What's Wrong with DSM-III Personality Disorders?

DSM–III and DSM–III–R personality disorders represent a major advance on earlier classifications but are deficient in several major respects. A fundamental criticism is that the system for classifying mental state disorders has been applied uncritically to personality disorders with considerably less success. The gains made by the introduction of well–defined operational criteria to DSM–III mental state disorders are considerably less successful with personality disorders, and there is doubt whether they are apposite at all because of the pervasiveness and variability of behavior shown in personality disorders. Many of the criteria used for the diagnosis of DSM–III personality disorders are based, with the exception of antisocial personality disorder, on inadequate evidence. Too much reliance is placed on questions to the subject, which is suspect with personality disorder as it is largely the impact of the abnormal personality on other individuals that leads to the diagnosis being made. Subjective report can also lead to unnecessary confusion with mental state disorders. The reliance of DSM–III on a categorical system of diagnosis fails to recognize the wide variation of personality abnormality in which severe personality disorder represents only a small part. A change to a dimensional classification with a significant contribution being made to the diagnosis from interviews with an informant will improve the validity of classification and be more in tune with clinical practice.