Bridging the implementation gap in dimensional personality models

Summary

This commentary addresses the persistent gap between the strong evidence base for dimensional models of personality pathology and their limited uptake in everyday clinical practice. Writing in response to a proposal by Natoli and colleagues, Monaghan considers a hierarchical framework that aligns dimensional assessment of personality traits with the delivery of treatment. The framework integrates common therapeutic factors that apply across presentations with trait-specific interventions targeted to a patient's particular profile. Monaghan argues this alignment offers a promising route to translating dimensional systems, such as those in ICD-11 and the AMPD, into usable clinical workflows. The piece situates the proposal within ongoing debates about how to make dimensional personality diagnosis practical for clinicians and identifies what is still needed to bridge the implementation gap.