The ironic fate of the personality disorders in DSM-5.

Abstract

An alternative model for the diagnosis of personality disorders (PDs), based on assessments of impairments in personality functioning and of pathological personality traits, was intended for the official classification in the Diagnostic and Statistical Manual for Mental Disorders-Fifth Edition (DSM-5), but was instead placed in Section III, "Emerging Measures and Models." This article attempts to describe forces in play during the development of DSM-5 that may have contributed to this outcome, from the perspectives of the Chair of the Personality and Personality Disorders Work Group (PPDWG) and three of its members. These include a failed imperative to shift away from the Diagnostic and Statistical Manual for Mental Disorders-Fourth Edition (DSM-IV) categories toward a dimensional perspective on psychopathology, dynamics within the American Psychiatric Association DSM-5 Task Force and PPDWG and the roles and impact of individuals and groups in the PD community. From these considerations, we present some suggestions for how the field might move forward in the future. A new opportunity exists to use the proposed alternative model as a foundation for research. In the immediate future, with the existence of two different models of PDs in DSM-5, studies can be done comparing the models to each other and to other models with respect to reliability and antecedent, concurrent, and predictive validity. If the Section III model continues to perform as early studies suggest, it may migrate into Section II of a planned DSM-5.1. This valuable research, already underway, will shape future editions of the DSM, by providing data to articulate a clearer vision, with broader representation of reliable and valid models. Going forward, personal investments must be put aside for the benefit of the greater good.

Assessing DSM–5 nonsuicidal self-injury disorder in a clinical sample.

“…In contrast, an ordinal level NSI severity score, created by summing the ABASI items assessing the core symptoms of NSI disorder (i.e., Criteria B and C) into a total score, accounts for additional variance in criterion measures of overall psychopathology, borderline personality traits, and quality of life. The utility of an ordinal scale of NSI severity over a dichotomous diagnosis is consistent with calls for a dimensional approach to diagnosing mental disorders in the DSM (Skodol, Morey, Bender, & Oldham, 2013). Although a dichotomous diag nosis of NSI disorder is associated with a worse clinical presen tation, dimensional indicators of NSI severity are likely to provide more utility for clinical practice and research than reliance on NSI disorder.…”

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

“…Alternative DSM-5 Model for PD The AMPD is considered as an "emerging model" in section III of the DSM-5 [12][13][14]. The key innovation of the AMPD is to define PDs on the basis of impairments in personality functioning (criterion A) and the presence of maladaptive personality traits (criterion B).…”

Introduction to the Special Series on the Personality Functioning Component of the Alternative DSM–5 Model for Personality Disorders

“…In the heady early days of the DSM-5 process, there was much excitement about the prospects for innovation, and the leadership signaled their interest in moving the manual's overall diagnostic approach forward to be in sync with dimensional strategies becoming commonly used elsewhere in medicine. In fact, it was articulated that the PPDWG might lead the way in this regard (Skodol, Morey, Bender, & Oldham, 2013). The ensuing process, both generative and controversial, resulted in the development of the AMPD, published in Section III of the DSM-5.…”