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The hybrid model for the classification of personality disorders in DSM-5: A critical analysis

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Abstract

A personality disorder can be considered to be a generalized pattern of behaviors, cognitions, and emotions that is enduring, begins in adolescence or early adulthood, remains stable over time, and generates stress or psychological damage. The current focus on personality disorders (PDs) is found in Section II of DSM-5 and is unchanged compared to DSMIV, except that the PDs were removed from the former Axis II of the DSM-IV and included in the central classification of disorders. However, an alternative model for further study is presented in Section III that aims to address the deficiencies in the current categorical model of PDs. The underlying idea is that PDs are an extreme version of the personality traits that everyone has. According to this approach, PDs are characterized by impaired personality functioning (areas of identity, self-direction, empathy, and intimacy) and pathological personality factors (negative affectivity, detachment, antagonism, disinhibition, and psychoticism). The diagnostic categories derived from this model include only antisocial, avoidant, borderline, narcissistic, obsessive-compulsive, and schizotypal PDs. This hybrid approach to the diagnosis of PDs is complex and requires more empirical evidence before it can be incorporated into clinical practice. The proposals of the draft ICD-11 for PDs, which are based primarily on severity and dominant personality traits, are also included.

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... Personality trait facets are relatively stable patterns of behaviors, cognitions, and emotions, which develop during childhood and adolescence. Traits can be placed on a continuum from normality to pathology (dimensional), which means that they can develop in a healthy way or become maladaptive [1]. ...
... Personality trait facets were measured with the Dutch self-report Personality Inventory for DSM 5 (PID-5) [8] according to the dimensional model of personality [1]. The PID-5 is a 220-item self-report measure, designed to assess personality domains (antagonism, detachment, disinhibition, negative affectivity, and psychoticism) and 25 underlying trait facets, included in the DSM-5 alternative dimensional model [8]. ...
... It has been suggested that the measurement of stable personality traits may lead to biased results in adolescent samples because they are still in development [1]. In this sample, however, the average age of the patients was 27 years, and the majority of the sample were adult patients. ...
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Purpose Personality functioning is strongly linked to well-being in the general population. Yet, there is a lack of scientific knowledge about the pathways between personality trait facets and emotional, psychological and social well-being in ED patients. The general aim was to examine potential associations between maladaptive personality trait facets and the three main dimensions of well-being. Methods Participants were 1187 female eating disorder patients who were referred for specialized treatment. Patients were diagnosed with anorexia nervosa (31.7%), bulimia nervosa (21.7%), binge eating disorder (11%) and other specified eating disorders (35.5%). The Personality Inventory for the DSM 5 (PID-5) was used to measure 25 trait facets, and well-being was measured with the Mental Health Continuum Short Form (MHC-SF). Multiple hierarchical regression analyses were applied to examine potential associations between personality and well-being while controlling for background and illness characteristics. Results Personality trait facets led to a statistically significant increase of the explained variance in emotional (38%), psychological (39%), and social well-being (26%) in addition to the background and illness characteristics. The personality trait facets anhedonia and depression were strongly associated with all three well-being dimensions. Conclusion Personality traits may play an essential role in the experience of well-being among patients with EDs. To promote overall mental health, it may be critical for clinicians to address relevant personality trait facets, such as anhedonia and depression, associated with well-being in treatment. Level of evidence Level V, cross-sectional descriptive study.
... For example, in the DSM-IV the threshold required to make a diagnosis was arbitrary, yet the impression was conveyed that overall a given disorder is either present or it is not, rather than conceptualizing it as a symptom and trait pattern with varying gradients of severity (Oldham, 2015). Inclusion in a category involves satisfying in each case one-half plus one of a group of diagnostic criteria; this is known as polythetic assessment (Esbec & Echeburúa, 2015). A downside of this system is that it generates a marked level of heterogeneity within similar diagnoses. ...
... This diagnosis indicates that a patient meets the general criteria for a personality disorder and has a pathological trait profile that can include characteristics of different disorders and trait facets (Oldham, 2015). In this conceptualization, the DSM-V covers other specified and unspecified personality disorders with mixed personality characteristics and other PDs not included in standard classification (for example, depressive PD or psychotic/sadistic PD) (Esbec & Echeburúa, 2015). ...
