Dimensional models of personality disorders

In personality pathology, dimensional models of personality disorders (also known as the dimensional approach to personality disorders, dimensional classification, and dimensional assessments) conceptualize personality disorders as quantitatively—not qualitatively—distinct from normal personality, viewing disorders as extreme positions on continuous trait dimensions shared by the general population. They consist of extreme, maladaptive levels of certain personality characteristics (these characteristics are commonly described as facets within broader personality factors or traits). Within the context of personality psychology, a "dimension" refers to a continuum on which an individual can have various levels of a characteristic, in contrast to the dichotomous categorical approach in which an individual does or does not possess a characteristic. According to dimensional models personality disorders are classified according to which characteristics are expressed at which levels. This stands in contrast to the traditional categorical models of classification, which are based on the boolean presence or absence of symptoms and do not take into account levels of expression of a characteristic or the presence of any underlying dimension.

The way in which these diagnostic dimensions should be constructed has been under debate, particularly in the run up to the publication of the DSM-5. A number of dimensional models have been produced, differing in the way in which they are constructed and the way in which they are intended to be interpreted. There are four broad types of dimensional representation, although others also exist:

  1. Dimensional representation of the original DSM categories of personality disorders;
  2. Dimensional representation based on identification of latent traits with the DSM disorders;
  3. Dimensional representation based on the traits from normal personality research;
  4. Representation based on integration of dimensional modals, e.g. by using network analysis.

The dimensional approach is included in Section III ("Emerging Measures and Models") of the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), where it is titled Alternative DSM-5 Model for Personality Disorders.: p.761–781  The decision to retain the old DSM-IV categorical model of personality disorders in DSM-5 was controversial, and efforts continue to persuade the American Psychiatric Association to replace it with the dimensional model in DSM 5.1.

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