title: Beyond dysfunction and threshold-based classification: a multidimensional model of personality disorder diagnosis.
abstract: An alternative dimensional model of personality disorder (PD) diagnosis that addresses several difficulties inherent in the current DSM conceptualization of PDs (excessive PD overlap and comorbidity, use of arbitrary thresholds to distinguish normal from pathological personality functioning, failure to capture variations in the adaptative value of PD symptoms, and inattention to the impact of situational influences on PD-related behaviors) is outlined. The model uses a set of diagnostician-friendly strategies to render PD diagnosis in three steps: (1) the diagnostician assigns every patient a single dimensional rating of overall level of personality dysfunction on a 50-point continuum; (2) the diagnostician assigns separate intensity and impairment ratings for each PD dimension (e.g., narcissism, avoidance, dependency); and (3) the diagnostician lists any personality traits-including PD-related traits-that enhance adaptation and functioning (e.g., histrionic theatricality, obsessive attention to detail). Advantages of the proposed model for clinicians and clinical researchers are discussed.
authors.affiliation: Derner Institute of Advanced, Psychological Studies, Adelphi University, Garden City, NY 11530, USA. bornstein@adelphi.edu
authors.forename: Robert F
authors.initials: RF
authors.lastname: Bornstein
authors.forename: Steven K
authors.initials: SK
authors.lastname: Huprich
mesh_terms: D006801:Humans; D008960:Models, Psychological; D010552:Personality Assessment; D010554:Personality Disorders / Q000145:classification / Q000175:diagnosis* / Q000523:psychology*; D012720:Severity of Illness Index