Is Your Relationship a Disorder?

If you and your spouse seem to coexist in a state of constant conflict, with a marital relationship that's sinking faster than a capsized ship, your therapist could someday attach a formal diagnosis to your domestic dissension. The American Psychiatric Association (APA), the National Institute of Mental Health, and other agencies have raised the possibility that a new diagnosis -- called "relational disorders" -- might someday describe your spousal squabbling.

The proposed new diagnosis defines a relational disorder as "persistent and painful patterns of feelings, behaviors, and perceptions" among two or more people in an important personal relationship, such a husband and wife, or a parent and children.

According to psychiatrist Darrel Regier, MD, some psychiatrists and other therapists involved in couples and marital counseling have recommended that the new diagnosis be considered for possible incorporation into the professional bible of mental illnesses -- called the Diagnostic and Statistical Manual of Mental Disorders(DSM).

We are trying to determine if there is enough evidence and support for the diagnosis, says Regier, director of the APA's division of research. "Right now, it is just a 'condition' that is a reason for clinical contact, as opposed to a 'disorder' defined by explicit criteria."

A listing in the DSM would provide mental-health professionals with well-defined guidelines for diagnosing a "relational disorder," which would allow psychiatrists and other therapists to clearly identify cases needing treatment, says psychiatrist Michael First, MD. By including the diagnosis in the next DSM, and formally labeling it as a "disorder," it would "basically give it more prominence," says First, editor of the current edition of the DSM.

The interest in pursuing more research and giving more attention to "relational disorders" is not confined only to psychiatrists. "Many family psychologists have been working on this for years, and have been making the argument that certain kinds of family relationships, characterized by particular patterns of interactions, tend to be destructive of the mental health of individuals within the family," says Ronald Levant, EdD, former president of the division of family psychology of the American Psychological Association.

Changing the Focus

The DSM has been used by professionals for 50 years, and it has gone through several revisions. The next edition, DSM-V, is not expected to be published until 2010, and only after input about its contents is collected from hundreds of mental-health experts. Already, however, the possible inclusion of "relational disorders" in the manual is beginning to stir up discussion, and not only because it would label troubled relationships as pathological. The new diagnosis would also represent a clear paradigm shift in the way that mental illnesses are perceived. For the first time, a psychological disorder would be defined as involving two or more people, rather than just one.