Reconceptualizing personality disorder diagnosis in the DSM-V: The discriminant validity challenge.

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Abstract
Research on personality disorder (PD) diagnostic reliability, comorbidity, and treatment confirms that PD diagnoses lack discriminant validity: Our ability to describe different PDs in an abstract sense has outstripped our ability to diagnose them accurately in real-world clinical settings. Here an alternative model of PD diagnosis is presented wherein three types of information are coded on Axis II: (a) an overall rating of level of personality pathology, (b) separate intensity and impairment ratings for each relevant PD dimension, and (c) a listing of personality traits (including PD-related traits) that enhance adaptation and functioning. Possible objections to the alternative model are considered (e.g., problems of diagnostician compliance, disci-plinewide resistance to a new diagnostic framework), and advantages of the model over the current diagnostic system are discussed (e.g., greater heuristic value, increased predictive validity).

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