... For example, in the DSM-IV the threshold required to make a diagnosis was arbitrary, yet the impression was conveyed that overall a given disorder is either present or it is not, rather than conceptualizing it as a symptom and trait pattern with varying gradients of severity (Oldham, 2015). Inclusion in a category involves satisfying in each case one-half plus one of a group of diagnostic criteria; this is known as polythetic assessment (Esbec & Echeburúa, 2015). A downside of this system is that it generates a marked level of heterogeneity within similar diagnoses. ...
... This diagnosis indicates that a patient meets the general criteria for a personality disorder and has a pathological trait profile that can include characteristics of different disorders and trait facets (Oldham, 2015). In this conceptualization, the DSM-V covers other specified and unspecified personality disorders with mixed personality characteristics and other PDs not included in standard classification (for example, depressive PD or psychotic/sadistic PD) (Esbec & Echeburúa, 2015). ...
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Two studies test the hypothesis of conserving resources while performing depleting physical tasks and the modifying role of metacognitive self (MCS). A total of 216 undergraduate students performed two types of physical tasks (a body support on forearms―the first experiment; and a cold water test―the second experiment) in anticipation vs. no anticipation of the future task conditions. Among individuals with high-MCS much weaker persistence could be observed than among those with low-MCS. These results support theories of adaptive goal disengagement suggesting that how individuals apply their resources may stem from other reasons than ego depletion. Keywords: conserving resources, ego depletion, metacognitive self, biases
... The results of the PID-5 personality model showed that the drug users had higher scores regarding negative affectivity, antagonism, disinhibition, and psychoticism, and these results are consistent with other research findings that reported higher scores and positive correlations of the dimensions of this model with alcohol use disorders (Creswell et al., 2015;Creswell et al., 2016) and drug use disorders (Gunnarsson, 2012;Francis, 1996;Seyed Hashemi & Mosavi, 2017;Pour Rajabali Moafi et al., 2018). Concerning the explanation of these findings, it can be stated that negative affectivity is an internalizing personality dimension that tends to show negative emotional experiences such as depressivity, perseveration, anxiousness, withdrawal, and anhedonia (Esbec & Echeburúa, 2015;Krueger et al., 2012;Wright et al., 2012). Emotions are considered as an important component of addictive behavior. ...
... Also, the dimensions of antagonism and disinhibition are recognized as externalized pathological traits that are characterized by behaviors and states of manipulativeness, deceitfulness, attention seeking, grandiosity, irresponsibility, impulsivity, and risk taking, and these dimensions are overlapping with antisocial and borderline features (Esbec & Echeburúa, 2015;Krueger et al., 2012;Wright et al., 2012), which has been identified as a determining factor in substance use disorder (Nevid et al., 2019;Shorey, Elmquist, Anderson, & Stuart, 2016). Individuals having this pattern do not pay attention to the feelings and problems of others, lack feelings of guilt and regret about the negative and harmful effects of their actions toward others, fear of being alone because of rejection or separation from important influential persons which consequently comes from uncertainty about their ability to take physical and emotional care of themselves. ...
Article
Objective: Personality traits play a vital role in addictive behaviors, drug addiction in particular. Aim of study: To compare normal and pathological personality traits in drug users and non-drug users. Methods: In this comparative study, we employed convenience sampling to recruit drug users (n = 110; 58 men and 52 women), from addiction treatment centers in a selected city in Azarbaijan province, and matched group of non-drug users (n = 110; 58 men and 52 women). The data were collected using demographic information questionnaire, Jakson-5 scale, Temperament and Character Cloninger (TCI), and Personality Inventory for DSM-5-Brief Form (PID-5-BF). The data were analyzed by chi square and multivariate analysis of variance (MANOVA). Results: Two groups were significantly different in normal (r-RST, TCI) and pathological (PID-5) personality models. In TCI model, drug users gained high scores in the dimensions of novelty seeking and harm avoidance; and obtained low scores in the dimensions of reward dependence, persistence, and self-directedness. In r-RST model, they gained high scores in r-BAS and r-fight System; and obtained low scores in r-BIS. Also, in pathological personality model (PID-5), the scores of drug users were high in all of the dimensions except for detachment dimension. Conclusion: Our findings suggest that personality traits are coincidence in drug users. Professional evaluation of drug using patients in order to differentiate normal and pathological personality models of them is recommended.
