The ironic fate of the personality disorders in DSM-5.
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abstract
An alternative model for the diagnosis of personality disorders (PDs), based on assessments of impairments in personality functioning and of pathological personality traits, was intended for the official classification in the Diagnostic and Statistical Manual for Mental Disorders-Fifth Edition (DSM-5), but was instead placed in Section III, "Emerging Measures and Models." This article attempts to describe forces in play during the development of DSM-5 that may have contributed to this outcome, from the perspectives of the Chair of the Personality and Personality Disorders Work Group (PPDWG) and three of its members. These include a failed imperative to shift away from the Diagnostic and Statistical Manual for Mental Disorders-Fourth Edition (DSM-IV) categories toward a dimensional perspective on psychopathology, dynamics within the American Psychiatric Association DSM-5 Task Force and PPDWG and the roles and impact of individuals and groups in the PD community. From these considerations, we present some suggestions for how the field might move forward in the future. A new opportunity exists to use the proposed alternative model as a foundation for research. In the immediate future, with the existence of two different models of PDs in DSM-5, studies can be done comparing the models to each other and to other models with respect to reliability and antecedent, concurrent, and predictive validity. If the Section III model continues to perform as early studies suggest, it may migrate into Section II of a planned DSM-5.1. This valuable research, already underway, will shape future editions of the DSM, by providing data to articulate a clearer vision, with broader representation of reliable and valid models. Going forward, personal investments must be put aside for the benefit of the greater good.
