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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/advagg_css\/css__ce2QY63WIanKyr8eSq7eavr1XQRRmFD6ZSmwpyJi8lM__zXwFqpqmxrZOXXcd_TpBQpjuELbmIP9wBR5UuTDWAO4__YJWWMMdfCJuAFm5cUEp88OsodhO3ZA-2lzRfoBsSlk4.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n            \u003Cp id=\u0022p-1\u0022\u003EA significant change to DSM-V that is being considered is the use of a dimensional, instead of a categorical, approach to the diagnosis of mental disorders. The research agenda for personality disorders in DSM-V can be considered a test case for such a change.\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003EPersonality Disorders Guidelines\u003C\/li\u003E\u003C\/ul\u003E\u003Cp id=\u0022p-2\u0022\u003EA significant change to DSM-V that is being considered is the use of a dimensional, instead of a categorical, approach to the diagnosis of mental disorders. The research agenda for personality disorders in DSM-V can be considered a test case for such a change. Andrew E. Skodol, MD, University of Arizona College of Medicine, Tucson, AZ, and Chair of the DSM-V Personality Disorders Work Group, provided a glimpse into the group\u0027s current thinking.\u003C\/p\u003E\u003Cp id=\u0022p-3\u0022\u003EIn considering dimensional approaches to psychiatric illnesses, personality disorder was identified as a good starting point, because it is an area in which both researchers and clinicians have been most dissatisfied with the current categorical approach to diagnosis. The Personality and Personality Disorders Work Group is currently working on a 5-part model that includes an overall rating of personality functioning, prototypes that describe the major personality disorder types, a system to address the traits that are associated with the prototypes, generic criteria for personality disorder, and measures of adaptive functioning [Skodol AE \u0026amp; Bender DS. \u003Cem\u003EAm J Psychiatry\u003C\/em\u003E 2009].\u003C\/p\u003E\u003Cp id=\u0022p-4\u0022\u003EThe key adaptive capacities that are not functioning properly in individuals with personality disorders occur in the domains of the self and of interpersonal relationships. The Work Group has proposed that each of these areas might be represented by 3 subdomains. With issues that involve the self, the first is \u003Cem\u003Eidentity integration\u003C\/em\u003E, which includes regulation of self-states, boundary delineation, sense of time and personal history, and self-other differentiation. The second involves the concept of \u003Cem\u003Eintegrity of the self\u003C\/em\u003E \u2014having basic esteem regulation, self-respect, agency, and realistic self-appraisal, etc. \u003Cem\u003ESelf directedness\u003C\/em\u003E, or the ability to find meaning in life and having purpose, constitutes the third subdomain. \u003Cem\u003EEmpathy\u003C\/em\u003E (the ability to accurately model another person\u0027s thoughts and emotions, identify with other people\u0027s experience, pay attention to a range of other perspectives, and understand the issues of social causality) is the first subdomain within the interpersonal area. \u003Cem\u003EIntimacy\u003C\/em\u003E\u2014the depth and duration of connection with others and tolerance and desire for closeness\u2014and the \u003Cem\u003Ecomplexity and integration of representations of others\u003C\/em\u003E form the other 2.\u003C\/p\u003E\u003Cp id=\u0022p-5\u0022\u003EThe following levels of self and interpersonal functioning have been proposed, each level defined by pertinent attributes that are associated with the 5 subdomains: no impairment (ie, healthy personality functioning), and mild, moderate, serious, and severe impairment. The group is currently working on whether, how, and at what point to set a cutoff for a level of impairment in personality functioning that is consistent with a personality disorder. One of the interesting questions that the group is currently debating is whether personality disorder can be defined only in terms of pathology of the self or whether it is necessary to combine the self and the interpersonal. Determining a patient\u0027s level of self and interpersonal functioning would be the first step in assessing the presence and severity of personality psychopathology.