... However, this method poses problems such as heterogeneity within the same category because the boundaries between disabilities are unclear, or having one disorder belonging to two or more categories at the same time (Widiger and Trull, 2007;Livesley, 2010). In addition, the inter-rater reliability among experienced clinical psychologists and/or psychiatrists diagnosing personality disorders using the categorical approach did not reach a sufficient level (Kraemer et al., 2012;Esbec and Echeburúa, 2015). For this reason, a dimensional model, which understands personality as a complex hierarchy of continuously distributed attributes rather than a categorical approach, is receiving attention in understanding personality and diagnosing disorders (Costa and McCrae, 2017). ...
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Background Self-report multiple choice questionnaires have been widely utilized to quantitatively measure one’s personality and psychological constructs. Despite several strengths (e.g., brevity and utility), self-report multiple choice questionnaires have considerable limitations in nature. With the rise of machine learning (ML) and Natural language processing (NLP), researchers in the field of psychology are widely adopting NLP to assess psychological construct to predict human behaviors. However, there is a lack of connections between the work being performed in computer science and that of psychology due to small data sets and unvalidated modeling practices. Aims The current article introduces the study method and procedure of phase II which includes the interview questions for the five-factor model (FFM) of personality developed in phase I. This study aims to develop the interview (semi-structured) and open-ended questions for the FFM-based personality assessments, specifically designed with experts in the field of clinical and personality psychology (phase 1), and to collect the personality-related text data using the interview questions and self-report measures on personality and psychological distress (phase 2). The purpose of the study includes examining the relationship between natural language data obtained from the interview questions, measuring the FFM personality constructs, and psychological distress to demonstrate the validity of the natural language-based personality prediction. Methods Phase I (pilot) study was conducted to fifty-nine native Korean adults to acquire the personality-related text data from the interview (semi-structured) and open-ended questions based on the FFM of personality. The interview questions were revised and finalized with the feedback from the external expert committee, consisting of personality and clinical psychologists. Based on the established interview questions, a total of 300 Korean adults will be recruited using a convenience sampling method via online survey. The text data collected from interviews will be analyzed using the natural language processing. The results of the online survey including demographic data, depression, anxiety, and personality inventories will be analyzed together in the model to predict individuals’ FFM of personality and the level of psychological distress (phase 2).
... This approach is based on the perspective that PD is an extreme variant of normal personality, as suggested by Schneider in early stage of PD history, and it came to be insisted that PDs were well conceptualized as comprising extreme variants of general personality traits (Costa & Widiger, 1994, 2002. The dimensional model has certain advantages: (a) it is consistent with fuzzy boundaries between disorders and normality; (b) the dimensional measure can be converted into categorical criterion such as a cutoff point; (c) the inter-rater reliability of assessment is improved; (d) and comorbidity ceases to be a problem because an individual can be defined based on their combined characteristics of traits (Esbec & Echeburúa, 2015). ...
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The validity of the Five-Factor Model (FFM) of personality for diagnosing personality disorder (PD) was examined in two equivalent PD groups, one with dimensional criteria (N = 246) and the other with categorical criteria (N = 165), selected from 1,088 university students. Both equivalent PD groups did not exhibit specific profiles for each PD on FFM scales of the NEO Personality Inventory- Revised (NEO-PI-R), and multiple regression analyses showed that FFM scores only partly predicted PD, although it was improved by the prototype-matching method. The comorbidity was not different in dimensional and categorical measures of PD. The results suggest that the FFM of personality is useful for providing information about the personality in each individual, but is not very helpful for diagnosing PDs, because each PD does not necessarily exhibit a specific homogeneous trait constellation on FFM based on the NEO-PI-R. Personality trait description and diagnosis of PD are not the same issues. It is necessary to integrate dimensional and categorical approaches to PDs for a more precise classification and diagnosis.
