SUGGESTIONS FOR A FRAMEWORK FOR AN EMPIRICALLY BASED CLASSIFICATION OF PERSONALITY-DISORDER

Background. The classification of personality disorder is one of the l east satisfactory sections of contemporary psychiatric classification Fundamental problems with current classifications include extensive di agnostic overlap, limited evidence of validity, and poor empirical sup port. Methods: Conceptual analysis and the results of empirical studie s are used to propose a framework for organizing an empirically based classification. Results: First personality disorder is a form of menta l disorder and, therefore, should be classified as a single diagnostic entity on Axis I along with other mental disorders. A preliminary def inition of personality disorder as a tripartite failure involving the self system, kinship relationships and societal relationships is propo sed. The evidence suggests that this definition can be translated into a reliable set of items. Second, the diagnosis of personality disorde r should be separated from the assessment of clinically relevant perso nality traits. Given the consistent evidential support for a dimension al model of personality disorder, it is suggested that personality be coded on a set of trait dimensions selected to provide a systematic re presentation of the domain of behaviours represented by current diagno stic concepts. Third, given that personality traits are hierarchically organized, if is suggested that an at-is for coding personality inclu de basic or lower-order dimensions as the primary level of assessment and a few higher-order patterns to summarize information for some purp oses. Conclusion: A preliminary list of 16 basic dispositional traits is proposed to describe the more specific components of personality di sorder based, in part, on the convergence of evidence across studies: anxiousness, affective lability, callousness, cognitive dysregulation, compulsivity, conduct problems, insecure attachment intimacy avoidanc e, narcissism, oppositionality, rejection, restricted expression, soci al avoidance, stimulus seeking, submissiveness, and suspiciousness. Th ree higher-order patterns were proposed: emotional dysregulation, diss ocial behaviour, and inhibitedness, which may occur independently or i n combination.