A step toward DSM-V: Cataloguing personality-related problems in living

Intractable problems with DSM-IV's Axis II mandate an entirely new approach to the diagnosis of personality-related pathology. The Five-Factor Model of personality provides a scientifically grounded basis for personality assessment, and Five-Factor Theory postulates that personality pathology is to be found in characteristic maladaptations that are shaped by both traits and environment. A four-step process of personality disorder (PD) diagnosis is proposed, in which clinicians assess personality, problems in living, clinical severity, and, optionally, PD patterns. We examine item content in five problem checklists to update the list of personality-related problems used in Step 2 of the four-step process. Problems were reliably assigned to relevant factors and facets, and a number of additions were made to an earlier catalogue. The four-step process can be used by clinicians, and may be incorporated in a future DSM. This article is a U.S. government publication and is in the public domain in the United States.