Criteria
Schizotypal personality disorder (DSM-5-TR)
Social and interpersonal deficits marked by acute discomfort with and reduced capacity for close relationships, accompanied by cognitive/perceptual distortions and eccentric behavior; may include ideas of reference, odd thinking or speech, unusual perceptual experiences, social anxiety regardless of familiarity with situation, suspiciousness or paranoid ideation, inappropriate or constricted affect.[1] This is classified with the schizophrenia-spectrum disorders in ICD-11.[2]
Schizoid personality disorder (DSM-5-TR)
Pattern of detachment in social relationships and restricted emotional expression in interpersonal interactions; solitary, indifferent toward others; affectively detached; little, if any, interest in having sexual experiences with another person; lacks close friends and confidants (other than first degree relatives).[1]
Paranoid personality disorder (DSM-5-TR)
Distrust and suspiciousness of others, whose motives are viewed as malevolent; suspicious and bears grudges; perceives threats in neutral events; preoccupied with unjustified doubts about the loyalty or trustworthiness of friends or associated; reluctant to confide in others; recurrent suspicions (without justification) about fidelity of a spouse/partner; perceives attacks on character/reputation that are not apparent to others and is quick to react angrily or counterattack.[1]
Avoidant personality disorder (DSM-5-TR)
Social inhibition, feelings of inadequacy, hypersensitivity to negative evaluation; interpersonally inhibited and extremely reluctant to take personal risks, even in occupational activities, due to fear of rejection; shows restraint in intimate relationships due to fear of being shamed or ridiculed, views self as socially inept, preoccupied with being criticized or rejected in social situations.[1]
Dependent personality disorder (DSM-5-TR)
Excessive need to be taken care of leading to submissive and clinging behavior; difficulty with decision making in the absence of advice; fears solitude due to fear of inability to care for self; has difficulty expressing disagreement with others; difficulty initiating projects or doing things on his or her own; urgently seeks another relationship as a source of care and support when a close relationship ends.[1]
Obsessive-compulsive personality disorder (DSM-5-TR)
Preoccupation with orderliness, perfectionism, and mental/interpersonal control (and subsequent lack of flexibility, openness, and efficiency); overconscientious, stubborn, and excessively devoted to work; scrupulous and inflexible about matters of morality, ethics, and values; reluctant to delegate tasks or work with others; unless they conform to his/her style of doing things; rigid; unable to discard worthless or worn-out objects even when they have no sentimental value; adopts a miserly spending style towards self and others.[1]
Borderline personality disorder (DSM-5-TR)
Instability of interpersonal relationships, self-image, and affects, and impulsivity; intense anger and affective instability; recurrent suicidal behavior/gestures; impulsive behavior with potential for self-harm; frantic efforts to avoid real or imagined abandonment; chronic feelings of emptiness; affective instability due to a marked reactivity of mood; inappropriate, intense anger, or difficulty controlling anger.[1]
Histrionic personality disorder (DSM-5-TR)
Excessive emotionality and attention-seeking; discomfort when not center of attention; shifting and shallow expression of emotions; draws attention to self through physical appearance; superficial; style of speech is impressionistic and lacks details; considers relationships to be more intimate than they actually are; easily influenced by others or circumstances.[1]
Narcissistic personality disorder (DSM-5-TR)
Grandiosity (in fantasy and behavior), need for admiration, lack of empathy; views self as "special" and needs to be admired; unwilling to recognize feelings of others; is arrogant and interpersonally exploitative; lacks empathy; often envious of others and believes that others are envious of him or her.[1]
Antisocial personality disorder (DSM-5-TR)
Disregard for and violation of rights of others occurring since age 15; impulsivity; deceitfulness; lack of remorse; engages in acts that are illegal or show disrespect for social norms; irritability and aggressiveness, as indicated by repeated physical fights or assaults; reckless disregard for safety of others; fails to sustain consistent work behavior or honor financial obligations.[1]
Other specified personality disorder/unspecified personality disorder (DSM-5-TR)
Symptoms characteristic of a personality disorder are present and cause clinically significant distress or impairment in social, occupational, or other important areas, but do not meet the full criteria for any of the disorders in the personality disorders class. If the clinician chooses to communicate the specific reason that the presentation does not meet the criteria for any specific personality disorder (e.g. "mixed personality features"), the diagnosis is other specific personality disorder. If the clinician does not choose to specify a reason that the criteria are not met for a specific personality disorder, the diagnosis is unspecified personality disorder. This may include presentations where there is insufficient information to make a more specific diagnosis.[1]
Alternative DSM-5-TR model for personality disorders
An alternative model has been proposed for diagnosis and classification of personality disorders. Using the alternative model, personality disorders are characterized by impairments in personality functioning and pathological personality traits. The alternative model was developed because, in the established model, symptoms frequently meet the criteria for more than one personality disorder, and individuals do not tend to present with patterns of symptoms that correspond to one, and only one, personality disorder.[1]
Antisocial, avoidant, borderline, narcissistic, obsessive compulsive, and schizotypal personality disorders may be derived from this model.[1]
Using the alternative model, the essential features of a personality disorder are:
Moderate or greater impairment in personality (self/interpersonal) functioning
One or more pathological personality traits
The impairments in personality functioning and the individual’s personality trait expression are relative inflexible and pervasive across a broad range of social situations
The impairments in personality functioning and the individual's personality trait expression are relatively stable across time, with onsets that can be traced back to at least adolescence or early adulthood
The impairments in personality functioning and the individual's personality trait expression are not better explained by another mental disorder
The impairments in personality functioning and the individual's personality trait expression are not solely attributable to the physiological effects of a substance or another medical condition (e.g., severe head trauma)
The impairments in personality functioning and the individual's personality trait expression are not better understood as normal for an individual's developmental stage or sociocultural environment.