\u003C\/p\u003E\u003Cp id=\u0022p-6\u0022\u003ETo more specifically characterize an individual\u0027s personality, 6 domains, representing a total of 33 personality traits on which to base prototypes, are being evaluated:\u003C\/p\u003E\u003Cul class=\u0022list-unord \u0022 id=\u0022list-1\u0022\u003E\u003Cli id=\u0022list-item-1\u0022\u003E\n            \u003Cp id=\u0022p-7\u0022\u003EEmotionality (eg, emotional lability, anxiousness, suspiciousness, dependency, attachment insecurity, self-harm, and pessimism)\u003C\/p\u003E\n         \u003C\/li\u003E\u003Cli id=\u0022list-item-2\u0022\u003E\n            \u003Cp id=\u0022p-8\u0022\u003EIntroversion (eg, social withdrawal, anhedonia, reservedness, detachment, and intimacy avoidance)\u003C\/p\u003E\n         \u003C\/li\u003E\u003Cli id=\u0022list-item-3\u0022\u003E\n            \u003Cp id=\u0022p-9\u0022\u003EAntagonism (eg, callousness, narcissism, hostility, aggression, oppositionality, deceitfulness, manipulativeness, and conduct disorder problems)\u003C\/p\u003E\n         \u003C\/li\u003E\u003Cli id=\u0022list-item-4\u0022\u003E\n            \u003Cp id=\u0022p-10\u0022\u003EDisinhibition (eg, impulsivity, distractibility, reckless sensation seeking, and irresponsibility)\u003C\/p\u003E\n         \u003C\/li\u003E\u003Cli id=\u0022list-item-5\u0022\u003E\n            \u003Cp id=\u0022p-11\u0022\u003ECompulsivity (eg, perfectionism, indecisiveness, perseveration, rigidity, and orderliness)\u003C\/p\u003E\n         \u003C\/li\u003E\u003Cli id=\u0022list-item-6\u0022\u003E\n            \u003Cp id=\u0022p-12\u0022\u003EPeculiarity (eg, unusual perceptions, unusual beliefs, eccentricity, and cognitive dysregulation)\u003C\/p\u003E\n         \u003C\/li\u003E\u003C\/ul\u003E\u003Cp id=\u0022p-13\u0022\u003EThe final number of traits will likely be reduced either by elimination or combination after secondary analysis and field trials have been completed. A simple definition will be developed for each trait (eg, emotional lability might be described as \u201cprone to unbidden mood fluctuations,\u201d \u201cemotions are easily aroused and intense,\u201d \u201cunstable emotional experiences,\u201d \u201cfrequent mood changes,\u201d and \u201cincapacitated by extremity of emotions\u201d). The group is also currently working on a rating scale so that patients could be described on a 4- or 5-point scale, depending on how applicable the trait was to their usual personality.\u003C\/p\u003E\u003Cp id=\u0022p-14\u0022\u003EThe current expectation is that there will be a more limited number of diagnostic types than the 10 that are currently listed in the DSM-IV. The Work Group is considering several narrative-type descriptions that capture a number of styles that are currently represented by the DSM-IV categories. Dr. Skodol noted that this does not mean that all DSM-IV (and other) types can not be diagnosed; it just means that they will be diagnosed on the basis of the level of personality functioning, the generic criteria, and some combination of traits. Each prototype will have a clinical description, as well as a criteria type system to describe the level of impairment in self-structure and interpersonal functioning that is represented, the domain and particular traits that are elevated in each prototype, and in what combination and to what extreme the traits are present.\u003C\/p\u003E\u003Cp id=\u0022p-15\u0022\u003EFinally, the group intends to provide guidance on how to combine these various new elements in a systematic way that would be most clinically feasible and useful.\u003C\/p\u003E\u003Cp id=\u0022p-16\u0022\u003EWithin the personality work group alone, there are currently 20 ongoing literature reviews that are representing the validity of each of the 10 existing personality disorders, a proposed tripartite model, the definition of personality disorder, the clinical utility of different dimensional models, concepts and measures of functioning, criteria for change, gender and personality disorder, culture and personality disorder, levels of personality functioning, dimensionalizing existing personality disorder constructs, and the resilient personality. Secondary data analyses are being performed, and field trials will be conducted.\u003C\/p\u003E\u003Cp id=\u0022p-17\u0022\u003EDSM-V is still at least 3 years away, with much work still to be done.\u003C\/p\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2009 MD Conference Express\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/9\/3\/28.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzmk01\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}