The continued evolution of the diagnosis of Personality Disorders

This paper traces the evolution of the diagnostic formulations for personality disorders (PDs) through the current Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR; American Psychiatric Association, 2022) and in the International Classification of Diseases (ICD-11; World Health Organization, 2019). It outlines key arguments for and against three major diagnostic approaches: the categorical approach that is currently in use in the DSM-5-TR, which lists ten categories of PDs; the dimensional model, which diagnoses PDs according to five domains, their respective facets, and their severity; and the mixed/hybrid approach in Section III of the DSM-5-TR, which has been proposed as an Alternative Model of Personality Disorder (AMPD) diagnosis. Finally, three case studies are compared and contrasted using all three approaches. All three diagnostic systems appear to have advantages and disadvantages, although the dimensional and mixed/hybrid seem to be gaining adherents, particularly among younger mental health professionals.