Psychiatrists had a seat-of-the pants definition of a PD: “If your first impression of your patient is that he is an asshole, then he probably has a personality disorder.”
And what kind of disorder was this anyway, an illness in which the identified patient thinks he personally is fine but is making everyone around him unhappy? This is not like psychosis.
You can see why the drafters of DSM-V, due this May, have despaired. They wanted something clinically relevant and that also would sound vaguely like science (which psychoanalysis certainly didn’t). It will be interesting to see how the APA sorts this out. Personality disorders exist not as natural phenomena but as cultural phenomena: We as a society need some way of identifying people who can’t quite get it all together. But is this an illness that psychiatrists can treat? In the way that they treat schizophrenia with Zyprexa and depression with Prozac? What do we, as a society in 2012, do with people who can’t quite get it all together? I’m asking you.