Personality disorder as harmful dysfunction: DSM'S cultural deviance criterion reconsidered

Area of Science:

• Psychiatry
• Evolutionary Psychology
• Clinical Psychology

Background:

• Current diagnostic systems for personality disorders (PD) rely on general criteria to distinguish between disordered and non-disordered personality traits.
• Proposed changes in the DSM-V may involve dimensionalizing PD and separating diagnosis from case formulation, necessitating robust general criteria to avoid false positives.

Purpose of the Study:

• To examine the cultural deviance requirement (CDR) for personality disorder diagnosis.
• To analyze the CDR through the lens of an evolution-based harmful-dysfunction model of disorder.

Main Methods:

• Conceptual analysis of the cultural deviance requirement (CDR).
• Application of an evolution-based harmful-dysfunction analysis to understand the role of cultural values in personality disorder.

Main Results:

• The CDR is often misinterpreted as solely reflecting value relativity in diagnostic harm.
• Cultural values are integral to human social functioning and personality development, not merely external relativistic factors.
• The CDR can serve as an indicator of whether an individual's personality organization stems from an evolutionary dysfunction.

Conclusions:

• The cultural deviance requirement, when viewed through an evolutionary lens, can help identify true personality dysfunction.
• Integrating evolutionary analysis with value relativity provides a convergent approach to understanding and diagnosing personality disorders.