Personality disorders: three classifications with a fly in the ointment
A new, hybrid, categorical–dimensional model that had been developed for DSM-5 was not, however, retained by the Board of Trustees of the American Psychiatric Association, who decided to ‘to preserve continuity with current clinical practice’ and ‘to maintain the current approach to personality disorders’, that is to keep the model that had been introduced in previous editions and maintained with only minor changes up to DSM-IV-TR. The new model was relegated to Section III, labeled ‘Emerging Measures and Models’ containing ‘tools and techniques to enhance the clinical decision-making process, understand the cultural context of mental disorders, and recognize emerging diagnoses for further study’. In the meantime, the personality disorders workgroup for ICD-11 has developed a dimensional model, which is slated to replace the categorical model that had been included in the ICD up to ICD-10.
As such, clinicians, researchers and other stakeholders, most notably patients, may choose, in the years to come and for an as yet unknown duration, between three widely different models for classifying personality disorders: a categorical model, a hybrid model and a dimensional model. Each of the three models has its advantages, but each also has its drawbacks or at the very least a ‘fly in the ointment’.