Rather than focusing attention on the identification of one and only one optimal diagnostic label, clinical application of the Section III personality trait model involves reviewing all five broad personality domains portrayed in Table 3. The clinical approach to personality is similar to the well-known review of systems in clinical medicine. For example, an individual’s pre- senting complaint may focus on a specific neurological symptom, yet during an initial evaluation clinicians still systematically review functioning in all relevant systems (e.g., car- diovascular, respiratory, gastrointestinal), lest an important area of diminished functioning and corresponding opportunity for effective intervention be missed.
Clinical use of the Section III personality trait model proceeds similarly. An initial in- quiry reviews all five broad domains of personality. This systematic review is facilitated by the use of formal psychometric instruments designed to measure specific facets and do- mains of personality. For example, the personality trait model is operationalized in the
Personality Inventory for DSM-S (PID-S), which can be completed in its self—report form by patients and in its informant-report form by those who know the patient well (e.g., a spouse). A detailed clinical assessment would involve collection of both patient- and in- formant—report data on all 25 facets of the personality trait model. However, if this is not possible, due to time or other constraints, assessment focused at the five-domain level is an acceptable clinical option when only a general (vs. detailed) portrait of a patient’s person- ality is needed (see Criterion B of PD—TS). However, if personality-based problems are the focus of treatment, then it will be important to assess individuals’ trait facets as well as do- mains.
Because personality traits are continuously distributed in the population, an approach to making the judgment that a specific trait is elevated (and therefore is present for diag- nostic purposes) could involve comparing individuals’ personality trait levels with pop— ulation norms and / or clinical judgment. If a trait is elevated—that is, formal psychometric testing and/ or interview data support the clinical judgment of elevation—then it is con- sidered as contributing to meeting Criterion B of Section III personality disorders.
Clinical Utility of the Multidimensional Personality
Disorder and trait constructs each add value to the other in predicting important anteced- ent (e.g., family history, history of child abuse), concurrent (e.g., functional impairment, medication use), and predictive (e.g., hospitalization, suicide attempts) variables. DSM-S ute independently to clinical decisions about degree of disability; risks for self—harm, vio- lence, and criminality; recommended treatment type and intensity; and prognosis—all important aspects of the utility of psychiatric diagnoses. Notably, knowing the level of an the clinician with a rich base of information and is valuable in treatment planning and in predicting the course and outcome of many mental disorders in addition to personality disorders. Therefore, assessment of personality functioning and pathological personality traits may be relevant whether an individual has a personality disorder or not.
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