Annual Review of Clinical Psychology Personality Disorders: Current Conceptualizations and Challenges

Annual Review of Clinical Psychology Personality Disorders: Current Conceptualizations and Challenges Abstract

The personality disorders are said to be at the vanguard in the shift to a dimensional model of classification, as exemplified in the Alternative Model of Personality presented in Section three of the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders for emerging models and in the eleventh edition of the International Classification of Diseases. Considered herein are some limitations and challenges. For the DSM-five Alternative Model of Personality Disorders trait model, these include problematic placements, inadequate coverage, perceived complexity, and lack of cutoff points. For the DSM-five Alternative Model of Personality Disorders Level of Personality Functioning, they include the complexity, the questionable presumption that the Level of Personality Functioning defines the core of personality disorder, the presumption that the Level of Personality Functioning identifies what is unique to the personality disorders, and the premise that the Level of Personality Functioning is distinct from the maladaptive traits. Limitations and challenges of the ICD-eleven model are the absence of lower-order facet scales and the fact that only the level of severity is required. This review suggests that the trait of depressivity belongs with negative affectivity and suspicion belongs within antagonism, that maladaptive traits from all ten poles of the five domains should be provided, and that cutoff points based on social-occupational impairment and/or distress should be provided. The review summarizes research that questions whether the Level of Personality Functioning represents the core of personality disorder, identifies what is unique to the personality disorders, and is distinct from maladaptive traits. Finally, the review suggests that the ICD-eleven should require the assessment of the traits and include facet scales.

INTRODUCTION

The purpose of this article is to discuss the current conceptualizations and challenges facing the diagnosis of personality disorder. Personality disorders are said to be at the vanguard of the shift to a dimensional model of classification. Considered herein are the Alternative Model of Personality Disorders included within Section three of the fifth edition of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders and the personality disorder section within the eleventh edition of the World Health Organization's International Classification of Diseases. The field is indeed shifting toward a dimensional rather than categorical model of personality disorder, although valid concerns remain concerning the proposed dimensional models.