Too few or too many? Reactions to removing versus retaining specific personality disorders in DSM-5

The present review examines the decision of the DSM-5 Personality and Personality Disorders Working Group to retain or to remove specific personality disorders included in DSM-IV-TR and presents the reactions elicited by the decision and published between 10 February 2010 and 30 September 2012.

In the first draft of Chapter P (Personality disorders), posted on the DSM-5 Internet site on 10 February 2010, the DSM-5 Personality and Personality Disorders Working Group proposed to remove paranoid, schizoid, histrionic, dependent and narcissistic personality disorders from the classification. A revised version of the draft, posted on the Internet in June 2011, reinstated narcissistic personality disorder but not the four remaining types that had been slated for removal. Underlying the decision of the Work Group for retaining versus removing specific personality disorder types are arguments concerning the clinical utility and validity of each type. The arguments provided by the Work Group have not been accepted unanimously by other personality disorder experts.

DSM-5 will retain six out of the 10 personality disorder types listed in DSM-IV-TR while removing the remaining four types. Reactions to the decision and to the arguments presented for doing so have been mixed.