The role of identity in the DSM-5 classification of personality disorders

Abstract

In the revised Diagnostic and Statistical Manual DSM-5 the definition of personality disorder diagnoses has not been changed from that in the DSM-IV-TR. However, an alternative model for diagnosing personality disorders where the construct “identity” has been integrated as a central diagnostic criterion for personality disorders has been placed in section III of the manual. The alternative model’s hybrid nature leads to the simultaneous use of diagnoses and the newly developed “Level of Personality Functioning-Scale” (a dimensional tool to define the severity of the disorder). Pathological personality traits are assessed in five broad domains which are divided into 25 trait facets. With this dimensional approach, the new classification system gives, both clinicians and researchers, the opportunity to describe the patient in much more detail than previously possible. The relevance of identity problems in assessing and understanding personality pathology is illustrated using the new classification system applied in two case examples of adolescents with a severe personality disorder.

Identity-Related Dysfunction: Integrating Clinical and Developmental Perspectives

“…In addition, and also consistent with Erikson (1956), functioning in these areas is conceptualized as existing along continua, with moderate or greater impairment being indicative of disorder. Implementing a more dimensional approach is now favored by many in the psychological community, including proponents of the developmental psychopathology perspective, as it can more accurately capture developmental nuances, allow for more flexibility in diagnosis, and better account for intraindividual change over time (Schmeck et al, 2013;Widiger & Trull, 2007). With identity taking a more prominent place in the DSM-5, developmental researchers have an important role in guiding of how to define and measure identity problems.…”

Borderline Personality Disorder in Adolescence

“…93 Potential advantages of a dimensional approach are that (1) adolescents with BPD can be described much more in detail than previously possible, (2) subthreshold conditions can be easily identified and classified, (3) changes in BPD symptomatology over the course of illness can be more sensitively detected, and (4) therapeutic interventions could be more individually targeted. 94 …”

The Brave New World of Personality Disorder-Trait Specified: Effects of Additional Definitions on Coverage, Prevalence, and Comorbidity

“…For example, Livesley (2012) thought that PD-TS would be the most prevalent diagnosis and wondered whether the type diagnoses would add any information beyond that provided by the trait dimensions. Schmeck, Schlüter-Müller, Foelsch, and Doering (2013) provided two case-study examples of individuals who met criteria for DSM-5 -II dependent and narcissistic PD (NPD), respectively. They diagnosed both individuals using the DSM-5 -III model, and stated that the new system provided more information and was more helpful for treatment planning than the single diagnoses.…”