD,(in french)
    Do we have the right to ask the question of the training and competence of "shrinks" ?,(in french)
    French medical code of ethics, right to information and diagnosis
    AAPEL's code of ethics
    For those wanting to order l'ouvrage "le DSM" en français


    AAPEL - Back to BPD summary page
    ,

    ,
    Warning:
    All the information in this site is aimed at helping people understand a "rather particular" and puzzling kind of disease
    But more especially, to support everyone affected by it, sick or not.  In any case, it is ESSENTIAL to see a therapist who specialises in this field they can confirm or give an alternative diagnosis
    The name of what you’ve got doesn’t matter so much, getting the right treatment for the right patient does
    .
    .
    last update  2008
    Copyright AAPELTM - All rights reserved
    Author, Alain Tortosa, psychotherapist, founder president of the Aapel
    (translation by maureen)

    Trouble de la personnalité borderline, état limite, TPL, personalité, border line, bordeline, boderline, border-line, maladie, syndrome, désordre, psy, définition, definition, borderlines