Personality Assessment in the DSM-5

Steven K. Huprich, Christopher J. Hopwood, Steven K. Huprich, Christopher J. Hopwood

• Editorial: Routledge
• Año: 2014
• ISBN:
  9781317980711
• Edición: 1
• Categoría: Psicologia
• Categoría: Psicologia anormale

The DSM-5 promises to be a major reformulation of psychopathology, and no section is likely to change diagnostic practice more than that of personality pathology. Unlike the DSM-IV, the DSM-5 personality disorders will be conceptualized as involving core deficits in interpersonal and self-functioning, and will utilize a hybrid assessment model involving both pathological trait dimensions and a limited set of personality disorder types. These changes are based on empirical and theoretical work conducted during the era of DSM-III/IV, but nevertheless there is significant disagreement among personality assessors regarding the DSM-5 proposal. In this volume, several members of the DSM-5 work group offer rationales for the proposal and offer empirical evidence regarding suggested changes, and several personality assessment researchers critique the proposal and offer alternative conceptualizations.

This book was originally published as a special issue of the Journal of Personality Assessment.

Introduction: Personality Assessment in the DSM-5

Steven K. Huprich

Department of Psychology
Eastern Michigan University

Christopher J. Hopwood

Department of Psychology
Eastern Michigan University

Many personality assessors have expressed significant dissatisfaction with the Diagnostic and Statistical Manual of Mental Disorders (3rd ed. [DSM–III]; American Psychiatric Association, 1980; and 4th ed. [DSM–IV]; American Psychiatric Association, 1994) framework for conceptualizing personality disorders (e.g., Bornstein, 1998; Clark, 2007; Widiger & Trull, 2007). Common concerns have involved the categorical nature of the disorders, the use of arbitrary diagnostic cutoffs, diagnostic overlap, unclear distinctions between Axis I and II, the overly atheoretical nature of the criteria, the mix of traits and behaviours in those criteria, limited validity support for the overall model and some specific diagnoses, and limited associations with personality models commonly used in basic research and clinical practice. Despite the recommended changes, and the expectation that the DSM-5 personality disorder section would look considerably different than what it has in the past, the American Psychiatric Association (APA) decided at the end of 2012 to reject the proposal of the PPDWG and to retain the current DSM-IV personality disorders, in spite of the fact that this system is replete with shortcomings. However, they opted to retain for further consideration the proposed trait system for how it might inform the assessment and diagnosis of personality pathology.

The DSM-5 Personality and Personality Disorders Work Group (PPDWG) thus had a very difficult task on its hands. After some initial revisions, they eventually proposed a hybrid model of personality pathology for DSM-5, in which six of the extant categories would be retained as diagnostic types (Schizotypal, Antisocial, Borderline, Narcissistic, Avoidant, and Obsessive-Compulsive; Skodol et al., 2011a–c). Four of the current personality disorders (PDs) (Paranoid, Schizoid, Histrionic, and Dependent) were eliminated for lack of empirical support, and an empirically derived trait system was developed, which reflected a wide body of research that supported a hierarchical organization of universally identifiable traits (Allik, 2005; Markon, Krueger, & Watson, 2005; Widiger & Simonsen, 2005). Furthermore, the PPDWG introduced the need to assess an individual’s level of functioning as part of their personality structure. Drawing upon the extensive object relations, interpersonal, and empirical literatures, level of functioning is assessed among the following dimensions: the extent to which the self is viewed as integrated and positively viewed, the individual’s level of personal agency, the extent to which others can be perceived and related to empathically, and the capacity to experience intimacy with others. Thus, the personality disorder section in DSM-5 is likely to look considerably different than what it has in the past.

Discussion about the DSM-5 personality disorders has been ongoing for some time (e.g., Widiger & Clark, 2000), and a number of researchers and clinicians have commented on how the field can move forward. Because of the need to advance the field’s knowledge of the personality disorders, particularly given the ongoing debate about the needed transition to a dimensionalized model of personality pathology, Steven Huprich and Robert Bornstein organized in 2007 a Special Issue of the Journal of Personality Assessment—“Dimensional versus Categorical Personality Disorder Diagnosis: Implications from and for Psychological Assessment.” Not long after that, Christopher Hopwood and Steven Huprich organized two symposia on the future of personality disorder assessment that were presented at the 2010 Midwinter Meeting of the Society for Personality Assessment. Collectively, they combined papers from these symposia into another Special Issue of the Journal of Personality Assessment in 2011—“Personality Assessment in the DSM-5.” This book, therefore, is a compilation of two papers from the former series and the entirety of papers from the latter series. It also includes two other papers relevant to the issue of assessing personality in a DSM-5 era; one focusing upon the passive aggressive and negativistic personality disorder proposals and another on the social cognitive literature and how this field of experimental psychology should inform future research on the assessment of personality pathology.

Thus, with the support of Taylor & Francis Publishers, we are pleased to present this book on personality assessment in the DSM-5 era. We have organized the book into three sections. First, we present a series of papers on how the personality assessment literature has led to the development of DSM-5, including an extended discussion of DSM-5 personality disorder assessment. The opening paper by Steven Huprich and Robert Bornstein presents a discussion of the categorical and dimensional framework for assessing personality disorders and considers the implications of what movement toward this framework means. Next, Ronald Ganellen reviews the strengths and limits of self-report, observer-based, and performance-based personality assessment for both normative and abnormal personality functioning. This is followed with three papers presented by members of the PPDWG. Robert Krueger and colleagues introduce the rationale for a trait structure in the DSM-5 and what such a structure looks like. Donna Bender and Les Morey then each take the lead in two respective papers that discuss the theory, methods, and empirical support for assessing the level of functioning of the individual and why this type of assessment can be useful for advancing our assessment of personality pathology.

