DSM-IV and ICD-10 both diagnose personality disorders
categorically, yet studies indicate that many patients meet
criteria for an excessive number of diagnoses, raising the question
of whether personality disorders are discrete conditions or rather
distinctions along dimensions of general personality functioning.
This collection of papers renews long-standing proposals for a
dimensional model of personality disorder, describing alternative
models, addressing questions about their clinical application and
utility, and suggesting that future research seek to integrate such
models within a common hierarchical structure.
With contributions by preeminent researchers in the field,
"Dimensional Models of Personality Disorders" is drawn from a
conference series convened by APA, WHO, and NIH in order to plan
for the fifth edition of the DSM. The Nomenclature Work Group
concluded that consideration should be given to basing part or all
of DSM-V on dimensions rather than categories, and recommended that
a dimensional model for personality disorders should serve as a
basis for exploring dimensional approaches in other areas.
Accordingly, the volume opens with a presentation of 18 proposals
for dimensional models and proceeds with provocative contributions
on a number of related issues ranging from hard science to clinical
practice. Among the topics addressed are Behavioral and molecular
genetic research supporting an etiologically informed dimensional
classification of personality disorders The as-yet tenuous
associations between dimensional trait measures of personality as
contained in the models of Cloninger, Depue, and Siever-Davis, and
specific neurobiological measures, as examined inneurotransmitter
research Potential links between childhood and adolescent
temperament and personality dimensions and adult personality
psychopathology Studies examining the covariation of personality
dimensions across cultures The continuity of Axis I and Axis II
disorders and a proposed hierarchical structure of mental disorders
that integrates the psychopathology of Axis I disorders with
specific personality traits The dual challenges of coverage and
cutoffs that must be addressed if dimensional models are to be
considered viable alternatives to the existing categorical
diagnostic system
Although the editors acknowledge that concerns are certain to be
raised regarding conversion to a dimensional classification&
mdash;such as the disruption to clinical practice by a radical
shift in diagnosing personality disorder& mdash;these papers
make a strong case for opening the field to alternative ways of
enhancing clinical utility and improving the validity of basic
classification concepts. Together, they offer stimulating insight
into how we approach personality disorders, with the hope of
encouraging a new model of diagnosis for DSM-V.
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