The search for critical dimensions of personality pathology to inform diagnostic assessment and treatment planning: a commentary on Hopwood et al.
Hopwood, Wright, Ansell, and Pincus (2013) present an interpersonal theoretical orientation in an effort to demonstrate that the personality disorders are—at their core—interpersonal in nature. This is not a new idea as Hopwood and colleagues are joining a parade of individuals who identify interpersonal difficulties as central to the personality disorders (Bender & Skodol, 2007; Benjamin, 2005; Fonagy & Target, 2006; Gunderson & Lyons-Ruth, 2008; Kernberg, 1984; Livesley, 2001; Meyer & Pilkonis, 2005; Mikulincer & Shaver, 2007). What is new is the argument that interpersonal theory should have preeminence in future renditions of the American Psychiatric Association’s diagnostic system because of its empirically investigated assessment instruments. In this commentator’s view, the two issues are related but involve important differences in their goals and methods. It is important to place the issues in context. The leadership of the effort to generate DSM-5 posed the question: What are the crucial dimensions of pathology—with less emphasis on categories—that are central to the diagnosis and assessment of patients, dimensions that can be reliably and dimensionally rated both at assessment and as treatment progresses? The answer given by the personality disorders work group was judged inadequate in its current state and was placed in Section III of DSM-5 for further consideration and empirical investigation. There is much in the article by Hopwood and colleagues that is important to progress in the field and with which this commentator agrees with enthusiasm, not the least of which is their positive, energetic approach to the refinement of the diagnosis of personality disorders. The authors value personality theory and related empirical efforts in informing the individual markers of interpersonal and emotional difficulties as listed in DSM-IV.