Suggestions for a Framework for an Empirically Based Classification of Personality Disorder

Abstract

A preliminary list of 16 basic dispositional traits is proposed to describe the more specific components of personality disorder based, in part, on the convergence of evidence across studies: anxiousness, affective lability, callousness, cognitive dysregulation, compulsivity, conduct problems, insecure attachment, intimacy avoidance, narcissism, oppositionality, rejection, restricted expression, social avoidance, stimulus seeking, submissiveness, and suspiciousness. Three higher-order patterns were proposed: emotional dysregulation, dissocial behaviour, and inhibitedness, which may occur independently or in combination.

Personality Assessment in DSM-5: Empirical Support for Rating Severity, Style, and Traits

“…The closest the DSM-IV comes to a severity dimension is its definition of criteria for general PD involving (a) manifestation in two domains of functioning among cognition, affect, interpersonal behavior, or impulse control; (b) enduring inflexibility; (c) clinically significant distress or impairment; (d) stability, with onset in adolescence or childhood; and diagnostic primacy relative to (e) other psychiatric or (f) medical conditions. This model of PD severity has been described as too vague to operationalize effectively (Livesley, 1998), and it does not provide a theoretically justified quantification of severity. As it is also inefficient, researchers have argued for more parsimonious PD severity dimensions (Bornstein, 1998;Kernberg, 1984;Livesley, 1998;Morey, 2005;Parker, Hadzi-Pavlovic, Both, Kumar, Wilhelm, & Olley, 2004;Rutter, 1987).…”

“…This model of PD severity has been described as too vague to operationalize effectively (Livesley, 1998), and it does not provide a theoretically justified quantification of severity. As it is also inefficient, researchers have argued for more parsimonious PD severity dimensions (Bornstein, 1998;Kernberg, 1984;Livesley, 1998;Morey, 2005;Parker, Hadzi-Pavlovic, Both, Kumar, Wilhelm, & Olley, 2004;Rutter, 1987). Finally, despite this general definition, severity and style remain confounded in the PD constructs of the DSM-IV (Parker, 1997).…”

“…While they could all be translated into a single, global rating of overall severity, the content that each model emphasizes varies. Livesley (1998) views severity as involving deficits in achieving a stable self-system, close relationships, and social obligations. Widiger and Trull (2007) see severity in a manner less specifically linked to personality.…”

“…Livesley (1998) suggested generally defining PD as present when "the structure of personality prevents the person from achieving adaptive solutions to the universal life tasks of establishing a self-system, attachment and intimacy, and cooperativeness and prosocial behavior" (p. 141). In his model, PD would be coded, like other mental disorders, on the DSM Axis I. Livesley separates PD diagnosis from the assessment of personality traits, which would be coded on Axis II.…”

What’s in a name? Borderline personality disorder in adolescence

“…This reflects a growing recognition of the questionable diagnostic validity of personality disorders as distinct categorical entities. In adults, supposedly distinct personality disorders are often highly comorbid, and factor analyses of personality disorder traits yield inconsistent results, with factor structures that do not resemble the distinct disorders outlined in DSM-5 [4,9,11,13,15]. The factor analytic structure of personality disorder traits in adolescents has been less well studied, with mixed findings.…”