Clinical Utility of the DSM-5 Alternative Model of Personality Disorders

Abstract

In Section III, Emerging Measures and Models, DSM-5 presents an Alternative Model of Personality Disorders, which is an empirically based model of personality pathology measured with the Level of Personality Functioning Scale (LPFS) and the Personality Inventory for DSM-5 (PID-5). These novel instruments assess level of personality impairment and pathological traits. Objective. A number of studies have supported the psychometric qualities of the LPFS and the PID-5, but the utility of these instruments in clinical assessment and treatment has not been extensively evaluated. The goal of this study was to evaluate the clinical utility of this alternative model of personality disorders. Method. We administered the LPFS and the PID-5 to psychiatric outpatients diagnosed with personality disorders and other nonpsychotic disorders. The personality profiles of six characteristic patients were inspected (involving a comparison of presenting problems, history, and diagnoses) and used to formulate treatment considerations. We also considered 6 specific personality disorder types that could be derived from the profiles as defined in the DSM-5 Section III criteria. Results. Using the LPFS and PID-5, we were able to characterize the 6 cases in a meaningful and useful manner with regard to understanding and treatment of the individual patient and to match the cases with 6 relevant personality disorder types. Implications for ease of use, communication, and psychotherapy are discussed. Conclusion. Our evaluation generally supported the utility for clinical purposes of the Alternative Model for Personality Disorders in Section III of the DSM-5, although it also identified some areas for refinement. (Journal of Psychiatric Practice 2015;21:3-25).

The Personality Inventory for DSM-5 Short Form (PID-5-SF): psychometric properties and association with big five traits and pathological beliefs in a Norwegian population

“…Furthermore, the DSM-5 AMPD predicts treatment decisions (e.g., level of treatment, type of psychotherapeutic or pharmacological treatment) better than the DSM-IV-TR/DSM-5 PD categories [36]. Examples of how the DSM-5 AMPD can be used in clinical practice are provided by Skodol, Morey, Bender, and Oldham [44] and Bach, Markon, Simonsen, and Krueger [11]. …”

A framework for treating DSM‐5 alternative model for personality disorder features

“…A detailed assessment of Criterion B traits allows the clinician to develop a patient‐specific formulation based on the particular manner in which the patient's personality interacts with her environment (see Table ). This trait model helps the clinician develop an idiographic formulation that implies particular treatment strategies that target the patient's specific problems …”

“…Perceived clinical utility is among the chief reasons for the persistence of the categorical model in the DSM . A number of case examples are now available in the literature for using the AMPD to develop treatment plans, and practice reviews generally suggest acceptability among clinicians . However, a framework for connecting AMPD features to specific therapeutic techniques is currently unavailable.…”

The Challenge of Transforming the Diagnostic System of Personality Disorders

“…For instance, in a recent review of the literature, Al-Dajani, Grainick, and Bagby (2016) reported that there are now 29 empirical studies on the PID-5’s psychometric properties; however, only eight of these studies were conducted using clinical samples. Further, Al-Dajani and colleagues note that only one paper (based on six case studies) described the clinical application of the PID-5 (Bach, Markon, Simonsen, & Krueger, 2015), raising unresolved questions about its clinical utility. Thus, while promising, more research is needed to compare this model with the traditional categorical one and to arrive at a more effective integration of the two determinants of diagnosing PDs, that is, functional impairment and trait facets.…”

“…We would encourage such studies, as they might help to guide the field forward. Moreover, we are not aware of any guidelines in the clinical or empirical literature that document how broad trait domains might be utilized in clinically meaningful ways (see Clarkin & Huprich, 2011, and Meehan & Clarkin, 2015, for a further discussion of these issues), except for a recent set of published case studies based on the DSM-5 alternative model (Bach et al, 2015). …”