On Our Evolving Understanding of Personalty: A Clinical Guide to Assessment

In this episode of On the Mind, host Dr. Daniel Knoepflmacher speaks with Dr. Frank Yeomans, a clinical professor of psychiatry at Weill Cornell Medicine and Director of Training at the Personality Disorders Institute, about how to assess personality in a comprehensive psychiatric evaluation. Dr. Yeomans traces the shift from the DSM-5’s traditional categorical model of personality disorders to its dimensional alternative model, which identifies difficulties in one’s sense of self and relationships with others as the core features underlying all personality pathology. Drawing on decades of clinical experience, he walks through six key dimensions clinicians can assess in any patient: identity, defenses, aggression, reality testing, interpersonal relationships, and moral functioning, illustrating each with vivid case examples. The conversation also addresses how to sensitively discuss a personality disorder diagnosis with patients, the key distinctions between borderline and narcissistic personality disorder, and why understanding personality pathology as existing on a spectrum we all share can reduce stigma in clinical practice.