Challenges and Strategies in Helping the DSM Become More Dimensional and Empirically Based
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The DSM-5 creation process and outcome underlines a core tension in psychiatry between empirical evidence that mental pathologies tend to be dimensional and a historical emphasis on delineating categorical disorders to frame psychiatric thinking. The DSM has been slow to reflect dimensional evidence because doing so is often perceived as a disruptive paradigm shift. As a result, other authorities are making this shift, circumventing the DSM in the process. For example, through the Research Domain Criteria (RDoC), NIMH now encourages investigators to focus on a dimensional and neuroscientific conceptualization of mental disorder research. Fortunately, the DSM-5 contains a dimensional model of maladaptive personality traits that provides clinical descriptors that align conceptually with the neuroscience-based dimensions delineated in the RDoC and in basic science research. Through frameworks such as the DSM-5 trait model, the DSM can evolve to better incorporate evidence of the dimensionality of mental disorder.
KeywordsNosology Mental disorder Dimensions Categories Classification
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Conflict of Interest
Robert F. Krueger, Christopher J. Hopwood, and Aidan G. C. Wright declare that they have no conflict of interest.
Kristian E. Markon was an Adviser to the DSM-5 Personality and Personality Disorders Workgroup.
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This article does not contain any studies with human or animal subjects performed by any of the authors.
Papers of particular interest, published recently, have been highlighted as: • Of importance
- 10.Krueger RF, Hopwood CJ, Wright, AGC, Markon KE. DSM-5 and the Path toward Empirically Based and Clinically Useful Conceptualization of Personality and Psychopathology. Clin Psychol Sci Pract. 2014;21(3):245–261. doi: 10.1111/cpsp.12073
- 11.Gunderson JG. Introduction to section IV: personality disorders. In: Widiger TA, Frances A, Pincus H, et al., editors. DSM IV sourcebook, vol. 2. Washington DC: American Psychiatric Association; 1996.Google Scholar
- 14.Ramos V, Canta G, deCastro F, Leal I. Discrete subgroups of adolescents diagnosed with borderline personality disorder: a latent class analysis of personality features. J Pers Dis. 2014. In press.Google Scholar
- 19.Kendler KS, Myers J. The boundaries of the internalizing and externalizing genetic spectra in men and women. Psychol Med. 2014;44(3):647–55. doi: 10.1017/S0033291713000585
- 24.Costa Jr PT, Widiger TA. Personality disorders and the five-factor model of personality. 3rd ed. Washington, DC: American Psychological Association; 2012.Google Scholar
- 25.Harkness AR, McNulty JL. The Personality Psychopathology Five (PSY-5): Issues from the pages of a diagnostic manual instead of a dictionary. In: Strack S, Lorr M, editors. Differentiating normal and abnormal personality. New York: Springer; 1994. p. 291–315.Google Scholar
- 27.•Krueger RF, Markon KE. The role of the DSM-5 personality trait model in moving toward a quantitative and empirically based approach to classifying personality and psychopathology. Annu Rev Clin Psychol. 2014;10:477–501. doi: 10.1146/annurev-clinpsy-032813-153732. Provides a recent review of empirical literature on the DSM-5 personality trait model.PubMedCrossRefGoogle Scholar
- 29.•Adelstein JS et al. Personality is reflected in the brain’s intrinsic functional architecture. PLoS One. 2011;6(11):e27633. doi: 10.1371/journal.pone.0027633. Provides evidence that aspects of the intrinsic functional organization of the brain reflect major domains of human personality.PubMedCentralPubMedCrossRefGoogle Scholar