Personality Disorder Types Proposed for DSM-5

University of Arizona College of Medicine and Sunbelt Collaborative, 6340 N. Campbell Ave., Tucson, AZ 85718, USA.
Journal of personality disorders (Impact Factor: 3.08). 04/2011; 25(2):136-69. DOI: 10.1521/pedi.2011.25.2.136
Source: PubMed


The Personality and Personality Disorders Work Group has proposed five specific personality disorder (PD) types for DSM-5, to be rated on a dimension of fit: antisocial/psychopathic, avoidant, borderline, obsessive-compulsive, and schizotypal. Each type is identified by core impairments in personality functioning, pathological personality traits, and common symptomatic behaviors. The other DSM-IV-TR PDs and the large residual category of personality disorder not otherwise specified (PDNOS) will be represented solely by the core impairments combined with specification by individuals' unique sets of personality traits. This proposal has three main features: (1) a reduction in the number of specified types from 10 to 5; (2) description of the types in a narrative format that combines typical deficits in self and interpersonal functioning and particular configurations of traits and behaviors; and (3) a dimensional rating of the degree to which a patient matches each type. An explanation of these modifications in approach to diagnosing PD types and their justifications--including excessive co-morbidity among DSM-IV-TR PDs, limited validity for some existing types, lack of specificity in the definition of PD, instability of current PD criteria sets, and arbitrary diagnostic thresholds--are the subjects of this review.

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    • "Moreover, some specific forms of PD (i.e., paranoid, schizoid, dependent, histrionic, and narcissistic), were diagnostic categories in consideration of being omitted, in part citing reasons due to the insufficient levels of epidemiological and/or evidence describing pathophysiological mechanisms for these disorders, and questionable clinical utility (Skodol et al., 2011). Yet the DSM–5 Task Force and Work Group were unable to achieve consensus regarding the proposed hybrid model of 5 PD types, to be rated dimensionally, and thus 10 specific PD categories were retained from the DSM–IV–TR (Skodol et al., 2011). PD in the general population is common; studies from the United Kingdom of Great Britain (England, Wales, and Scotland), Norway, and Australia indicate the prevalence of any categorical PD range between 4.4% (Coid, Yang, Tyrer, Roberts, & Ullrich, 2006) and 13.4% (Torgersen, Kringlen, & Cramer, 2001). "
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    ABSTRACT: Personality disorder (PD), outcomes of diverse comorbid physical health conditions, and the associated burden on health service resources have seldom been studied at a population level. Consequently, there is limited evidence that might inform a public health approach to managing PD and associated mental and physical disability. A review was conducted of population-based studies examining the prevalence of PD and associations between physical comorbidities and service utilization. The prevalence of any PDs were common (4.4% -21.5%) among populations spanning England, Wales, Scotland, Western Europe, Norway, Australia, and the United States. Preliminary evidence supports associations between PDs from Clusters A and B and physical comorbidities, namely cardiovascular diseases and arthritis. PD appears to increase health care utilization, particularly in primary care. In order to facilitate rational population health planning, further population studies are required. (PsycINFO Database Record
    Personality Disorders: Theory, Research, and Treatment 10/2015; DOI:10.1037/per0000148 · 3.54 Impact Factor
    • "The two-factor model of the IDI-6 (i.e., emotional dependency and functional dependency) mirrors previous two-factor models of dependency (Arntz, 2005; Gude et al., 2006; Gurtman, 1992; Livesley et al., 1990; Morgan & Clark, 2010; Skodol et al., 2011). From the current results, we can infer that emotionally dependent individuals perceive themselves as helpless and are insecure in their relationships. "
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    ABSTRACT: The Interpersonal Dependency Inventory (IDI) is a frequently used, 48-item measure of maladaptive dependency. Our goal was to develop and psychometrically evaluate a very brief version of the IDI. An exploratory factor analysis of the IDI in Study 1 (N=838) yielded a six-item IDI (IDI-6), with three items loading on an emotional dependency factor (IDI-6-ED), and the other three items loading on a functional dependency factor (IDI-6-FD). This factor solution was validated by confirmatory factor analysis in Study 2 (N = 916). The IDI-6-ED and IDI-6-FD demonstrated good convergent and divergent validity in Study 3 (N = 100). In Study 4 (N = 22-43), the IDI-6-ED and IDI-6-FD were generally stable over 4-week and 8-week intervals and were found to be responsive to the effects of psychological treatment. These results have implications for dependency conceptualizations and support the IDI-6 as a brief, psychometrically sound instrument.
    Assessment 09/2015; DOI:10.1177/1073191115605178. · 3.29 Impact Factor
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    • "The second criterion (Criterion B) dictates that an individual must also exhibit maladaptive personality traits based on a model of five dimensional personality domains and their accompanying set of three to seven facets. These trait domains include Antagonism, Psychoticism, Disinhibition, Negative Affectivity, and Detachment (American Psychiatric Association, 2011; Skodol et al., 2011), and are grounded in literature showing the empirical validity of dimensional models for maladaptive personality functioning (Harkness and McNulty, 1994; Krueger et al., 2011; Samuel and Widiger, 2008; Watson et al., 1994; Widiger and Simonsen, 2005; among others). This model has also shown strong associations with other models of personality such as the Personality Psychopathology Five (PSY-5) model (Anderson et al., 2013; see also Harkness et al., 2012), and the Five Factor Model (FFM) (Gore and Widiger, 2013; Thomas et al., 2013; Widiger et al., 2013). "
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    ABSTRACT: The DSM-5 Section III includes a hybrid model for the diagnosis of personality disorders, in which sets of dimensional personality trait facets are configured into personality disorder types. These PD types resemble the Section II categorical counterparts with dimensional traits descriptive of the Section II criteria to maintain continuity across the diagnostic systems. The current study sought to evaluate the continuity across the Section II and III models of personality disorders. This sample consisted of 397 undergraduate students, administered the Personality Inventory for the DSM-5 (Krueger et al., 2012) and the Structured Clinical Interview for the DSM-IV Axis II Disorders–Personality Questionnaire (First et al., 2002). We examined whether the DSM-5 Section III trait facets for the PDs would be associated with their respective Section II counterparts, as well as determining whether additional facets could augment the prediction of the Section II disorders. Results revealed that, generally, the DSM-5 Section II disorders were most strongly associated with their Section III traits. Results also showed evidence to support the addition of facets not included in the Section III diagnostic criteria in the prediction of most disorders. These results show general support for the Section III model of personality disorders, however, results also show that additional research is needed to replicate these findings.
    05/2014; 216(3). DOI:10.1016/j.psychres.2014.01.007
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