Diagnostic and Statistical Manual of Mental Disorders

Abstract

Proposed changes in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V) include replacing current personality disorder (PD) categories on Axis II with a taxonomy of dimensional maladaptive personality traits. Most of the work on dimensional models of personality pathology, and on personality disorders per se, has been conducted on young and middle-aged adult populations. Numerous questions remain regarding the applicability and limitations of applying various PD models to early and later life. In the present paper, we provide an overview of such dimensional models and review current proposals for conceptualizing PDs in DSM-V. Next, we extensively review existing evidence on the development, measurement, and manifestation of personality pathology in early and later life focusing on those issues deemed most relevant for informing DSM-V. Finally, we present overall conclusions regarding the need to incorporate developmental issues in conceptualizing PDs in DSM-V and highlight the advantages of a dimensional model in unifying PD perspectives across the life span.Work toward a new edition of the Diagnostic and Statistical Manual of Mental Disorders (5th ed., DSM-V ) is well underway. Proposed changes to the conceptualization of personality disorders (PDs), which are classified on Axis II, include substantial revisions to the current categorical system. Utilization of a dimensional approach is being given serious attention. Before such a fundamental change takes place, numerous factors must be considered, including implications for personality pathology across the life span. In this paper, we present evidence that supports the unifying features of a dimensional system and argue that these features would rectify numerous problems that plague the current system, focusing on problems associated with measuring personality pathology in younger and older age groups. To begin, we review the basic features of dimensional models of personality and specifically discuss present proposals for classifying PDs in DSM-V. Next, we conduct a comprehensive review of current evidence for the development of PDs in early life, including longitudinal studies of PDs, critical developmental periods for PDs, and clinical presentation of PDs in younger age groups. We highlight the importance of two concepts from