... Extrait du DSM 5 (du projet Research Diagnostic Criteria) : exemple de composition des troubles de la personnalité en domaines, selon des facettes cliniques(Esbec et Echeburúa, 2015) ...
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La notion de pathocénose offre un cadre méthodologique à l'étude des classifications en santé mentale. En nous basant sur les principes épistémologiques qu'elle fournit, nous apportons des précisions sur les relations entre les Research Diagnostic Criteria, les Research Domain Criteria, la Hierarchical Taxonomy Of Psychopathology et le modèle de réseau des symptômes en psychiatrie (ou Symptom Network Models). La clarification de ces relations nous permettra de mieux comprendre quelles contributions ces taxonomies de la psychiatrie contemporaine peuvent échanger les unes avec les autres. En effet, la notion de pathocénose permet de coordonner l'ensemble des classifications. Cette analyse épistémologique des nosologies nous permet de saisir combien l'émergence des classifications ne peut être séparée du contexte spatio-temporel dans lequel elles se manifestent. La pathocénose semble être un outil intéressant pour modéliser les relations complexes entre les différentes classifications contemporaines.
... The predominance of this model over the categorical approach stems from its solid scientific foundations. While there is no empirical evidence that personality disorders are categorical (Hopwood et al., 2018), the dimensional approach is a researchdriven field, verified by genetic and neuropsychological studies (Esbec & Echeburúa, 2015). Such a paradigm is a step towards making clinical psychology a truly evidence-based science (Stoyanov, Machamer, & Schaffner, 2012). ...
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Background: Recent research suggested that personality disorders could be diagnosed as a continuous phenomenon. Therefore, in our study we examined whether the dimensional model of pathological personality traits could be applied to the assessment of borderline personality. Participants and procedure: For this purpose, we modified an existing measure of borderline personality, the McLean Screening Instrument for Borderline Personality Disorder (MSI-BPD), and scrutinized its psychometric properties (i.e., reliability, factorial structure, criterion validity). To assess criterion validity we calculated correlations with pathological personality traits. Our sample comprised 354 participants (67.8% women). Results: Confirmatory factor analysis revealed that the modified MSI-BPD measures borderline personality as a global construct , giving one-factor structure. The reliability of the measurement was excellent (α = .90). Moreover, we found positive associations between borderline personality and all five pathological personality traits, which supports the validity of the continuous assessment of borderline personality. Conclusions: Our findings suggest that the DSM-5 dimensional model may be applied in the assessment of borderline personality.
... After the DSM-5 was published in 2013, the ICD-11 has to some extent had the advantage of being able to respond or adapt to the criticisms that have followed the publication of DSM-5 (16,44). The alternative DSM-5 model for personality disorders has been criticized for being too complicated and cumbersome for busy clinicians (45,46). Therefore, it seems reasonable to state that the proposed ICD-11 model, relatively simple as it is, is more parsimonious and feasible for practitioners in all cultures and settings, while also aligning with the domains of the DSM-5 model (7,47). ...
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Objective: The personality disorder domains proposed for the ICD-11 comprise Negative Affectivity, Detachment, Dissociality, Disinhibition, and Anankastia, which are reasonably concordant with the higher-order trait domains in the Alternative DSM-5 Model for Personality Disorders. Method: We examined (i) whether designated DSM-5 trait facets can be used to describe the proposed ICD-11 trait domains, and (ii) how these ICD-11 trait features are hierarchically organized. A mixed Danish derivation sample (N = 1541) of 615 psychiatric out-patients and 925 community participants along with a US replication sample (N = 637) completed the Personality Inventory for DSM-5 (PID-5). Sixteen PID-5 traits were designated to cover features of the ICD-11 trait domains. Results: Exploratory structural equation modeling (ESEM) analyzes showed that the designated traits were meaningfully organized in the proposed ICD-11 five-domain structure as well as other recognizable higher-order models of personality and psychopathology. Model fits revealed that the five proposed ICD-11 personality disorder domains were satisfactorily resembled, and replicated in the independent US sample. Conclusion: The proposed ICD-11 personality disorder domains can be accurately described using designated traits from the DSM-5 personality trait system. A scoring algorithm for the ICD-11 personality disorder domains is provided in appendix.
