Study supports alternative model for personality disorders in upcoming DSM-5

A new "alternative model" included in the upcoming Fifth Edition of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM -5) lines up well with the current approach to diagnosis of personality disorder, according to a study in the May Journal of Psychiatric Practice. The journal is published by Lippincott Williams & Wilkins, a part of Wolters Kluwer Health.

The findings lend support to the new "hybrid" model, which combines the "core" dimensions of personality disorder with various maladaptive personality traits found in individual patients, according to the report by Leslie C. Morey, PhD, of Texas A & M University and Andrew E. Skodol, MD, of the University of Arizona College of Medicine and Columbia University College of Physicians and Surgeons.

Hybrid Model Compares Well with DSM-IV Diagnosis of Personality Disorders

Experts working on the long-awaited DSM-5 - to be published later this month - recommended substantial revisions to the section on personality disorders. Specifically, they proposed a "hybrid categorical-dimensional model" including not only "core impairments in personality functioning" but also various combinations of "pathological personality traits" associated with these conditions. Goals of the proposal included:

Reducing overlap among personality disorder diagnoses
Reducing heterogeneity among patients receiving the same diagnosis
Eliminating arbitrary diagnostic thresholds with little or no research basis
Addressing the widespread use of the vague "personality disorder not otherwise specified" diagnosis
Providing diagnostic thresholds that are related to level of impairment in a meaningful way

Although the proposal was endorsed by the DSM-5 Task Force, it was decided that the hybrid model required more research support before being fully adopted. Therefore, the hybrid model will be referred to as an "alternative model" and placed in Section III of the DSM-5, which contains concepts for which further research is needed. Meanwhile, the main body of the DSM-5 will retain the DSM-IV criteria for personality disorders.

A key concern was whether the new model would lead to discrepancies between DSM-IV and DSM-5 definitions of the same disorder—especially for diagnoses such as borderline, antisocial, and schizotypal personality disorders for which a substantial body of research literature exists. "It is important to evaluate whether thresholds can be established that provide solid continuity between DSM-IV and proposed DSM-5 definitions," Drs Morey and Skodol write.

This new edition of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM-5), used by clinicians and researchers to diagnose and classify mental disorders, is the product of more than 10 years of effort by hundreds of international experts in all aspects of mental health. Their dedication and hard work have yielded an authoritative volume that defines and classifies mental disorders in order to improve diagnoses, treatment, and research. This manual, which creates a common language for clinicians involved in the diagnosis of mental disorders, includes concise and specific criteria intended to facilitate an objective assessment of symptom presentations in a variety of clinical settings inpatient, outpatient, partial hospital, consultation-liaison, clinical, private practice, and primary care. The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, is the most comprehensive, current, and critical resource for clinical practice available to today's mental health clinicians and researchers of all orientations. The information contained in the manual is also valuable to other physicians and health professionals, including psychologists, counselors, nurses, and occupational and rehabilitation therapists, as well as social workers and forensic and legal specialists. DSM-5 is the most definitive resource for the diagnosis and classification of mental disorders.