The hybrid model for the classification of personality disorders in DSM-5: a critical analysis

Abstract

A personality disorder can be considered to be a generalized pattern of behaviors, cognitions, and emotions that is enduring, begins in adolescence or early adulthood, remains stable over time, and generates stress or psychological damage. The current focus on personality disorders (PDs) is found in Section II of DSM-5 and is unchanged compared to DSMIV, except that the PDs were removed from the former Axis II of the DSM-IV and included in the central classification of disorders. However, an alternative model for further study is presented in Section III that aims to address the deficiencies in the current categorical model of PDs. The underlying idea is that PDs are an extreme version of the personality traits that everyone has. According to this approach, PDs are characterized by impaired personality functioning (areas of identity, self-direction, empathy, and intimacy) and pathological personality factors (negative affectivity, detachment, antagonism, disinhibition, and psychoticism). The diagnostic categories derived from this model include only antisocial, avoidant, borderline, narcissistic, obsessive-compulsive, and schizotypal PDs. This hybrid approach to the diagnosis of PDs is complex and requires more empirical evidence before it can be incorporated into clinical practice. The proposals of the draft ICD-11 for PDs, which are based primarily on severity and dominant personality traits, are also included.