The Classification of Personality Disorders: Critical Review and Need for Rethinking

Jablensky, Assen

doi:10.1159/000065129

Cited by 14 publications

(8 citation statements)

References 22 publications

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“…The diagnostic criteria for NPD have been changing and developing since NPD was officially listed in the DSM-III in 1980. At the same time, the debate over the validity and reliability of NPD has never stopped [6, 18]. Because of these controversies, NPD has rarely been used in clinical practice of psychiatry in China, and therefore the frequency of NPD in the Chinese clinical population is largely unknown.…”

Section: Discussionmentioning

confidence: 99%

Frequency of narcissistic personality disorder in a counseling center population in China

Jiang

Wang

Sun³

et al. 2019

BMC Psychiatry

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Background Narcissistic personality disorder (NPD) has never been applied in Chinese clinical practice, and the distribution of NPD in the clinical population of China is largely unknown. The current study uses two-stage clinic-based screening to investigate the frequency and clinical features of NPD in a Chinese help-seeking sample. Methods A total of 1402 consecutive outpatients ages 18–60 were recruited during their visit to the Shanghai Mental Health Center and screened with the Personality Diagnostic Questionnaire Fourth Edition Plus (PDQ-4+) and Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) Axis II (SCID-II). The structured clinical interview was administered to estimate the rate of NPD and the frequency of each disorder criterion. Results The frequency estimate of NPD in the total sample was 4.0%. Among the 56 outpatients who met the criteria for NPD, there were more males than females, and many had a better educational background. The SCID-II interviews revealed high frequencies of diagnostic criterion 1 ("exaggerated sense of self-importance. NPD likely overlaps with Histrionic PD, Borderline PD, and Paranoid PD. This two stage screening method can enhance detection of Chinese NPD patients in clinical settings. Conclusions Narcissism pathology is not rare in the Chinese psychiatric community when using the DSM-IV NPD criteria. Existing evidence suggests, at least indirectly, that there are important benefits of NPD diagnosis in psychiatric practice.

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Section: Discussionmentioning

confidence: 99%

Frequency of narcissistic personality disorder in a counseling center population in China

Jiang

Wang

Sun³

et al. 2019

BMC Psychiatry

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“…However, conceptual difficulties and controversies have persisted (Clark et al 1997, Livesley 2003, Widiger & Samuel 2005, there is widespread dissatisfaction in the field, and articles critiquing the domain are common ( Jablensky 2002, Livesley 2003, Millon 2002. declared, "Official diagnoses are substantially arbitrary, often unreliable, overlapping, and incomplete and have only a limited utility for treatment planning" (p. 435), and Tyrer et al (2006) stated bluntly, "The assessment of personality disorder is currently inaccurate, largely unreliable, frequently wrong, and in need of improvement.…”

Section: Personality Disorder (Pd) Is Defined In the Diagnostic And Smentioning

confidence: 99%

Assessment and Diagnosis of Personality Disorder: Perennial Issues and an Emerging Reconceptualization

Clark

2007

Annu. Rev. Psychol.

696

718

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This chapter reviews recent (2000)(2001)(2002)(2003)(2004)(2005) personality disorder (PD) research, focusing on three major domains: assessment, comorbidity, and stability. (a) Substantial evidence has accrued favoring dimensional over categorical conceptualization of PD, and the five-factor model of personality is prominent as an integrating framework. Future directions include assessing dysfunction separately from traits and learning to utilize collateral information. (b) To address the pervasiveness and extent of comorbidity, researchers have begun to move beyond studying overlapping pairs or small sets of disorders and are developing broader, more integrated common-factor models that cross the Axis I-Axis II boundary. (c) Studies of PD stability have converged on the finding that PD features include both more acute, dysfunctional behaviors that resolve in relatively short periods, and maladaptive temperamental traits that are relatively more stable-similar to normal-range personality traits-with increasing stability until after 50 years of age. A new model for assessing PDand perhaps all psychopathology-emerges from integrating these interrelated reconceptualizations.

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“…In this instance, EPCACE is no different from other mental disorders, in that some symptoms are not exclusive to 1 disorder only. The blurring of boundaries between categories is no different from the difficulties that are faced in attempts to derive a typology of the conventional personality disorders in general [45,51,52] . Criterion E underscores the importance of understanding thoroughly the aetiology and course of enduring personality change after a catastrophic event before a diagnosis of EPCACE is made.…”

Section: Criterion Ementioning

confidence: 95%

“…One of the flaws identified in the current classification of personality disorders is the lack of consideration of personality strengths [45] . Despite the focus on negative personality changes, evidence of positive changes related to coping and resilience has been identified among survivors of trauma [46,47] .…”

Section: Criterion C -Interference With Personal Functioningmentioning

confidence: 99%

Comparison of ICD-10 Diagnostic Guidelines and Research Criteria for Enduring Personality Change after Catastrophic Experience

2009

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Enduring personality change after catastrophic experience (EPCACE) is a diagnostic category included in the International Statistical Classification of Diseases and Related Health Problems, 10th revision (ICD-10), as one of the adult personality disorders. Preliminary investigation suggests there is considerable endorsement in principle for this new category amongst experts in the field of intentional human trauma, yet many aspects of the diagnosis remain contentious. EPCACE is described in 2 sets of ICD-10 criteria: the Diagnostic Criteria for Research (DCR) and the Clinical Description and Diagnostic Guidelines (CDDG). Studies have found that the use of the DCR and CDDG for some disorders has created issues related to lack of compatibility and agreement between these 2 versions. This article examines the similarities and differences between the DCR and CDDG for EPCACE. Using background literature to inform our analysis, this article highlights issues related to the stressor criterion, symptom criteria, impairment criterion, criterion related to exclusion of personal vulnerability and early psychiatric history, symptom duration and relationship of post-traumatic-stress disorder with EPCACE. The similarities and differences between the research criteria and diagnostic guidelines of EPCACE are consistent with concerns already identified in the literature for other disorders. This presents a challenge to the way in which diagnostic criteria are conceptualized and stated.

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The Classification of Personality Disorders: Critical Review and Need for Rethinking

Cited by 14 publications

References 22 publications

Frequency of narcissistic personality disorder in a counseling center population in China

Frequency of narcissistic personality disorder in a counseling center population in China

Assessment and Diagnosis of Personality Disorder: Perennial Issues and an Emerging Reconceptualization

Comparison of ICD-10 Diagnostic Guidelines and Research Criteria for Enduring Personality Change after Catastrophic Experience

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