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Personality Disorder Classification: Stuck in Neutral, How to Move Forward?

  • Psychiatric Diagnosis (MB First, Section Editor)
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Abstract

An “Alternative DSM-5 Model for Personality Disorders” was published in Sect. III of DSM-5, while the identical categories and criteria from DSM-IV for the personality disorders (PDs) are in Sect. II. Given strong shifts from categorical diagnoses toward dimensional representations in psychiatry, how did the PDs end up “stuck in neutral,” with the flawed DSM-IV model perpetuated? This article reviews factors that influenced the development of the new model and data to encourage and facilitate its use by clinicians. These include recognizing 1) a dimensional structure for psychopathology for which personality may be foundational; 2) a consensus on the structure of normal and abnormal personality; 3) the clinical significance of personality; 4) PD-specific severity required to establish disorder; 5) disruption, discontinuity, and perceived clinical utility of the Alternative Model may not be problems; and 6) a way forward involving collaborative research on neurobiological and psychosocial processes, treatment planning, and outcomes.

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Conflict of Interest

Andrew E. Skodol has received expert testimony fees from Lazarus & Associates. Dr. Skodol has received honorarium from Penn State University, Brigham Young University, Global Medical Education, Arizona Psychiatric Society, St. Luke’s-Roosevelt Hospital, Norwegian Psychiatric Association. Wright State University, World Psychiatric Association, and the American Psychiatry Association. He has also received royalties from American Psychiatric Publishing, Inc., and UpToDate. Dr. Skodol has also receive paid travel accommodations from Penn State University, Brigham Young University, St. Luke’s-Roosevelt Hospital, Norwegian Psychiatric Association, Wright State University, World Psychiatric Association, and the American Psychiatric Association.

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  1. Department of Psychiatry, University of Arizona College of Medicine, Tucson, AZ, USA

    Andrew E. Skodol

  2. Columbia University College of Physicians and Surgeons, New York, NY, USA

    Andrew E. Skodol

  3. 2626 E. Arizona Biltmore Circle, Unit #29, Phoenix, AZ, 85016, USA

    Andrew E. Skodol

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Skodol, A.E. Personality Disorder Classification: Stuck in Neutral, How to Move Forward?. Curr Psychiatry Rep 16, 480 (2014). https://doi.org/10.1007/s11920-014-0480-x

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