The validity, reliability and clinical utility of the Alternative DSM-5 Model for Personality Disorders (AMPD) according to DSM-5 revision criteria.

A substantial body of empirical evidence has accumulated over the last 12 years since the publication of the Alternative Model for Personality Disorders (AMPD) in the DSM-5. As yet, this evidence has not been organized and reported using the criteria required by the American Psychiatric Association (APA) for proposals submitted to revise the DSM-5. These criteria are based on the Kendler-Kupfer update and expansion of the classic Robins-Guze criteria for establishing psychiatric diagnostic validity. We have been invited by the APA to undertake a review of the last decade of research on the AMPD and to propose a revised, simplified version of the model informed by this evidence. Here we present the findings of the review and our recommendations for the revision of the model. We begin with a brief reiteration of the background and rationale for the AMPD, followed by a description of the revision criteria required by the APA. We then summarize the evidence in support of the AMPD using the required framework. Our review indicates that AMPD-defined personality disorder (PD) shows similar patterns of associations as have been demonstrated for categorical PD diagnoses in terms of antecedent, concurrent and predictive validators. Head-to-head comparisons between AMPD-defined PD and categorical diagnoses suggest a more precise characterization of personality pathology by the AMPD. In addition, AMPD-defined PD appears to show higher reliability estimates than categorical PDs, and strong clinical utility, often outperforming categorical PD diagnoses. We conclude that the AMPD is ready for inclusion in the main section of the DSM. Recommendations are made for: a) further streamlining the AMPD in light of the last decade of accumulated evidence, and b) future research directions in areas where evidence is lacking or more limited.