The DSM’s Reconnection to Psychoanalytic Theory through the Alternative Model for Personality Disorders

2019 ◽  
Vol 67 (6) ◽  
pp. 1023-1045 ◽  
Author(s):  
Adam P. Natoli
Keyword(s):  
Personality Disorders ◽  
Alternative Model ◽  
Psychoanalytic Theory ◽  
Diagnostic System ◽  
Personality Pathology ◽  
Statistical Manual ◽  
Diagnostic And Statistical Manual ◽  
Dsm 5 ◽  
Psychodynamic Diagnostic Manual ◽  
Current Systems

Often believed to have Kraepelinian origins, the Diagnostic and Statistical Manual of Mental Disorders—5th Edition (DSM-5) defines personality disorders using a categorical, hierarchical taxonomic system. This system possesses many long-standing problems for clinical practice, including a large assortment of symptom combinations that contribute to problematic heterogeneity and likely impair diagnostic validity. The DSM diagnostic system was at one time heavily influenced by psychoanalytic theory (Shorter 2005). A desire for greater theoretical neutrality then encouraged a shift away from psychoanalytic theory, resulting in the problematic atheoretical model of personality pathology introduced in DSM-III (1980) and still used today. The Alternative Model for Personality Disorders (AMPD), introduced in DSM-5 (2013), is an attempt to reconcile many of the categorical model’s issues and directly parallels primary themes that characterize psychoanalytic models of personality. After a review of the historical development of DSM, three current systems for diagnosing personality pathology—the DSM-5’s categorical model (2013), its AMPD (2013), and the Psychodynamic Diagnostic Manual (2nd ed.; Alliance of Psychoanalytic Organizations 2017) are compared. The comparison illustrates how the AMPD brings psychoanalytic theory back into the DSM system and acknowledges the implications of a more psychoanalytic DSM.

scholarly journals Sociocultural Context and the DSM-5 Alternative Model of Personality Disorder: Comment on Widiger & Hines

2022 ◽  
Author(s):  
Craig Anthony Rodriguez-Seijas
Keyword(s):  
Personality Disorder ◽  
Personality Disorders ◽  
Alternative Model ◽  
Sociocultural Context ◽  
Statistical Manual ◽  
Diagnostic And Statistical Manual ◽  
Dsm 5 ◽  
Psychological Stressors ◽  
And Gender ◽  
Theory Research

Widiger and Hines provide a brief overview of the development of the Alternative Model of Personality Disorder (AMPD) housed within Section 3 of the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5; American Psychiatric Association, 2013). They highlight eight issues and controversies related to the AMPD in need of resolution for improvement of both the AMPD model itself as well as the field of personality disorders more broadly. In this brief commentary, I add a ninth issue in need of attention both with respect to the AMPD but also within the field of personality disorders more broadly: 9) How is sociocultural context to be accommodated in AMPD—and more generally personality disorder—theory, research, and treatment? The historical intra-individual, deficit-based models for conceptualizing personality disorders linger in current personality disorder discourse. However, failure to appropriately consider sociocultural context that systematically predisposes wide swaths of the population to unequal access to resources and exposure to psychological stressors, which can impact the appearance of personality pathology, serves to stigmatize minoritized individuals. The personality disorder field, and the AMPD discourse, must appropriately contend with sociocultural context in its models otherwise it risks developing models with limited generalizability and which hold potential to adversely affect sexual and gender minoritized populations, among others.

Mental Health

2018 ◽  
Author(s):  
Gianni Pirelli
Keyword(s):  
Mental Health ◽  
Personality Disorders ◽  
Behavioral Science ◽  
Diagnostic System ◽  
Statistical Manual ◽  
Diagnostic And Statistical Manual ◽  
Dsm 5 ◽  
Clinical Disorders ◽  
Key Issues ◽  
Empirical Thought

In this chapter, the authors provide a broad overview of diagnosable psychiatric disorders, their symptoms, and examples of current theoretical and empirical thought underlying these conditions. In providing a primer concerning mental health, they first review the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5), with respect to how psychopathology is defined and the nature of the diagnostic system. They then shift to definitions, key examples, and example theories for (i) clinical disorders (e.g., depressive and anxiety disorders), (ii) personality disorders (with an emphasis on borderline and antisocial personality disorders), and (iii) substance use disorders. While this chapter draws heavily from the DSM-5, such is done primarily for educational and illustrative purposes within the broader context of discussing key issues related to the behavioral science of firearms.

