The DSM-III-R Categorical Personality Disorder Diagnoses: A Critique and an Alternative

Thepurpose of this article is to review the Diagnostic andStatistica1 Manual ofMental Disorders (DSM-III-R; American Psychiatric Association, 1987) categorical diagnosis of personality disorders and to provide an alternative. The results from a variety of studies indicate that the categorical distinctions provided in DSM-ZII-R lack empirical support and that a dimensional model of classification would provide more reliable and valid assessments of personality disorder. The arguments favoring the categorical model--familiarity, tradition, simplicity, ease, and consistency with clinical decisions-are also addressed An alternative approach based on the five-factor model of personality is presented. Two concerns regarding this model are the relevance of the openness-to-experience dimension and the differentiation of abnormality from normality, but neither concern is problematic when personality disorders are understood to be maladaptive variants of normal personality traits.