Personality and Personality Disorders
Please find below a list of disorders in the diagnostic class Personality Disorders. The
Personality and Personality Disorders Work Group has been responsible for addressing
these disorders. You will find that the work group has recommended a significant
reformulation of the approach to the assessment and diagnosis of personality
psychopathology, including the proposal of a revised general category of personality
disorder, and the provision for clinicians to rate dimensions of personality traits, a limited
set of personality types, and the overall severity of personality dysfunction. Accordingly,
the structure of this section of the Web site is necesarily somewhat different from those
of the other disorders.
Reformulation of Personality Disorders in DSM-5
The work group recommends a major reconceptualization of personality
psychopathology with core impairments in personality functioning, pathological
personality traits, and prominent pathological personality types. Personality disorder is
diagnosed when core impairments and pathological traits are severe or extreme and other
critieria are met.
Please comment on this reformulation as a whole by using the Overall Comments
section. You may submit comments on each of its components using the comment box on
each page linked below.
(a) 5 identified severity levels of personality functioning
(b) 5 personality disorder (PD) types (proposed, pending empirical validation),
each defined by core PD components and a subset of:
(c) 6 broad, higher order personality trait domains, with 4-10 lower-order, more
specific trait facets comprising each, for a total of 37 specific trait facets
(proposed, pending empirical validation)
(d) a new general definition of personality disorder based on severe or extreme
deficits in core components of personality functioning and elevated pathological
traits
This four-part assessment focuses attention on identifying personality psychopathology with increasing
degrees of specificity, based on available time, information, and expertise. Assessment of personality
functioning, types, and traits is intended for patients whether or not they have a personality disorder. The
optimal order of the assessments of the types and the traits will be determined in Field Trials (please click
here to see two alternative assessment formats).
The work group is still holding discussions about how personality disorders ultimately
will be represented in DSM-5. We appreciate your review and comment on each of the
components of the proposed reformulation.
DSM-IV Disorders Being Recommended for Reformulation
301.0 Paranoid Personality Disorder
301.20 Schizoid Personality Disorder
301.22 Schizotypal Personality Disorder
301.7 Antisocial Personality Disorder
301.83 Borderline Personality Disorder
301.50 Histrionic Personality Disorder
301.81 Narcissistic Personality Disorder
301.82 Avoidant Personality Disorder
301.6 Dependent Personality Disorder
301.4 Obsessive-Compulsive Personality Disorder
301.9 Personality Disorder Not Otherwise Specified
Appendix B Diagnosis: Depressive Personality
Disorder
Appendix B Diagnosis: Passive-Aggressive
(Negativistic) Personality Disorder
General Diagnostic Criteria for Personality Disorder
Levels of Personality Functioning
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Proposed Revision
Rationale
Severity
DSM-IV
http://www.dsm5.org/PROPOSEDREVISIONS/Pages/PersonalityandPersonalityDisorder
s.aspx
The Work Group recommends the following for severity of impairment in personality
functioning.
Personality psychopathology fundamentally emanates from disturbances in thinking about self
and others. Because there are greater and lesser degrees of disturbance of the self and
interpersonal domains, the following continuum —comprised of levels of self and interpersonal
functioning—is provided for assessing individual patients.
Each level is characterized by typical functioning in the following areas:
Self: Identity Integration, Integrity of Self-concept, and Self-directedness
Interpersonal: Empathy, Intimacy and Cooperativeness, and Complexity and Integration of
Representations of Others
As with the General Diagnostic Criteria for Personality Disorder, when applying these dimensions
diagnostically, the self and interpersonal difficulties must:
A.
be multiple years in duration
B.
not be solely a manifestation or consequence of another mental disorder
C. not be due solely to the direct physiological effects of a substance or general medical
condition
D.
not be better understood as a norm within an individual’s cultural background
Self and Interpersonal Functioning Continuum (Click this link to see the full scale with definitions
or terms and detailed definitions of scale points)
_____ 0 = No Impairment
_____ 1 = Mild Impairment
_____ 2 = Moderate Impairment
_____ 3 = Serious Impairment
_____ 4 = Extreme Impairment
Personality Disorder Types
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Proposed Revision
Rationale
Severity
DSM-IV
The Work Group recommends 5 specific personality disorder types, to be rated on a dimension of
graded membership. Each type is comprised of core components and is associated with a trait list
specifying its component personality traits.
