Comparing DSM-5-hybrid, SWAP, and PDM prototype models of personality disorders: Convergent and divergent findings

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Personality Disorders: Theory, Research, and Treatment


Although dimensional models of personality disorders are of great interest, there exist three methods by which personality disorders may be diagnosed for their fit to a predetermined prototype. In this study, we evaluate a Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), hybrid model prototype match (modified from the original prototype DSM-5 proposal; Skodol, Bender, Morey, et al., 2011; Skodol, Bender, Oldham, et al., 2011), the Shedler-Westen Assessment Procedure-2 (Shedler, 2015), and the Psychodynamic Diagnostic Manual prototype match (PDM Task Force, 2006). Three hundred twenty-nine clinical psychology graduate students and interns rated patients they currently were treating with each of the aforementioned diagnostic models, as well as completing a checklist of their DSM-IV personality disorder symptoms. Matching a prototype was defined as being a very good match (exemplifying the disorder, a prototypical case) or a good match (has the diagnosis, disorder applies). Frequencies of the prototype assignments are reported. For the SWAP-2 and PDM, depressive and borderline personality disorders were most frequently assigned, whereas avoidant and borderline personality disorder were the most assigned prototypes for the DSM-5 hybrid categories. However, the degree of convergence across methods on similar diagnostic constructs was low. Implications of these findings for personality disorder diagnosis are discussed.

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