have been raised regarding the effectiveness of the FFM for describing all of the aspects and nuances of a patient’s personality disorder (Benjamin, 1993; Shedler & Westen, 2004; Zanarini et al., in press). This concern was supported by the results of Sprock (2003), who reported that the DSM categorical system was more useful than the FFM for case conceptualization. In contrast, the current study found that the clinicians considered the FFM to be much more useful for conceptualization of the patient’s personality problems.
The inconsistency with the findings of Sprock is probably due to the use of vignettes that were not written in terms of the DSM diagnostic criteria, as well as the inclusion of all 30 facets of the FFM. It seems likely that the inclusion of the 30 facets, as opposed to the 5 broad domains, would have the effect of improving the model’s utility for comprehensively describing an individual’s important difficulties (although in turn potentially decreasing ease of usage). In addition, the vignettes of the current study used the descriptions and language provided within the original source materials rather than being confined to sentences describing individual diagnostic criteria.
The higher rating for case conceptualization is also consistent with prior studies that have indicated that the existing nomenclature is inadequate in its coverage of maladaptive personality traits, as suggested by the clinical survey of Westen and Arkowitz-Westen (1997) and the popularity of the PDNOS diagnosis in clinical practice (Verheul & Widiger, 2004). The real life cases of Ted, Earnst, and Madeline would meet criteria for one of the existing diagnoses, but the clinicians indicated that these persons met criteria for multiple diagnoses and many of the clinicians preferred the diagnosis of PDNOS for Earnst and Madeline. Systematic reviews of the