Journal of Psychiatric Practice Vol. 21, No. 1 January 2015 3
In Section III, Emerging Measures and Models,
DSM-5 presents an Alternative Model of
Personality Disorders, which is an empirically
based model of personality pathology measured
with the Level of Personality Functioning Scale
(LPFS) and the Personality Inventory for DSM-5
(PID-5). These novel instruments assess level of
personality impairment and pathological traits.
Objective. A number of studies have supported
the psychometric qualities of the LPFS and the
PID-5, but the utility of these instruments in
clinical assessment and treatment has not been
extensively evaluated. The goal of this study was
to evaluate the clinical utility of this alternative
model of personality disorders. Method. We
administered the LPFS and the PID-5 to psychi-
atric outpatients diagnosed with personality
disorders and other nonpsychotic disorders. The
personality profiles of six characteristic
patients were inspected (involving a comparison
of presenting problems, history, and diagnoses)
and used to formulate treatment considerations.
We also considered 6 specific personality disor-
der types that could be derived from the profiles
as defined in the DSM-5 Section III criteria.
Results. Using the LPFS and PID-5, we were able
to characterize the 6 cases in a meaningful and
useful manner with regard to understanding
and treatment of the individual patient and to
match the cases with 6 relevant personality dis-
order types. Implications for ease of use, com-
munication, and psychotherapy are discussed.
Conclusion. Our evaluation generally supported
the utility for clinical purposes of the
Alternative Model for Personality Disorders in
Section III of the DSM-5, although it also identi-
fied some areas for refinement. (Journal of
Psychiatric Practice 2015;21:3–25)
KEY WORDS: Diagnostic and Statistical Manual of
Mental Disorders, Fifth Edition (DSM-5), personality
traits, personality functioning, personality disorders,
clinical utility, five-factor model, diagnostics, Levels of
Personality Functioning Scale (LPFS), Personality
Inventory for DSM-5 (PID-5), therapy
A novel approach to personality pathology is includ-
ed in Section III, Emerging Measures and Models, of
the Diagnostic and Statistical Manual of Mental
Disorders, Fifth Edition (DSM-5) as a dimensional
alternative to the categorical model of personality
disorders (PDs) that was retained in Section II of the
DSM-5.
1
This alternative model is operationalized
with the Level of Personality Functioning Scale
(LPFS)
2
and the Personality Inventory for DSM-5
(PID-5).
3
Further investigations of this emerging
model will likely result in a major revised approach
to PDs in a future version of the DSM and possibly
also in ICD-11, which will influence the work of
many mental health professionals. As we will
review, the psychometric features of the LPFS and
the PID-5 have been evaluated with promising
results. Such quantitative evaluations are vital to
responsible and good clinical use, but we also need
to examine the actual clinical utility and usability of
this alternative DSM-5 model. One comprehensive
survey found that mental health clinicians general-
ly judged the DSM-5 Alternative PD Model as more
useful than the DSM-IV-TR Axis II model that was
retained in DSM-5.
4
In this article, we evaluate clinical utility based on
the rationale that clinical instruments should inter-
weave meaningfully with clinicians’ experiences,
using case vignettes from real world practice.
5,6
First, we review features of the LPFS and the PID-5,
including clinical application, scoring, interpreta-
tion, and current empirical status. Next, we inspect 6
LPFS and PID-5 profiles of mental health patients,
accompanied by their presenting problems, history,
and Axis I and II diagnoses according to the DSM-IV-
BO BACH, MSc
KRISTIAN MARKON, PhD
ERIK SIMONSEN, MD
ROBERT F. KRUEGER, PhD
BACH: Slagelse Psychiatric Clinic, Region Zealand, Denmark;
MARKON: University of Iowa, Iowa City; SIMONSEN: Psychiatric
Research Unit, Region Zealand, Denmark; KRUEGER: University
of Minnesota, Minneapolis.
Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.
Please send correspondence to: Bo Bach, Psykiatrien Vest, Inge-
mannsvej 18, 4200 Slagelse, Denmark.
bobachsayad@gmail.com
The authors declare no conflicts of interest.
DOI:10.1097/01.pra.0000460618.02805.ef
Clinical Utility of the DSM-5 Alternative Model of
Personality Disorders: Six Cases from Practice
Copyright © WoltersKluwerHealth,Inc. Unauthorized reproduction of this article is prohibited.