Second, we present three papers on how trait assessment can be advanced in DSM-5 and beyond. Douglas Samuel begins with a critique of the trait model proposed for DSM-5 for deviating significantly from the models commonly used in basic personality research, and highlights, in particular, concerns with using unipolar as opposed to bipolar personality traits. This is followed by Christopher Hopwood’s argument for the utility of separating normative and pathological elements of personality traits explicitly in the DSM–5 to increase the importance of personality assessment for psychiatric diagnosis in general and in line with recent empirical research regarding differences between normative and pathological personality features. Finally, Leonard Simms and colleagues provide some preliminary data from their Computerized Adaptive Assessment of Personality Disorder, a study funded by the National Institute of Mental Health which capitalizes upon the methodologies of computerized adaptive testing and item-response theory. Such a method allows the researcher to efficiently identify those items most likely to characterize the construct of interest, as well as the severity or extremity to which this trait exists in those who possess the construct.

In the final section of the book, we present a series of papers that introduces several issues related to how personality disorder assessment has been and should be conducted in the future. First, Steven Huprich begins by describing two issues relevant to personality assessment in the DSM–5: the limitations of several assessment methods that have informed existing models of personality pathology and the potential for psychoanalytic theory to usefully inform personality disorder nosology. Second, a unique and stimulating paper is offered by Michael Robinson and Kathryn Gordon on how social cognitive methodologies and the extant literature provide important insight into what and how personality pathology should be assessed. They critique the extensive use of self-report methodologies and demonstrate what experimentally-based assessment offers to the dynamic understanding of personality processes. Robert Bornstein then describes an alternative model of personality disorders, which retains many of the virtues of the DSM–III/DSM–IV, with important additions such as the depiction of overall personality pathology and personality-related strengths. Fourth, Aidan Wright reframes debates regarding categorical versus dimensional approaches to diagnosis in a manner that highlights the need to examine more carefully dynamic processes. In doing so he proposes that interpersonal theory offers a viable theoretical and measurement framework for understanding the dynamics of personality pathology. Finally, Christopher Hopwood and Aidan Wright present a comparison of the passive aggressive and negativistic personality disorders, and argue that the move toward the broader construct of negativism weakened the construct and contributed to its demise in the DSM system, despite the clinical importance of passive-aggressive behavior.

These are just some of the issues that will affect the DSM-5 era of personality and personality disorder assessment. For instance, some questioned the clinical utility of the proposed DSM-5 model of personality disorder assessment (Clarkin & Huprich, 2011; Shedler et al., 2010). And, with the APA Board of Trustees’ retention of the DSM-IV system, many ideas and questions remain unanswered about the nature of personality assessment and its relationship to psychopathology. Thus, what the future holds for personality assessment in this era is simultaneously unknown, exciting, and potentially concerning. Moving forward, we offer this book as a sampling of the issues before the field and in the deepest spirit of advancing the science and practice of understanding human personality.

REFERENCES

Allik, J. (2005). Personality dimensions across cultures. Journal of Personality Disorders, 19, 212–232.

American Psychiatric Association. (1980). Diagnostic and statistical manual of mental disorders (3rd ed.). Washington, DC: Author.

American Psychiatric Association. (1994). Diagnostic and Statistical manual of mental disorders (4th ed.). Washington, DC: Author.

*Bender, D. S., Morey, L. C, & Skodol, A. E. (2011). Toward a model for assessing level of personality functioning in DSM–5, Part I: A review of theory and methods. Journal of Personality Assessment, 93, 332–346.

Bornstein, R. F. (1998). Reconceptualizing personality disorder diagnosis in the DSM–V: The discriminant validity challenge. Clinical Psychology: Science and Practice, 5, 333–343.

*Bornstein, R. F. (2011). Toward a multidimensional model of personality disorder diagnosis: Implications for DSM–5. Journal of Personality Assessment, 93, 362–369.

Clark, L. A. (2007). Assessment and diagnosis of personality disorder: Perennial issues and an emerging reconceptualization. Annual Review of Psychology, 58, 227–257.

Clarkin, J. F., & Huprich, S. K. (2011). Do the DSM-5 proposals for personality disorders meet the criteria for clinical utility? Journal of Personality Disorders, 25, 192–205.

*Ganellen, R. J. (2007). Assessing normal and abnormal personality functioning: Strengths and weaknesses of self-report, observer, and performance-based methods. Journal of Personality Assessment, 89, 30–40.

*Hopwood, C. J. (2011). Personality traits in the DSM-5. Journal of Personality Assessment, 93, 398–405.

*Hopwood, C. J., & Wright, A. G. C. (2012). A comparison of passive-aggressive and negativistic personality disorders. Journal of Personality Assessment, 94, 296–303.

*Huprich, S. K. (2011). Contributions from personality- and psychodynamically oriented assessment to the development of the DSM–5 personality disorders. Journal of Personality Assessment, 93, 354–361.

*Huprich, S. K., & Bornstein, R. F. (2007). Categorical and dimensional assessment of personality disorders: A consideration of the issu...