Psychodynamic underpinnings of the DSM–5 Alternative Model for Personality Disorder.

Abstract

There has been much research in recent years on the Alternative Model for Personality Disorders (AMPD) in the most recent edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5; American Psychiatric Association, 2013). Although this research has by and large validated the model from a psychometric perspective, it has sometimes been criticized by psychodynamically oriented researchers and clinicians for its (lack of) clinical utility and its disregard for the rich history and tradition of psychodynamic thought that formed the foundation for personality disorder research in the first place. These critiques have merit. However, there is much in DSM-5 AMPD that is not only consistent with the broad corpus of the psychodynamic tradition, but which may be useful to consider in psychodynamic research and clinical practice. In this article we review prominent (psychodynamic) critiques of the AMPD, consider the AMPD as a product of (and, thus, its dependency on) psychodynamic thought, and suggest how psychodynamically oriented researchers and clinicians might use the AMPD in their work in service of benefiting both the AMPD and psychodynamic thought more generally.

Deconstructing criterion a of the alternative model for personality disorders.

“…Personality theory is not monolithic and personality assessment benefits from multiple paradigmatic perspectives (Hopwood & Waugh, 2019;Wiggins, 2003). To varying extents, the AMPD blends psychodynamic, interpersonal, narrative, multivariate-trait, and empirical perspectives (Mulay et al, 2018;Yalch, 2019). Each lens brings points of utility in the clinical setting-both across patients and when working with an individual This document is copyrighted by the American Psychological Association or one of its allied publishers.…”

Social Cognition and Object Relations Scale as level of personality functioning.

“…We contend that LPF contains personality-specific construct variance within a larger (highly correlated) general individual difference dimension of psychometric severity, in contrast to more typical interpretations from a purely psychometric trait perspective (see Oltmanns et al, 2018). This idea does not minimize the relevance of the trait perspective in understanding personality functioning or psychodynamic conceptualization (see Yalch, 2020), but broadens and enriches appreciation for nuance within LPF. In other words, we suggest the complexity of personality requires the use of constructs at different levels of abstraction and multiple modes of assessment [see Waugh (2019a, 2019b), for an extended discussion of these ideas].…”

Transference-focused psychotherapy.

“…Several authors stress that Otto Kernberg's conceptualization of personality organization, with its focus on linking self and other representations to selfand interpersonal functioning and the overall severity of personality pathology not only predated the AMPD but was influential in its architecture (Bender et al, 2011;Clarkin et al, 2020;Natoli, 2021;Waugh et al, 2017;Yalch, 2020). Bender et al (2011) noted that Kernberg's object relations model, the concept of personality organization that is the basis for the TFP model, was one of the first to articulate a model of personality types arrayed along a continuum of severity.…”