Hostname: page-component-cd9895bd7-7cvxr Total loading time: 0 Render date: 2024-12-23T02:07:29.001Z Has data issue: false hasContentIssue false
  • English
  • Français

Personality disorder in DSM-5: an oral history

Published online by Cambridge University Press:  20 October 2015

P. Zachar ,
R. F. Krueger  and
K. S. Kendler
P. Zachar
Affiliation:
Department of Psychology, Auburn University Montgomery, Montgomery, AL, USA
R. F. Krueger
Affiliation:
Department of Psychology, University of Minnesota, Minneapolis, MN, USA
K. S. Kendler*
Affiliation:
Department of Psychiatry and Department of Human and Molecular Genetics, Virginia Institute of Psychiatric and Behavioral Genetics, Virginia Commonwealth University School of Medicine, Richmond, VA, USA
*
*Address for correspondence: K. Kendler, MD, Department of Psychiatry and Department of Human and Molecular Genetics, Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University Medical School, Box 980126, 800 E. Leigh Street, Room 1-123, Richmond, VA 23298-0126, USA. (Email: [email protected])
Get access Rights & Permissions [Opens in a new window]

Abstract

As the revision process leading to DSM-5 began, the domain of personality disorder embodied the highest aspirations for major change. After an initial prototype-based proposal failed to gain acceptance, the Personality and Personality Disorders Work Group (P&PDWG) developed a hybrid model containing categorical and dimensional components. A clash of perspectives both within the P&PDWG and between the P&PDWG and DSM-5 oversight committees led to the rejection of this proposal from the main body of DSM-5. Major issues included conflicting ways of conceptualizing validation, differences of opinion from personality disorder experts outside the P&PDWG, divergent concepts of the magnitude of evidence needed to support substantial changes, and the disagreements about clinical utility of the hybrid model. Despite these setbacks, the ‘Alternative DSM-5 Model of Personality Disorder’ is presented in Section III of the DSM-5. Further research should clarify its performance relative to the DSM-IV criteria reprinted in the main DSM-5 text.

