Integrating theory-driven and empirically-derived models of personality development and psychopathology: A proposal for DSM V

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Abstract

Although there is growing consensus that the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM) should replace the categorical view of mental disorders with a dimensional approach rooted in personality theory, no consensus has emerged about the dimensions that should be the basis of the new classification system. Moreover, recent attempts to bridge the gap between psychiatric nosology and personality theories have primarily relied on empirically-derived dimensional personality models. While this focus on empirically-derived personality theories may result in a psychometrically valid classification system, it may create a classification system that lacks theoretical and empirical comprehensiveness and has limited clinical utility. In this paper, we first argue that research findings increasingly suggest that an integration of theory-driven and empirically-derived models of personality development is not only possible, but also has the potential to provide a more comprehensive and clinically-relevant approach to classification and diagnosis than either approach alone. Next, we propose a comprehensive model of personality development and psychopathology based on an integration of contemporary theory-driven and empirically-derived models of personality. Finally, we outline the implications of this approach for the future development of DSM, and especially its potential for developing research that addresses the interactions between psychosocial and neurobiological processes implicated in personality development and psychopathology.

Research Highlights

  • A lack of consensus about dimensions underlying psychopathology hampers the development of DSM-V.

  • An integration of theory-driven and empirically-derived personality models is needed.

  • Such an approach possesses greater research and clinical utility than either approach alone.

Introduction

With plans underway for the fifth edition of the DSM, an increasing number of critical assessments of the current DSM classification system has been published (Blatt and Levy, 1998, Blatt and Luyten, 2010, Livesley, 2001, Millon, 2000, Parker, 2005, Westen et al., 2006, Widiger et al., 2006, Widiger and Trull, 2007). These assessments clearly indicate that we are on the brink of a new era in psychiatric diagnosis which may lead to a radical shift in the conceptualization, classification, and treatment of mental disorders (Brown and Barlow, 2005, Luyten and Blatt, 2007). In particular, several authors have pointed out that a number of the implicit and explicit assumptions underlying DSM-III and its successors has not been validated by empirical research (Blatt and Luyten, 2010, Luyten and Blatt, 2007, Westen et al., 2004). Most of these criticisms center on the categorical approach of DSM, arguing that future editions of the DSM should embrace a dimensional view of psychopathology (Spitzer et al., 2008, Widiger et al., 2006).

Despite the growing consensus that future editions of the DSM should adopt a dimensional perspective, considerable disagreement exists concerning the dimensions that should form the basis of a new classification system. Yet, there is increasing consensus that these dimensions should be based on contemporary theories of personality development and personality organization (Clark, 2005, Krueger et al., 2007, Watson, 2005). Broadly speaking, these personality theories fall into two categories, i.e., they are either more empirically-derived or more theory-driven personality theories. Among the more empirically-derived models, research has recently concentrated mainly on the Internalization–Externalization model (I/E; Achenbach, Krukowski, Dumenci & Ivanova, 2005), the Five Factor Model (FFM; McCrae & Costa, 1999), the Tripartite Model (Clark, 2005, Watson, 2005), and Livesley's dimensional personality model (Livesley, 1998, Livesley, 2008). Among the more theory-driven personality theories, Blatt's two polarities model of relatedness and self-definition (Blatt, 2008, Blatt and Shichman, 1983) and Beck's Sociotropy-Autonomy model (Beck, 1983, Beck, 1999), contemporary interpersonal models (e.g., Pincus, 2005, Wiggins, 1991), attachment approaches (e.g., Mikulincer & Shaver, 2007), and self-determination theory (Deci and Ryan, 2000, Ryan et al., 2006) have received much research attention.

Yet, unfortunately, empirically-derived and theory-driven theories of personality pathology have progressed relatively independently, resulting in a marked division between these dimensional models of personality development. Moreover, recent attempts to bridge the gap between psychiatric nosology and personality theories have primarily relied on empirically-derived dimensional models (Blatt and Luyten, 2010, Pincus, 2005). While this focus on empirically-derived personality theories may result in a psychometrically valid classification system, an exclusive focus on purely empirically-derived models may create a classification system that has little clinical utility and may not be the best model to study the nature and processes involved in the treatment of mental disorders (Blatt and Luyten, 2010, Fonagy, 2008).

In this paper, we argue that research findings increasingly suggest that an integration of theory-driven and empirically-derived models of personality development and organization is not only possible, but that it also may provide a more comprehensive and clinically-relevant approach to classification and diagnosis than either approach alone. First, we discuss the current divide between empirically-derived and theory-driven dimensional models of personality development and psychopathology, which is rooted in a historical divide between both approaches. We then review research findings indicating a growing empirical convergence among theory-driven models in suggesting that interpersonal relatedness and self-definition are central coordinates for understanding personality development and for organizing, classifying and treating psychological disorders. Next, we discuss research findings demonstrating the growing convergence among empirically-derived theories of personality development with theory-driven models of personality. Finally, we propose an integrative, hierarchically organized model of the development and nature of psychopathology, and discuss the implications of this model for research and clinical practice.

Section snippets

Theory-driven and empirically-derived models in psychiatric classification

From a historical perspective, psychiatric classification has always been characterized by two competing approaches (Luyten and Blatt, 2007, Pincus, 2005). On the one hand, theory-driven approaches emphasize that classification should be based on theoretical conceptions about the nature of psychopathology. This often involves specifying the nature of a number of dimensions that characterize psychopathology, as in Beck's (Beck, 1983) cognitive approach to personality disorders. From this

Contemporary theories of relatedness and self-definition

A remarkable convergence among a number of dominant theory-driven approaches to psychopathology suggests that relatedness and self-definition are two fundamental psychological dimensions that provide a theoretical matrix for the classification of psychopathology linking concepts of psychopathology to processes of personality development, variations in normal personality organization, as well as to mechanisms of therapeutic action (Blatt, 2008, Livesley, 1998, Livesley, 2001, Mikulincer and

Towards a hierarchical view of the development and nature of psychopathology: prototypes as an alternative to diagnostic categories

Based on the research reviewed, we propose that different forms of psychopathology can be situated within a hierarchical model that integrates theory-driven models that emphasize relatedness and self-definition as central coordinates in normal and disrupted personality development, with empirically-derived models of basic temperament and personality factors. Fig. 5 presents a schematic depiction of the proposed model. In the next sections, we outline the main properties of this model.

Implications for future research and clinical practice

Throughout this paper we have discussed implications of a combined theory-driven and empirically-derived approach for future research concerning the nature and classification of psychopathology. To summarize these implications, the proposed integrated prototype approach spells out a clear agenda for future research, consisting of (a) the identification of prototypical conflict-defense constellations, (b) locating these prototypes in the two-dimensional space spanned by relatedness and

Conclusions

Our paper integrates theory-driven and empirically-derived approaches toward personality development and the classification of psychopathology to identify new perspectives for integrating disparate literatures that link classification, assessment, prevention and treatment of psychopathology to principles of normal and disrupted personality development. We take a developmental perspective that emphasizes continuity in development throughout life, as well as continuity between normal personality

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