A compromise solution between overlapping and overlooking DSM personality disorders in Chinese psychiatric practice
Abstract
Objective This study aimed to examine the overlaps between the Diagnostic and Statistical Manual-5 (DSM-5) Personality Disorders (PDs) in a high-risk clinical population and to explore a transitional model for implementing DSM-5 PDs.Method A sample population of 982 outpatients with at least one diagnosed PD was selected from 3,075 outpatients of the Shanghai Mental Health Center. The diagnostic process comprised of a personality diagnostic questionnaire and a structured clinical interview.Results 685 (22.3%) patients were diagnosed with at least one of six PDs (antisocial, avoidant, borderline, narcissistic, obsessive-compulsive, and schizotypal) under the alternative DSM-5 model for personality disorders proposed in Section III of the DSM-5. Nearly 20.3% of the subjects with PD met criteria for at least two PDs (of the 685 PD patients/6 PD model). Cluster and principal component analyses suggest a transitional model for the 7 specific PD categories (among the 722 PD patients, the overlapping rate was 24.1%) will be more appropriate for PD diagnosis in China.Conclusions Using the simplified PD categories in the alternative DSM-5 model for personality disorders will reduce the overlaps in PD diagnoses in Chinese psychiatric practice, and should be preferred over the DSM-5 PD diagnostic system.
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BPD is often overlooked in psychiatric practice in China.
“However, despite BPD being classified as a Cluster B personality disorder (PD), it is often overlooked in the psychiatric practice in China (5, 6).”
From Age-related differences in borderline personality disorder traits and childhood maltreatment: a cross-sectional study (2025) · cites this paper as [6]
Cites
Diagnostic and Statistical Manual of Mental Disorders
American Psychiatric Association (2013) · doi:10.1176/appi.books.9780890425596 · Cited by 116,369 · see citing works
Diagnostic and Statistical Manual of Mental Disorders
Williams, J. B. W., & First, M. B. (2013) · Oxford University Press eBooks · doi:10.1093/acrefore/9780199975839.013.104 · Cited by 109,841 · see citing works
Diagnostic and Statistical Manual of Mental Disorders
American Psychiatric Association (2022) · doi:10.1176/appi.books.9780890425787 · Cited by 23,476 · see citing works
Initial reliability and validity of a new retrospective measure of child abuse and neglect
(1994) · American Journal of Psychiatry · doi:10.1176/ajp.151.8.1132 · Cited by 3,577 · see citing works
The prevalence of DSM-IV personality disorders in psychiatric outpatients
Zimmerman, M., Rothschild, L., & Chelminski, I. (2005) · American Journal of Psychiatry · doi:10.1176/appi.ajp.162.10.1911 · Cited by 825 · cited 2× · see citing works
“Furthermore, the current categorical approaches to diagnosis a PD have been criticized due to their high within-PD overlapping rates as reported by many studies [12, 13].”
BackgroundResultThe American Psychiatric Association at Washington
(1930) · Psychiatric Quarterly · doi:10.1007/bf01579058 · Cited by 771 · see citing works
Hyler, S. E., Skodol, A. E., Kellman, H. D., Oldham, J. M., & Rosnick, L. (1990) · American Journal of Psychiatry · doi:10.1176/ajp.147.8.1043 · Cited by 390 · see citing works
DSM-III Personality Disorder Diagnoses in a Nonpatient Sample
Zimmerman, M. A. (1989) · Archives of General Psychiatry · doi:10.1001/archpsyc.1989.01810080012002 · Cited by 386 · see citing works
Diagnosis of DSM-III-R personality disorders by two structured interviews: patterns of comorbidity
Oldham, J. M., Skodol, A. E., Kellman, H. D., Hyler, S. E., Rosnick, L., & Davies, M. (1992) · American Journal of Psychiatry · doi:10.1176/ajp.149.2.213 · Cited by 324 · see citing works
Validity of the Personality Diagnostic Questionnaire-Revised: A replication in an outpatient sample
Hyler, S. E., Skodol, A. E., Oldham, J. M., Kellman, H. D., & Doidge, N. (1992) · Comprehensive Psychiatry · doi:10.1016/0010-440x(92)90001-7 · Cited by 247 · see citing works
Verheul, R., & Widiger, T. A. (2004) · Journal of Personality Disorders · doi:10.1521/pedi.18.4.309.40350 · Cited by 166 · see citing works
Individual Growth Curve Analysis Illuminates Stability and Change inPersonality Disorder Features
Lenzenweger, M. F., Johnson, M. D., & Willett, J. B. (2004) · Archives of General Psychiatry · doi:10.1001/archpsyc.61.10.1015 · Cited by 159 · see citing works
Hurt, S. W., Hyler, S. E., Frances, A., Clarkin, J. F., & Brent, R. L. (1984) · American Journal of Psychiatry · doi:10.1176/ajp.141.10.1228 · Cited by 117 · see citing works
Stability and Change in Personality Disorders
Morey, L. C., & Hopwood, C. J. (2012) · Annual Review of Clinical Psychology · doi:10.1146/annurev-clinpsy-050212-185637 · Cited by 111 · see citing works
Yang, J., McCrae, R. R., Costa, P. T., Yao, S., Dai, X., Cai, T., & Gao, B. (2000) · Journal of Personality Disorders · doi:10.1521/pedi.2000.14.3.249 · Cited by 100 · see citing works
Subtypes, Dimensions, Levels, and Mental States in Narcissism and Narcissistic Personality Disorder
