The Problems With Criterion A: A Comment on Morey et al. (2022)

The alternative model of personality disorder (American Psychiatric Association, 2013), introduced in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, represents a significant advancement in our understanding of personality disorders. Despite this advancement, nearly 10 years after its introduction, considerable debate remains regarding the conceptualization, operationalization, and ultimately the utility of personality impairment (i.e., Criterion A). Morey et al. (2022) review the impetus for, conceptualization of, the current state of our understanding of Criterion A, and conclude that Criterion A is a valid and clinically useful component of the alternative model of personality disorder. In our commentary, we present a more pessimistic view and review literature critical of Criterion A not included in the main text of their review. We conclude that Criterion A, as currently operationalized by the Level of Personality Functioning Scale, does not provide the functionality or utility as suggested by Morey and colleagues in their review. Instead, we suggest that pathological traits are well-positioned to capture severity of dysfunction and likely carry the most clinically useful information.