Emerging approaches to the conceptualization and treatment of personality disorder.

Abstract

Personality disorders are both prevalent and debilitating, but controversies abound concerning the definition, assessment and treatment of these conditions. This review examines major approaches to conceptualizing the personality disorders, as recently emerging in DSM-5, Section III, and the research domain criteria initiative of the National Institute of Mental Health. Three prominent models for understanding these disorders (neural functioning, interpersonal model, and the cognitive-affective processing system model) are considered with their relevant empirical foundations. The implications for future psychopathology and treatment research and practice are detailed. Personality disorders (PD) are prevalent in the general popula- tion (10.56% median prevalence across studies; see Lenzenweger, 2008). They are highly debilitating, exerting a powerful impact on work functioning as well as interpersonal and intimate relations. However, there are many impediments to the assessment and treatment of patients with a personality disorder, not the least of which are the controversies in defining personality disorder, the range of severity across the disorders, the difficulties in identifying the key dimensions of personality dysfunction, the striking heter- ogeneity amongst patients that carry the same personality disorder diagnosis, and the paucity of treatment research on the majority of the personality disorder types. In this overview, which is necessarily selective and nonexhaus- tive, we explore a number of empirical developments in person- ality pathology research, with a particularly focus on the potential impact of these developments on conceptualization, assessment and treatment. While there is substantial agreement about the limitations of the PD nosology articulated in the Diagnostic and Statistical Manual for Mental Disorders, now in its fifth edition (DSM-5; APA, 2013), there is less agreement about how to ad- vance our conceptualization. The alternative DSM-5 model for personality disorders, retained in Section 3 of the DSM-5, pro-