Antisocial/Psychopathic Type
Avoidant Type
Borderline Type
Obsessive-Compulsive Type
Schizotypal Type
301.7
Antisocial Personality Disorder
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Proposed Revision
Rationale
Severity
DSM-IV
The work group is recommending that this disorder be reformulated as the
Antisocial/Psychopathic Type.
Individuals who match this personality disorder type are arrogant and self-centered, and feel
privileged and entitled. They have a grandiose, exaggerated sense of self-importance and they
are primarily motivated by self-serving goals. They seek power over others and will manipulate,
exploit, deceive, con, or otherwise take advantage of others, in order to inflict harm or to achieve
their goals. They are callous and have little empathy for others’ needs or feelings unless they
coincide with their own. They show disregard for the rights, property, or safety of others and
experience little or no remorse or guilt if they cause any harm or injury to others. They may act
aggressively or sadistically toward others in pursuit of their personal agendas and appear to
derive pleasure or satisfaction from humiliating, demeaning dominating, or hurting others. They
also have the capacity for superficial charm and ingratiation when it suits their purposes. They
profess and demonstrate minimal investment in conventional moral principles and they tend to
disavow responsibility for their actions and to blame others for their own failures and
shortcomings.
Individuals with this personality type are temperamentally aggressive and have a high threshold
for pleasurable excitement. They engage in reckless sensation-seeking behaviors, tend to act
impulsively without fear or regard for consequences, and feel immune or invulnerable to adverse
outcomes of their actions. Their emotional expression is mostly limited to irritability, anger, and
hostility; acknowledgement and articulation of other emotions, such as love or anxiety, are rare.
They have little insight into their motivations and are unable to consider alternative interpretations
of their experiences.
Individuals with this disorder often engage in unlawful and criminal behavior and may abuse
alcohol and drugs. Extremely pathological types may also commit acts of physical violence in
order to intimidate, dominate, and control others. They may be generally unreliable or
irresponsible about work obligations or financial commitments and often have problems with
authority figures.
Instructions
A. Type rating. Rate the patient’s personality using the 5-point rating scale shown below. Circle
the number that best describes the patient’s personality.
5 = Very Good Match: patient exemplifies this type
4 = Good Match: patient significantly resembles this type
3 = Moderate Match: patient has prominent features of this type
2 = Slight Match: patient has minor features of this type
1 = No Match: description does not apply
B. Trait ratings. Rate extent to which the following traits associated with
the Antisocial/Psychopathic Type are descriptive of the patient using this four-point scale:
0 = Very little or not at all descriptive
1 = Mildly descriptive
2 = Moderately descriptive
3 = Extremely descriptive
1. Antagonism: Callousness
Lack of empathy or concern for others’ feelings or problems; lack of guilt or remorse about the
negative or harmful effects of one’s actions on others; exploitativeness
2. Antagonism: Aggression
Being mean, cruel, or cold-hearted; verbally, relationally, or physically abusive; humiliating and
demeaning of others; willingly and willfully engaging in acts of violence against persons and
objects; active and open belligerence or vengefulness; using dominance and intimidation to
control others
3. Antagonism: Manipulativeness
Use of cunning, craft, or subterfuge to influence or control others; casual use of others to one’s
own advantage; use of seduction, charm, glibness, or ingratiation to achieve one’s own end
4. Antagonism: Hostility
Irritability, hot temperedness; being unfriendly, rude, surly, or nasty; responding angrily to minor
slights and insults
5. Antagonism: Deceitfulness
Dishonesty, untruthfulness; embellishment or fabrication when relating events; misrepresentation
of self; fraudulence
6. Antagonism: Narcissism
Vanity, boastfulness, exaggeration of one’s achievements and abilities; self-centeredness; feeling
and acting entitled, believing that one deserves only the best; preoccupation with having unlimited
success, power, brilliance, and/or beauty
7. Disinhibition: Irresponsibility
Disregard for, or failure to honor, financial and other obligations or commitments; lack of respect
and follow through on agreements and promises; unreliability; failure to keep appointments or to
complete tasks or assignments; carelessness with own and/or others’ possessions
8. Disinhibition: Recklessness
Craving and pursuit of stimulation and variety without regard for consequences; boredom
proneness and unplanned initiation of activities to counter boredom; unnecessary risk taking; lack
of concern for ones limitations; denial of the reality of personal danger; high tolerance for
uncertainty and unfamiliarity
9. Disinhibition: Impulsivity
Acting on the spur of the moment in response to immediate stimuli; acting on a momentary basis
without a plan or consideration of outcomes; difficulty establishing and following plans; failure to
learn from experience
301.82
Avoidant Personality Disorder
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Proposed Revision
Rationale
Severity
DSM-IV
The work group is recommending that this disorder be reformulated as the Avoidant Type.
