Reflections on clinical judgment and the dimensional-categorical distinction in the study of personality disorders: Comment on Bornstein (2019).

Abstract

In his stimulating commentary, Bornstein (2018) correctly observes that dimensional and categorical approaches have long competed for scientific legitimacy in theory and research on personality disorders. I argue, however, that Bornstein (a) overstates the similarities of these 2 approaches in their implications and (b) risks conflating ontological (the state of the world) with epistemic (how we think about the state of the world) considerations by implying that clinicians' thinking processes should shape how we conceptualize and operationalize personality disorders. Complementing Bornstein's arguments, I contend that some commonplace errors in clinical reasoning may stem from the misapplication of analytic as well as intuitive thinking processes, and that debiasing efforts may need to be supplemented by the implementation of forcing functions in routine clinical practice. (PsycINFO Database Record (c) 2019 APA, all rights reserved).