Although the transition to an alternative model for diagnosing personality disorders is supported by the research, the literature regarding treatment is still predominantly focused on the categorical approach. The highest-quality evidence for various treatments concerns borderline personality disorder (BPD), which is the most frequently diagnosed personality disorder in clinical settings and the most extensively researched personality disorder. There is also support for the notion that BPD represents features of personality dysfunction that are shared across all manifestations of personality disorder.[69] The categorical approach to the classification of personality disorders will be utilized in this monograph.
International Classification of Diseases (ICD-11)[2]
ICD-11 departs from the categorical model of personality disorders. Diagnosis has three components:[2][53]
Identify the presence of a core problem in self and interpersonal functioning
Classify the level of severity
Identify the main traits and whether a borderline pattern exists
A core problem in self and interpersonal functioning is indicated by:
An enduring disturbance characterized by problems in functioning of aspects of the self (e.g., identity, self-worth, accuracy of self-view, self-direction), and/or interpersonal dysfunction (e.g., ability to develop and maintain close and mutually satisfying relationships, ability to understand others’ perspectives and to manage conflict in relationships).
The disturbance has persisted over an extended period of time (e.g., lasting 2 years or more).
The disturbance is manifest in patterns of cognition, emotional experience, emotional expression, and behavior that are maladaptive (e.g., inflexible or poorly regulated).
The disturbance is manifest across a range of personal and social situations (i.e., is not limited to specific relationships or social roles), though it may be consistently evoked by particular types of circumstances and not others.
The symptoms are not due to the direct effects of a drug or substance, including withdrawal effects, and are not better accounted for by another mental disorder, a disease of the nervous system, or another medical condition.
The disturbance is associated with substantial distress or significant impairment in personal, family, social, educational, occupational, or other important areas of functioning.
Personality disorder should not be diagnosed if the patterns of behavior characterizing the personality disturbance are developmentally appropriate (e.g., problems related to establishing an independent self-identity during adolescence) or can be explained primarily by social or cultural factors, including sociopolitical conflict.
Trait domain qualifiers describe the most prominent characteristics that contribute to the personality disturbance:
Negative affectivity: experiences a broad range of negative emotions with a frequency and intensity out of proportion to the situation; emotional lability and poor emotion regulation; negativistic attitudes; low self-esteem and self-confidence; mistrustfulness
Detachment: tendency to maintain interpersonal and social distance; social detachment; emotional detachment
Dissociality: disregard for the rights and feelings of others; self-centeredness, lack of empathy
Disinhibition: acts rashly based on immediate external or internal stimuli, without consideration of potential negative consequences; impulsivity; distractibility; irresponsibility; recklessness; lack of planning
Anankastia: a narrow focus on own rigid standards of perfection and of rights and wrong, and on controlling own and others’ behaviors and controlling situations to ensure these standards are met; perfectionism; emotional and behavioral constraint
Borderline pattern: frantic efforts to avoid real or imagined abandonment; a pattern of unstable and intense interpersonal relationships, which may be characterized by vacillations between idealization and devaluation, typically associated with both strong desire for and fear of closeness and intimacy; identity disturbance, manifested in markedly and persistently unstable self-image or sense of self; a tendency to act rashly in states of high negative affect, leading to potentially self-damaging behaviors (e.g., risky sexual behavior, reckless driving, excessive alcohol or substance use, binge eating); recurrent episodes of self-harm (e.g., suicide attempts or gestures, self-mutilation); emotional instability due to marked reactivity of mood-fluctuations of mood may be triggered either internally (e.g., by one’s own thoughts) or by external events and the individual experiences intense dysphoric mood states, which typically last for a few hours but may last for up to several days; chronic feelings of emptiness; inappropriate intense anger or difficulty controlling anger manifested in frequent displays of temper (e.g., yelling or screaming, throwing or breaking things, getting into physical fights); transient dissociative symptoms or psychotic-like features (e.g., brief hallucinations, paranoia) in situations of high affective arousal.
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