Individuals who match this personality disorder type have a negative sense of self, associated
with a profound sense of inadequacy, and inhibition in establishing intimate interpersonal
relationships. More specifically, they feel anxious, inadequate, inferior, socially inept, and
personally unappealing; are easily ashamed or embarrassed; and are self-critical, often setting
unrealistically high standards for themselves. At the same time, they may have a desire to be
recognized by others as special and unique. Avoidant individuals are shy or reserved in social
situations, avoid social and occupational situations because of fear of embarrassment or
humiliation, and seek out situations that do not include other people. They are preoccupied with
and very sensitive to being criticized or rejected by others and are reluctant to disclose personal
information for fear of disapproval or rejection. They appear to lack basic interpersonal skills,
resulting in few close friendships. Intimate relationships are avoided because of a general fear of
attachments and intimacy, including sexual intimacy.
Individuals resembling this type tend to blame themselves or feel responsible for bad things that
happen, and to find little or no pleasure, satisfaction, or enjoyment in life’s activities. They also
tend to be emotionally inhibited or constricted and have difficulty allowing themselves to
acknowledge or express their wishes, emotions – both positive and negative – and impulses.
Despite high standards, affected individuals may be passive and unassertive about pursuing
personal goals or achieving successes, sometimes leading to aspirations or achievements below
their potential. They are often risk averse in new situations.
Instructions
A. Type rating. Rate the patient’s personality using the 5-point rating scale shown below. Circle
the number that best describes the patient’s personality.
5 = Very Good Match: patient exemplifies this type
4 = Good Match: patient significantly resembles this type
3 = Moderate Match: patient has prominent features of this type
2 = Slight Match: patient has minor features of this type
1 = No Match: description does not apply
B. Trait ratings. Rate extent to which the following traits associated with the Avoidant Type are
descriptive of the patient using this four-point scale:
0 = Very little or not at all descriptive
1 = Mildly descriptive
2 = Moderately descriptive
3 = Extremely descriptive
1. Negative Emotionality: Anxiousness
Having frequent, persistent, and intense feelings of nervousness/tenseness/ being on edge; worry
and nervousness about the negative effects of past unpleasant experiences and future negative
possibilities; feeling fearful and threatened by uncertainty
2. Negative Emotionality: Separation insecurity
Having fears of rejection by, and/or separation from, significant others; feeling distress when
significant others are not present or readily available; active avoidance of separation from
significant others, even at a cost to other areas of life
3. Negative Emotionality: Pessimism
Having a negative outlook on life; focusing on and accentuating the worst aspects of current and
past experiences or circumstances; expecting the worst outcome
4. Negative Emotionality: Low self-esteem
Having a poor opinion of one’s self and abilities; believing that one is worthless or useless;
disliking or being dissatisfied with one’s self; believing that one cannot do things or do them well
5. Negative Emotionality: Guilt/ shame
Having frequent and persistent feelings of guilt/ shame/ blameworthiness, even over minor
matters; believing one deserves punishment for wrongdoing
6. Introversion: Intimacy avoidance
Disinterest in and avoidance of close relationships, interpersonal attachments, and intimate
sexual relationships
7. Introversion: Social withdrawal
Preference for being alone to being with others; reticence in social situations; avoidance of social
contacts and activity; lack of initiation of social contact
8. Introversion: Restricted affectivity
Lack of emotional experience and display; emotional reactions, when evident, are shallow and
transitory; unemotional, even in normally emotionally arousing situations
9. Introversion: Anhedonia
Lack of enjoyment from, engagement in, or energy for life’s experiences; deficit in the capacity to
feel pleasure or take interest in things
10. Introversion: Social detachment
Indifference to or disinterest in local and worldly affairs; disinterest in social contacts and activity;
interpersonal distance; having only impersonal relations and being taciturn with others (e.g.,
solely goal- or task-oriented interactions)
11. Compulsivity: Risk aversion
Complete lack of risk-taking; unwillingness even to consider taking even minimal risks; avoidance
of activities that have even a small potential to cause injury or harm to oneself; strict adherence
to behaviors to minimize health and other risks
301.83
Borderline Personality Disorder
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Proposed Revision
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Severity
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DSM-IV
The work group is recommending that this disorder be reformulated as the Borderline Type.