Personality Disorders are Dead, Long Live the Interpersonal Disorders

2021 ◽  
Author(s):  
Aidan G.C. Wright ◽  
Whitney R. Ringwald
Keyword(s):  
Mental Disorders ◽  
Personality Disorders ◽  
Conceptual Model ◽  
Alternative Model ◽  
The Self ◽  
Relevant Research ◽  
Statistical Manual ◽  
Diagnostic And Statistical Manual ◽  
Major Class ◽  
Interpersonal Dysfunction

Widiger and Hines raise a number of significant concerns with the Alternative Model of Personality Disorders (AMPD). This places the major class of psychiatric difficulties represented by the personality disorders in a precarious position because the model used in prior editions of the Diagnostic and Statistical Manual of Mental Disorders and currently reprinted in Section II is moribund if not dead, and with the AMPD’s significant problems their future is unclear. Although we agree that Widiger and Hines’ criticisms have merit, they are not the whole picture. We review additional relevant research that supports the contention that what differentiates personality disorders from other psychopathology is the self and interpersonal dysfunction, as Criterion A of the AMPD currently states. We emphasize the importance of drawing a distinction between the conceptual model and its operationalization. We argue that paradoxically, to save personality disorders we need to do away with them and replace them with the “interpersonal disorders”. There is strong theory, empirical research, and ethical arguments in favor of this conceptual reframing.

Examining the Contribution of Perfectionistic Traits to the Construct Validity of the DSM-5 Alternative Model of Personality Disorder

2020 ◽  
pp. 1-18
Author(s):  
Azad Hemmati ◽  
Brandon Weiss ◽  
Atefeh Mirani ◽  
Farzin Rezaei ◽  
Joshua D. Miller
Keyword(s):  
Personality Disorder ◽  
Construct Validity ◽  
Personality Disorders ◽  
Alternative Model ◽  
Clinical Utility ◽  
Personality Pathology ◽  
Obsessive Compulsive ◽  
Large Sample ◽  
Dsm 5 ◽  
Do So

Scholars of perfectionism have proposed significant modifications to DSM-5's alternative model of personality disorders (AMPD), such that (1) perfectionism be expanded beyond the inclusion of a singular trait—rigid perfectionism—and (2) perfectionistic traits be specified as trait descriptors of personality disorders (PDs) other than obsessive-compulsive PD. In this study, we evaluate these proposals by examining the degree to which (a) perfectionistic traits are already instantiated in Section II and Section III models of personality pathology; and (b) perfectionistic traits meaningfully augment the construct validity of AMPD PDs. We conducted these approaches in a large sample (N =3D 435) from an Iranian undergraduate population that is atypically found in the literature. Results showed that perfectionistic traits are already fairly well instantiated in Section III Criterion B. Perfectionistic traits minimally improved the construct validity of OCPD, but did not meaningfully do so for other PDs. Future investigation into the clinical utility of perfectionistic traits is needed.

Mixed features in major depressive disorder: diagnoses and treatments

CNS Spectrums ◽  
2017 ◽  
Vol 22 (2) ◽  
pp. 155-160 ◽  
Author(s):  
Trisha Suppes ◽  
Michael Ostacher
Keyword(s):  
Major Depression ◽  
Mood Disorders ◽  
Diagnostic System ◽  
Statistical Manual ◽  
Diagnostic And Statistical Manual ◽  
Dsm 5 ◽  
Mixed Features ◽  
Depression Disorders ◽  
First Time ◽  
Linear Manner

