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Charting the future of axis II.

J M Oldham¹, A E Skodol

¹Department of Psychiatry, Columbia University, College of Physicians and Surgeons, NY, USA.

Journal of Personality Disorders

|April 4, 2000

Summary

Personality disorders are best understood dimensionally, but current diagnostic systems use categories. A proposal for DSM-V aims to integrate both dimensional and categorical approaches for better personality disorder assessment.

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Area of Science:

Psychiatry
Psychology
Clinical Diagnosis

Background:

Current diagnostic systems for personality disorders predominantly use categorical approaches.
There is a recognized need for dimensional conceptualizations that reflect continuity between normal personality traits and disorders.
Existing categorical systems face challenges in capturing the nuances of personality disorder presentations.

Purpose of the Study:

To review the arguments for and against dimensional and categorical conceptualizations of personality disorders.
To propose a hybrid approach for the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-V).
To enhance the clinical utility and accuracy of personality disorder diagnosis.

Main Methods:

Review of existing literature and theoretical arguments supporting dimensional and categorical models.
Analysis of the strengths and weaknesses of each approach in clinical practice.
Development of a proposal integrating elements of both dimensional and categorical frameworks.

Main Results:

General agreement exists on the conceptual advantages of a dimensional approach for personality disorders.
Categorical systems remain prevalent for practical clinical diagnosis despite limitations.
The proposed DSM-V model incorporates both dimensional and categorical features.

Conclusions:

A purely dimensional or categorical system may not fully address the complexities of personality disorders.
Integrating dimensional insights into a structured diagnostic system offers a promising path forward.
The proposed DSM-V framework seeks to balance theoretical understanding with clinical applicability for personality disorders.

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