Reply to Commentators: From B to Z

Abstract

The bulk of my target article was concerned with question of whether diagnosis of personality disorders should remain categorical. Only a few of commentators seem to disagree with my statement that the categorical diagnoses represent ... a simplistic and presumptive understanding of personality disorder pathology that is a hindrance to empirical research and clinical practice. The support among these commentators for dimensional perspective is neither surprising nor artifactual. Previously, I reviewed published literature in order to assess systematically support for these alternative perspectives (Widiger, 1992). I identified 35 review articles, chapters, and papers that discussed explicitly question of whether personality disorders should be diagnosed categorically or dimensionally. Eighteen favored dimensional approach (e.g., Livesley, 1991), 12 were neutral or unclear in their position (e.g., Blashfield, 1984), and 5 advocated categorical approach (i.e., Frances, 1990; Gunderson, Links, & Reich, 1991; Millon, 1981; Spitzer & Williams, 1985; 0. P. Wiggins & Schwartz, 1991). The consensus within literature clearly favors dimensional approach. Only commentaries by Benjamin, Davis and Millon, and Frances in this series favor categorical approach. Benjamin suggests that a dimensional model is useful only for description of individuals and that it fails to offer more general theoretical concepts on which scientific progress depends. Benjamin, however, seems to be equating hypothetical constructs with categories or other latent class groupings of individuals. It is not clear why she would not consider dimensions of neuroticism, introversion, and conscientiousness as possessing as much scientific value as diagnostic categories of dependent, borderline, and narcissistic. There are many valid and scientifically meaningful constructs that involve a continuum. It is true that dimensional constructs are more precise and exact in their description of individual cases, but that hardly makes them less scientific. Benjamin offers as ideal to which a taxonomy of personality should aspire abstract geometric typology of triangles, squares, and spheres: