Personality disorder classification: stuck in neutral, how to move forward?

Area of Science:

• Psychiatry
• Psychology
• Mental Health

Background:

• The Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) includes an Alternative Model for Personality Disorders (PDs) in Section III, while retaining the DSM-IV categorical criteria in Section II.
• Despite a broader trend toward dimensional diagnoses in psychiatry, the categorical PD model persists.
• This situation prompts an examination of the factors influencing the development and potential clinical adoption of the dimensional Alternative Model.

Purpose of the Study:

• To review the factors that influenced the development of the Alternative DSM-5 Model for Personality Disorders.
• To present data that encourages and facilitates the clinical use of this dimensional model.
• To address potential concerns regarding disruption, discontinuity, and perceived clinical utility.

Main Methods:

• Review of literature and data concerning personality structures and diagnostic models.
• Analysis of factors supporting a dimensional approach to psychopathology.
• Examination of the clinical significance and utility of personality disorder assessment.

Main Results:

• Personality may be foundational to a dimensional structure of psychopathology.
• There is emerging consensus on the structure of normal and abnormal personality.
• The clinical significance of personality traits and the necessity of PD-specific severity criteria are recognized.
• Concerns about disruption and clinical utility of the Alternative Model may be unfounded.
• A path forward involves collaborative research on neurobiological, psychosocial processes, and treatment outcomes.

Conclusions:

• The Alternative DSM-5 Model for Personality Disorders offers a promising dimensional framework.
• Clinical adoption can be facilitated by recognizing the foundational role of personality and addressing potential utility concerns.
• Future research should focus on collaborative efforts to integrate this model into clinical practice and understand its impact on treatment.