Individuals who match this personality disorder type have an extremely fragile self-concept that is
easily disrupted and fragmented under stress and results in the experience of a lack of identity or
chronic feelings of emptiness. As a result, they have an impoverished and/or unstable self
structure and difficulty maintaining enduring intimate relationships. Self-appraisal is often
associated with self-loathing, rage, and despondency. Individuals with this disorder experience
rapidly changing, intense, unpredictable, and reactive emotions and can become extremely
anxious or depressed. They may also become angry or hostile, and feel misunderstood,
mistreated, or victimized. They may engage in verbal or physical acts of aggression when angry.
Emotional reactions are typically in response to negative interpersonal events involving loss or
disappointment.
Relationships are based on the fantasy of the need for others for survival, excessive dependency,
and a fear of rejection and/or abandonment. Dependency involves both insecure attachment,
expressed as difficulty tolerating aloneness; intense fear of loss, abandonment, or rejection by
significant others; and urgent need for contact with significant others when stressed or distressed,
accompanied sometimes by highly submissive, subservient behavior. At the same time, intense,
intimate involvement with another person often leads to a fear of loss of an identity as an
individual. Thus, interpersonal relationships are highly unstable and alternate between excessive
dependency and flight from involvement. Empathy for others is severely impaired.
Core emotional traits and interpersonal behaviors may be associated with cognitive
dysregulation, i.e., cognitive functions may become impaired at times of interpersonal stress
leading to information processing in a concrete, black-and white, all-or-nothing manner. Quasipsychotic reactions, including paranoia and dissociation, may progress to transient psychosis.
Individuals with this type are characteristically impulsive, acting on the spur of the moment, and
frequently engage in activities with potentially negative consequences. Deliberate acts of selfharm (e.g., cutting, burning), suicidal ideation, and suicide attempts typically occur in the context
of intense distress and dysphoria, particularly in the context of feelings of abandonment when an
important relationship is disrupted. Intense distress may also lead to other risky behaviors,
including substance misuse, reckless driving, binge eating, or promiscuous sex.
Instructions
A. Type rating. Rate the patient’s personality using the 5-point rating scale shown below. Circle
the number that best describes the patient’s personality.
5 = Very Good Match: patient exemplifies this type
4 = Good Match: patient significantly resembles this type
3 = Moderate Match: patient has prominent features of this type
2 = Slight Match: patient has minor features of this type
1 = No Match: description does not apply
B. Trait ratings. Rate extent to which the following traits associated with the Borderline Type
are descriptive of the patient using this four-point scale:
0 = Very little or not at all descriptive
1 = Mildly descriptive
2 = Moderately descriptive
3 = Extremely descriptive
1. Negative Emotionality: Emotional Lability
Having unstable emotional experiences and mood changes; having emotions that are easily
aroused, intense, and/or out of proportion to events and circumstances
2. Negative Emotionality: Self-harm
Engaging in thoughts and behaviors related to self-harm (e.g., intentional cutting or burning) and
suicide, including suicidal ideation, threats, gestures, and attempts
3. Negative Emotionality: Separation insecurity
Fears of rejection by, and/or separation from, significant others; distress when significant others
are not present or readily available
4. Negative Emotionality: Anxiousness
Feelings of nervousness, tenseness, and/or being on edge; worry about past unpleasant
experiences and future negative possibilities; feeling fearful and threatened by uncertainty
5. Negative Emotionality: Low self-esteem
Having a poor opinion of one’s self and abilities; believing that one is worthless or useless;
disliking or being dissatisfied with one’s self; believing that one cannot do things or do them well
6. Negative Emotionality: Depressivity
Having frequent feelings of being down/ miserable/ depressed/ hopeless; difficulty “bounding
back” from such moods; belief that one is simply a sad/ depressed person
7. Antagonism: Hostility
Irritability, hot temperedness; being unfriendly, rude, surly, or nasty; responding angrily to minor
slights and insults
8. Antagonism: Aggression
Being mean, cruel, or cold-hearted; verbally, relationally, or physically abusive; humiliating and
demeaning of others; willingly and willfully engaging in acts of violence against persons and
objects; active and open belligerence or vengefulness; using dominance and intimidation to
control others
9. Disinhibition: Impulsivity
Acting on the spur of the moment in response to immediate stimuli; acting on a momentary basis
without a plan or consideration of outcomes; difficulty establishing and following plans; failure to
learn from experience
10. Schizotypy: Dissociation Proneness
Tendency to experience disruptions in the flow of conscious experience; “losing time,” (e.g., being
unaware of how one got to one’s location); experiencing one’s surroundings as strange or unreal
301.4
Obsessive-Compulsive Personality
Disorder
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Proposed Revision
Rationale
Severity
DSM-IV
The work group is recommending that this disorder be reformulated as the ObsessiveCompulsive Type.
