Comparing the utility of a clinical staging approach and the DSM-5 in diagnosing personality disorders among older adults

Clinical staging may provide a valuable alternative to the limitations of categorical diagnostic models like the DSM-5 for mental disorders. However, research on the clinical utility of staging models on mental disorders is limited, particularly in comparison to the DSM-5, which hinders the implementation of staging models in clinical practice. The limitations of categorical models are even more pronounced in older adults, as personality disorders (PDs) may manifest differently later in life, potentially leading to over- or underdiagnosis when relying on the DSM-5.

Aim: This study compared the clinical utility of a clinical staging model (CSM) with the DSM-5 for diagnosing PDs in older adults from the perspective of clinicians.

Method: Thirty-four Dutch participants, including psychiatrists, geriatricians, psychologists, and psychiatric nurse practitioners (PNP), completed an online questionnaire featuring an introduction to the CSM and the assessment of 2 fictional vignettes. Each vignette represented different stages of PDs and was evaluated using both the CSM and the DSM-5. Participants rated their experiences across 6 domains for both models.

Results: The clinicians rated the clinical utility of the CSM significantly higher than that of the DSM-5 across all domains, with 55.9% preferring the CSM, 32.8% opting for both models, and 11.8% preferring the DSM-5 in clinical practice.

Conclusions: These findings suggest that the CSM may be a valuable addition to the diagnosis of PDs in older adults. This highlights the need for further research into its clinical application and the general utility of staging models.