Lastly, the use of traits rather than behaviors in diagnostic criteria was an acknowledgement of the continuity between personality and personality disorders. For the diagnostic procedure itself, a prototype-matching approach,

already used in psychology in the 1980s, was recommended. In this approach, the clinician is asked to use a 5-point scale to assess how well the subject matches clinical vignettes representing either clinical types or prototypical character traits. Most reactions to the proposed changes were highly critical. In a signed comment,5 eight internationally renowned specialists Inhibitors,research,lifescience,medical considered that the new system was too complex, and that there was no proof of the validity of the dimensional model chosen. Mark Zimmerman criticized the proposed prototype rating system.6 A few months later, Andrew Skodol, in a Letter to the Editor,7 simplified the proposed system, restored narcissistic personality disorder as a category in its own right, and affirmed that the validity Inhibitors,research,lifescience,medical and clinical value of the proposed hybrid system would be verified in planned Held trials. In the January 2011 version, the essential features of a personality disorder are impairments in Identity and sense of self and in the capacity for effective interpersonal

functioning. To diagnose Inhibitors,research,lifescience,medical a personality disorder, the impairments must meet all of the following criteria: A. A rating of mild impairment or greater in self and interpersonal functioning on the levels of personality

functioning. B. Associated with a “good match” or “very good match” to a personality disorder type or with a rating of “quite a bit like the trait” Inhibitors,research,lifescience,medical or “extremely like the trait” on one or more personality trait domains. C. Relatively stable across time and consistent across situations. D. Not better understood as a norm within an individual’s dominant SKI-606 in vivo culture. E. Not solely due to the direct physiological effects of a substance (drug Inhibitors,research,lifescience,medical of abuse, medication) or a general medical condition (eg, severe head trauma). The simplification also concerns the number of domains considered: 5 (negative emotionality, second detachment, disinhibition [vs constraint], antagonism, and schizotypy-psychoticism) and the number of facets: 25. These simplifications did nothing to silence the criticisms, some of which emanated from the working group itself. Two members of the working group questioned the validity of a hybrid system in assessing personality, mirroring the problem diagnosing hypertension (Livesley8), and warned against (Verheul9) a complete break with the past, which would cast aside over 30 years of research on the diagnostic criteria of DSM-III and -IV, with no guarantee that the proposed new system had any advantage over the old one! Lastly, a survey of two personality disorder associations showed that most members were hostile to the proposed deletion of diagnostic categories.