Seeking clarity for future revisions of the personality disorders in DSM-5

Abstract

This article reviews the process by which the DSM-5 Personality Disorder (PD) proposal for change was developed, challenged, and then ultimately rejected. The DSM-5 workgroup's mandate to introduce radical changes were inherently fraught by the limited time allowed, but their efforts were undermined by dissension within the committee, the lack of a clearly identified scientific rationale, and by the inconsistent dialogue with the existing community of PD experts. Nonetheless, valuable steps were taken to establish a better definition for PD's, introduce dimensions, and identify the steps needed for future revisions. The author only in retrospect has concluded that borderline personality disorder and antisocial personality disorder be treated differently than other PD's because of their clinical significance and empirical support. Specifically, these "major" PD's should remain on Axis I, while other PD's are secondary disorders that are more comfortably dimensionalized and belong on Axis II.