Twenty frequent errors and inaccuracies in the diagnostic evaluation of personality disorders

Abstract

ContextThe ICD-11 proposal and the incorporation of the alternative Model of DMS-5, Section III (AMPD), a hybrid system which combines categorical and dimensional criteria for the assessment of personality disorders, based in levels of severity of impairment in self and interpersonal functioning, has permitted the alignment of descriptive psychiatric nosology with psychoanalytic frames that use the same dimension in the diagnostic evaluation and empirical research of the treatment of personality disorders. This approach has also allowed the conceptual bridging of neurobehaviorally-linked personality dimensions and psychostructural organization. Most diagnostic methodologies of personality disorders explore: 1) the perception of subjective experience, 2) observable and inferential behaviors, and 3) psychological structure and processes mediating self and interpersonal functioning. ObjectivesThis article highlights 20 frequent errors and inaccuracies on the diagnostic evaluations of personality disorders that are described in the ICD-11 proposal and the Model of DMS-5, Section III (AMPD). MethodThe study exposes the difficulties encountered in exploring subjective experience and underlying psychological structure to develop and apply overarching frameworks between descriptive phenomenology and psychological organization, on one side, and interpersonal neurobiology and psychological motivation on the other toward explanatory diagnostic formulations with therapeutic and prognostic implications. ResultsThe proposal of an alternative model for personality disorders in the DSM-5, section III, toward hybrid systems which combine categorical and dimensional features to personality pathology has allowed the alignment of descriptive psychiatric nosology with psychoanalytic frames that use the same dimension in the assessment and empirical research of the treatment of personality disorders. ConclusionA diagnostic evaluation for patients is an opportunity to systematically explore personal and life circumstances, toward the possibility of a mutative reorganization. For clinicians, every new diagnostic assessment provides an occasion for a critical analysis of past experiences, and the feasibility of assimilating new information and findings from the contemporary empirical investigation of the diagnostic assessment and treatment of personality disorders.