The time has come for dimensional personality disorder diagnosis

Hopwood, Christopher J.; Kotov, Roman; Krueger, Robert F.; Watson, David; Widiger, Thomas A.; Althoff, Robert R.; Ansell, Emily B.; Bach, Bo; Bagby, R. Michael; Blais, Mark A.; Bornovalova, Marina A.; Chmielewski, Michael S.; Cicero, David C.; Conway, Christopher; Clercq, Barbara De; Fruyt, Filip De; Docherty, Anna R.; Eaton, Nicholas R.; Edens, John F.; Forbes, Miriam K.; Forbush, Kelsie T.; Hengartner, Michael Pascal; Ivanova, Masha Y.; Leising, Daniel; Livesley, W. John; Lukowitsky, Mark R.; Lynam, Donald R.; Markon, Kristian E.; Miller, Joshua D.; Morey, Leslie C.; Mullins‐Sweatt, Stephanie N.; Ormel, Johan; Patrick, Christopher J.; Pincus, Aaron L.; Ruggero, Camilo J.; Samuel, Douglas B.; Sellbom, Martin; Slade, Tim; Tackett, Jennifer L.; Thomas, Katherine M.; Trull, Timothy J.; Vachon, David D.; Waldman, Irwin D.; Waszczuk, Monika A.; Waugh, Mark H.; Wright, Aidan G.C.; Yalch, Mathew M.; Zald, David H.; Zimmermann, Johannes

doi:10.1002/pmh.1408

Cited by 267 publications

(217 citation statements)

References 46 publications

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“…Sixth, in arguing for accepting the ICD-11 proposal in its current form, Hopwood and colleagues (Hopwood et al, in press) write that the “majority of clinicians and researchers support a transition to a more dimensional, evidence-based framework” (p. 4). This statement is inaccurate and conflates the science in support of a dimensional structure of personality pathology with a diagnostic system for PD.…”

Section: The Icd-11 Proposal: Limitations Of a Purely Dimensional Appmentioning

confidence: 99%

“…Nevertheless, the proposed system completely ignores this impressive body of research and clinical guidelines that have advanced the care of adolescent and adults with this disorder. While Hopwood and colleagues (Hopwood et al, in press) claim that many of the extant categories are “clinically problematic” (p. 4), there are well documented accounts of the empirical scope and clinical management of DSM –derived borderline (Linehan, 1993), dependent (Bornstein, 1993) and narcissistic (Ronningstam, Gunderson, & Lyons, 1995) PDs, as well as empirically derived descriptions of most of the DSM-IV / 5 PDs and how to engage and treat patients with these diagnoses (Clarkin, Fonagy, & Gabbard, 2010; Livesley, 1995). What should be done with this information and body of (largely publicly funded) research and clinical experience, especially since it was never conducted within a trait-based dimensional framework?…”

Section: The Icd-11 Proposal: Limitations Of a Purely Dimensional Appmentioning

confidence: 99%

See 1 more Smart Citation

The Challenge of Transforming the Diagnostic System of Personality Disorders

Herpertz

Huprich

Bohus

et al. 2017

Journal of Personality Disorders

140

100

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While the DSM-5 alternative model of personality disorder (PD) diagnosis allows the field to systematically compare categorical and dimensional classifications, the ICD-11 proposal suggests a radical change by restricting the classification of PDs to one category, deleting all specific types, basing clinical service provision exclusively upon a severity dimension, and restricting trait domains to secondary qualifiers without defining cutoff points. This article reflects broad international agreement about the state of PD diagnosis. It is argued that diagnosis according to the ICD-11 proposal is based on broad, potentially stigmatizing descriptions of impaired functioning and ignores much of the impressive body of research and treatment guidelines that have advanced the care of adults and adolescents with borderline and other PDs. Before radically changing classification, which highly impacts the provision of health care, head-to-head field trials coupled with the views of patients as well as thorough debate among scientists are urgently needed.

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Section: The Icd-11 Proposal: Limitations Of a Purely Dimensional Appmentioning

confidence: 99%

Section: The Icd-11 Proposal: Limitations Of a Purely Dimensional Appmentioning

confidence: 99%

The Challenge of Transforming the Diagnostic System of Personality Disorders

Herpertz

Huprich

Bohus

et al. 2017

Journal of Personality Disorders

140

100

View full text Add to dashboard Cite

show abstract

“…This dimensional trait approach was recently recognized by major psychiatric nosologies (DSM-5; American Psychiatric Association [2013] and ICD-11;Tyrer [2013]), and is supported by an extensive group of international researchers and clinicians who continue to stimulate the field to move toward a dimensional and evidence-based framework for personality and psychopathology (Hopwood, 2017;Kotov et al, 2017). This dimensional trait approach on personality-related pathology has also been complemented by a developmental perspective, showing that childhood maladaptive traits can be represented within a similar structural model and have significant value for understanding adaptive and maladaptive outcomes (De Fruyt, De Clercq, De Caluwé, & Verbeke, 2017).…”

mentioning

confidence: 99%

Developmental pathways of childhood dark traits.