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In this paper, a study of personality disorders and psychopathy in imprisoned male batterers is carried out. A sample of 76 batterers sentenced for a severe offence of violence against their intimate partner was selected. All the participants were assessed with the MCMI-II before beginning a treatment program in prison for gender violence. Likewise, all participants were assessed with the PCL-R in order to identify psychopathic symptoms. According to the results, 86.8% of the sample showed at least one personality disorder. The most prevalent one was the Obsessive-compulsive Personality Disorder (57.8% of cases), followed by the Dependent Personality Disorder (34.2% of cases) and Paranoid Personality Disorder (25%). Regarding psychopathy, the results of PCL-R showed that there were 11 people (14.4% of the sample) who met the criteria for psychopathy or probable psychopathy. Finally, implications of this study for clinical practice and future research in this field are commented upon.
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La Clasificación Internacional de las Enfermedades (CIE) de la Organización Mundial de Salud (OMS) es muy poco conocida en el ámbito de la psicología en España, y existe la falsa percepción de que su importancia es escasa en el campo de la salud mental. El propósito de este artículo es familiarizar a los psicólogos y otros profesionales en salud mental con el sistema de clasificación CIE, algo especialmente relevante al encontrarse actualmente en proceso de revisión. La OMS está haciendo un gran esfuerzo para crear una clasificación de trastornos mentales global, multicultural y multidisciplinar, centrándose en mejorar su utilidad clínica. Además, en la actual revisión de la CIE, la OMS ha adoptado el español como segunda lengua de trabajo, lo que da una gran oportunidad a los profesionales de la salud mental de España y otros países hispanohablantes de implicarse activamente en el desarrollo de la próxima
Chapter
The territory that psychologists explore is still largely uncharted; so to find Eysenck’s model for personality in the middle of this terra incognita is rather like stumbling across St. Pancras Station in the heart of the African jungle. Faced with this apparition, one’s first question is, not “does it work?”, but “what’s it for?” This, indeed, is the right question to ask. Eysenck’s model bestrides the field of personality like a colossus. There have been other attempts to describe personality, notably Cattell’s and Guilford’s, and other attempts to explain it, above all, Pavlov’s and Teplov’s: but no one has tried to achieve both these aims on the same scale as Eysenck. In consequence, it is extremely difficult to see the Eysenckian edifice in perspective: there are too few other buildings with which to compare it, only the surrounding trackless jungle. It is by asking “what’s it for?” that we can best provide this perspective. In answer to this question, Fig. 8.1 dis plays what I take to be the general structure of Eysenck’s theory of extra version-introversion (E-I) and neuroticism (N).
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The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) represents a watershed moment in the history of official psychopathology classification systems because it is the first DSM to feature an empirically based model of maladaptive personality traits. Attributes of patients with personality disorders were discussed by the DSM-5 Personality and Personality Disorders Work Group and then operationalized and refined in the course of an empirical project that eventuated in the construction of the Personality Inventory for DSM-5 (PID-5). We review research to date on the DSM-5 trait model, with a primary aim of discussing how this kind of research could serve to better tether the DSM to data as it continues to evolve. For example, studies to date suggest that the DSM-5 trait model provides reasonable coverage of personality pathology but also suggest areas for continued refinement. This kind of research provides a way of evolving psychopathology classification on the basis of research evidence as opposed to clinical authority. Expected final online publication date for the Annual Review of Clinical Psychology Volume 10 is March 20, 2014. Please see http://www.annualreviews.org/catalog/pubdates.aspx for revised estimates.
