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DSM axis II: personality disorders or adaptation disorders?

Svrakic, Dragan Ma; Lecic-Tosevski, Dusicab; Divac-Jovanovic, Mirjanac

doi: 10.1097/YCO.0b013e32831a4763
Personality disorders and neurosis: Edited by Charles B. Pull and Aleksandar Janca

Purpose of review After the initial enthusiasm, the study of personality disorder seems to be at a crossroad, without clear direction. This is mainly due to overlapping categorical diagnostic criteria of personality disorders. Study samples based on these criteria are inadequate and their results questionable.

Recent findings The literature is unanimously advocating a dimensional concept of personality disorders. Four dimensions are consistently reported to underlie personality disorder symptoms. We put forward an argument that personality disorders are disorders of adaptation, not of personality per se, as extreme personality traits are not ipso facto dysfunctional. Available methods to assess maladaptation are reviewed.

Summary The diagnosis ‘personality disorder’ should be replaced by the diagnosis ‘adaptation disorders’. This reflects the real nature of the disorder more accurately, and is likely to reduce the stigmatizing component of the personality disorder diagnosis as it places emphasis on positive efforts to improve adaptation. The suggested revisions of the personality disorder diagnosis and dimensional approach to these disorders are likely to advance treatment and research – we discuss these aspects in some detail.

aWashington University School of Medicine, St Louis, Missouri, USA

bInstitute of Mental Health, University of Belgrade School of Medicine, Serbia

cSingidunum University, Belgrade, Serbia

Correspondence to Dragan M. Svrakic, MD, PhD, Department of Psychiatry, 4940 Children's Place, Washington University School of Medicine, St Louis, MO 63110, USA Tel: +1 314 362 1880; e-mail:

© 2009 Lippincott Williams & Wilkins, Inc.