Clinician Judgments of Clinical Utility: A Comparison of DSM-IV-TR Personality Disorders and the Alternative Model for DSM-5 Personality Disorders

This study compared the perceived clinical utility of DSM-IV-TR personality disorder diagnoses (retained in DSM-5) with the alternative model presented in DSM-5 Section III, using a national sample of clinicians applying both systems to their own patients. A sample of 337 mental health clinicians (26% psychiatrists, 63% psychologists, and 11% other professional disciplines) provided a complete assessment of all personality disorder features listed in DSM-IV-TR and DSM-5 Section III. After applying each diagnostic model, clinicians evaluated the clinical utility of that model with respect to communication with patients and with other professionals, comprehensiveness, descriptiveness, ease of use, and utility for treatment planning. These perceptions were compared across DSM-IV-TR and the 3 components of the DSM-5 Section III model, and between psychiatrists and nonpsychiatrists. Although DSM-IV-TR was seen as easy to use and useful for professional communication, in every other respect the DSM-5 Section III model was viewed as being equally or more clinically useful than DSM-IV-TR. In particular, the DSM-5 dimensional trait model was seen as more useful than DSM-IV-TR in 5 of 6 comparisons-by psychiatrists as well as other professionals. Although concerns were expressed about the clinical utility of the DSM-5 personality disorder system during its development, these criticisms were offered without data on the proposed system. The results of this study demonstrate that aside from the current familiarity of the DSM-IV-TR approach, it offers little advantage in perceived clinical utility over the DSM-5 Section III system, whereas the latter is viewed as being more useful in several respects.