Reconceptualizing personality disorder diagnosis in the DSM-V: The discriminant validity challenge.

Abstract

Research on personality disorder (PD) diagnostic reliability, comorbidity, and treatment confirms that PD diagnoses lack discriminant validity: Our ability t o describe dfierent PDs in an abstract sense has outstripped our ability t o diagnose them accurately in real-world clinical settings. Here an alternative model of PD diagnosis is presented wherein three types of information are coded on h i s 11: (a) an overall rating of level of personality pathology, (b) separate intensity and impairment ratings for each relevant PD dimension, and (c) a listing of personality traits (including PDrelated traits) that enhance adaptation and functioning. Possible objections to the alternative model are considered (e.g., problems of diagnostician compliance, d i dplinewide resistance t o a new diagnostic framework),and advantages of the model over the cumnt diagnostic system are discussed (e.g., greater heuristic value, increased predictive validity).

Convergent Validity of the SWAP-200 Dependency Scales

“…Additionally, the Narcissistic composite description demonstrated substantial discriminant validity, because the remaining correlations between the Narcissistic composite description and clinician ratings of other Axis II disorders are modestly correlated. The taxonomy of Shedler and Westen (2004a), therefore, has shown promising results in the effort to minimize diagnostic overlap that is common to current measures of Axis II psychopathology (see Bornstein, 1998;, for detailed discussions of Axis II diagnostic overlap and comorbidity).…”

Evolução do DSM quanto ao critério categorial de diagnóstico para o distúrbio da personalidade antissocial

“…O sistema categórico para a avaliação do TPAS perde em relação a outros procedimentos diagnósticos por não identificar outras variáveis associadas à sua manifestação, por exemplo, componentes genéticos e neurológicos, fatores relacionados à origem e ao desenvolvimento 47 , bem como o tipo de crime, o tratamento e a reincidência criminal 6,10 . Bornstein 48 , Bernstein et al 49 e Widiger e Clark 25 acreditam que as atuais críticas sobre o modelo encontrado no DSM-IV e no DSM-IV-TR contribuirão, sem dúvida alguma, para a reformulação do próximo manual, o DSM-V. De qualquer forma, sabe-se que o sistema categórico não pretende fazer uma avaliação global do transtorno de personalidade, quer seja do Antissocial ou não, tampouco o sistema categó-rico deve ser abandonado 17 . O que os manuais procuram é desenvolver, basicamente, uma linguagem objetiva e acessí-vel e não um sistema final de reconhecimento de manifestações patológicas.…”

Psychometric characteristics of Cloninger's criteria for personality disorder in a population of French prisoners

“…There is now general agreement that personality disorders are best conceptualized dimensionally (Bornstein, 1998;Nestadt et al, 2006;Trull and Durrett, 2005;Widiger and Samuel, 2005). Thus, several dimensional or mixed dimensional/categorical models have been submitted to discussion for the construction of DSM-V (Bornstein, 1998;Costa et al, 2005;Livesley, 2005;Westen et al, 2006).…”

“…Thus, several dimensional or mixed dimensional/categorical models have been submitted to discussion for the construction of DSM-V (Bornstein, 1998;Costa et al, 2005;Livesley, 2005;Westen et al, 2006). Cloninger developed a practical means to diagnosis personality disorder based on his long experience with an earlier multidimensional personality model using the Temperament and Character Inventory (TCI) Svrakic et al, 1993).…”