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Confusion and Incoherence in the Classification of Personality Disorder: Commentary on the Preliminary Proposals for DSM-5

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Abstract

The compilation of Diagnostic and Statistical Manual of Mental Disorders (DSM)-5 afforded an unprecedented opportunity to advance the study of personality disorder by constructing an evidence-based, etiologically informed classification. The conceptual models and empirical knowledge are available and the field is looking for substantial changes to the way personality disorder is classified and diagnosed. Given the opportunity and need, the preliminary proposal by the DSM-5 Personality and Personality Disorders Work Group is disappointing. The proposal totally reformulates the way personality disorders are classified so that there is virtually no continuity with the previous system. The reformulation is a confusing mixture of innovation and a return to previous ways of representing diagnostic constructs that is inconsistent, incoherent, impractical, and frequently incompatible with empirical facts. Particularly problematic is the replacement of criterion-based diagnosis with a prototype matching system that, if implemented, will result in personality disorder being diagnosed in a fundamentally different way from all other disorders in psychiatry and medicine. Implementation of the proposal would have serious adverse consequences for patients, treatment, research, and administrative and legal applications, especially in the area of psychological injury and law.

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Authors and Affiliations

  1. Department of Psychiatry, 2255 Wesbrook Mall, Vancouver, BC, Canada, V6T 2A1

    W. John Livesley

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  1. W. John Livesley
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Correspondence to W. John Livesley.

Additional information

This commentary is based on information in the public domain and does not rely on information to which I have privileged access as a member of the DSM-5 Working Group on Personality and Personality Disorder. In accepting the invitation to write a commentary, I did not consider that I have a conflict of interests. I did, however, feel discomfort due to a conflict of values. Obviously one has, and feels, loyalty to any committee of which one is part. This value, however, conflicts with the ones of intellectual honesty, respect for empirical findings, and concern for the future of the field and patient care; values that trump loyalty to a committee process. This commentary should be read and interpreted as a dissenting point of view in my role on the Working Group.

The author wishes to thank two reviewers for their helpful comments.

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Livesley, W.J. Confusion and Incoherence in the Classification of Personality Disorder: Commentary on the Preliminary Proposals for DSM-5. Psychol. Inj. and Law 3, 304–313 (2010). https://doi.org/10.1007/s12207-010-9094-8

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  • DOI: https://doi.org/10.1007/s12207-010-9094-8

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