Combining Interpersonal and Intrapersonal Perspectives on Personality Pathology: A Commentary on Hopwood et al.

Abstract

Sometimes the limitations of a conceptual framework or classification system are illuminated not by the nature of the criticisms leveled at it, but by who is doing the criticizing. Such has been the case with the personality disorder (PD) symptoms and categories in DSM-IV (American Psychiatric Association [APA], 1994) and DSM-IV-TR (APA, 2000). Behaviorists, psychoanalysts, trait theorists, cognitive researchers, and humanistic psychologists agree on very little, but they are of one mind in disliking the current framework for conceptualizing and diagnosing PDs. Problems with the extant DSM conceptualization of PDs have been documented extensively. Among the major limitations noted by clinicians and clinical researchers are excessive PD overlap and comorbidity, and reliance on a threshold model of PD diagnosis that is inconsistent with a plethora of research demonstrating that personality dysfunction exists on a continuum of severity, with no sharp cutoff distinguishing normality from pathology. Critics have also noted the difficulties that stem from heterogeneity within PD categories and the equal weighting of different PD symptoms even when these symptoms contrast sharply with respect to pathognomonic value (see Huprich & Hopwood, 2013, for reviews of limitations in extant PD models). Accompanying these criticisms has come a diverse array of proposed solutions—alternative frameworks for conceptualizing and diagnosing personality pathology. These include the formal proposal offered by the DSM-5 Personality and Personality Disorders (PPD) Work Group (see Skodol, 2012), and the Personality (P) Axis of the Psychodynamic Diagnostic Manual (Alliance of Psychoanalytic Organizations, 2006). Other prominent alternatives include trait-based frameworks (e.g., Krueger, Derringer,