Alternative Model

Hello again!

 

This week found me searching through the DSM-V in pursuit of inspiration for this week’s post. I am fairly familiar with what the DSM-IV-TR has to say about personality disorders and as they stayed the same in the newest edition of our diagnostic manual I hadn’t given much thought to the changes that APA considered making when they created the DSM-V. So, I decided to take a look; and the result was fascinating. 

In section III of the DSM-V an entire alternative model for diagnosing personality disorders is presented. This approach was developed to address shortcomings of our current way of diagnosing personality disorders. One such problem, for example, is the tendency for patients meeting the criteria for one of the disorders to also meet criteria for other personality disorders. 

In this alternative model, personality disorders are characterized by traits and impairments in functioning of the individual’s personality. Further, the personality disorders included have been funneled down to include only: schizotypal, obsessive-compulsive, narcissistic, borderline, avoidant, and antisocial personality disorders. The alternative model also contains a “personality disorder- trait specified” (PD-TS) that clinicians can use if a personality disorder is believed to be present but they do not meet the criteria for any of the aforementioned specific personality disorders.

There are seven criteria used to diagnose personality disorders in this alternative model. Here’s a walk through of the first four, as they are the meat and potatoes of the diagnosis criteria:

¨      Criterion A is a measure of the level of personality functioning, which is evaluated on a continuum from little to no impairment (Level 0) all the way to extreme impairment (Level 4). Disturbances in personality are divided into two categories: self and interpersonal functioning. The “self “component is comprised of a description of a person’s level of identity and self-direction and the “interpersonal” component encompasses a person’s capacity for empathy and intimacy, all of which are further defined in the DSM-V.

¨      Criterion B measures a person’s pathological personality traits, which are organized into five categories: Psychoticism, Disinhibition, Antagonism, Detachment and Negative affectivity. These categories are then broken down into trait facets that include traits such as suspiciousness, hostility, emotional lability, impulsivity, grandiosity, etc. There are 25 trait facets in all which are all reminiscent of established personality disorders that we are all familiar with. These traits are listed as Criterion B under individual personality disorders and define the qualities of the specific disorder the clinician is considering for their diagnosis.

¨      Criteria C and D relate back to the title of this blog, and in the alternative model they encompass pervasiveness and stability of pathological personality traits. All except the most extreme pathological personalities show some level of adaptability, so in the new model, pathological personality traits are seen to be relatively pervasive and stable across multiple social contexts and environments.

The personality trait domains of Criterion B are by far the most interesting component of this alternative model. The way that they are combined to define specific personality disorders helps create an understanding of the essence of the disorder, giving the clinician a clearer sense of what the creators of the model are trying to convey through their conceptualization of each of the personality disorders. Narcissistic Personality Disorders is my favorite example of this; it is clear and to the point. After a description in Criterion A of the Identity, Self-Direction, Empathy and Intimacy level of functioning in the Narcissist, Criterion B encompasses only the traits of Grandiosity and Attention Seeking. Straightforward and to the point; I love it. Both are traits from the domain of Antagonism and encompass feelings of entitlement, self-centeredness, admiration seeking and attempts to attract attention to themselves. After coupling this with the excessive references to others for self-definition, goal setting based on approval from others, difficulty identifying with the feelings of others and superficial relationships, to name a few characteristics, found in Criterion A, I feel as though I can picture a Narcissist standing right in front of me. The other personality disorders follow in the same vein, organizing traits and characteristics into groupings that capture the crux of the disorder.

So, however lengthy it may be, my discussion here does not give this alternative model justice and I strongly encourage you to go check it out for yourself! If you’re like me, you’ll soon be seeing visions of people you know (and possibly family members...) appear before you as you read through the traits composing each individual personality disorder.

And oddly, it seems that APA decided to print all of this valuable information on delectable tasting paper as I spent the whole time writing and researching for this post fending off PJ from trying to munch on its expensive corners. I was not largely successful as I now have bite marks all over my DSM-V’s cover. Thank you, PJ.

Until next time,

Kim

American Psychiatric Association., & American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders: DSM-5.