When is it time to move on? Rejoinder for "the ironic fate of the personality disorders in DSM-5".
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abstract
Presents a rejoinder to comments by Silk (see record 2013-45025-005) and Zimmerman (see record 2013-45025-006) on the original article by Skodol et al. (see record 2013-45025-004) regarding personality disorders in the DSM-5. Here, Skodol et al. comment that many of the early decisions made by the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) PPDWG and within the Personality and Personality Disorders Work Group (PPDWG) noted in Silk's commentary should be viewed in light of the original goals of the DSM-5, which included a break from past practices of "tinkering" with categorical criteria. In the end, a compromise hybrid dimensional-categorical model-the favored option of most personality disorder (PD) experts-was developed and was published in DSM-5 Section III. The "alternative model" preserves continuity with current clinical practice while also addressing numerous shortcomings of the exclusively categorical approach to PDs. The personality functioning and pathological trait components of the revised general criteria and the criteria for the six specific disorders and PD-TS are based on extensive data on the core features of PDs and the trait representation of personality pathology. The final model's thresholds for diagnosis, its criteria composition, and its decision rules are based for the first time on empirical data, unlike the diagnostic thresholds and decision rules for DSM-IV (now also in DSM-5 Section II), which for the most part are unsubstantiated. Thus, Zimmerman's comments to the contrary, the Section III alternative model has a greater empirical basis than much of what is in Section II and holds more promise for the future.