Individuals who match this personality disorder type are ruled by their need for order, precision,
and perfection. Activities are conducted in super-methodical and overly detailed ways. They
have intense concerns with time, punctuality, schedules, and rules. Affected individuals exhibit
an overdeveloped sense of duty and obligation, and a need to try to complete all tasks thoroughly
and meticulously. The need to try to do things perfectly may result in a paralysis of indecision, as
the pros and cons of alternatives are weighed, such that important tasks may not ever be
completed. Tasks, problems, and people are approached rigidly, and there is limited capacity to
adapt to changing demands or circumstances. For the most part, strong emotions – both positive
(e.g., love) and negative (e.g., anger) – are not consciously experienced or expressed. At times,
however, the individual may show significant insecurity, lack of self confidence, and anxiety
subsequent to guilt or shame over real or perceived deficiencies or failures. Additionally,
individuals with this type are controlling of others, competitive with them, and critical of them.
They are conflicted about authority (e.g., they may feel they must submit to it or rebel against it),
prone to get into power struggles either overtly or covertly, and act self-righteous or moralistic.
They are unable to appreciate or understand the ideas, emotions, and behaviors of other people.
Instructions
A. Type rating. Rate the patient’s personality using the 5-point rating scale shown below. Circle
the number that best describes the patient’s personality.
5 = Very Good Match: patient exemplifies this type
4 = Good Match: patient significantly resembles this type
3 = Moderate Match: patient has prominent features of this type
2 = Slight Match: patient has minor features of this type
1 = No Match: description does not apply
B. Trait ratings. Rate extent to which the following traits associated with the ObsessiveCompulsive Type are descriptive of the patient using this four-point scale:
0 = Very little or not at all descriptive
1 = Mildly descriptive
2 = Moderately descriptive
3 = Extremely descriptive
1. Compulsivity: Perfectionism
Insistence on everything being flawless, without errors or faults, including own and others’
performance; conviction that reality should conform to one’s own ideal vision; holding oneself and
others to unrealistically high standards; sacrificing of timeliness to ensure every detail is correct
2. Compulsivity: Rigidity
Being rule- and habit-governed; belief that there is only one right way to do things; insistence on
an unchanging routine; difficulty adapting behaviors to changing circumstances; processing of
information on the basis of fixed ideas and expectations; difficulty changing ideas and/or
viewpoint, even with overwhelming contrary evidence
3. Compulsivity: Orderliness
Need for order and structure; insistence on everything having a correct place or order and on
keeping them so; intolerance of things being “out of place”; concern with details, lists,
arrangements, schedules
4. Compulsivity: Perseveration
Persistence at tasks long after behavior has ceased to be functional or effective; belief that lack of
success is due solely to lack of effort or skill; continuance of the same behavior despite repeated
failures.
5. Negative Emotionality: Anxiousness
Feelings of nervousness, tenseness, and/or being on edge; worry about past unpleasant
experiences and future negative possibilities; feeling fearful and threatened by uncertainty
6. Negative Emotionality: Pessimism
Having a negative outlook on life; focusing on and accentuating the worst aspects of current
circumstances; expecting the worst outcome
7. Negative Emotionality: Guilt/shame
Having frequent and persistent feelings of guilt/ shame/ blameworthiness, even over minor
matters; believing one deserves punishment for wrongdoing
8. Introversion: Restricted Affectivity
Lack of emotional experience and display; emotional reactions, when evident, are shallow and
transitory; unemotional, even in normally emotionally arousing situations
9. Antagonism: Oppositionality
Displaying defiance by refusing to cooperate with requests, meet obligations, or complete tasks;
behavioral resistance to performance expectations; resentment and undermining of authority
figures
301.22
Schizotypal Personality Disorder
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Proposed Revision
Rationale
Severity
DSM-IV
The work group is recommending that this disorder be reformulated as the Schizotypal Type.
