The network approach to psychopathology: promise versus reality

Abstract

World Psychiatry 18:3 October 2019 pathic personality disorders, respectively. The obsessive-compulsive personality disorder is defined largely by maladaptive conscientiousness (e.g., perfectionism, compulsivity, workaholism, and ruminative deliberation), but most measures of FFM conscientiousness do not assess for these maladaptive variants. Measures to assess maladaptive FFM traits, though, have been developed, including the Five Factor Model Personality Disorder scales, the Personality Inventory for DSM-5, and the Personality Inventory for ICD-11. There are a number of advantages in conceptualizing the ICD and DSM personality disorders from the perspective of the FFM. Many of the ICD and DSM personality disorder syndromes have limited research interest and inadequate empirical support. The FFM brings to the personality disorders a substantial body of construct validation, including a resolution of such notable controversies as gender bias, excessive diagnostic overlap, and temporal instability. An understanding of the etiology, pathology and treatment of the personality disorders has been hindered substantially by the heterogeneity within and the overlap across the diagnostic categories. The American Psychiatric Association has been publishing treatment guidelines for every disorder within the DSM, but guidelines have been provided for only one of the ten personality disorders (i.e., borderline). The complex heterogeneity of the categorical syndromes complicates considerably the ability to develop an explicit, uniform treatment protocol. The domains of the FFM are considerably more homogeneous and distinct, lending themselves well for more distinct models of etiology, pathology and treatment. Empirically validated treatment protocols have already been developed for FFM neuroticism. A common concern regarding the FFM and any other dimensional trait model is that clinicians will be unfamiliar with this approach and will find it difficult to apply. However, the FFM organization is consistent with the manner in which persons naturally think of personality trait description. Persons who apply the FFM typically find it quite easy to use. There have in fact been a number of studies concerning the clinical utility of the FFM in comparison to the DSM syndromes. A few of these studies have favored the DSM syndromes but, when the methodological limitations of these particular studies were addressed in subsequent studies, the results consistently favored the FFM. Experienced clinicians prefer the FFM and dimensional trait models for the conceptualization of personality disorders. In sum, the FFM is the predominant model of general personality structure and offers the opportunity for a truly integrative understanding of personality structure across the fields of clinical psychiatry and basic personality science. The ICD and DSM models for the classification and diagnosis of personality disorder are shifting toward the FFM because of its empirical validation and clinical utility.