Keywords

DSM-5historypersonality disorder
Type
Review Article
Information
Psychological Medicine , Volume 46 , Issue 1 , January 2016 , pp. 1 - 10
Copyright
Copyright © Cambridge University Press 2015 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Alarcón, RD, Sarabia, S (2012). Debates on the narcissism conundrum: trait, domain, dimension, type, or disorder? Journal of Nervous and Mental Disease 200, 16–25.CrossRefGoogle ScholarPubMed
APA (1994). Diagnostic and Statistical Manual of Mental Disorders, 4th edn. Washington, DC: American Psychiatric Association.Google Scholar
Blashfield, RK, Reynolds, SM (2012). An invisible college view of the DSM-5 personality disorder classification. Journal of Personality Disorders 26, 821–829.CrossRefGoogle ScholarPubMed
Campbell, WK, Miller, JD (eds) (2011). The Handbook of Narcissism and Narcissistic Personality Disorder. The Guilford Press: New York.CrossRefGoogle Scholar
Clark, LA (2007). Assessment and diagnosis of personality disorder: perennial issues and an emerging reconceptualization. Annual Review of Psychology 58, 227–257.Google Scholar
Costa, PT Jr., McCrae, RR (1990). Personality disorders and the five-factor model of personality. Journal of Personality Disorders 4, 362–371.CrossRefGoogle Scholar
Costa, PT Jr., McCrae, RR (1992). Revised NEO Personality Inventory (NEO-PI-R) and NEO Five Factor Inventory (NEO-FFI) . Psychological Assessment Resources, Inc.: Odessa, FL.Google Scholar
Cuthbert, B, Insel, T (2010). The data of diagnosis: new approaches to psychiatric classification. Psychiatry 73, 311–314.Google Scholar
Eaton, NR, Krueger, RF, South, SC, Simms, LJ, Clark, LA (2011). Contrasting prototypes and dimensions in the classification of personality pathology: evidence that dimensions, but not prototypes, are robust. Psychological Medicine 41, 1151–1163.CrossRefGoogle Scholar
Eysenck, SG, White, O, Eysenck, HJ (1976). Personality and mental illness. Psychological Reports 39, 1011–1022.CrossRefGoogle ScholarPubMed
Frances, A (1982). Categorical and dimensional systems of personality diagnosis: a comparison. Comprehensive Psychiatry 23, 516–527.CrossRefGoogle ScholarPubMed
Frances, A (2009). A warning sign on the road to DSM-V: beware of its unintended consequences (http://www.psychiatrictimes.com/display/article/10168/1425378). Psychiatric Times 26(8).Google Scholar
Frances, A (2011). Two who resigned from DSM-5 explain why. (http://www.psychologytoday.com/blog/dsm5-in-distress/201207/two-who-resigned-dsm-5-explain-why). Psychology Today, 11 July 2011.Google Scholar
Gunderson, JG (2013). Seeking clarity for future revisions of the personality disorders in DSM-5. Personality Disorders: Theory, Research, and Treatment 4, 368–376.CrossRefGoogle ScholarPubMed
Harkness, AR, McNulty, JL, Ben-Porath, YS (1995). The personality psychopathology five (PSY-5): constructs and MMPI-2 scales. Psychological Assessment 7, 104–114.CrossRefGoogle Scholar
Helzer, JE, Kraemer, HC, Krueger, RF, Wittchen, H-U, Sirovatka, PJ, Regier, DA (2008). Dimensional Approaches in Diagnostic Classification: Refining the Research Agenda for DSM-V. American Psychiatric Association: Arlington, VA, USA.Google Scholar
Hull, DL (1988). Science as a Process: An Evolutionary Account of the Social and Conceptual Development of Science. University of Chicago Press: Chicago.Google Scholar
Insel, T, Cuthbert, B, Garvey, MA, Heinssen, RK, Pine, DS, Quinn, KJ, Sanislow, CA, Wang, PS-E (2010). Research Domain Criteria (RDoC): toward a new classification framework for research on mental disorders. American Journal of Psychiatry 167, 748–751.Google Scholar
Kendler, KS (2013). A history of the DSM-5 scientific review committee. Psychological Medicine 43, 1793–1800.Google Scholar
Kendler, KS, Kupfer, DJ, Narrow, W, Phillips, KA, Fawcett, J (2009). Guidelines for making changes to DSM-5 revised 10/21/09.Google Scholar
Krueger, RF, Skodol, AE, Livesley, WJ, Shrout, PH, Huang, Y (2008). Synthesizing dimensional and categorical approaches to personality disorders. In Dimensional Approaches in Diagnostic Classification: Refining the Research Agenda for DSM-V (ed. Helzer, J. E., Kraemer, H. C., Krueger, R. F., Wittchen, H.-U., Sirovatka, P. J. and Regier, D. A.), pp. 85–99. American Psychiatric Association: Arlington, VA, USA.Google Scholar
Kupfer, DJ, First, MB, Regier, DA (2002). A Research Agenda for DSM-V. American Psychiatric Association: Washington, DC.Google Scholar
Livesley, WJ (2006). The Dimensional Assessment of Personality Pathology (DAPP) approach to personality disorder. In Differentiating Normal and Abnormal Personality, 2nd edn (ed. Strack, S.), pp. 401–429. Springer Publishing Co: New York, NY, USA.Google Scholar
Livesley, WJ (2012). Tradition versus empiricism in the current DSM-5 proposal for revising the classification of personality disorders. Criminal Behavior and Mental Health 22, 81–91.Google Scholar
Livesley, WJ, Jackson, DN (2009). Dimensional Assessment of Personality Pathology – Basic Questionnaire. Sigma Assessment Systems, Inc: Port Huron, MI.Google Scholar