For the first time in 20 years, the American Psychiatric Association (APA) updated the psychiatric diagnostic system for mood disorders in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). Perhaps one of the most notable changes in the DSM-5 was the recognition of the possibility of mixed symptoms in major depression and related disorders (MDD). While MDD and bipolar and related disorders are now represented by 2 distinct chapters, the addition of a mixed features specifier to MDD represents a structural bridge between bipolar and major depression disorders, and formally recognizes the possibility of a mix of hypomania and depressive symptoms in someone who has never experienced discrete episodes of hypomania or mania. This article reviews historical perspectives on “mixed states” and the recent literature, which proposes a range of approaches to understanding “mixity.” We discuss which symptoms were considered for inclusion in the mixed features specifier and which symptoms were excluded. The assumption that mixed symptoms in MDD necessarily predict a future bipolar course in patients with MDD is reviewed. Treatment for patients in a MDD episode with mixed features is critically considered, as are suggestions for future study. Finally, the premise that mood disorders are necessarily a spectrum or a gradient of severity progressing in a linear manner is argued.

scholarly journals If an Entrepreneur Founded the DSM-5 Alternative Model of Personality Disorder: When Axis II Meets Disruptive Innovation

2022 ◽  
Author(s):  
Jennifer L Tackett ◽  
Kathleen Wade Reardon ◽  
Melissa Kaufman ◽  
Ryne A. Sherman
Keyword(s):  
Personality Disorder ◽  
Alternative Model ◽  
Developmental Process ◽  
Disruptive Innovation ◽  
Statistical Manual ◽  
Axis Ii ◽  
Diagnostic And Statistical Manual ◽  
Dsm 5 ◽  
Paradigm Shifting

Personality disorder (PD) researchers proposed a highly innovative “paradigm-shifting” revamp for the Diagnostic and Statistical Manual of Mental Disorders 5th edition (DSM-5; APA, 2013). Yet, ten years later, Widiger and Hines (this issue) summarize a developmental process plagued by disagreement and stagnation, with little evidence of the field having reaped the desired benefits of this diagnostic revolution. In this commentary, we draw on principles from entrepreneurial creation, operation, and success—positioning the personality disorder scientists in the role of “disruptive innovator”—and summarize key principles from the entrepreneurial process that may be relevant in understanding the challenges and failures of the personality disorder revolution to date.

Assessment of Pathological Traits in DSM-5 Personality Disorders By the DAPP-BQ: How Do These Traits Relate to the Six Personality Disorder Types of the Alternative Model?

2019 ◽  
Vol 33 (1) ◽  
pp. 49-70 ◽  
Author(s):  
Han Berghuis ◽  
Theo J. M. Ingenhoven ◽  
Paul T. van der Heijden ◽  
Gina M. P. Rossi ◽  
Chris K. W. Schotte
Keyword(s):  
Personality Disorder ◽  
Personality Disorders ◽  
Alternative Model ◽  
Psychiatric Patients ◽  
Personality Pathology ◽  
Personality Functioning ◽  
Dsm 5 ◽  
Criterion A ◽  
Dsm Iv ◽  
Dimensional Assessment

The six personality disorder (PD) types in DSM-5 section III are intended to resemble their DSM-IV/DSM-5 section II PD counterparts, but are now described by the level of personality functioning (criterion A) and an assigned trait profile (criterion B). However, concerns have been raised about the validity of these PD types. The present study examined the continuity between the DSM-IV/DSM-5 section II PDs and the corresponding trait profiles of the six DSM-5 section III PDs in a sample of 350 Dutch psychiatric patients. Facets of the Dimensional Assessment of Personality Pathology—Basic Questionnaire (DAPP-BQ) were presumed as representations (proxies) of the DSM-5 section III traits. Correlational patterns between the DAPP-BQ and the six PDs were consistent with previous research between DAPP-BQ and DSM-IV PDs. Moreover, DAPP-BQ proxies were able to predict the six selected PDs. However, the assigned trait profile for each PD didn't fully match the corresponding PD.

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