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37.4: Validity

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    It is quite possible that in future revisions of the DSM some of the personality disorders included in DSM-5 and DSM- IV-TR will no longer be included. In fact, for DSM-5 it was originally proposed that four be deleted. The personality disorders that were slated for deletion were histrionic, schizoid, paranoid, and dependent (APA, 2012). The rationale for the proposed deletions was in large part because they are said to have less empirical support than the diagnoses that were at the time being retained (Skodol, 2012). There is agreement within the field with regard to the empirical support for the borderline, antisocial, and schizotypal personality disorders (Mullins-Sweatt et al., 2012; Skodol, 2012). However, there is a difference of opinion with respect to the empirical sup- port for the dependent personality disorder (Bornstein, 2012; Livesley, 2011; Miller et al., 2010; Mullins-Sweatt et al., 2012).

    Little is known about the specific etiology for most of the DSM-5 personality disorders. Because each personality disorder represents a constellation of personality traits, the etiology for the syndrome will involve a complex interaction of an array of different neurobiological vulnerabilities and dispositions with a variety of environmental, psychosocial events. Antisocial personality disorder, for instance, is generally considered to be the result of an interaction of genetic dispositions for low anxiousness, aggressiveness, impulsivity, and/or callousness, with a tough, urban environment, inconsistent parenting, poor parental role modeling, and/or peer support (Hare et al., 2012). Borderline personality disorder is generally considered to be the result of an interaction of a genetic disposition to negative affectivity interacting with a malevolent, abusive, and/or invalidating family environment (Hooley et al., 2012).

    To the extent that one considers the DSM-5 personality disorders to be maladaptive variants of general personality structure, as described, for instance, within the Five-Factor Model, there would be a considerable body of research to sup- port the validity for all of the personality disorders, including even the histrionic, schizoid, and paranoid. There is compel- ling multivariate behavior genetic support with respect to the precise structure of the Five-Factor Model (e.g., Yamagata et al., 2006), childhood antecedents (Caspi et al., 2005), universality (Allik, 2005), temporal stability across the life- span (Roberts & DelVecchio, 2000), ties with brain structure (DeYoung et al., 2010), and even molecular genetic support for neuroticism (Widiger, 2009).

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