Individuals who match this personality disorder type have social deficits, marked by
discomfort with and reduced capacity for interpersonal relationships; eccentricities of
appearance and behavior, and cognitive and perceptual distortions. They have few close
friends or relationships. They are anxious in social situations (even when they have the
time to become familiar with the situation), feel like outcasts or outsiders, find it difficult
to feel connected to others, and are suspicious of others’ motivations, including their
spouse, colleagues, and friends.
Individuals with this type are eccentric, odd, or peculiar in appearance or manner (e.g.,
grooming, hygiene, posture, and/or eye contact are strange or unusual). Their speech
may be vague, circumstantial, metaphorical, overelaborate, impoverished, overly
concrete, or stereotyped. Individuals with this type experience a limited or constricted
range of emotions, and are inhibited in their expression of emotions. They may appear
detached and indifferent to other’s reactions, despite internal distress at being “set apart.”
Odd beliefs influence their behavior, such as beliefs in superstition, clairvoyance, or
telepathy. Their perception of reality can become further impaired, often under stress,
when reasoning and perceptual processes become odd and idiosyncratic (e.g., they may
make seemingly arbitrary inferences, or see hidden messages or special meanings in
ordinary events) or quasi-psychotic, with symptoms such as pseudo-hallucinations,
sensory illusions, over-valued ideas, mild paranoid ideation, or transient psychotic
episodes. Individuals with this personality disorder type are, however, able to “reality
test” psychotic-like symptoms and can intellectually acknowledge that they are products
of their own minds.
Instructions
A. Type rating. Rate the patient’s personality using the 5-point rating scale shown below. Circle
the number that best describes the patient’s personality.
5 = Very Good Match: patient exemplifies this type
4 = Good Match: patient significantly resembles this type
3 = Moderate Match: patient has prominent features of this type
2 = Slight Match: patient has minor features of this type
1 = No Match: description does not apply
B. Trait ratings. Rate extent to which the following traits associated with the Schizotypal Type
are descriptive of the patient using this four-point scale:
0 = Very little or not at all descriptive
1 = Mildly descriptive
2 = Moderately descriptive
3 = Extremely descriptive
1. Schizotypy: Eccentricity
Unusual behavior (e.g., unusual mannerisms; wearing clothes obviously inappropriate to
the occasion or season); saying unusual or inappropriate things, using neologisms, or
concrete and impoverished speech; seen by others of the same culture and society as
bizarre, odd, and strange
2. Schizotypy: Cognitive Dysregulation
Unusual thought processes; having thoughts and ideas that do not follow logically from
each other; derailment of one’s train of thought; making loose associations or nonsequiturs; disorganized and/or confused thought, especially when stressed
3. Schizotypy: Unusual Perceptions
Having odd experiences in various sensory modalities; having synesthesia (cross-modal
perception); perceiving events and things in ways that others do not
4. Schizotypy: Unusual Beliefs
Content of thoughts that is viewed by others of the same culture and society as bizarre;
idiosyncratic but deeply held convictions that are not well justified by objective evidence;
interest in the occult and in unusual views of reality
5. Introversion: Social Withdrawal
Preference for being alone to being with others; reticence in social situations; avoidance
and lack of enjoyment of social contacts/activity; lack of initiation of social contact
6. Introversion: Restricted Affectivity
Lack of emotional experience and display; emotional reactions, when evident, are
shallow and transitory; unemotional, even in normally emotionally arousing situations s
7. Introversion: Intimacy Avoidance
Disinterest in and avoidance of close relationships, interpersonal attachments, and
intimate sexual relationship
8. Negative Emotionality: Suspiciousness
Mistrust of others; expectations of and hyper-alertness to signs of interpersonal ill-intent
or harm; having doubts about others’ loyalty and fidelity; feelings of persecution
9. Negative Emotionality: Anxiousness
Feelings of nervousness, tenseness, and/or being on edge; worry about past unpleasant
experiences and future negative possibilities; feeling fearful and threatened by
uncertainty
Personality Traits
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Proposed Revision
Rationale
Severity
DSM-IV
The Work Group recommends that patients be rated on 6 broad, higher order personality trait
domains each comprised of several lower order, more specific trait facets. The broad trait
domains and their definitions are listed below, with the trait facets comprising each domain
listed below the domain name. The proposed trait model is in the process of empirical validation.
