Les troubles de la personnalité dans le DSM-5

This presentation summarizes the revision process in preparing DSM-5 for personality disorders. The preliminary steps were The Research Agenda for DSM-5 published by D Kupfer et al. in 2002 and the APA/NIH Conference on Dimensional Models of Personality Disorders (Arlington, 12.01.2004) published in 2006 by T Widiger et al. DSM-IV categories showed excessive comorbidities and within- diagnosis heterogeneity, temporal instability and poor convergent and discriminant validity. The workgroup on personality and personality disorders chaired by Andrew Skodol has been working since 2007. The initial recommendations were published online on February 10, 2010. A major reconceptualization of personality disorders has been proposed by the workgroup with five severity levels of personality functioning based on degrees of impairment in core self and interpersonal capacities. A reduction in the number of categories (5) was expected to reduce the comorbidities and the replacement of some behavioral criteria by traits in 6 broad domains was expected to result in a better coverage and temporal stability. This new model did not receive a real approval from the American Psychiatric Association. The final decisions consist in the removal of the multiaxial perspective and the maintenance of DSM-IV personality disorders categories and criteria in DSM-5 Section II. The alternative hybrid model was placed in Section III with five domains and 25 trait facets. More validation studies are needed for the Personality Inventory for DSM-5 (PID-5) from R. Krueger (stability of factorial structure in psychiatric samples and concurrent validity with the new version of NEO PI-R (NEO 3).