The Brave New World of Personality Disorder-Trait Specified: Effects of Additional Definitions on Coverage, Prevalence, and Comorbidity

Abstract

The alternative dimensional model for personality disorder (PD) in DSM-5, Section III (DSM-5-III) includes two main criteria: (A) personality-functioning impairment, and (B) personality-trait pathology; provides specific functioning-and-trait criteria for six PD-type diagnoses; and introduces PD-trait specified (PD-TS), which requires meeting the general PD criteria and not meeting criteria for any specific PD type. We termed this Simple PD-TS and developed two additional definitions: Mixed PD-TS, meeting criteria for one or two PD types and having five or more additional pathological traits; and Complex PD-TS, meeting criteria for three or more PD types. In a mixed sample of 165 outpatients and 215 community adults screened to be at high-risk for PD, we investigated the effect of these additional definitions on prevalence, coverage, comorbidity, and within-diagnosis heterogeneity, and conclude that eliminating the PD-type diagnoses and thus having PD-TS as the only PD diagnosis would be both more parsimonious and more useful clinically.

A Brief but Comprehensive Review of Research on the Alternative DSM-5 Model for Personality Disorders

“…Currently, there is only a single study showing that the LPFS-BF can be used as an outcome measure in a 3month residential treatment program [31]. Fifth, one study has questioned the necessity of utilizing the complex hybrid model of the AMPD for diagnosing PDs, since applying the diagnosis of PD-TS (i.e., meeting the general PD criteria but not the criteria of not any specific type) provides full coverage of all personality pathology [311]. More research is needed into the validity of the specific PDs listed in the AMPD, incorporating the specific impairment criteria [88••] and using mixture modeling to test whether they indeed represent latent categories [312].…”

Personality profiles as potential targets for intervention: Identification and replication

“…Detailed demographic information is provided by Clark et al, so we summarize those data here. Mean age was 48.0 years (SD = 12.5; range = 18–84); most (59%) participants were female; 28% were racial/ethnic minorities, of which most (71%) were Black/African‐American; 34% were employed and 28% on disability; 50% of the sample had an annual family income <$20, 000 and only 22% over $50, 000; and 40% were married or living with a partner and 28% single‐never married.…”

Three Approaches to Understanding and Classifying Mental Disorder:ICD-11, DSM-5, and the National Institute of Mental Health’s Research Domain Criteria (RDoC)

“…Comorbid PD diagnoses could be avoided entirely by expanding the definition of PD-trait specified (L. A. Clark et al, 2015), but the DSM-5 Task Force felt that specific PD configurations would help clinicians transition from traditional categories to a more fully dimensional system in the future. As noted earlier, the APA Board of Trustees went even further and rejected the AMPD for placement in DSM-5's main Section II, placing it instead in Section III, "Emerging Models and Measures.…”