Personality disorders, fact or fiction? the dark future of their diagnosis

The categorical diagnosis of personality disorders (PDs) has been criticized for various reasons, among which are overlapping of symptoms between different disorders, their high comorbidity, and the dichotomous nature of their diagnosis. These criticisms have led to the development of a dimensional approach in the latest versions of the classification systems, DSM-5/DSM-5-TR and ICD-11, considering two substantial aspects for its new diagnosis: personality functioning, and a series of pathological features. Despite the large amount of literature that has been published since the beginning of this century on this dimensional proposal, it is not clear, to date, that this approach enhances clinical utility. The vague, abstract, and inoperative exposition of what constitutes personality functioning and the complex and forced designation of major and minor traits (facets) in the DSM-5/DSM-5-TR, and only major and optional traits in the ICD-11, complicate, in an unusual way, the dimensional diagnosis of PDs. This paper discusses all of these issues in an attempt to shed some light on the potentially dark future of the current PDs panorama.