A New Framework for Personality Assessment in DSM-5

The DSM-IV itself helps the clinician organize his or her thinking around patterns that have proved beneficial in the treatment of these difficult and often self-defeating patients. No matter whether the treatment is pharmacologic, psychodynamic, cognitive-behavioral, or supportive, the personality construct helps guide the treatment and informs both clinicians’ and patients’ expectations. The trait/facet assessment model asks researchers to function like researchers performing a structured clinical interview, during which all domains of psychiatric difficulty need to be queried, whether or not they fit with the emerging clinical picture. Such an approach seems transplanted directly out of the world of academic personality research, where it is helpfully and rightfully ensconced, and into the clinically oriented DSM system, where it does not belong.

In September 2010, a rather extraordinary editorial appeared in the American Journal of Psychiatry that called into question the elimination of the personality syndromes and the proposed adaptation of the trait domain/facet system. The editorial was signed by a diverse set of personality experts: Jonathan Shedler, Ph.D.; Dr. Aaron Beck; Peter Fonagy, Ph.D.; Dr. Glen O. Gabbard; John Gunderson, Ph.D.; Dr. Otto Kernberg; Dr. Robert Michels; and Drew Westen, Ph.D. (Am. J. Psychiatry 167:1026-8). Subsequently, the work group reinstated narcissistic personality disorder into the DSM-5 framework.

In a recent article on the initial construction of a maladaptive personality trait model and inventory for DSM-5 (Psychol. Med. 2011 Dec. 8 [doi:10.1017/S0033291711002674]), Dr. Skodol and his colleagues from the work group have emphasized the preliminary nature of the current proposals, which are still undergoing field trials and are months away from finalization. It certainly will be interesting to see whether these proposals undergo further refinement before they are set down in print 18 months from now.

Shakespeare wrote: "That which we call a rose by any other name would small as sweet." But a rose without a name would be just another aromatic wildflower, and a rose subdivided by attributes of petal, leaf, thorn, and stem just might miss the point entirely.

This column, "The Long View," regularly appears in Clinical Psychiatry News, an Elsevier publication. Dr. Brodsky is the medical director of Bridges to Recovery in Pacific Palisades, Calif., as well as the director of psychiatric services at the Venice (Calif.) Family Clinic. He is a member of the teaching faculty of the department of psychiatry at the University of California, Los Angeles.