Conditions

New Model For Personality Disorders Could Help Doctors More Effectively Diagnose Patients

Sally Field & Joanne Woodward in Sybil, who suffered from dissociative identity disorder
A new "alternative model," gaining strong support from researchers, will be published in the latest manual for personality disorder diagnosing and could essentially improve the way patients are diagnosed. Creative Commons

A new "alternative model" for diagnosing personality disorders (PD) showed strong signs of improving old diagnostic criteria while supporting today's thoroughly researched standards, a new study shows. I will be included in the world's largest psychiatric diagnostic manual, which could assist in better diagnosing some of today's most pressing disorders.

In the findings published in the May issue of Journal of Psychiatric Practice, researchers found the new model includes the descriptions that were previously exempt from the personality disorder sections of the upcoming American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders.  The new fifth edition (DSM-5) will include the new model.

The study involved sampling 337 patients diagnosed using the fifth and fourth edition (DSM-IV) manuals and found that the proposed hybrid model and original diagnostic tools agreed strongly for borderline, avoidant, obsessive-compulsive, antisocial, narcissistic and schizotypal personality disorders.

These findings are just as revolutionary as the story of personal accounts of individuals struggling with personality disorders.

The historical record of Shirley Mason, also known by her pseudonym Sybil Dorset, was portrayed in a enthralling book and film starring Sally Field. Her tale as a patient with multiple-personality disorder (MPD), although MPD is not a personality disorder, "was instrumental in creating a new psychiatric diagnosis: multiple-personality disorder, known today as dissociative-identity disorder," reported The New York Times Magazine.

In the United States, nearly 9.1 percent of American adults ages 18 and older are diagnosed with personality disorder of some kind, including antisocial, borderline and schizotypal personality disorders, among others, according to the National Institute of Mental Health

A major concern with this "alternative model" was whether it would be inconsistent and risk misreading diagnoses for borderline, antisocial, and schizotypal personality disorders that have already been thoroughly researched. 

"It is important to evaluate whether thresholds can be established that provide solid continuity between DSM-IV and proposed DSM-5 definitions," the lead authors, Leslie Morey of Texas A& M University and Andrew Skodol of the University of Arizona, College of Medicine, wrote in the study.

The new edition will call the "hybrid" model, from the fourth book, the "alternative" model and includes several more improvements that were strenuously researched before being approved, which are:

  • Reducing the overlap among personality disorder diagnoses
  • Reducing different categorization of patients with same diagnosis
  • Removing random and outlying diagnostic data with little or no basis
  • Including more diagnostic criteria related to the extent of personality disorder impairment

The new "hybrid" model or "alternative model" merged core aspects of personality disorders with different maladaptive personality traits seen in patients. However, a substantial portion of the fifth edition will keep the same criteria from the fourth manual.

"[T]raditional DSM-IV categories of personality disorder can be rendered in terms of core impairments in personality functioning and pathological personality traits with high fidelity," Drs Morey and Skodol wrote. They say their study "should allay fears that translating PDs into personality functioning and trait terms will be disruptive to clinical practice or research." 

The researchers add, "[T]he definition of all personality disorders in terms of core impairments in personality functioning and pathological personality traits identifies personality pathology with high sensitivity and specificity and utility for treatment planning and prognosis." 

 

Morey LC, Skodol AE. Convergence between DSM-IV-TR and DSM-5 Diagnostic Models for Personality Disorder: Evaluation of STrategies for Establishing Diagnostic Thresholds. Journal of Psychiatric Practice. 19 (3). Accessed May 10, 2013. 

"A Girl Not Named Sybil" By Debbie Nathan, The New York Times Magazine, October 14, 2011.

[Previous version incorrectly stated MPD, or dissociative identity disorder, was a personality disorder]

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