Do not copy complete sentences out of the article without also explaining in you
ID: 3484740 • Letter: D
Question
Do not copy complete sentences out of the article without also explaining in your own words.
1. In this article, what were the four problems with the categorical diagnostic system of personality disorders in the DSM-IV?
2. What were four advantages of the dimensional model of classification
Dimensional models of personality disorder: Diagnostic and Statistical Manual of Mental Disorders Fifth Edition and beyond Timothy J. Trull, Sarah L. Tragesser, Marika Solhan and Rebecca Schwartz-Mette Introduction Diagnostic manuals of mental disorders continue to Purpose of review We describe several dimensional models of personality disorders and highlight future directions for the integration represent the personality disorders in a categorical way, of dimensional approaches in the Diagnostic and Statisticalcoded as cither prescnt or absent. The Diagnostic and Manual of Mental Disorders, Fifth Edition (DSM-V). This Statistical Manual of Mental Disorders, Fourth Edition, Tex! review is timely and relevant, given the upcoming revision ofRevision (DSM-IV-TR) [1], however, does acknowledge DSM (DSM-V) Recent findings Research has identified four common higher order factors rcpresent maladaptive variants of personality traits that that could be used to characterize personality pathology Evidence supports the inclusion of this dimensional representation of personality disorders in DSM-V, possibly Association and thc National Institute of Mcntal Health as an adjunct to the traditional categorical classification scheme. A dimensional approach would ameliorate many of and Statistical Manual of Mental Disorders, Fifth Edition the problems associated with the categorical approach. Issues that still need to be addressed are on how to integrate these dimensions into the current classification system in a way that they will be accepted by clinicians and They emphasized, in particular, the development ofa psychopathologists. The clinical utility of the dimensional models must be demonstrated, and the development of a end, an international conference was held recently that method that combines trait elevations and impairment associated with personality pathology is needed in order to of personality disorders and suggested how such a system define personality disorder from a dimensional perspective.might be implemented [3"]. Summary Although there may be some initial resistance to the incorporation of the dimensional models in the future diagnostic manuals, researchers and clinicians are expected to benefit from the more reliable and valid portrayal of personality pathology that 'an alternative perspective to the categorical approach is the dimensional perspective that personality disorders merge imperceptibly into normality and into one another (p. 689). A joint committee of the American Psychiatric charged with identifying pressing issues for Diagnostic (DSM-V) concluded that 'there is a clear need for dimen- sional models to be developed and for their utility to be compared with that of existing typologics' (12], p. 13). dimensional model of personality disorder. Toward this reviewed the empirical evidence for a dimensional model The article reviews recent evaluations of dimensional approaches to the description of personality disorders and personality pathology. More in-depth treatments of this topic are available 4",5]. First, our review briefly dis- cusses the limitations of the current categorical model of personality disorders. Next, we present alternative pro- posals for 'dimensionalizing' personality pathology and discuss recent findings relevant to these approaches. We then present an integrative dimensional model of person lity pathology that is receiving increasing attention. Finally, we discuss several issues that need to be addressed to facilitate the adoption of a dimensional model of personality disorder clinical utility, dimensional models, personality disorder personality pathology Curr Opin Psychiatry 20:52-56. 2007 Lippincott Williams & Wilkins. University of Mssouri, Missouri, USA Corrpondence to Timothy J. Trull, Department of Psychology, University of Missouri, 1060 McAester, Columbia, MO 65211, USA e-mail: trulltmissoui.edu Categorical models of personality disorder In DSM-IV-TR, personality disorders are defined within a categorical, hierarchical taxonomic system The 10 personality disorders are polythetic categories defined by approximately 7-9 items, of which a subset must be present in order to meet the diagnostic threshold. In addition, the DSM-IV-TR includes a hierarchical system of three clusters of personality disorders. This categorical system does offer several pragmatic advan tages: it maps neatly on the decision of whether to Current Opinion in Psychiatry 2007, 20:52-56 Abbreviations DSM FFM Diagnostic and Statistical Manual of Mental Disorders five-factor model 2007 Lippincott Williams& Wilkins 0951-7367 52Explanation / Answer
Dimensional modals are intended to reflect what constitutes personality disordersymptomology according to a spectrum, rather than in a dichotomous way. As a result of this they have been used in three key ways; firstly to try to generate more accurate clinical diagnoses, secondly to develop more efficacious treatments and thirdly to determine the underlying etiology of disorders.
Clinical diagnosis
The "checklist" of symptoms that is currently used is often criticized for a lack of empirical support and it's inability to recognize personality-related issues that do not fit within the current personality disorder constructs or DSM criteria. It has also been criticized for leading to diagnoses that are not stable over time, have poor cross-rater agreement and high comorbidity suggesting that they do not reflect distinct disorders.
In contrast the dimensional approach has been shown to predict and reflect current diagnostic criteria, but also add to them. It has been argued to be especially useful in explaining comorbidity which is often high for patients diagnosed with a personality disorders.
Following from these claims, the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) incorporates a combined categorical-dimensional approach to diagnosing personality disorders based on the degree to which a person shows elevated levels of particular personality characteristics. However one of the issues in using a dimensional approach to diagnosis has been determining appropriate cut off points so as to know who belongs to the category of people requiring treatment, this is partly why both categorical and dimensional diagnoses are included.
Since the categorical model is widely used in clinical practice and has a significant body of research supporting it, its common usage is compelling to laypeople when they are judging the credibility of professional opinion.
Therefore, the dimensional approach is often further criticized for being difficult to interpret and less accessible. It is however widely used in some professional settings as the established approach, for example by forensic psychologists.
Treatment efficacy
Another suggested usage of the dimensional approach is that it can aid clinicians in developing treatment plans and assessing other mechanisms contributing to patient’s difficulty in functioning within the social, personal, or occupational domains.
The approach can improve treatment in two ways. Firstly it can enable development of more personalized care plans for individuals based on their adaptive and maladaptive characteristics. Secondly, it means that relevant symptomology which is not considered maladaptive can be considered when developing and evaluating general therapeutic and medical treatment.
Determining cause
Attempts at presenting an etiological description of personality disorders have been avoided due to the influence of the DSM and its principles in psychiatric research (See history section). However some techniques are looking at potential interrelated causalities between symptoms of personality disorders and broader influences including aspects of normal personality (See integrated approaches section).
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