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The current study tests empirically the relationship of the dimensional trait model proposed for the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) with five-factor models of general personality. The DSM-5 maladaptive trait dimensional model proposal included 25 traits organized within five broad domains (i.e., negative affectivity, detachment, antagonism, disinhibition, and psychoticism). Consistent with the authors of the proposal, it was predicted that negative affectivity would align with five-factor model (FFM) neuroticism, detachment with FFM introversion, antagonism with FFM antagonism, disinhibition with low FFM conscientiousness and, contrary to the proposal; psychoticism would align with FFM openness. Three measures of alternative five-factor models of general personality were administered to 445 undergraduates along with the Personality Inventory for DSM-5. The results provided support for the hypothesis that all five domains of the DSM-5 dimensional trait model are maladaptive variants of general personality structure, including the domain of psychoticism. (PsycINFO Database Record (c) 2013 APA, all rights reserved).
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The purpose of this article is to demonstrate that personality pathology is, at its core, fundamentally interpersonal. The authors review the proposed DSM-5 Section 3 redefinition of personality pathology involving self and interpersonal dysfunction, which they regard as a substantial improvement over the DSM-IV (and Section 2) definition. They note similarities between the proposed scheme and contemporary interpersonal theory and interpret the Section 3 definition using the underlying assumptions and evidence base of the interpersonal paradigm in clinical psychology. The authors describe how grounding the proposed Section 3 definition in interpersonal theory, and in particular a focus on the "interpersonal situation," adds to its theoretical texture, empirical support, and clinical utility. They provide a clinical example that demonstrates the ability of contemporary interpersonal theory to augment the definition of personality pathology. The authors conclude with directions for further research that could clarify the core of personality pathology, and how interpersonal theory can inform research aimed at enhancing the Section 3 proposal and ultimately justify its migration to Section 2.
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The overall objective of the program of research on the classification of personality disorder that led to the construction of the Dimensional Assessment of Personality Pathology (DAPP) measures is to explicate and validate the basic components of personality disorder. The research program, initiated in the early 1980s, was originally designed to validate DSM-III ( Diagnostic and Statistical Manual of Mental Disorders; American Psychiatric Association, 1980) personality disorders. Each disorder was systematically defined by a cluster of traits identified from a review of the clinical literature. Self-report scales were developed to assess the 100 traits used to define the 11 DSM-III personality disorders. Because scales were developed to assess clinical concepts, the DAPP incorporates the features of personality disorder that clinicians have traditionally considered important. The program was initiated with the expectation that multivariate studies would reveal factors that resembled DSM diagnostic constructs. When this proved not to be the case, attention focused on explicating the dimensional structure of personality disorder. These studies provided multiple opportunities to evaluate categorical versus dimensional models of personality disorder and test assumptions of the categorical model that a boundary or discontinuity occurs between normal and disordered personality and that the structure or organization of traits of disordered personality differs from that of normal personality. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
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it would seem difficult to doubt the truth of the proposition that man is a biosocial animal / the proper theory of personality requires some knowledge of the relationships between social behavior . . . which gives rise to the descriptions of the major dimensions of personality, based on patterns of behavior, and specific biological features of the organism / what is needed clearly is a set of theories relating the various dimensions of personality / discuss some of the issues in question, with particular reference to the theory of "arousal" in relation to extraversion-introversion biological theories of personality / problems in theories testing / EEG studies and personality / electrodermal studies of personality / miscellaneous measures of personality (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Article
DSM-IV-TR suggests that clinicians should assess clinically relevant personality traits that do not necessarily constitute a formal personality disorder (PD), and should note these traits on Axis II, but DSM-IV-TR does not provide a trait model to guide the clinician. Our goal was to provide a provisional trait model and a preliminary corresponding assessment instrument, in our roles as members of the DSM-5 Personality and Personality Disorders Workgroup and workgroup advisors. An initial list of specific traits and domains (broader groups of traits) was derived from DSM-5 literature reviews and workgroup deliberations, with a focus on capturing maladaptive personality characteristics deemed clinically salient, including those related to the criteria for DSM-IV-TR PDs. The model and instrument were then developed iteratively using data from community samples of treatment-seeking participants. The analytic approach relied on tools of modern psychometrics (e.g. item response theory models). A total of 25 reliably measured core elements of personality description emerged that, together, delineate five broad domains of maladaptive personality variation: negative affect, detachment, antagonism, disinhibition, and psychoticism. We developed a maladaptive personality trait model and corresponding instrument as a step on the path toward helping users of DSM-5 assess traits that may or may not constitute a formal PD. The inventory we developed is reprinted in its entirety in the Supplementary online material, with the goal of encouraging additional refinement and development by other investigators prior to the finalization of DSM-5. Continuing discussion should focus on various options for integrating personality traits into DSM-5.
