General Diagnostic Criteria for Personality Disorder

• 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)