Is the Alternative Model for Personality Disorders Able to Capture Avoidant Personality Disorder According to Section II of the DSM-5? A Systematic Review

This review aims at examining the continuity between the categorical model for personality disorders (PDs) as defined by Section II of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, and the alternative model for personality disorders (AMPD) with respect to Section II avoidant personality disorder (AvPD). Because the Criterion A of the AMPD, that is, the Level of Personality Functioning Scale (LPFS), is a prerequisite for a PD diagnosis, only studies assessing the LPFS were included, whether or not the Criterion B, that is, pathological personality traits, were assessed as well. A total of 13 studies met the inclusion criteria, with 6 studies comprising community/undergraduate samples and 7 studies comprising clinical samples. Weighted correlation between global LPFS and AvPD was .39 (r(w) = .55 for community/undergraduate studies; r(w) =.17 for clinical studies). When AvPD-specific impairment was evaluated, that is, impairment of personality functioning characterizing AvPD in the AMPD, correlations were substantially larger. In studies using regression analyses, the Criterion B appeared to have incremental utility in predicting the presence of Section II AvPD. To capture Section II AvPD in a sufficient degree by the AMPD, it might be necessary to use an AvPD-specific impairment questionnaire.