Sociocultural context and the DSM–5 alternative model of personality disorder: Comment on Widiger and Hines (2022).

Abstract

Widiger and Hines (2022) provide a brief overview of the development of the alternative model of personality disorder (AMPD) housed within Section 3 of the Fifth Edition of the Diagnostic and Statistical Manual of Mental Disorders (American Psychiatric Association, 2013). They highlight 8 issues and controversies related to the AMPD in need of resolution for improvement of both the AMPD model itself as well as the field of personality disorders more broadly. In this brief commentary, I add a 9th issue in need of attention both with respect to the AMPD but also within the field of personality disorders more broadly: (9) How is sociocultural context to be accommodated in AMPD-and more generally personality disorder-theory, research, and treatment? The historical intraindividual, deficit-based models for conceptualizing personality disorders linger in current personality disorder discourse. However, failure to appropriately consider sociocultural context that systematically predisposes wide swaths of the population to unequal access to resources and exposure to psychological stressors, which can impact the appearance of personality pathology, serves to stigmatize minoritized individuals. The personality disorder field, and the AMPD discourse, must appropriately contend with sociocultural context in its models otherwise it risks developing models with limited generalizability and that hold potential to adversely affect sexual and gender minoritized populations, among others.

Ten-year retrospective on the DSM–5 alternative model of personality disorder: Seeing the forest for the trees.

“…They call for the demonstration of the AMPD’s superiority over the DSM–IV /Section II categories, proof of the usefulness of Criterion A, proof of the usefulness of retaining the six traditional PD categorical constructs in step three of the diagnostic process of the AMPD (e.g., borderline; schizotypal), refinement of Criterion B coverage, harmonization of the AMPD with International Classification of Diseases, 11th Revision ( ICD-11 ), and the development of treatment protocols explicitly developed for the AMPD. In his commentary, Rodriguez-Seijas (2022) added another important question for consideration, namely, the explicit accommodation of sociocultural context in AMPD. He points out that personality disorder theory and research continue to operate in a manner that is decontextualized from the broader social, structural environment in which individuals exist.…”

Personality disorders research and social decontextualization: What it means to be a minoritized human.

“…The Diagnostic and Statistical Manual of Mental Disorders ( DSM ) conceptualization has evolved over time from one that explicitly centers disorder within the individual, to an arguably atheoretical conceptualization of personality disorders. As noted in Rodriguez-Seijas (2022), DSM-I explicitly frames personality pathology as constitutional defect. Personality disorders are “characterized by developmental defects or pathological trends in personality structure” (American Psychiatric Association, 1952, p. 34).…”

Video-based Interpersonal Behavioral Evaluation (VIBE): A novel method for the assessment of interpersonal judgment.

“…For instance, an individual who experiences harsh or inconsistent parenting from childhood caregivers may not develop the same capacity for interpersonal trust and intimacy as others raised in consistent, nurturing environments (e.g., Jeung & Herpertz, 2014). Interpersonal dysfunction may also manifest as a function of structural inequality, such as the chronic stress experienced by individuals of minoritized sexual, gender, or racial/ethnic identities (Rodriguez-Seijas, 2022). Such deviations in interpersonal behavior are common across a variety of psychiatric disorders (Girard et al, 2017; Horowitz, 2004) and can develop and manifest in different ways.…”