Levy, K. N. (2012) · Journal of Clinical Psychology · doi:10.1002/jclp.21893 · Cited by 93 · see citing works
Murphy, C., & Vess, J. D. (2003) · Psychiatric Quarterly · doi:10.1023/a:1021137521142 · Cited by 82 · see citing works
The alternative DSM-5 model for personality disorders
Oldham, J. M. (2015) · World Psychiatry · doi:10.1002/wps.20232 · Cited by 67 · see citing works
Patterns of Comorbidity among DSM-III-R Personality Disorders
Marinangeli, M. G., Butti, G., Scinto, A., Cicco, L. D., Petruzzi, C., Daneluzzo, E., & Rossi, A. (2000) · Psychopathology · doi:10.1159/000029123 · Cited by 62 · see citing works
Zhang, T., Wang, L., Good, M. D., Good, B. J., Chow, A., Dai, Y., Yu, J., Zhang, H., & Xiao, Z. (2011) · Social Psychiatry and Psychiatric Epidemiology · doi:10.1007/s00127-011-0445-x · Cited by 48 · see citing works
Self-citationMorey, L. C., & Stagner, B. H. (2012) · Journal of Clinical Psychology · doi:10.1002/jclp.21895 · Cited by 41 · see citing works
The Classification of Personality Disorders: Critical Review and Need for Rethinking
Jablensky, A. V. (2002) · Psychopathology · doi:10.1159/000065129 · Cited by 29 · see citing works
Culture and personality disorder
Ryder, A. G., Sunohara, M., & Kirmayer, L. J. (2014) · Current Opinion in Psychiatry · doi:10.1097/yco.0000000000000120 · Cited by 27 · see citing works
Zhang, T.-H., Li, H.-J., Tang, Y.-Y., Li, H., Zheng, L.-N., Guo, Q., Zhao, S.-Y., Zhuo, K., Qian, Z.-Y., Wang, L., et al. (2015) · Psychiatry Research · doi:10.1016/j.psychres.2015.04.049 · Cited by 26 · see citing works
Self-citationDoes the Diagnosis of Multiple Axis Ii Disorders Have Clinical Significance?
Zimmerman, M. A., Galione, J. N., Chelminski, I., Young, D., Dalrymple, K. L., & Morgan, T. A. (2012) · Annals of Clinical Psychiatry · doi:10.1177/104012371202400303 · Cited by 14 · see citing works
Personality disorders in the DSM-5: Current status, lessons learned, and future challenges.
Widiger, T. A., & Krueger, R. F. (2013) · Personality Disorders Theory Research and Treatment · doi:10.1037/per0000051 · Cited by 11 · see citing works
The need to establish diagnostic criteria for borderline personality disorder in China.
Wang, L., & Xiao, Z. (2012) · PubMed Central · doi:10.3969/j.issn.1002-0829.2012.04.006 · Cited by 6 · see citing works
Self-citationA Survey on the Comorbidity of Personality Disorders in Patients Counseling in a Mental Hospital
Yun, D. (2008) · Zhongguo xinli weisheng zazhi · Cited by 5 · see citing works
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Li, G., Lin, Y., Xu, Y., Zhou, Y., Wei, Y., Xu, L., Tang, X., Wang, Z., Hu, Q., Wang, J., et al. (2025) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2025.1454328 · Cited by 3 · see citing works
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- Authors
- Zhu, S., Zhang, T., Yang, C., Wei, Y., Xu, L., Wang, J., Chow, A., Liu, X., Jiang, K., Xiao, Z., Zhou, H., & Wang, J.
- Affiliations
- Shanghai Jiao Tong University (CN)
- James Cook University Singapore (SG)
- Corresponding author
- Zhang, TianHong
- Zhou, Hui
- Wang, JiJun
- Venue
- Social Psychiatry and Psychiatric Epidemiology
- Published
- 2017-09-27
- Volume
- 53
- Issue
- 1
- Pages
- 99-106
- ISSN
- 0933-7954 (ISSN-L)
- 1433-9285
- OpenAlex
- W2759503594
- Cited by
- 7
- References
- 28
- Citations by year
- 2025: 2 · 2024: 1 · 2022: 1 · 2021: 1 · 2019: 2
- FWCI
- 0.68
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Social Psychiatry and Psychiatric Epidemiology (publishedVersion)
- PubMed (publishedVersion)
- ResearchOnline at James Cook University (James Cook University) (submittedVersion)
- Funders
- National Natural Science Foundation of China (81671329, 81671332)
- Ministry of Science and Technology of the People's Republic of China (2016YFC1306803)
- Shanghai Science and Technology Committee (15411967200, 14411961400)
- Shanghai Shenkang Hospital Development Center (16CR2015A, 16CR3016A)
- Shanghai Key Laboratory of Psychotic Disorders (13dz2260500)
- Division of early psychosis (2013-YJTSZK-05)
- Shanghai Jiao Tong University Foundation (14JCRY04, YG2014MS40)
- Shanghai Mental Health Center Foundation (2016-FX-01)
- SHSMU-ION Research Center for Brain Disorders (2015NKX001)
- Program of Shanghai Academic Research Leader (16XD1402400)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Personality Disorders and Psychopathology
- Social Sciences › Psychology › Clinical Psychology › Personality Traits and Psychology
- Health Sciences › Medicine › Psychiatry and Mental health › Bipolar Disorder and Treatment
- Keywords
- personality disorders, DSM-5 personality disorders, diagnostic overlap, antisocial personality disorder, borderline personality disorder, narcissistic personality disorder, schizotypal personality disorder, obsessive-compulsive personality disorder, avoidant personality disorder, personality disorder diagnosis
- MeSH terms
- Adult, Antisocial Personality Disorder, China, Female, Humans, Male, Middle Aged, Outpatients, Personality, Personality Disorders, Surveys and Questionnaires, Diagnostic and Statistical Manual of Mental Disorders
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