A postmortem and future look at the personality disorders in DSM-5

Area of Science:

• Psychiatry
• Psychological diagnostics

Background:

• The American Psychiatric Association's (APA) Personality and Personality Disorders Work Group (PPDWG) proposed changes to personality disorder classifications.
• These proposals were ultimately not adopted in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5).

Purpose of the Study:

• To evaluate the outcome of the PPDWG's proposals for personality disorder diagnosis.
• To assess the contribution of the PPDWG's efforts to the field and future research directions.

Main Methods:

• Analysis of the PPDWG's proposals and their rejection.
• Discussion of the DSM-5 development process concerning personality disorders.
• Consideration of the impact of rejected proposals on future research.

Main Results:

• All PPDWG proposals for personality disorder classification were rejected for the DSM-5.
• The PPDWG's work is viewed as a step forward, potentially stimulating significant future research.
• The outcome might not have differed substantially even with a more conservative initial approach.

Conclusions:

• The PPDWG's efforts, despite rejection, represent a valuable contribution to the understanding and research of personality disorders.
• The proposals are expected to generate a substantial body of future research.
• The DSM-5 process and the PPDWG's suggestions offer insights into the magnitude of change, empirical support, and opposition in psychiatric classification.