Personality Disorders Flashcards
- Advantages of DSM-5 Alternative Personality Trait Model (Krueger & Makron, 2014):
- Empirical model that extends knowledge of FFM into maladaptive personality traits.
- It predicts clinical outcomes above and beyond categorical classification
- More in accordance with the complexity of syndromes observed in clinical practice.
- Finer analyses can be made of the patient characteristics.
- Disadvantages of DSM-5 Alternative Personality Trait Model
- Loss of categories thought to have significant clinical utility (Herpetz et al., 2017)
- Openness to experience (normative) – Psychoticism (maladaptive); researchers have questioned the strength of this dimension (e.g., Suzuki et al., 2015)
Challenges with categorical approach
- Hopwood et al. (2018) Commentary: The time has come for dimensional personality disorder diagnosis:
- No evidence supporting presence of 10 discrete PD categories
- Diagnostic comorbidity between 10 PD categories
- Within-disorder heterogeneity
- Few validated interventions for the 10 distinct PD categories
- Categorical approach lacks evidence base when compared to trait approach
What is the dimensional approach to Personality Disorders?
- Theoretically proposed 5 broad traits:
- Extraversion – Introversion
- Antagonism – Compliance
- Constraint – Impulsivity
- Negative Affect – Emotional Stability
- Unconventionality – Closed to Experience
Krueger et al 2012
Empirically validated a dimensional approach for use in DSM-5
Traits and their relations to FFM
Detachment (prev. introversion) - Absence of E
Disinhibition (prev. impulsivity) - Absence of C
Antagonism - Absence of A
Negative affect - Presence of N
Psychoticism - No clear consensus, presence of O??
Less evidence for openness
Categorical approach
Clear Diagnostic Criteria - provides clear-cut diagnostic criteria for each personality disorder
Clinical utility - helpful in guiding treatment decisions and providing a common language for clinicians to communicate about patients’ symptoms
Research and treatment development - historically the foundation for research into personality disorders, allowing research to investigate the prevalence, etiology and treatment outcomes for specific disorders
Dimensional approach
Reflects Continuum of Traits - views PDs as existing on a continuum rather than discrete categories. Reflects reality that individuals may exhibit varying degrees of traits associated with different disorders
Enhanced sensitivity to change - may be more sensitive to changes over time or in response to treatment, as they capture variations in symptom severity more precisely than categorical diagnoses
Better fit with empirical data - research suggests that PD are better conceptualised as dimensional constructs rather than discrete categories. Studies have found high rates of comorbidity between different
Conclusion (for comparing)
In conclusion, both categorical and dimensional approaches have their merits, and the choice between them depends on the specific goals and contexts of assessment, research, and treatment. Many contemporary researchers advocate for an integrated approach that combines elements of both paradigms to capture the complexity of personality pathology more comprehensively
Dimensional approach support
Empirical Support: Numerous studies have provided empirical support for the dimensional nature of personality disorders. Research using factor analysis consistently finds that personality disorder traits tend to cluster along a few key dimensions, such as the Five-Factor Model (FFM) traits or other trait configurations.
Clinical Utility: Dimensional models offer greater granularity and may provide more clinically relevant information compared to categorical diagnoses. For example, they can capture the severity and nuances of individual symptoms more accurately, which can inform treatment planning and monitoring.
Predictive Validity: Some research suggests that dimensional assessments of personality pathology have better predictive validity for important outcomes such as treatment response, functional impairment, and risk of relapse.
Categorical approach support
Standardization: Categorical systems like the DSM provide standardized diagnostic criteria, which facilitates communication among clinicians, researchers, and insurance providers. This uniformity can be beneficial for ensuring consistency in diagnosis and treatment across different settings.
Treatment Guidelines: Categorical diagnoses often form the basis for treatment guidelines and protocols. Having clear-cut diagnostic categories may simplify decision-making in clinical practice and help guide appropriate interventions.
Research Tradition: The categorical approach has a long-standing tradition in psychiatric research and has been the basis for much of the existing literature on personality disorders. As a result, there is a wealth of data available on the epidemiology, etiology, and treatment of specific personality disorders.
Overall categorical vs dimensional
the evidence suggests that both approaches have their strengths and limitations. Dimensional models offer a more nuanced understanding of personality pathology and may have advantages in terms of clinical utility and predictive validity. However, categorical systems provide standardization and have been the basis for much of the existing research and clinical practice in the field
Examples of categorical approach
Borderline personality disorder
Antisocial personality disorder
Narcissistic personality disorder
Examples of dimensional approach
Five Factor Model (FFM)
DSM-5
