Moral disorder in the DSM-IV? The Cluster B Personality Disorders

Psychiatry has often been accused of 'medicalizing morals.' The DSM-IV's inclusion of the Cluster B Personality Disorders (Antisocial, Borderline, Histrionic, and Narcissistic) might seem to lend credence to this charge. Bioethicist Louis Charland and physicianphilosopher Carl Elliott would likely concur. Whereas Charland argues that the Cluster B disorders are 'moral rather than medical' conditions, that they are genuine 'illnesses' is an idea that, according to Elliott, 'should give us pause.' Although the intuitions captured in the arguments of Charland and Elliott are undeniably strong, the arguments themselves are rather weak. In responding to these arguments, I defend the view that the Cluster B Personality Disorders are 'fundamentally mental' and only 'contingently moral.' They are genuine mental disorders, rightly included in the DSM, whose symptoms consist largely of morally disvalued traits.