New Personality Disorder Framework Proposed for Upcoming DSM Revision

The diagnosis of personality disorders is set to undergo a major change in the proposed revision of the Diagnostic and Statistical Manual of Mental Disorders (DSM). The DSM-V would drop the number of diagnosable personality disorders from 10 to six and create a hybrid model for making a diagnosis.

“This hybrid model is very different from the way personality disorders are presented as rigid behavioral categories in the current manual,” according to an American Psychiatric Association (APA) news release. “The change integrates disorder types with pathological personality traits and, most importantly, levels of impairment in what is known as ‘personality functioning.’”

Proposed Personality Disorder Types

The committee working on the DSM-V revisions proposed the following six personality disorder types:

• Antisocial Personality Disorder
• Avoidant Personality Disorder
• Borderline Personality Disorder
• Narcissistic Personality Disorder
• Obsessive Compulsive Personality Disorder
• Schizotypal Personality Disorder

Personality Functioning and Traits

For a diagnosis to be made within one of those personality disorder types, several conditions must be met:

• The person must be significantly impaired in the two areas of personality functioning: self and interpersonal. Self is how the person views themselves and how they accomplish goals. Interpersonal is how the person forms close relationships and experiences empathy.
• The person must be displaying pathological personality treats in at least one of five broad areas: antagonism, detachment, negative affectivity, psychoticism, or compulsivity vs. disinhibition.

“The importance of personality functioning and personality traits is the major innovation here,” said Andrew Skodol, MD, chair of the DSM-V Personality and Personality Disorders Work Group and a research professor of psychiatry at the University of Arizona College of Medicine.

“In the past, we viewed personality disorders as binary,” he said. “You either had one or you didn’t. But we now understand that personality pathology is a matter of degree.”

The current behavior-based criteria for personality disorders are not always reliable, according to the APA release, because behavior can be intermittent and changeable over time. This can hinder an accurate diagnosis and impede personality disorder treatment.

“Impairments in personality functioning and pathological personality traits tend to be more stable over time and consistent regardless of the situation,” said the APA. “Both stability and consistency would be required under the revisions to the diagnostic criteria.”

Real-World Trials

Clinical settings around the country are currently evaluating the proposed criteria for personality disorders. About  3,900 mental health professionals in individual practice and smaller settings will participate in the field trials.

The proposed diagnostic criteria for personality disorders can be reviewed in its entirety at www.dsm5.org.

Let us know below what you think of the proposed changes.