Abstract
This chapter reviews recent (2000-2005) personality disorder (PD) research, focusing on three major domains: assessment, comorbidity, and stability. (a) Substantial evidence has accrued favoring dimensional over categorical conceptualization of PD, and the five-factor model of personality is prominent as an integrating framework. Future directions include assessing dysfunction separately from traits and learning to utilize collateral information. (b) To address the pervasiveness and extent of comorbidity, researchers have begun to move beyond studying overlapping pairs or small sets of disorders and are developing broader, more integrated common-factor models that cross the Axis I-Axis II boundary. (c) Studies of PD stability have converged on the finding that PD features include both more acute, dysfunctional behaviors that resolve in relatively short periods, and maladaptive temperamental traits that are relatively more stable-similar to normal-range personality traits-with increasing stability until after 50 years of age. A new model for assessing PD-and perhaps all psychopathology-emerges from integrating these interrelated reconceptualizations.
Highlights
Comorbidity: co-occurrence of two diagnoses in an individual major directions in which future research should focus
Limitations and implications for future directions. These findings indicate that a lower-level five-factor model (FFM) personality trait structure could supplant the current categorical system for diagnosing personality disorder (PD), but that—just as with extant measures—certain limitations must be overcome
bulimia nervosa (BN) as well as anorexia nervosa (AN) patients score high on perfectionism and related OC traits (Halmi 2005), which suggests that OC traits are not facets of constraint, as is often assumed. These findings provide a generally coherent picture of Eating disorders (EDs)-PD overlap, but in a special issue of Eating Disorders: The Journal of Treatment & Prevention that focused on ED-PD comorbidity, Vitousek & Stumpf (2005) caution against assessing personality traits and disorders in ED individuals until after the initial treatment phase because of assessment difficulties (e.g., “state” effects of semistarvation and chaotic eating, denial/distortion in self report, and instability of ED subtypes)
Summary
Recent research has documented increased reliability and validity of assessment when multiple sources are used to diagnose personality. Comorbidity both within Axis II and between Axes I and II has been well documented; personality trait dimensions have been shown to relate moderately to strongly with both Axis I and Axis II disorders. 7. Four strikingly similar models for diagnosing PD have emerged and can be integrated as follows: a diagnosis of PD, focused on personality dysfunction, would be recorded on Axis I, whereas the relevant personality traits, that is, the relatively stable characteristics underlying the Axis I PD diagnosis, would be recorded on Axis II. 1. At some point, perhaps as early as DSM-V, the Axis II PDs will be diagnosed using a dimensional conceptualization, but several key issues remain to be addressed. For a dimensional system to have utility in clinical settings, a consensually validated lower-order structure of adaptive and maladaptive personality is needed to capture personality’s rich complexity
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