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DSM-IV and ICD-10 both diagnose personality disorders categorically, yet studies indicate that many patients meet criteria for an excessive number of diagnoses, raising the question of whether personality disorders are discrete conditions or rather distinctions along dimensions of general personality functioning. This collection of papers renews long-standing proposals for a dimensional model of personality disorder, describing alternative models, addressing questions about their clinical application and utility, and suggesting that future research seek to integrate such models within a common hierarchical structure.
With
contributions by preeminent researchers in the field, Dimensional Models
of Personality Disorders is drawn from a conference series convened
by APA, WHO, and NIH in order to plan for the fifth edition of the DSM. The
Nomenclature Work Group concluded that consideration should be given to
basing part or all of DSM-V on dimensions rather than categories, and
recommended that a dimensional model for personality disorders should serve
as a basis for exploring dimensional approaches in other areas. Accordingly,
the volume opens with a presentation of 18 proposals for dimensional models
and proceeds with provocative contributions on a number of related issues
ranging from hard science to clinical practice. Among the topics addressed are
• Behavioral and molecular genetic research supporting an etiologically
informed dimensional classification of personality disorders
• The
as-yet tenuous associations between dimensional trait measures of
personality as contained in the models of Cloninger, Depue, and
Siever-Davis, and specific neurobiological measures, as examined in
neurotransmitter research
• Potential links between childhood and
adolescent temperament and personality dimensions and adult personality
psychopathology
• Studies examining the covariation of personality
dimensions across cultures
• The continuity of Axis I and Axis II
disorders and a proposed hierarchical structure of mental disorders that
integrates the psychopathology of Axis I disorders with specific personality
traits
• The dual challenges of coverage and cutoffs that must be
addressed if dimensional models are to be considered viable alternatives to
the existing categorical diagnostic system
Although the editors acknowledge that concerns are certain to be raised regarding conversion to a dimensional classification—such as the disruption to clinical practice by a radical shift in diagnosing personality disorder—these papers make a strong case for opening the field to alternative ways of enhancing clinical utility and improving the validity of basic classification concepts. Together, they offer stimulating insight into how we approach personality disorders, with the hope of encouraging a new model of diagnosis for DSM-V.
I enthusiastically recommend [Dimensional Models of Personality Disorders] to all people with an interest in the intersection of personality and disorder, be they clinicians, researchers, or students.
Clinicians with a serious interest in problems of psychiatric diagnosis in general, or in regard to personality disorders in particular, will find this volume illuminating.
This is a fascinating collection of presentations on personality disorders and alternative models for them. It does take a little time initially to understand the concept of a factor rating system and not a categorical model such as in DSM IV, and there are a lot of abbreviations for the myriad of personality tests and scoring systems. However, after getting my bearings, the discussions really expanded my understanding of the ongoing research on personality disorders both in terms of DSM V and the attempt to define them more clearly. I enjoyed the point-counterpoint method of the papers. Overall, an excellent choice for seeing where personality disorder work is and where it will be heading for the future.
— Brett C. Plyler, M.D.
Thomas A. Widiger, Ph.D., is professor in the Department of Psychology at the University of Kentucky in Lexington, Kentucky.
Erik Simonsen, M.D., is Chief Psychiatrist at Roskilde County Hospital Fjorden and Medical Director at the Institute of Personality Theory and Psychopathology in Roskilde, Denmark.
Paul J. Sirovatka, M.S., is Associate Director for Research at the American Psychiatric Institute for Research and Education and the Division of Research at the American Psychiatric Association in Washington, D.C.
Darrel A. Regier, M.D., M.P.H., is Executive Director of the American Psychiatric Institute for Research and Education and Director of the Division of Research at the American Psychiatric Association in Washington, D.C.
Contributors
Disclosure
statement
Foreword
Preface
Introduction
Chapter 1.
Alternative dimensional models of personality disorder: finding a common
ground
Chapter 2. Commentary on Widiger and Simonsen: toward a consensus
personality trait structure
Chapter 3. Commentary on Widiger and
Simonsen: working out a dimensional framework
Chapter 4. Commentary on
Widiger and Simonsen: from ICD-10 and DSM-IV to ICD-11 and DSM-V
Chapter
5. Behavioral and molecular genetic contributions to a dimensional
classification of personality disorder
Chapter 6. Commentary on
Livesley: genetic contributions to a dimensional classification: problems
and pitfalls
Chapter 7. Neurobiological dimensional models of
personality: a review of three models
Chapter 8. Commentary on Paris:
personality as a dynamic psychobiological system
Chapter 9. Commentary
on Paris: the problem of severity in personality disorder
classification
Chapter 10. Temperament and personality as broad-spectrum
antecedents of psychopathology in childhood and adolescence
Chapter 11.
Commentary on Mervielde et al.: toward a developmental perspective on
personality disorders
Chapter 12. Personality dimensions across
cultures
Chapter 13. Commentary on Allik: the lexical approach to the
study of personality structure
Chapter 14. Commentary on Allik: a
historical perspective on personality disorder
Chapter 15. Commentary on
Allik: cross-cultural diagnosis of personality disorder
Chapter 16.
Continuity of Axes I and II: toward a unified model of personality,
personality disorders, and clinical disorders
Chapter 17. Commentary on
Krueger: what to do with the old distinctions
Chapter 18. Commentary on
Krueger: traits versus types in the classification of personality
pathology
Chapter 19. Dimensional models: coverage and
cutoffs
Chapter 20. Commentary on Trull: drizzling on the 5 3 factor
parade
Chapter 21. Commentary on Trull: just do it: replace Axis II with
a diagnostic system based on the Five-Factor Model of
Personality
Chapter 22. Commentary on Trull: reservations and
hopes
Chapter 23. Clinical utility of dimensional models for personality
pathology
Chapter 24. Commentary on Verheul: focusing on the clinician's
need for a better model
Chapter 25. Commentary on Verheul: clinical
utility of dimensional models for personality pathology
Chapter 26.
Personality disorder research agenda for DSM-V
Index