Article
Diagnosing disorders in the current edition of the DSMIV involves two aspects. The first is the concept of a personality disorder, which currently is defined as a pervasive, stable and presents at least from adolescence pattern of "inner experience and behavior" that is deviant from a person's cultural norms. The second aspect involves defining what type of personality disorder is present among a list of ten, with a catch-all "not otherwise specified category". There are many problems with the existing system: the different personality types are poorly defined and the diagnostic criteria overlap heavily. The proposed revision on the DSM-V website appears quite complicated and has three major facets: a new definition for personality disorder, focused on "adaptive failure" involving "impaired sense of self-identity" or "failure to develop effective interpersonal functioning"; five personality types (Antisocial/Psychopathic, Avoidant, Borderline, Obsessive-Compulsive, and Schizotypal); and a series of six personality "trait domains", each of them with a subset of facets. This new proposed system for personality disorder diagnosis may be controversial. Finally challenges for the next future are discussed.
Article
Aquí se expone la influyente teoría interpersonal de la psiquiatría desarrollada por Sullivan a partir del psicoanálisis.
Article
A preliminary but growing body of evidence supports the existence of genetic and biological substrates of personality, suggesting the utility of a psychobiological perspective on the personality disorders. The investigation of biological correlates of personality disorders can provide an empirical base to explore the relationship between biological predispositions and psychological function. The authors propose a psychobiological model based on dimensions of cognitive/perceptual organization, impulsivity/aggression, affective instability, and anxiety/inhibition. These dimensions span the DSM-III-R axis I and axis II disorders. The authors review phenomenological, genetic, and biological evidence in relation to each of these dimensions. Although such an approach remains heuristic, this model provides a promising vantage point from which to generate investigation of the development and treatment of the personality disorders.
Article
The authors developed a simplified method of rating the severity of personality disorder. The new rating method is based on four levels of severity: no personality disorder, personality difficulty, simple personality disorder, and diffuse personality disorder. The new method was applied to different diagnostic systems and was then compared with an old rating system based on six severity levels. Data were derived from a longitudinal study in which 163 patients with anxiety and depressive disorders had initial assessments of personality status and were followed up over 2 years. Ratings of psychiatric symptoms were made by using the Comprehensive Psychopathological Rating Scale over this period. The results were analyzed with special attention to linear and quadratic trends. The new system was clinically useful in separating patients' initial assessments and outcomes. Patients with no personality disorder had the lowest initial symptom scores and the best outcomes, and those with diffuse personality disorder had the highest initial levels of symptoms and improved least over the 2 years. When the patients were separated by the old classification system, 72% of the variation between groups was accounted for by linear and quadratic trends; the comparable percentage was 97% when the patients were categorized by the new system. The new system of rating severity of personality disturbance is an improvement on existing methods and allows ratings to be made easily from DSM-IV and ICD-10.
Article
In 1998, we in England were shocked by the apparently motiveless murders of a mother and two of her children when they were traveling home from school in a rural area. Subsequently a patient with personality disorder, being monitored by the forensic psychiatric services, was convicted of their murders. The government was determined to prevent this type of offense from recurring and in 1999 introduced a new concept, dangerous and severe personality disorder (DSPD). This subsequently became a treatment and assessment program for individuals who satisfy three requirements: (1) have a severe disorder of personality, (2) present a significant risk of causing serious physical or psychological harm from which the victim would find it difficult or impossible to recover, and (3) the risk of offending should be functionally linked to the personality disorder. The implications of this program are discussed with regard to international systems of classification and service provision. We also attempt to place DSPD in the wider context of psychiatric participation in the management of personality disordered offenders.
La reformulación de los trastornos de la personalidad en el DSM-V
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