An expert consensus approach to relating the proposed DSM-5 types and traits

Although personality disorders (PDs) have been defined categorically throughout the history of psychiatric nomenclatures, the DSM-5 Personality and Personality Disorders Work Group proposed a substantial shift to a dimensional conceptualization and diagnosis of personality pathology. This proposal included the adoption of a trait model with 37 specific traits that fell within six higher-order domains. In addition, they specified that half of the current diagnoses be recast as types defined by narrative description, with the other half deleted. Instead, the deleted categories would be diagnosed through ratings on specifically assigned traits. The Work Group also specified a number of traits that are relevant to each of the five DSM-5 types. However, these assignments for the types and deleted DSM-IV PDs lack empirical justification. The current study examined the relations between the DSM-5 traits and PDs slated for inclusion and exclusion using an expert consensus approach. Researchers with expertise on specific PDs provided descriptions of either the DSM-5 type narratives or a prototypic case of DSM-IV PDs in terms of the trait model. The ratings by experts in the current study demonstrated moderate agreement with the Work Group's assignments, but also identified notable discrepancies between how these types were described by the Work Group and how they were perceived by other PD researchers. These results hold promise for improving the currently proposed system and will help inform researchers and clinicians who will ultimately use the DSM-5 model.