Plate tectonics in the classification of personality disorder: Shifting to a dimensional model.

Abstract

The diagnostic categories of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders were developed in the spirit of a traditional medical model that considers mental disorders to be qualitatively distinct conditions (see, e.g., American Psychiatric Association, 2000). Work is now beginning on the fifth edition of this influential diagnostic manual. It is perhaps time to consider a fundamental shift in how psychopathology is conceptualized and diagnosed. More specifically, it may be time to consider a shift to a dimensional classification of personality disorder that would help address the failures of the existing diagnostic categories as well as contribute to an integration of the psychiatric diagnostic manual with psychology's research on general personality structure.

Predictive validity of the five‐factor model prototype scores for antisocial and borderline personality disorders

“…More generally, these fi ndings are consistent with the position adopted by many researchers that personality disorders can be conceptualized as extreme variants of normal personality traits (e.g. Trull & McCrae, 2002;Widiger, 1993;Widiger & Trull, 2007). Adopting a dimensional perspective on personality pathology remedies many of the problems that exist with the current categorical nosology.…”

“…Adopting a dimensional perspective on personality pathology remedies many of the problems that exist with the current categorical nosology. These problems include (1) extreme rates of co-morbidity that question the validity of diagnostic constructs, (2) inadequate coverage of pathology that leads to a high rate of 'not otherwise specifi ed' (NOS) diagnoses, (3) arbitrary distinctions between normal and disordered functioning yielding sub-threshold cases, (4) heterogeneity of clinical presentations within the same diagnosis and (5) lack of scientifi c basis for the disorder (Widiger & Trull, 2007). Researchers and clinicians can use normal personality theory to shed light on the relations between personality disorder and behaviours that are related and frequently co-occur with these constructs.…”

“…Costa & McCrae, 1994;Krueger, 2002;Livesley, 2003;Westen & Shedler, 2000;Widiger & Simonsen, 2005). Advocates of dimensional models of personality pathology take the position that major personality traits underlie the personality disorder diagnoses, and that personality traits are better suited to defi ne and characterize personality pathology (Widiger & Trull, 2007).…”

Long-Term Outcomes in Borderline Psychopathology: Old Assumptions, Current Findings, and New Directions

“…Even assessment of the DSM-IV BPD measured dimensionally indicates greater stability than threshold criteria for a diagnosis [43]. Personality traits that undergird personality disorders are also more stable than DSM-IV diagnoses, and there has been an effort to incorporate dimensional trait assessments into the DSM-5 [44]. Interestingly, CLPS has reported that changes in lower-level personality traits precede changes in higher-level personality disorder symptoms, but not the reverse [45].…”

“…Among others [46], Widiger and Trull [44] have argued that personality disorders are best captured in dimensional terms, and suggested that the diagnostic system be revised accordingly. Although the final version of the BPD diagnosis has not yet been determined for DSM-5, it does appear that both trait ratings and functioning ratings will be integrated into the BPD diagnosis.…”