Personality disorders are the vanguard of the post-DSM-5.0 era.

Abstract

The process of constructing the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5; American Psychiatric Association, 2013) has concluded, with the manual published in May 2013. In this article, I review the evolution of personality disorders (PDs) in DSM-5 from my perspective as a participating workgroup member, and as an observer of the DSM-5 construction process. I emphasize well-documented shortcomings of the fourth edition of the DSM (DSM-IV; American Psychiatric Association, 1994), the diversity of potential changes to PD conceptualization and diagnosis that were proposed during the construction of DSM-5, and the final outcome, which consists of reproducing DSM-IV PD criteria in Section II of DSM-5 (diagnostic criteria and codes), while also printing a complete parallel PD system in Section III (emerging measures and models), with the idea of moving elements of the Section III material to Section II as DSM evolves (e.g., in DSM-5.1). Perhaps the PD field is too fractious to arrive at a consensus approach at this juncture, but, in addition, the current situation shows how the PD field is arguably the most forward-thinking area in contemporary psychopathology. This is because many PD scholars do not accept the inadequate polythetic-categorical approach to psychopathology classification of DSM-IV (which, owing to conservative political forces, also frames Section II of DSM-5). PD research is therefore at the vanguard in conceptualizing, studying, and treating psychopathology because it is not slavishly tethered to the DSM, and its approach to defining mental disorder through political processes.