Clercq¹,

Hofmans²,

Vergauwe³

et al. 2017

Journal of Abnormal Psychology

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The dark triad of personality has traditionally been defined by 3 interrelated constructs, defined as Narcissism, Machiavellianism, and Psychopathy. Although the content of each of these constructs is clearly represented in childhood maladaptive trait measures, no studies have jointly addressed the prospective developmental course of this core set of maladaptive characteristics throughout childhood and adolescence. The current study uses latent growth modeling to explore how early dark traits develop over time, relying on a selected set of 6 childhood maladaptive traits that conceptually cover the adult dark triad. Across a 5-wave multi-informant design spanning 10 years of childhood, adolescence, and emerging adulthood (N wave 1 ϭ 717, 54.4% girls, age range T 1 ϭ 8 -14.7 years, mean age ϭ 10.73), results indicate that childhood dark traits show to some extent shared growth across time, although notable unique growth variance was also observed. Early dark traits further demonstrate significant association patterns with an adult dark triad measure across informants and are increasingly able to discriminate among more and less prototypical profiles of adult dark triad scores. Findings are discussed from a developmental psychopathology framework, underscoring that the proposed set of childhood dark traits represents a meaningful developmental precursor of the adult dark triad. General Scientific SummaryThis article describes how socially aversive personality traits develop from childhood onward and demonstrates that these traits overall decline over time, although some unique developmental issues are observed too for each of the childhood traits. From an outcome perspective, the study shows that childhood dark traits, as perceived by the children themselves as well as by their mothers, are meaningfully related to adult socially aversive traits.

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“…We are mindful of proposed changes for the conceptualization of personality pathology, with an emerging preference for dimensional assessments and models ( [35]; e.g., the Alternative Model for Personality Disorders in the DSM-5; the Five-Factor/Big-5; the Lenzenweger and Depue [13,29] neurobehavioral approaches) as well as a focus on dimensions of pathology that might exist outside the traditional nomenclatures (e.g., the RDoC approach). The dimensional approach is one that our team has long embraced [3,5,29,36,37].…”

Section: Discussionmentioning

confidence: 99%

Malignant Narcissism in Relation to Clinical Change in Borderline Personality Disorder: An Exploratory Study

et al. 2018

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Background: Normal and pathological narcissism have been the focus of considerable theoretical discussion and empirical research in recent years in personality psychology and psychopathology. Kernberg [1-4] has argued that there is a particularly dysfunctional and impairing variant of narcissistic disturbance known as malignant narcissism. This exploratory study sought to develop, using established assessment methods, a dimensional measure of malignant narcissism that incorporates the key features of grandiose narcissism, paranoid propensities, psychopathic features, and proclivity for a sadistic and aggressive interpersonal style. Method and Sampling: This study examined 57 subjects, diagnosed with borderline personality disorder that were treated using 3 different empirically supported treatments in a previous study [5], for possible deviance on the proposed malignant narcissism index. It also evaluated 2 important clinical domains of change in relation to malignant narcissism. To wit, it was predicted, based on Kernberg’s [3, 4] clinical model, that elevated levels of malignant narcissism would be significantly associated with slower rates of improvement in both general psychosocial/psychological functioning and anxiety among treated individuals. Results: Higher levels of malignant narcissism were associated, as predicted, with slower rates of improvement in both global functioning and anxiety. The proposed malignant narcissism index was a more powerful predictor of slowed improvement in global functioning than simple narcissistic personality disorder features. Conclusions: The heuristic potential of the malignant narcissism construct is discussed and the utility of a dimensional approach to this construct is explored, especially in reference employing personality traits/processes to better understand pathological configurations and personality disturbance.

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The time has come for dimensional personality disorder diagnosis

Cited by 267 publications

References 46 publications

The Challenge of Transforming the Diagnostic System of Personality Disorders

The Challenge of Transforming the Diagnostic System of Personality Disorders

Developmental pathways of childhood dark traits.

Malignant Narcissism in Relation to Clinical Change in Borderline Personality Disorder: An Exploratory Study

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