Personality disorder in DSM-5: an oral history
Abstract
As the revision process leading to DSM-5 began, the domain of personality disorder embodied the highest aspirations for major change. After an initial prototype-based proposal failed to gain acceptance, the Personality and Personality Disorders Work Group (P&PDWG) developed a hybrid model containing categorical and dimensional components. A clash of perspectives both within the P&PDWG and between the P&PDWG and DSM-5 oversight committees led to the rejection of this proposal from the main body of DSM-5. Major issues included conflicting ways of conceptualizing validation, differences of opinion from personality disorder experts outside the P&PDWG, divergent concepts of the magnitude of evidence needed to support substantial changes, and the disagreements about clinical utility of the hybrid model. Despite these setbacks, the 'Alternative DSM-5 Model of Personality Disorder' is presented in Section III of the DSM-5. Further research should clarify its performance relative to the DSM-IV criteria reprinted in the main DSM-5 text.
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During the development of the DSM-5, a proposal to adopt a hybrid categorical/dimensional approach to the diagnosis of Personality Disorders was ultimately unsuccessful.
“Although there was a proposal during the development of the DSM-5 to adopt a hybrid categorical/dimensional approach to the diagnosis of Personality Disorders, that effort was ultimately unsuccessful 86 .”
From An organization‐ and category‐level comparison of diagnostic requirements for mental disorders in <scp>ICD</scp> ‐11 and <scp>DSM</scp> ‐5 (2021) · cites this paper as [86]
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- Authors
- Zachar, P., Krueger, R. F., & Kendler, K. S.
- Affiliations
- Auburn University (US)
- University of Minnesota (US)
- Virginia Commonwealth University (US)
- Corresponding author
- Kendler, K. S.
- Venue
- Psychological Medicine
- Publisher
- Cambridge University Press (CUP)
- Published
- 2015-10-20
- Volume
- 46
- Issue
- 1
- Pages
- 1-10
- ISSN
- 0033-2917 (ISSN-L)
- 1469-8978
- OpenAlex
- W1770229507
- Cited by
- 206
- References
- 8
- Citations by year
- 2026: 6 · 2025: 8 · 2024: 34 · 2023: 8 · 2022: 10 · 2021: 17 · 2020: 24 · 2019: 28 · 2018: 25 · 2017: 25 · 2016: 20 · 2015: 1
- FWCI
- 29.35
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Psychological Medicine (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Personality Disorders and Psychopathology
- Social Sciences › Psychology › Clinical Psychology › Personality Traits and Psychology
- Social Sciences › Arts and Humanities › Philosophy › Mental Health and Psychiatry
- Keywords
- personality disorders, DSM-5, diagnostic criteria, diagnostic validation, clinical utility, DSM-IV diagnostic criteria, psychiatric classification
- MeSH terms
- Humans, Personality Disorders, Diagnostic and Statistical Manual of Mental Disorders, History, 21st Century
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