Dimensional Diagnosis andDSM-5

Abstract

we do not know the psychometrics of such ratings, particularly if made by clinicians with variable training and skill. Zimmerman et al8 point out that these complex procedures may not even be necessary if, as in DSM-IV, one can score traits as absent, subclinical, or clinically diagnosable. While that method of scoring is a rough procedure, so are the procedures under consideration for DSM-5. By and large, dimensional scoring makes the most sense for subclinical problems, and less sense for diagnosable and severe personality disorders. Most trait measures have been validated in community populations, not in clinical settings. It remains to be seen whether describing patients as having a severe personality disorder, and then describing their traits, can do justice to the sickest patients we see. Dimensions could be most helpful with the problem of personality disorder, not otherwise specified (PD-NOS), which DSM-5 plans to call personality disorder trait-specified.9 These terms describe patients who meet overall criteria for a personality disorder but do not fit into any of the well-established categories. Zimmerman et al10 had found PD-NOS to be the most frequent diagnosis in clinical practice when systematic methods are applied, even if clinicians did not necessarily recognize the clinical picture. It would be advantageous to develop trait profiles for such cases, but severity ratings could suffer from the same problems as those described above. In summary, the findings of the present study can be viewed as showing that the emperor has no (or few) clothes. Complex scoring of the severity of psychopathology looks like a scientific procedure. But it may not be much better than what we already have.