Overview and critique of the classification of personality disorders proposed for DSM-V

Summary This paper describes some of the concerns that motivated the committee d eveloping the new classification of personality disorders for the DSM-V. They included the tension between empirical research on normal populations, on the one hand, and clinicians interested in the personality disorders constellations found in clinical settings, on the other. This tension was e xpressed in the controversies between categorical and dimensional a pproaches to the classification. There also was an effort to relate a dimensional system of concrete behavioural traits with neurobiological and genetic markers. In addition, there was also a tension between neurobiological and psychodynamic approaches. A major compromise was reached in a “hybrid,” dimensional and c ategorical approach that maintained six of the ten categories of the DSM-IV systems, while developing a dimensional approach to a general level of p ersonality function centered on the pathology of the experience of the self. This included the assessment of identity, the experience of oneself, selfesteem and self-appraisal, and emotional regulation; and self-direction. It also included the assessment of interpersonal functioning as reflected in the capacity for empathy and intimacy. In a critical review of this proposal, the author expresses his general agreement with the main thrust of this proposal, the emphasis on identity and interpersonal functioning and their pathology, and points to the fact that this emphasis corresponds to central concerns of psychodynamic approaches to personality pathology. Regarding the selection of six of the ten personality prototypes of DSM-IV, the criteria for the elimination of the paranoid, schizoid, histrionic, and dependent personality disorder, and the depressive personality disorder (in the appendix of DSM-IV) may be questioned in terms of their prevalence and clinical significance. An underlying problem may be the fact that we do not yet have an integrated understanding of the interplay of neurobiological and psychodynamic structures in the development and psychopathology of the personality. In any case, the introduction of the pathology of identity and interpersonal relations in the proposed DSM-V system seems an important step forward.