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

The purpose of this article is to review the Diagnostic and Statistical Manual of Mental 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-III-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.