Do personality disorders exist? On the validity of the concept and its cognitive-behavioral formulation and treatment

Since the introduction of personality disorders as important diagnostic categories in the DSM-III [APA (1980). Diagnostic and statistical manual of mental disorders (3rd ed.). Washington, DC: American Psychiatric Association] the concept of personality disorder (PD) has met both skepticism and enthusiasm. This paper addresses criticisms, reviews theoretical and empirical evidence for the concept of personality disorders (PD), critically discusses widespread clinical ideas about PDs, and reviews cognitive-behavioral models and treatments of PDs. It is concluded that there is enough evidence for the usefulness of PDs as diagnostic categories. A confirmatory factor analysis for instance yielded very reasonable evidence for the categories hypothesized by the DSM. Contradicting widespread ideas, research indicates that PDs are not a contraindication for cognitive-behavioral treatments of axis-I problems, and that there are even indications that PD pathology itself can be successfully treated using modified CBT methods. In stark contrast to the generally rich empirical history of CBT, research on cognitive models and treatment of PDs is virtually absent. However, the sparse attempts indicate that cognitive models may be fruitful in this area. Future research should be directed at further developing and testing cognitive conceptualizations and treatment models.