The Plight of Personality Disorders in theDSM-5

Abstract

This article provides a brief history of the development of the Diagnostic and Statistical Manual of Mental Disorders published by the American Psychiatric Association, and how it relates to the proposed fifth edition to be published in 2013. Of particular emphasis is Axis II and how this axis is likely to be restructured. The reconceptualization of the nosology for personality disorders has been controversial since the publication of the DSM-III-R (Wilson, 1993). In both the clinical and academic communities, ongoing debate about diagnostic classification of personality disorders has been common. One recurrent theme among the deliberations on diagnosis and personality disorder focuses on the question of whether distinct (categorical) diagnoses exist or whether diagnoses are dimensionally related to each other in some empirically determined way. The proposed changes for Axis II in the DSM-5 are likely to bridge the gap between these two arguments by revamping the overall criteria and discarding the three currently used diagnostic clusters. The resulting nosology proposes six personality disorders with common factors in Criteria A and Criteria B. However, a major concern and a continuing problem not likely to be resolved in this edition is the symptom resemblance of borderline personality disorder and bipolar disorder. This article suggests some ways the revised DSM might affect mental health nursing practice.

Antisocial Personality Disorder in Older Adults: A Critical Review

“…The most widely studied dimensional approach is based on the FFM, 62 and there has been considerable effort on the part of researchers for the DSM to adopt this model. 40,63 –65 The FFM was developed through empirical methods and consists of 5 domains, extroversion versus introversion, openness versus closedness to experience, agreeableness versus antagonism, conscientiousness versus negligence, and neuroticism versus emotional stability. 40,66 Researchers applied the FFM to PDs, finding that characteristics of the disorders are indeed related to the maladaptive variants of the FFM.…”