Dimensional models of personality disorders: Challenges and opportunities

Abstract

Categorical models of personality disorders have been beneficial throughout psychiatric history, providing a mechanism for organizing and communicating research and treatment. However, the view that individuals with personality disorders are qualitatively distinct from the general population is no longer tenable. This perspective has amassed steady criticism, ranging from inconsequential to irreconcilable. In response, stronger evidence has been accumulated in support of a dimensional perspective that unifies normal and pathological personality on underlying trait continua. Contemporary nosology has largely shifted toward this dimensional perspective, yet broader adoption within public lexicon and routine clinical practice appears slow. This review focuses on challenges and the related opportunities of moving toward dimensional models in personality disorder research and practice. First, we highlight the need for ongoing development of a broader array of measurement methods, ideally facilitating multimethod assessments that reduce biases associated with any single methodology. These efforts should also include measurement across both poles of each trait, intensive longitudinal studies, and more deeply considering social desirability. Second, wider communication and training in dimensional approaches is needed for individuals working in mental health. This will require clear demonstrations of incremental treatment efficacy and structured public health rebates. Third, we should embrace cultural and geographic diversity, and investigate how unifying humanity may reduce the stigma and shame currently generated by arbitrarily labeling an individual's personality as normal or abnormal. This review aims to organize ongoing research efforts toward broader and routine usage of dimensional perspectives within research and clinical spaces.

Understanding Broader Community Perspectives on the Scientific Accuracy and Stigma of Personality Trait Labels

“…There have been proposals to fundamentally change how personality disorders (PD) are conceptualized, diagnosed, and labeled in the Diagnostic and Statistical Manual of Mental Disorders (currently 5 th ed., text rev. ; DSM-5-TR; American Psychiatric Association [APA], 2022; Monaghan & Bizumic, 2023). For example, alternative labels such as "interpersonal disorders" have been proposed as potentially more valid and clinically useful than traditional "personality disorders" terminology (Wright et al, 2022).…”

“…Example studies integrating broader community perspectives find that community adults generally agree with researchers and clinicians regarding which narcissistic PD features are central versus peripheral (Miller et al, 2017), thereby informing narcissism conceptualizations and assessment. Additionally, the dimensionally-based Alternative DSM-5 Model for Personality Disorders (AMPD) has been proposed as a system for addressing limitations of the categorical DSM PD model (Monaghan & Bizumic, 2023). Cano and Sharp's (2023) assessment of diagnostic model perceptions across undergraduate and clinical/community samples identified both potential benefits and challenges of using dimensionally-based models for communicating clinical information with patients.…”

“…Regarding other considerations related to use of standard PD language, it would have been interesting to assess terminology views in relation to the AMPD, which may eventually supplant current DSM PD descriptions as discussed (Monaghan & Bizumic, 2023). In addition to models such as the AMPD that would alter PD conceptualizations specifically, more comprehensive dimensional frameworks such as the Hierarchical Taxonomy of Psychopathology (HiTOP; Conway et al, 2022) would reshape diagnostic classification even more broadly.…”

Narcissistic and dependent traits and behavior in four archetypal 2-person, 2-choice games

“…This might result in passive or selfless behavior in cooperative games such as Hero or The Battle of the Sexes ( 52 ). Moreover, although these models represent simplified interactions, they may be used to predict behaviors in real life situations and provide primary treatment targets ( 56 ).…”

The relationship between mood disorders, personality disorder and suicidality in adolescence: does general personality disturbance play a significant role in predicting suicidal behavior?

“…Furthermore, the debate on the of diagnosis of PD in the adolescent population has been influenced by the wider issues concerning the approach to be employed in assessing personality disorders [ 71 , 74 ]. In recent years there has been a long and significant [ 75 , 76 ].…”