Mental health professionals' perceptions of clinical utility: a comparison of the current and alternate DSM-5 models for personality disorder
Date
2018
Authors
Hadar, Rivka
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Abstract
Background: Despite its widespread international use, numerous criticisms have been aimed at the
Diagnostic and Statistical Manual of Mental Disorders’ (DSM) categorical approach towards the
conceptualisation and diagnosis of personality disorders (PD). A hybrid dimensional/categorical
diagnostic model was therefore developed, which was intended to replace the existing categorical PD
classification system. However, due to disagreement between leading professionals, it was instead
placed in Section III, “Emerging Measures and Models” of the DSM-5 as an “Alternative DSM-5 Model
for Personality Disorders” (DSM-5-AMPD).
Study Objective: This research aimed to explore the perceived clinical utility of the current DSM-5
categorical model for personality disorders (DSM-5-PD) in comparison to the DSM-5-AMPD.
Method: A sample of 13 mental health professionals applied four diagnostic instruments comprising
personality disorder features listed in the DSM-5-PD model and DSM-5-AMPD to a common patient
case file. Subsequent to the completion of each instrument, participants evaluated its clinical utility with
respect to the following six areas: (1) ease of use, (2) professional communication, (3) patient
communication, (4) comprehensive coverage, (5) treatment planning, and (6) global personality
description. Appropriate decision rules for each model were then employed by the researcher to assign
implied PD diagnoses. Information regarding the comparison of utility judgements and implied
personality disorder diagnoses were then presented to the sample at a focus group discussion. During
the discussion, professionals were requested to draw on this information, as well as the process of
applying both diagnostic models to the common case file, to inform a more in-depth discussion
regarding the perceived clinical utility of the DSM-5-PD model in relation to the DSM-5-AMPD.
Results and Discussion: There were no statistically significant differences in perceived clinical utility
between the DSM-5-PD model and the DSM-5-AMPD. However, a noticeable trend in the data revealed
that using the DSM-5-AMPD may reduce the extensive co-occurrence of personality disorders in
diagnosis, an often-cited criticism of the DSM-5-PD model. The qualitative analysis demonstrated
advantages of both models: the DSM-5-PD model is more familiar, easier to use, and provides a
shorthand, common diagnostic language for faster professional communication, while the DSM-5-
AMPD provides more individualised and informative personality disorder descriptions. The latter may
allow for more accurate personality disorder diagnoses, precise professional communication, improved
patient communication, and effective treatment.
Conclusion: A cost-benefit analysis between efficiency versus accuracy is required in order to
determine which diagnostic model is more clinically useful. However, both the DSM-5-PD model
and the DSM-5-AMPD fail to address cultural differences in relation to mental illness, such as
South Africa’s collectivist and ancestral ideology and cultural practices. Therefore, future
revisions of the DSM’s taxonomy of personality pathology should account for cultural
differences with regard to mental illness.
Description
A research report submitted in partial fulfillment of the requirement for the degree
Master of Arts in Clinical Psychology
In the Faculty of Humanities at the
University of the Witwatersrand, Johannesburg
15 March 2018
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Citation
Hadar, Rivka (2018) Mental health professionals' perceptions of clinical utility: a comparison of the current and alternate DSM-5 models for personality disorder, University of the Witwatersrand, Johannesburg, <http://hdl.handle.net/10539/25902>