Trait levels are assessed on a four-point scale:
0 = Very little or not at all
1 = Mildly Descriptive
2 = Moderately Descriptive
3 = Extremely Descriptive
Negative Emotionality: Experiences a wide range of negative emotions (e.g., anxiety, depression, guilt/
shame, worry, etc.), and the behavioral and interpersonal manifestations of those experiences
Trait facets: Emotional lability, anxiousness, submissiveness, separation insecurity, pessimism, low
self-esteem, guilt/ shame, self-harm, depressivity, suspiciousness
Introversion: Withdrawal from other people, ranging from intimate relationships to the world at large;
restricted affective experience and expression; limited hedonic capacity
Trait facets: Social withdrawal, social detachment, restricted affectivity, anhedonia, intimacy
avoidance
Antagonism: Exhibits diverse manifestations of antipathy toward others, and a correspondingly
exaggerated sense of self-importance
Trait facets: Callousness, manipulativeness, narcissism, histrionism, hostility, aggression,
oppositionality, deceitfulness
Disinhibition: Diverse manifestations of being present- (vs. future- or past-) oriented, so that behavior is
driven by current internal and external stimuli, rather than by past learning and consideration of future
consequences
Trait facets: Impulsivity, distractibility, recklessness, irresponsibility
Compulsivity: The tendency to think and act according to a narrowly defined and unchanging ideal, and
the expectation that this ideal should be adhered to by everyone
Trait facets: Perfectionism, perseveration, rigidity, orderliness, risk aversion
Schizotypy: Exhibits a range of odd or unusual behaviors and cognitions, including both process (e.g.,
perception) and content (e.g., beliefs)
Trait facets: Unusual perceptions, unusual beliefs, eccentricity, cognitive dysregulation, dissociation
proneness
Rationale for a Six-Domain Trait Dimensional Diagnostic System for Personality Disorder
Severity is assessed by the Self and Interpersonal Functioning Continuum.
Trait levels are assessed on a four-point scale.
DSM-IV did not provide for trait ratings.
http://www.dsm5.org/PROPOSEDREVISIONS/Pages/PersonalityandPersonalityDisorders.aspx
Note. Use above link to see full trait descriptions
General Diagnostic Criteria for
Personality Disorder
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Proposed Revision
Rationale
Severity
DSM-IV
The Work Group recommends a revised definition of personality disorder and a
corresponding revised set of general criteria.
Definition: Personality disorders represent the failure to develop a sense of self-identity and
the capacity for interpersonal functioning that are adaptive in the context of the individual’s
cultural norms and expectations.
A. Adaptive failure is manifested in one or both of the following areas:
1. Impaired sense of self-identity as evidenced by one or more of the following:
i. Identity integration. Poorly integrated sense of self or identity (e.g., limited sense of
personal unity and continuity; experiences shifting self-states; believes that the self
presented to the world is a façade)
ii. Integrity of self-concept. Impoverished and poorly differentiated sense of self or
identity (e.g., difficulty identifying and describing self attributes; sense of inner
emptiness; poorly delineated interpersonal boundaries; definition of the self changes
with social context)
iii. Self-directedness. Low self-directedness (e.g., unable to set and attain satisfying and
rewarding personal goals; lacks direction, meaning, and purpose to life)
2. Failure to develop effective interpersonal functioning as manifested by one or more of
the following:
i. Empathy. Impaired empathic and reflective capacity (e.g., finds it difficult to
understand the mental states of others)
ii. Intimacy. Impaired capacity for close relationships (e.g., unable to establish or
maintain closeness and intimacy; inability to function as an effective attachment figure;
inability to establish and maintain friendships)
iii. Cooperativeness. Failure to develop the capacity for prosocial behavior (e.g., failure
to develop the capacity for socially typical moral behavior; absence of altruism)
iv. Complexity and integration of representations of others. Poorly integrated
representations of others (e.g., forms separate and poorly related images of significant
others)
B. Adaptive failure is associated with extreme levels of one or more personality traits.
C. Adaptive failure is relatively stable across time and consistent across situations with an onset
that can be traced back at least to adolescence.
D. Adaptive failure is not solely explained as a manifestation or consequence of another mental
disorder
E. Adaptive failure is not solely due to the direct physiological effects of a substance (e.g., a drug
of abuse, medication) or a general medical condition (e.g., severe head trauma)