Historically, the DSM system of diagnostic classification has served to widen the gulf between a depth psychology understanding of psychopathology and a more medically oriented model. A welcome change may be on the horizon, as significantly reworking the current system for diagnosing personality disorders has been proposed for the next revision of the DSM. One suggestion has been to dimensionalize personality assessment using either a five-factor model (FFM) or a measure like the Shedler-Westen Assessment Procedure (SWAP). For most psychoanalytic clinicians this would represent a step in the right direction—though by no means the answer to a more complex and individualized approach to understanding psychiatric illness.

In this article, Rottman and colleagues begin by reviewing the empirical literature comparing FFM and current DSM-IV systems for diagnosing personality disorders. The results of previous research raise concerns whether the FFM descriptions are too ambiguous and without context. The authors then present two original studies in which clinicians were