In this issue…
As clinicians we tend to overlook personality disorders. One reason may be that time constraints in our practice prevent us from knowing our patients well enough. Prominent symptoms can be elicited in a few sessions, whereas elucidating personality traits requires more time and familiarity with the patient’s life history. Describing personality disorders is no easy task. There is no consensus on how personality disorders should be diagnosed. Should we rely on categories or dimensions? This debate was at the center of the major difficulties that plagued the preparation of the chapter on personality disorders in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5).
The Guest Editorial (p 131) by Julien Daniel Guelfi offers a detailed description of the successive stages in the development of DSM-5, from the monograph on dimensional models published following the APA/WHO/NIH/ conference in Arlington in 2004 up to the APA’s final decision in December 2012 to maintain the 10 diagnostic categories of DSM-IV and relegate the alternative DSM-5 model to section III. This alternative model proposes new criteria for personality disorder, keeps only six of the ten DSM-IV-IV categories, and introduces a dimensional model with 25 traits organized along five domains.
The State of the art article by Timothy Trull and Thomas Widiger (p 135) provides an in-depth analysis of the five-factor model (FFM). This model of normal and abnormal personality functioning is the most successful of all dimensional models. It comprises the five dimensions of neuroticism versus emotional stability, extraversion versus introversion, openness versus closedness to experience, agreeableness versus antagonism, and conscientiousness versus undependability. The authors compare the FFM with the DSM-5 Section 3 dimensional trait model.
The Clinical Research section begins with an article (p 147) by Marc-Antoine Crocq on the history of personality disorders, which reviews the major concepts of personality that have emerged from Greek and Chinese classical antiquity up to the early 21st century. Mark Zimmerman and Theresa Morgan (p 155) analyze the relationship between borderline personality disorder (BPD) and bipolar disorder. The authors challenge the notion that BPD is part of the bipolar spectrum. Marie-Pier Larrivée (p 171) focuses on the diagnosis and management of BPD in adolescents. James Blair (p 181) reviews the data on psychopathy, a neurodevelopmental disorder characterized by emotional deficits (reduced empathy and guilt) and an increased risk for antisocial behavior. Special attention is given to the neurobiology of this disorder. Elsa Ronningstam and Arielle Baskin-Sommers (p 191) link psychoanalysis with neuroscience to explore the role of fear in narcissistic personality functioning. Sally Johnson and Eric Elbogen (p 203) discuss the forensic impact of personality disorders. Personality disorders are frequent in criminal populations, but they are generally not accepted as significant psychiatric illnesses within the legal system.
In a Treatment research article, Luis Ripoll (p 213) outlines the best available evidence for the psychopharmacologic treatment of borderline personality disorder (BPD). The author reviews the use of antidepressants, antipsychotics, anticonvulsants, and other compounds such as omega-3 fatty acids and neuropeptides, as well as experimental use of glutamatergic medications or alteration of endocannabinoid signaling.
In a Free Paper, Laura Klinger et al (p 225) review the literature on caregiver-mediated behavioral interventions for children with autism spectrum disorder.
We hope that the innovative and original views expressed in this issue will provide useful information to our readers.
Marc-Antoine Crocq, MD; David Rubinow, MD