693 – Critical approach to dimensional models of personality in DSM-V (original) (raw)
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Dimensional models of personality disorders: Challenges and opportunities
Frontiers in Psychiatry, 2023
Categorical models of personality disorders have been beneficial throughout psychiatric history, providing a mechanism for organizing and communicating research and treatment. However, the view that individuals with personality disorders are qualitatively distinct from the general population is no longer tenable. This perspective has amassed steady criticism, ranging from inconsequential to irreconcilable. In response, stronger evidence has been accumulated in support of a dimensional perspective that unifies normal and pathological personality on underlying trait continua. Contemporary nosology has largely shifted toward this dimensional perspective, yet broader adoption within public lexicon and routine clinical practice appears slow. This review focuses on challenges and the related opportunities of moving toward dimensional models in personality disorder research and practice. First, we highlight the need for ongoing development of a broader array of measurement methods, ideally facilitating multimethod assessments that reduce biases associated with any single methodology. These efforts should also include measurement across both poles of each trait, intensive longitudinal studies, and more deeply considering social desirability. Second, wider communication and training in dimensional approaches is needed for individuals working in mental health. This will require clear demonstrations of incremental treatment efficacy and structured public health rebates. Third, we should embrace cultural and geographic diversity, and investigate how unifying humanity may reduce the stigma and shame currently generated by arbitrarily labeling an individual’s personality as normal or abnormal. This review aims to organize ongoing research efforts toward broader and routine usage of dimensional perspectives within research and clinical spaces.
Clinical utility of a dimensional model of personality disorder
Professional Psychology: Research and Practice, 2010
The purpose of this paper is to discuss the clinical utility of a dimensional classification of personality disorder. The paper begins with a brief description of the five-factor model of personality disorder, followed by a discussion of three fundamental components of clinical utility: ease of usage, communication, and treatment decisions. It is suggested that the five-factor model compares well to personality disorder diagnostic categories with respect to all three components of clinical utility.
Dimensional Models of Personality: A Framework for Systematic Clinical Assessment
European Journal of Psychological Assessment, 1998
Personality research has made considerable progress in developing dimensional models. This article reviews the application of these trait models to clinical theory and practice. Assessment of traits is useful for understanding the individual client, for diagnosis and therapy, and for tailoring the clinical interview to the needs of the patient. Dimensional models have been applied to several areas of pathology. Neuroticism and a variety of other traits are implicated in subclinical stress reactions. At the process level, the effects of traits such as neuroticism may be mediated by maladaptive coping strategies. Traits such as neuroticism may also have a causal effect on more severe mood and anxiety disorders, although it is likely that there are reciprocal linkages between personality and pathology. As with subclinical stress, traits may influence depression and anxiety through abnormality of cognitive processes, the clinical significance of which should be assessed in the light of the individual's trait characteristics. A further area of application is personality disorder: Dimensional models capture and clarify the principal clinical features of conditions such as schizoid and antisocial disorders. It is concluded that the dimensional approach provides a framework for the systematic understanding of clinical expressions of abnormality in personality and their implications for diagnosis and treatment.
The third edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM–III; APA, 1980) set forth a categorical system of personality psychopathology that is composed of discrete personality disorders (PDs), each with a distinct set of diagnostic criteria. Although this system is widely accepted and highly influential, alternative dimensional approaches to capturing personality psychopathology have been proposed. Three dimensional models of personality have garnered particular attention—the Five–Factor Model (FFM; Costa & McCrae, 1992), the Seven–Factor Psychobiological Model of Temperament and Character (Seven–Factor Model; Cloninger, Svrakic, & Przybeck, 1993); and the 18–factor model of personality pathology (18–factor model; Livesley, 1986). Although the personality traits from each of these models has been examined in relation to the ten personality disorders in the DSM–IV, no study has examined the comparative and in-cremental validity of these models in predicting PD symptoms for these ten disorders. Using self–report instruments that measure these models and the ten DSM–IV PDs, correlation and linear regression analyses indicate that traits from all three models had statistically significant associations with PD symptom counts. Hierarchical regressions revealed that the 18–fac-tor model had incremental predictive validity over the FFM and Seven–Fac-tor Model in predicting symptom counts for all ten DSM–IV PDs. The FFM had incremental predictive validity over the Seven–Factor Model model for all ten disorders and the Seven–Factor was able to add incremental predictive validity over the 18–factor model for five of the ten PDs and for eight of the ten disorders relative to the FFM.
Journal of Abnormal Psychology, 2001
This study sought to extend previous work on the five-factor dimensional model (FFM) of personality disorder (PD) by developing more comprehensive FFM descriptions of prototypic cases. Specifically, the authors asked experts in each of the 10 DSM-IV PDs to rate the prototypic case by using all 30 facets of the FFM. Aggregating across raters of the given disorder generated a prototype for each disorder. In general, there was good agreement among experts and with previous theoretical and empirical FFM translations of DSM diagnostic criteria. Furthermore, the ability of the FFM explanation to reproduce the high comorbidity rates among PDs was demonstrated. The authors concluded that, with the possible exception of schizotypal PD, the DSM PDs can be understood from the dimensional perspective of the FFM. Future directions for research, including the use of the present prototypes to "diagnose" personality disorder, are discussed. The American Psychiatric Association's Diagnostic and Statistical Manual'of Mental Disorders, fourth edition (DSM-IV; American Psychiatric Association, 1994), provides personality disorder diagnostic categories. There is good evidence that these diagnoses identify clinically meaningful maladaptive personality traits; several diagnoses seem especially well-validated, including antisocial (
Dimensions of personality: clinicians' perspectives
Canadian journal of psychiatry. Revue canadienne de psychiatrie, 2009
To obtain the opinions and preferences of practising clinicians about the clinical utility of personality scales included within 8 alternative dimensional models of personality disorder for inclusion within an official diagnostic nomenclature. Psychiatrists (n = 226) and psychologists (n = 164) from 2 continents provided clinical utility ratings on personality scales organized from 8 alternative dimensional models of personality disorder. The psychiatrists and the psychologists supported the inclusion of most of the scales from all 8 of the models that were compared. Normal personality traits were endorsed, although abnormal personality traits generally received higher levels of endorsement. The list of endorsed traits was reduced further by organizing the scales into groups based on redundancy within each of 5 broad domains and then selecting within each group the scale that received the highest rating. This list appears to represent each domain in a manner that is comprehensive bo...
Personality and Individual Differences, 1996
This paper reports the only study today into the empirical relationship between the Big Five dimensions of personality and symptoms of personality disorders according to both ICD-IO as well as DSM-III-R in two samples of 'normal' volunteers. Correlations were computed between the scores obtained with two different Big Five questionnaires and the number of personality disorder symptoms (criteria met) as measured by a self-report questionnaire (VKP). These questionnaires are the 23BBS: the 23 bipolar Big Five and the SPFT: the Five Personality Factor Test. Furthermore, we compared the results of our studies with those of all studies we could trace in the literature (12 in all) regarding correlations between Big Five dimensions and the personality disorder symptoms, according to DSM-III-(R) only. It was concluded that: (a) our study is unique, because for the first time the relationships between ICD-10 personality disorders criteria and Big Five dimensions are investigated; (b) the differences found with regard to the ICD-IO personality disorders symptoms and the corresponding DSM-III-R personality disorder symptoms are relatively small; (c) therefore in terms of underlying personality dimensions the criteria in both systems are more or less the same.