DSM-5 and the General Definition of Personality Disorder

There is a fundamental change proposed for DSM-5 in the general definition of personality disorder, representing a new conceptualization that shapes how the DSM distinguishes personality pathology from other undesirable or negative personality features. The change is needed due to serious deficiencies in the current DSM-IV approach. Specifically, personality disorder is to be conceptualized as impairment in both self organization and interpersonal relating, caused by pathological (extreme) personality traits. This represents progress in that marked impairment in self organization and interpersonal relating are plausibly characteristic of personality disorder. However, the required level of impairment remains too low, and the kinds of impairment are not restricted to those which indicate disorder versus culturally undesirable features. Moreover, extreme traits are neither necessary nor sufficient for personality disorder because personality represents not the sum of traits but the holistic organization of traits and other meanings. The DSM-5's diagnostic focus on traits thus potentially opens the way to massive false positive diagnoses. An earlier proposal to reframe personality disorders using global similarity matching of the patient's condition to prototypical descriptions of specific personality disorders is argued to also lead toward less valid diagnoses.