DSM axis II: personality disorders or adaptation disorders?
OBJECTIVE
After the initial enthusiasm, the study of personality disorder seems to be at a crossroad, without clear direction. This is mainly due to overlapping categorical diagnostic criteria of personality disorders. Study samples based on these criteria are inadequate and their results questionable.


RESULTS
The literature is unanimously advocating a dimensional concept of personality disorders. Four dimensions are consistently reported to underlie personality disorder symptoms. We put forward an argument that personality disorders are disorders of adaptation, not of personality per se, as extreme personality traits are not ipso facto dysfunctional. Available methods to assess maladaptation are reviewed.


CONCLUSIONS
The diagnosis 'personality disorder' should be replaced by the diagnosis 'adaptation disorders'. This reflects the real nature of the disorder more accurately, and is likely to reduce the stigmatizing component of the personality disorder diagnosis as it places emphasis on positive efforts to improve adaptation. The suggested revisions of the personality disorder diagnosis and dimensional approach to these disorders are likely to advance treatment and research - we discuss these aspects in some detail.
Svrakic
Dragan M
DM
Washington University School of Medicine, St Louis, MO 63110, USA. svrakicd@psychiatry.wustl.edu
Lecic-Tosevski
Dusica
D
Divac-Jovanovic
Mirjana
M
D000220:Adaptation, Biological; D000223:Adaptation, Psychological; D039721:Diagnostic and Statistical Manual of Mental Disorders; D044127:Epigenesis, Genetic; D005824:Genetics, Behavioral; D006801:Humans; D010553:Personality Development; D010554:Personality Disorders / Q000175:diagnosis* / Q000235:genetics* / Q000503:physiopathology / Q000523:psychology; D011582:Psychological Theory