Livesley, WJ, West, M, Tanney, A (1985). Historical comment on DSM-III schizoid and avoidant personality disorders. American Journal of Psychiatry 142, 1344–1347.Google Scholar
Maples, J, Carter, N, Few, LR, Crego, C, Gore, WL, Samuel, DB, Williamson, RL, Lynam, DR, Widiger, TA, Markon, KE, Krueger, RF, Miller, JD (2015). Testing wheter the DSM-5 personality disorder trait model can be measured with a reduced set of items: an item response theory investigation of the Personality Inventory for DSM-5. Psychological Assessment, 6 April 2015. doi: 10.1037/pas0000120.Google Scholar
Morey, LC, Skodol, AE, Oldham, JM (2014). Clinician judgments of clinical utility: a comparison on DSM-IV-TR personality disorders and the alternative model for DSM-5 personality disorders. Journal of Abnormal Psychology 123, 398–405.Google Scholar
Morey, LC, Waugh, MH, Blashfield, RK (1985). MMPI scales for DSM-III personality disorders: their derivation and correlates. Journal of Personality Assessment 49, 245–251.Google Scholar
Regeir, DA, Narrow, WE, Kuhl, EA, Kupfer, DJ (2009). The conceptual development of DSM-V. American Journal of Psychiatry 166, 645–650.Google Scholar
Robins, E, Guze, SB (1970). Establishment of diagnostic validity in psychiatric illness: its application to schizophrenia. American Journal of Psychiatry 126, 983–986.Google Scholar
Ronningstam, E (2011). Narcissistic personality disorder in DSM V – in support of retaining a significant diagnosis. Journal of Personality Disorders 25, 248–259.Google Scholar
Shedler, J, Beck, A, Fonagy, P, Gabbard, GO, Gunderson, J, Kernberg, O, Michels, R, Westen, D (2010). Personality disorders in DSM-5. American Journal of Psychiatry 167, 1026–1028.Google Scholar
Skodol, AE, Clark, LA, Bender, DS, Krueger, RF, Morey, LC, Verheul, R, Alacron, RD, Bell, CC, Siever, LJ, Oldham, JM (2011). Proposed changes in personality and personality disorder assessment and diagnosis for DSM-5 part I: description and rationale. Personality disorders: Theory, Research, and Treatment 2, 4–22.CrossRefGoogle ScholarPubMed
Spitzer, RL (2008). DSM-V: Open and transparent? In Psychiatric News, p. 26. Psychiatric News.Google Scholar
Spitzer, RL (2009). DSM-V transparency: fact or rhetoric? In Psychiatric Times, p. 26. Psychiatric Times.Google Scholar
Tyrer, P (2014). Time to choose – DSM-5, ICD-11 or both? Archives of Psychiatry and Psychotherapy 16, 5–8.Google Scholar
Tyrer, P, Alexander, J (1979). Classification of personality disorder. British Journal of Psychiatry 135, 163–167.Google Scholar
Tyrer, P, Crawford, M, Mulder, R, Blashfield, R, Farnam, A, Fossati, A, Kim, Y-R, Koldobsky, N, Lecic-Tosevski, D, Ndetei, D, Swales, M, Clark, LA, Reed, GM (2011). The rationale for the reclassification of personality disorder in the 11th revision of the International Classification of Diseases (ICD-11). Personality & Mental Health 5, 246–259.Google Scholar
Tyrer, P, Reed, GM, Crawford, MJ (2015). Classification, assessment, prevalence, and effect of personality disorder. Lancet 385, 717–726.CrossRefGoogle ScholarPubMed
Verheul, R (2012). Personality disorder proposal for DSM-5: a heroic and innovative but nevertheless fundamentally flawed attempt to improve DSM-IV. Clinical Psychology & Psychotherapy 19, 369–371.CrossRefGoogle ScholarPubMed
Walton, HJ, Presly, AS (1973). Use of a category system in the diagnosis of abnormal personality. British Journal of Psychiatry 122, 259–268.CrossRefGoogle ScholarPubMed
Westen, D, Shedler, J, Bradley, R (2006). A prototype approach to personality disorder diagnosis. American Journal of Psychiatry 163, 846–856.Google Scholar
Widiger, TA, Frances, A (1985). The DSM-III personality disorders: perspectives from psychology. Archives of General Psychiatry 42, 615–623.Google Scholar
Widiger, TA, Simonsen, E, Sirovatka, PJ, Reiger, DA (eds) (2007). Dimensional Models of Personality Disorder. American Psychiatric Press: Washington, DC.Google Scholar
Widiger, TA, Trull, TJ (2007). Plate tectonics in the classification of personality disorder: shifting to a dimensional model. American Psychologist 62, 71–83.CrossRefGoogle ScholarPubMed
Wing, JK (1976). Classification of psychiatric disorders: I. Psychiatric Annals 6, 7–80.CrossRefGoogle Scholar
Yager, J, McIntyre, JS (2014). DSM-5 Clinical and Public Health Committee: challenges and considerations. American Journal of Psychiatry 171, 142–144.CrossRefGoogle Scholar
Zachar, P, First, MB (2015). Transitioning to a dimensional model of personality disorder in DSM 5.1 and beyond. Current Opinion in Psychiatry 28, 66–72.Google Scholar
Zachar, P, Kendler, KS (2012). The removal of Pluto from the class of planets and homosexuality from the class of psychiatric disorders: a comparison. In Philosophy, Ethics, and Humanities in Medicine.CrossRefGoogle Scholar
Supplementary material: File

Zachar supplementary material

Appendix Table 1

Download Zachar supplementary material(File)
File 17.3 KB