Commentary explores a shift to a dynamic understanding of personality disorder diagnosis, emphasizing individual functioning and identity.
Identifying personality disorder have historically relied on readily observable symptoms, often encouraging a top-down approach that prioritizes symptoms labeled as "problematic behaviors" over the internal struggles that give rise to them.This commentary explores a fundamental shift in the field: The move from static diagnostic description toward a more dynamic understanding of personality functioning.Drawing on contributions from this special issue, the authors argues that dimensional models of personality disorder provide a needed kinetic framework for clinical thinking.Within this framework, attention is redirected toward impairments of core capacities for selfand interpersonal functioning, commonly referred to as Criterion A. By focusing on identity, emotional coherence, and relational capacity, dimensional models bring diagnostic language closer to lived experience and to the processes targeted in psychotherapy.Rather than emphasizing behavioral control alone, this approach foregrounds the restoration of internal coherence and meaningful direction in life.Centering personality functioning in this way helps ensure that clinical practice remains focused on what ultimately matters most: The person behind the diagnosis. Public Health Significance StatementThis commentary highlights a shift in mental health diagnosis.Moving away from labeling so-called "problem behaviours" toward understanding how a person functions in everyday life.By using diagnostic models that focus on identity and the ability to relate to others, clinicians gain a clearer picture of what drives distress across setting and over time.This approach can reduce the risk of stigmatization often associated with the personality disorder diagnosis by keeping attention on functioning rather than fixed labels.Importantly, it supports treatment that helps individuals develop a more coherent sense of self, stronger relationships, and a meaningful direction in live, rather than focusing solely on suppressing outward symptoms.
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Åse-Line Baltzersen (2026) studied this question.
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