Clinical Utility of the Five‐Factor Model of Personality Disorder

Abstract

There exists a great deal of research regarding the validity of the Five-Factor Model (FFM) of personality disorder. One of the most common objections to this model is concern regarding clinical utility. This article discusses clinical utility in terms of three fundamental components (i.e., ease of usage, communication, and treatment). In addition, a considerable number of recent empirical studies have examined whether the FFM compares well to personality disorder diagnostic categories with respect to all three components of clinical utility. The purpose of the current article is to provide a description of the implications of each component of clinical utility as it relates to the FFM and to acknowledge and address the empirical findings.

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

“…In addition, as a dimensional system, the DSM-5 Alternative PD Model has the flexibility to provide different thresholds for different social and clinical decisions and may consequently be more useful in different clinical fields than the categorical system. 8 Based on our experiences with the 6 individuals in the cases presented in this article as well as with the total sample of 142 patients, the DSM-5 Alternative PD Model seems rather "foolproof" and its ease of use is clear. The 6 cases were simply evaluated by following the LPFS rating guideline (Criterion A) and by a computerized scoring of the PID-5 responses (Criterion B) that automatically illustrated the trait scores in relation to each other.…”

“…11,56 While the DSM-5 Alternative PD Model communicates more specific information than a single diagnostic label, it is certainly easier to inform a colleague that a patient meets criteria for avoidant PD than to describe the patient in terms of personality functioning and pathological traits. 8 In other words, 10 categories may seem easier to manage than 25 traits. However, in order to evaluate the 10 categories thoroughly, one has to evaluate at a minimum whether or not the required threshold number of criteria is met to make a Section II PD diagnosis.…”

“…Furthermore, a maladaptively high level of Agreeableness (low Antagonism) may suggest that the patient is actually trying to please the therapist by appearing as if he is actually improving. 8 In other words, sometimes the patient's actual strength is an aspect of an otherwise maladaptive trait, and his weakness is an aspect of an otherwise adaptive trait (Table 7). Thus, it seems possible to have "too much of a good thing" and that almost any trait or characteristic can be adaptive or maladaptive at certain levels.…”

“…49,50 Neverthe less, ease of use should certainly be considered when developing an instrument for clinicians. 8 The number of levels, areas, and facets in the alternative PD model may seem complex and overwhelming to many clinicians. It has previously been stated that complexity seriously threatens user acceptability, and thus also clinical utility.…”

Approach, avoidance, and their conflict: the problem of anchoring

“…Each system is stable, with links to mental disorder (Strelau and Zawadzki, 2011; Gomez et al, 2012; Mullins-Sweatt and Lengel, 2012; Trull, 2012) and brain structure (Gardini et al, 2009; DeYoung et al, 2010). But even when starting with approach and avoidance as primary constructs, they are derived “top-down” from pools of lexically-chosen questionnaire items (Carver and White, 1994; Elliot and Thrash, 2010) not from biological anchors.…”