The Classification of Personality Disorder: II. The Problem of Diagnostic Criteria

Abstract

Although operational definitions have led to improved reliability of psychiatric diagnoses generally, this is not the case for personality disorders. It is suggested that this is due to a failure to develop definitions composed of criteria that can be reliably identified. Instead, extensive use is made of traits and other dispositions as criteria for assessing these conditions despite an extensive literature indicating that trait judgements are unreliable. The reasons for the low reliability of trait judgements are discussed, and the use of behavioral criteria is advocated as one way to increase diagnostic reliability. The results of a preliminary investigation show that the reliabilities of clinicians’ judgements of the behaviors associated with Schizoid, Histrionic, and Compulsive Personality Disorders are comparable to the reliabilities of their judgements of the traits associated with these conditions. These results support the feasibility of developing behavioral criteria for assessing personality.

Determinants of Diagnostic Prototypicality Judgments of the Personality Disorders

“…If diagnoses were determined based only on the presence of certain category features, no dominance effect would have occurred. Our results support Livesley's (1985aLivesley's ( , 1985b assertion that a negative correlation exists between the number of competing features presented and measures of diagnostic prototypicality. Moreover, the strong dominance effect raises questions about the clinical lore that the more assessment information clinicians gather, the more attuned they necessarily are to the most important pathognomonic features of their patients' psychopathology.…”

An Empirical Evaluation of the Structure ofDSM-IVPersonality Disorders in a Nationally Representative Sample: Results of Confirmatory Factor Analysis in the National Epidemiologic Survey on Alcohol and Related Conditions Waves 1 and 2

“…Livesley, in a series of articles (Livesley, 1985a(Livesley, , 1985b(Livesley, , 1998Livesley, Jackson, & Schroeder, 1991), has described several limitations to the current classification system used in the DSM, specifically the lack of a theoretical rationale and that comorbidity among the personality disorders is quite common (see also Fossati et al, 2000).…”

Diagnostic validity of antisocial personality disorder: A prototypical analysis.

“…They found a moderate degree of convergence (70% hit rate; kappas were not reported) between the two methods. Livesley (1985aLivesley ( , 1985bLivesley ( , 1986 has championed the use of prototypical analysis as an alternative approach to the validation of personality disorders. Prototype theory, based largely on the work of Rosch (1973Rosch ( , 1978, seeks to construct categories (e.g., diagnoses) through ratings of most representative or central characteristics.…”