Descriptive Psychopathology: The Signs and Symptoms of ...

373 Chapter 16: An evidence-based classificationTable 16.1. (cont.)Present classificationPersonality disorders: Divided into threepoorly validated groupings that arecategorically definedAdd missing but validated syndromesRecommended changeused as modifiers for validated syndromes(e.g. anxiety disorder with depersonalization,post-ictal fugue), or eliminated because of lack ofvalidity (e.g. conversion disorder, identitydisorder)Eliminate Axis II. The cluster construct has novalidity. Apply dimensional criteria as descriptorsEliminate Cluster A as it groups low-gradeforms of illness not maturational deviations.Place schizoid in a schizophrenia spectrumclass and paranoid as a mild form of delusionaldisorder. Classify schizotypal as an independentconditionEliminate Cluster B. Classify borderline personalitydisorder as an independent condition,recognizing that it is a heterogeneous classrepresenting low-grade illness (e.g. manicdepression,dysfunction of emotional regulationdue to illicit drugs, traumatic brain injury, andother neurologic disease) as well as abnormaltrait behavior (e.g. high behavioral activation)Define a separate antisocial/narcissistic/histrioniccluster by dimensional criteria (e.g. highbehavioral activation and low behavioralinhibition)Eliminate Cluster C. Define a separate avoidant/dependent cluster by dimensional criteria(e.g. low behavioral activation and highbehavioral inhibition)Place obsessive–compulsive personality disorderin the OCD spectrumFrontal lobe avolitional and disinhibited syndromesshould be added to the cognitive disorderscategoryIt is also time to reconsider the use of laboratory tests as diagnostic criteria.Taylor and Fink (2006) recommend sleep studies as an adjunct to verifying diagnosticcriteria for melancholia. They endorse measures of hypothalamic–pituitary–adrenal hyperactivity (late afternoon serum cortisol, and the dexamethasone