To diagnose or not to diagnose? Clinician perceptions of clinical utility and stigma in personality disorder diagnoses.

Abstract

The Alternative Model of Personality Disorder (AMPD) and the International Classification of Diseases, 11th edition's personality disorder nosologies reflect a shift from categorical to dimensional diagnosis. However, minimal research has investigated clinician perceptions and attitudes surrounding the diagnoses that dimensional models produce. The current study aimed to (a) investigate and directly compare the clinical utility of the Diagnostic and Statistical Manual of Mental Disorders, fifth edition, with the dimensional AMPD, from the perspective of clinicians, and (b) determine how these different diagnostic systems, and their variations in the portrayal of the same PD symptomology, may affect clinician-rated stigma. A sample of 89 psychologists read a series of case vignettes, with each vignette exhibiting a different variation of personality difficulties and accompanying diagnostic information. Clinicians answered a series of questions regarding clinical utility, their treatment recommendations, and stigma after each case vignette. A series of general linear models, post hoc analyses, and chi-squared tests were utilized. The AMPD was neither inferior nor superior to the Diagnostic and Statistical Manual of Mental Disorders, fifth edition, categorical model in terms of clinician-perceived clinical utility and stigma attitudes. Diagnostic information more broadly, regardless of the diagnostic system, was more clinically useful than a description-only, formulaic approach to conceptualizing personality difficulties. The absence of diagnostic information was associated with higher stigma among clinicians. (PsycInfo Database Record (c) 2026 APA, all rights reserved).