Clinical Utility of Categorical and Dimensional Perspectives on Personality Pathology: A Meta-Analytic Review

Increasing dissatisfaction with categorical personality disorder (PD) diagnoses has led to the development of dimensional PD frameworks, which have gained influence in recent years. Although most studies contrasting the dimensional and categorical frameworks focus on issues related to construct validity, there is a burgeoning literature evaluating the clinical utility of these two approaches, with studies typically contrasting clinicians' ratings of various dimensions of clinical utility in the 2 frameworks using case vignettes or actual patients. This study used meta-analytic techniques to synthesize extant findings in this area, integrating data from 11 studies (103 total effect sizes, N of raters = 2,033) wherein clinical utility ratings of categorical and dimensional PD frameworks were compared. Dimensional models in general, and the five-factor model in particular, received more positive clinical utility ratings than categorical PD models in the majority of clinical utility domains. Stronger results were obtained for ratings of actual patients than ratings derived from case vignettes. Implications of these findings for the conceptualization and diagnosis of personality pathology are discussed, and suggestions for future research in this area are offered.