Clinicians' judgments of clinical utility: a comparison of the DSM-IV with dimensional models of general personality

Abstract

Clinical utility, or the usefulness of a diagnostic system in clinical practice, has been identified as a potential limitation of alternative dimensional models of personality disorder, such as the five-factor model (FFM; McCrae & Costa, 1990), the Temperament and Character Inventory (TCI; Cloninger, 2000), the Multidimensional Personality Questionnaire (MPQ; Tellegen & Waller, 1987), and the Shedler & Westen Assessment Procedure-200 (SWAP-200; Shedler & Westen, 1998). Both proponents of and opponents to dimensional models of personality disorder have suggested that their clinical utility be assessed in preparation for DSM-V (e.g., Rounsaville et al., 2002; First et al., 2002; Verheul, 2005; First, 2005). Samuel & Widiger (2006) found the FFM to have significantly greater clinical utility than the existing diagnostic categories. In the current study, 1,572 practicing psychologists were asked to describe one of three cases using the DSM-IV and the constructs of one of four alternative dimensional models (FFM, TCI, MPQ, SWAP). Clinicians then rated each model on six aspects of clinical utility. Results indicate that clinicians find dimensional models to be higher in clinical utility than the DSM-IV on five of the six aspects of clinical utility, but not significantly different from each other. Implications of these findings are discussed.