The classification of personality disorders: critical review and need for rethinking

An overview is presented of the historical background to the current classification of personality disorders in ICD-10 and DSM-IV. Although the precursors of the present diagnostic concepts were originally developed as dimensional or prototype typologies, both ICD-10 and DSM-IV have adopted a quasi-nosological, categorical model of personality disorders on Axis II. It is argued that the model is fundamentally flawed and restricts the capacity to collect and communicate relevant data on the impact of personality characteristics on the manifestations, course and outcome of Axis I disorders. Dimensional models originating in recent psychological research offer an alternative, but considerable theoretical and field research work will be required before a meaningful and generally acceptable restructuring of Axis II becomes feasible.