Aim
The Diagnostic and Statistical Manual of Mental Disorders (DSMIV- TR) represents personality disorders in a categorical manner. This review briefly discusses the limitations of the current categorical model of personality disorders. An alternative view to the categorical approach is the dimensional perspective that personality disorders represent maladaptive variants of personality traits that merge into both normality and one another. The various proposals for “dimensionalizing” the personality pathology are discussed in the light of recent achievements in this field. A dimensional approach would ameliorate many of the problems associated with a categorical approach. This article reviews recent evaluations of dimensional approaches to the description of personality, personality disorders and psychopathology.
Methods
PubMed and PsycInfo (1970-2011) databases were searched for English language articles using the following keywords: categorical psychopathology, dimensional psychopathology, personality, personality disorders, personality traits and nosographic psychiatry. We reviewed papers that addressed the following aspects of personality disorders: personality traits, dimensional models of personality, dimensional assessment of personality pathology, aetio-epigenetic structure of traits delineating personality disorder and dimensional versus categorical classification of mental disorders covered by general psychopathology.
Results
Several dimensional models of personality disorders are presented in this short review. Recent studies have identified four main factors that can be used to characterize disorders of personality. Herein, an integrated dimensional approach to the personality pathology is presented. One issue that still needs to be addressed is how to integrate these dimensions into the current classification system such that they will be accepted by both clinicians and psychopathologists. The clinical utility of the dimensional models must also be demonstrated. The development of a method that combines trait elevations and impairment associated with personality pathology is needed in order to define personality disorder from a dimensional perspective. Several issues must be addressed to facilitate the adoption of a dimensional model of personality disorder.
Conclusions
In this literature review, future directions are presented that might be useful to integrate different dimensional approaches. A review on this theme is timely and relevant in consideration of the upcoming DSM-V. Research and clinical evidence support the inclusion of this dimensional representation of personality disorders in the DSM-V, possibly as an adjunct to the traditional categorical classification framework. It is likely, therefore, that in addition to the classical description of categorical “Personality Disorder”, in the future there will be a more complex dimensional description of personality psychopathology: “Personopathy”? Although there may be some initial resistance to the incorporation of dimensional models in future diagnostic manuals, clinicians and researchers would benefit from a more reliable and valid representation of personality pathology and of psychopathology itself.