Reconceptualizar los trastornos de personalidad

un abordaje eliminativo

Palabras clave: Trastornos mentales, Disfunción dañina, Condiciones patognomónicas, Discapacidad, Comorbilidad

Resumen

El concepto de trastorno mental permite justificar intervenciones médicas, psicológicas y judiciales. Además, facilita a la/el consultante acceder a tratamientos mediante reembolsos o programas de salud pública, y por otro lado, podría conllevar estereotipos sociales. No obstante, el significado de dicho concepto no ha dejado de suscitar debate.

En el presente artículo argumentaré que los trastornos de personalidad, tal como son definidos en el DSM-5, no cumplen con los criterios de patología de las propuestas principales (i.e. teoría bio-estadística de la salud, disfunción dañina, o entidad patológica) debido a tres razones independientes: (i) no se han propuesto dis/funciones a la base de cada trastorno y, dado el estado del arte de la psicología evolucionista, es poco probable que se pueda llevar a cabo ese programa en el futuro; (ii) el concepto de daño (distrés, perjuicio) aplicable a los trastornos de personalidad es constitutivamente social (aunque no exclusivamente social), por lo que resulta más adecuado hablar de grados de discapacidad que de trastornos del individuo; y (iii) que la ausencia de condiciones patognomónicas para cada trastorno, junto a la elevada comorbilidad y multimorbilidad entre trastornos de personalidad, horada la validez de la nosología actual y de los diagnósticos diferenciales.

Propondré como solución la eliminación de los trastornos de personalidad de la nosología psiquiátrica. Eliminar los trastornos de personalidad no equivale a desconocer el sufrimiento de las personas diagnosticadas, ni a ignorar que dicho sufrimiento precede a, –y no acaba con la disolución de– la etiqueta diagnóstica. Por ello, se propondrá una reconceptualización de dicho sufrimiento en términos de discapacidad, entendida desde el modelo social, y que no presupone patología.

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Publicado
2022-12-31
Sección
Dossier Filosofía de la Psiquiatría