PsychopathologyAn Overview of the DSM-5 Alternative Model of Personality Disorders

Dimensional Approach to Personality Disorders Gains Traction in DSM-5 and ICD-11

The field of psychiatry is witnessing a gradual shift towards dimensional models in conceptualizing personality disorders (PDs). This article provides an overview of the DSM-5 Alternative Model of Personality Disorders (AMPD) and its empirical support, while also discussing the similar approach adopted by ICD-11. The AMPD represents a significant departure from traditional categorical PD diagnoses, emphasizing personality functioning and maladaptive traits as key components in assessing PDs.

Key Points:

• The AMPD consists of two main criteria: Criterion A (personality functioning) and Criterion B (pathological personality traits)
• Criterion A assesses impairment in self and interpersonal functioning, measured by the Levels of Personality Functioning Scale (LPFS)
• Criterion B evaluates five broad trait domains: negative affectivity, detachment, antagonism, disinhibition, and psychoticism
• The AMPD allows for more nuanced descriptions of PDs, including recreating DSM-IV PD constructs within its framework
• Empirical studies generally support the reliability and validity of AMPD constructs
• High correlations between Criteria A and B have led to debates about potential simplification of the model
• ICD-11 has adopted a similar dimensional approach to PDs, focusing on severity and trait domains
• The shift to dimensional models creates challenges in linking with existing PD treatment literature, particularly for borderline PD
• Integration of multidimensional case conceptualization with intervention strategies is needed to advance PD treatment
• The DSM revision process faces challenges in adapting to dimensional approaches while maintaining clinical relevance
• Other dimensional models, such as RDoC and HiTOP, are gaining traction in research and may influence future nosology

In a total of 46 studies (from 21 different countries spanning 6 continents), the worldwide pooled prevalence of any personality disorder was 7.8%. Rates were greater in high-income countries (9.6%) compared with LMICs (4.3%). (British Journal of Psychiatry)

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