When we talk about personality psychopathology, you don’t know he can help thinking about the ten -year debate that has divided experts in terms of diagnosis and classification.
If, on the one hand, many professionals support a classification model based on discrete categories that distinguish the pathological personality From the “normal” one in qualitative terms (categorical diagnosis), the supporters of the dimensional model are placed on the opposite side, where the personality is seen as a set of traits arranged along a continuum and the pathology presents differences in quantitative order with the “healthy” personality.
Although the categorical model has long been criticized for the poor attention given to the subjective experience of the individual and the high number of co-diagnosis that it implies (because it is based on the principle of the presence/absence of certain criteria), the dimensional approach has never constituted a valid alternative that would allow mental health professionals to create a common language with which to connote certain pathological paintings of personality (also for the fact of considering the union individual traits as equivalent to the whole).
When the APA Task-Force found itself-during the drafting of the DSM-5 (2013) – To deal with the theme of Classification of personality disordersthe split between the two positions emerged again, generating many critical issues.
The outcome, after years debates that also involved well-known names from the psychiatry of our country, was to leave the categorical classification of the previous version of the DSM (DSM-4-TR) essentially unchanged, which illustrated 10 personality disorders divided into 3 distinct Clusters.
Alongside this framework, an alternative model for the diagnosis of personality disordersaccording to a Dimensional-Crategial hybrid approach.
Personality disorders, in this new model, are characterized by two main elements: 1) by compromises of the functioning of the personality and 2) by traits of pathological personality.
The operating elements of the personality proposed are:
- Identity: the experience of self as the only one, with clear boundaries to oneself and others; self-esteem and self-evaluation precision; emotional regulation capacity.
- Self -director: ability to pursue coherent and significant objectives both in short and in the long term, use of construction and prosocial internal standards of behavior; self-reflexive capacity (Self-Reflect) that allow to acquire the meaning of their skills and also of their limits.
- Empathy: understanding and appreciation of the experiences and motivations of others; tolerance of different perspectives; understanding of the effects of one’s behavior on others.
- Intimacy: depth and duration of the positive relationship with others; desire and ability of closeness; behavior based on mutual respect.
The functioning of the personality of the individual within the domain of the self (composed of identity and self -director) and in interpersonal domain (consisting of empathy and intimacy), is assessed along a dimensional continuum that ranges from a level 0, equivalent to an absence of impairment, to a level 4 that indicates extreme impairment (scale for the level of personality functioning; LPFS).
The second criterion (this time of categorical order!) Distinctive of a personality disorder Within this new model it is the presence of at least one trait of pathological personality.
The 25 Squares of tract proposals, which have been developed by a first review of the already existing tract models in the literature and then through research on clinical subjects, are organized in 5 sections of higher order:
- Negative affectivity (vs. emotional stability): experimenting with negative emotions intensely and frequently.
- Detachment (vs. Estroversion): withdrawal from other people and social interactions.
- Antagonism (see availability): present behaviors that contrast with other people.
- Disinhibition (see conscientiousness): engage in impulsive behavior without reflecting on possible future consequences.
- Psychoticism (vs. mental lucidity): to have unusual and bizarre experiences.
The DSM-5 also presents i diagnostic criteriaconsistent with the proposed alternative model, for 6 specific personality disorders (antisocial, avoidance, borderline, narcissistic, obsessive-compulsive, schizotypical) and for personality disorder specific trait (when the personality disorder is present but do not satisfy the criteria for any of the previous ones).
In conclusion, the new approach, certainly interesting from a theoretical point of view, has the opportunity to truly change the language of us professionals or that of remaining, even in the future, only an “alternative model”.
It is perhaps still too early to say if it will be successful among mental health professionals or if it will be able to fully settle the question of the Classification of personality disorders; However, what is desirable is that at least it can constitute a valid alternative well spent in clinical practice and research.
