The trait–type dialectic: Construct validity, clinical utility, and the diagnostic process.

Abstract

The current debate regarding how best to conceptualize, operationalize, and assess personality pathology is often framed as a choice between categorical ("type") and dimensional ("trait") models, but when viewed from the perspective of the diagnostician, these two approaches actually have much in common. It is not possible to assign symptom ratings in any categorical personality disorder framework without first evaluating the severity of each symptom on a continuum, nor to implement dimensional personality disorder assessments in clinical settings without using thresholds that demarcate the presence of personality pathology, or severity of personality dysfunction. Although recent discussions of these two frameworks have focused primarily on issues regarding construct validity (and to a lesser extent, clinical utility), it is important to consider the impact of the diagnostic process as well. When considered within this broader context, the advantages and limitations of each perspective are illuminated, and it becomes clear that the categorical and dimensional frameworks represent an evolving dialectic that will continue into the future, as new and better models alter the focus of these debates. (PsycINFO Database Record

Clinical utility of categorical and dimensional perspectives on personality pathology: A meta-analytic review.

“…For example, it will be important to obtain similar clinical utility ratings from other types of health care professionals. As Bornstein (2019) noted, PD clinical utility studies conducted to date have focused exclusively on mental health practitioners; it may be that different results emerge when health care professionals with other backgrounds (e.g., family physicians) engage the categorical and trait frameworks. Given ongoing efforts to strengthen psychology’s role within primary care (McDaniel & deGruy, 2014), and various medical specialties, this will be an important aspect of clinical utility to address during the coming years.…”

“…Reviews of emerging dimensional models are provided by Mullins-Sweatt and Widiger (2009), Krueger, Hopwood, Wright, and Markon (2014), and Morey, Benson, Busch, and Skodol (2015). Bornstein (2019), Clarkin and Huprich (2011), and Herpertz et al (2017) discussed strengths and limitations of the categorical and dimensional perspectives, along with unresolved issues and potential areas for future integration.…”

Personality in a Hierarchical Model of Psychopathology

“…One of the concerns or objections to any dimensional model of psychopathology, and to personality disorders more specifically, is the presumption that the human mind prefers or naturally thinks categorically (e.g., Bornstein, 2018). There is also the related presumption that clinical decisions are themselves categorical, such as whether to provide treatment (e.g., Kraemer, Noda, & O'Hara, 2004).…”

Open Peer Commentary and Author'S Response

“…Two particularly important problems are within-diagnosis heterogeneity and between-diagnosis comorbidity (Clark, 2007;Widiger & Samuel, 2005;Wright et al, 2013). With regard to the former, the Section II model essentially represents a typological scheme (Bornstein, 2018) that assumes that heterogeneous constructs contain surplus meaning, that is, that they incorporate important interactive or configural effects that cannot be captured by a simple trait-based approach. For example, borderline PD combines heterogeneous attributes reflecting negative affectivity (e.g.…”