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#DSM 5 PERSONALITY DISORDERS SERIES#
In order to maintain continuity with the DSM-IV categorical disorders, a decision was made to essentially re-create those categories via the requirement of elevation on a series of trait facets were conceptually deemed most representative of the various PD criteria.
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More specifically, in the following I present some thoughts about particular issues that require evaluation. As mentioned earlier, the criminal justice system is likely associated with the highest prevalence rates of personality pathology of any setting in which psychologists practice as such, information derived from correctional and other offender populations should be at the forefront when the revisions to the currently flawed PD system is eventually implemented in either DSM 5.1 or beyond. As the field progresses, it is imperative that we evaluate the optimal way of characterizing personality pathology in offenders as well as to determine the most clinically useful method of assigning diagnosis. These changes (or lack thereof) carry implications for psychologists in criminal justice settings. This, of course, remains an empirical question. The main impetus behind this decision (which has never been made clear publicly) was presumably that the proposal was considered to have insufficient scientific merit (i.e., it was untested) and therefore not ready for “prime time.” This was a rather disappointing decision given the substantial time and financial commitment devoted to this process, and the fact that a potentially unfinished dimensional system might nonetheless be superior to its seriously flawed predecessor. Instead, they decided to retain the DSM-IV PD system for DSM-5 Section II, which lists all formal clinical diagnoses. In the final hour, the APA Board of Trustees decided to reject the P&PD’s proposal and relegate it to Section III, which includes “emerging models and measures” (APA, 2013).
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A seventh type, Personality Disorder: Trait Specified, indicate the presence of maladaptive personality traits and associated impairment, but no trait profile that specifically maps onto one of the six aforementioned types (Skodol, 2012). For instance, for a diagnosis of Antisocial PD, elevations on trait facets from both the Antagonism (Callousness, Deceitfulness, Manipulativeness, and Hostility) and the Disinhibition (Impulsivity, Irresponsibility, and Risk Taking) domains are required in addition to impairment in both self- and interpersonal functioning. More specifically, a dimensional trait model consisting of five higher-order domains (Antagonism, Psychoticism, Disinhibition, Negative Affectivity, and Detachment), with three to seven trait facets each, was proposed.Ī configuration of trait facets is then used to define one of six proposed PDs(Antisocial, Avoidant, Borderline, Narcissistic, Obsessive-Compulsive, and Schizotypal)(Skodol, 2012). The primary foundation of this model is the reliance on dimensional personality traits coupled with impairment in self- and interpersonal functioning to characterize the PDs (APA, 2011). The P&PD workgroup proposed a hybrid dimensional-categorical system that would at least begin to address many of the problems just listed. The DSM-5 Personality and Personality Disorder (P&PD) workgroup were charged with the task of revising a severely flawed system of PDs featured in the DSM-IV, which included (but were not limited to) challenges associated with extremely high diagnostic co-occurrence rates, problematic within-disorder heterogeneity, insufficient coverage of personality disorder variance (most patients being diagnosed with PD NOS), polythetic criterion sets with arbitrary cut points, poor convergent and discriminant validity among different assessment measures, and poor scientific basis for many of the disorders (e.g., Clark, 2007 Widiger & Trull, 2007 Widiger & Mullins-Sweatt, 2010). Furthermore, PDs tend to be associated with a range of maladaptive outcomes, including violence, substance abuse, and reoffending (e.g., Hare & Neumann, 2009 McMurran & Howard, 2009 Soloff et al., 1994). Epidemiological studies have found that prevalence rates of PDs in the criminal justice system are quite high (e.g., Fazel & Danesh, 2002) for instance, estimates of Antisocial PD alone typically range from 50 to 80% in male correctional settings (Hare et al., 1991). Personality disorders (PDs) are considered chronic conditions that emerge in late adolescence, and typically carry pervasive implications for self- and/or interpersonal functioning (American Psychiatric Association, 2013 Skodol, 2012).