![]() The three concepts differ fundamentally from the current categorical classification of PDs in that they define core pathology dimensions based on disturbances in the self and interpersonal relations, which can be rendered to one global continuum, spanning levels from normal to severely disturbed functioning of personality. Personality structure and personality organization are psychoanalytic concepts that substantially influenced the development of the concept of personality functioning. This includes other new models, such as the PD classification proposal for ICD-11, and previously existing approaches, such as the concepts of personality structure and personality organization. The AMPD has stimulated plenty of research and has led to increased interest in dimensional assessments of PDs in general. ![]() The essential requirement for the presence of a PD are impairments in personality functioning (Criterion A), accompanied by a manifestation of pathological personality traits (Criterion B). ![]() The AMPD was meant to replace the categorical DSM classification, but was ultimately not adopted to the current official diagnostic codes, while the previous criteria of DSM-IV were maintained for DSM-5. In an effort to address these shortcomings, the DSM-5 Work Group for Personality and PDs proposed the Alternative DSM-5 Model for PDs (AMPD). The categorical system is considered to hinder progress in research and deemed insufficient for use in clinical practice. In addition, the current classification has serious limitations, such as high comorbidity between, and high heterogeneity within PDs, indicating that the notion of PDs as separate constructs may not be valid. Since its introduction 40 years ago, this conceptualization has been challenged by numerous studies suggesting that PDs are not categorical but dimensional constructs, i.e., they can be located on a continuum from well-functioning to highly dysfunctional personality. The contemporary classification of mental disorders-DSM-5 and ICD-10 -is based on the assumption that personality disorders (PDs) are a set of categorical and qualitatively distinct entities. SummaryĮvidence supports the three dimensional concepts, which share conceptual overlap, but also entail unique aspects of personality pathology, respectively. Their advantages compared to the categorical approach, but also the respective differences, have been demonstrated empirically, in line with clinical observations. Numerous studies demonstrate the broad empirical basis, validated assessment instruments and clinical usefulness of the dimensional concepts. Additionally, a case example illustrates the clinical application. In this review, the three dimensional approaches, their underlying models, and common instruments are introduced, and empirical studies on similarities and differences between the concepts and the categorical classification are summarized. While differing markedly from the current categorical classification, it is closely related to the psychodynamic concepts of personality structure and personality organization. The concept of personality functioning (Alternative DSM-5 Model of Personality Disorders) has led to increased interest in dimensional personality disorder diagnosis.
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