{{Short description|none}} '''Classification of personality disorders''' varies significantly, with the predominant models being either categorical or dimensional. As in the case of broader classification of mental disorders, personality disorders are mainly classified in accordance with two diagnostic frameworks: namely, the ''Diagnostic and Statistical Manual of Mental Disorders'' (DSM) and the ''International Classification of Diseases'' (ICD). {{As of|2026}}, the latest editions of these are the DSM-5-TR and ICD-11, respectively. While the main system in the former classifies personality disorders as distinct categories; the latter classifies a single ''personality disorder'' dimensionally according to severity, with the option to additionally diagnose trait domains.<ref name=":04">{{Cite journal |last1=Bach |first1=Bo |last2=First |first2=Michael B. |date=2018-10-29 |title=Application of the ICD-11 classification of personality disorders |journal=BMC Psychiatry |volume=18 |issue=1 |page=351 |doi=10.1186/s12888-018-1908-3 |issn=1471-244X |pmc=6206910 |pmid=30373564 |doi-access=free}} {{Creative Commons text attribution notice|cc=by4|from this source=yes}}</ref> A hybrid approach is implemented in the ''Alternative DSM-5 Model for Personality Disorders'',<ref name=":14">{{Cite journal |last=Oldham |first=John M. |date=October 2022 |title=How Will Clinicians Utilize the Alternative DSM-5-TR Section III Model for Personality Disorders in Their Clinical Work? |journal=Focus |language=en |volume=20 |issue=4 |pages=411–412 |doi=10.1176/appi.focus.20220053 |issn=1541-4094 |pmc=10187398 |pmid=37200885}}</ref> with diagnoses being ''specific'' or ''trait specified''; both of these are based on both severity and traits.<ref name=":12">{{Cite journal |last1=Clark |first1=Lee Anna |last2=Vanderbleek |first2=Emily N. |last3=Shapiro |first3=Jaime L. |last4=Nuzum |first4=Hallie |last5=Allen |first5=Xia |last6=Daly |first6=Elizabeth |last7=Kingsbury |first7=Thomas J. |last8=Oiler |first8=Morgan |last9=Ro |first9=Eunyoe |date=2015-02-01 |title=The Brave New World of Personality Disorder-Trait Specified: Effects of Additional Definitions on Coverage, Prevalence, and Comorbidity |journal=Psychopathology Review |language=EN |volume=a2 |issue=1 |pages=52–82 |doi=10.5127/pr.036314 |issn=2051-8315 |pmc=4469240 |pmid=26097740}}</ref> The ICD-11 classifies ''schizotypal disorder'' among primary psychotic disorders rather than as a personality disorder as in the DSM-5.<ref>{{Cite journal |last1=Department of Psychiatry and Psychotherapy, Medical Faculty, LVR-Klinikum Düsseldorf, Heinrich-Heine-University, Düsseldorf, Germany |last2=Gaebel |first2=Wolfgang |last3=WHO Collaborating Centre on Quality Assurance and Empowerment in Mental Health, Düsseldorf, Germany |last4=Kerst |first4=Ariane |last5=Department of Psychiatry and Psychotherapy, Medical Faculty, LVR-Klinikum Düsseldorf, Heinrich-Heine-University, Düsseldorf, Germany |last6=WHO Collaborating Centre on Quality Assurance and Empowerment in Mental Health, Düsseldorf, Germany |last7=Stricker |first7=Johannes |last8=Department of Psychiatry and Psychotherapy, Medical Faculty, LVR-Klinikum Düsseldorf, Heinrich-Heine-University, Düsseldorf, Germany |last9=WHO Collaborating Centre on Quality Assurance and Empowerment in Mental Health, Düsseldorf, Germany |date=2020-12-24 |title=Classification and Diagnosis of Schizophrenia or Other Primary Psychotic Disorders: Changes from Icd-10 to Icd-11 and Implementation in Clinical Practice |url=http://www.psychiatria-danubina.com/UserDocsImages/pdf/dnb_vol32_no3-4/dnb_vol32_no3-4_320.pdf |journal=Psychiatria Danubina |volume=32 |issue=3–4 |pages=320–324 |doi=10.24869/psyd.2020.320 |pmid=33370728 |quote=Schizotypal disorder is defined as an enduring pattern of unusual speech, perceptions, beliefs, and behaviours of insufficient intensity to meet requirements for another psychotic disorder in ICD-10 and in ICD11. Yet, schizotypal disorder may be a possible predecessor of schizophrenia (Jablensky 2011, Stein et al. 2020) and is therefore kept in the ICD-11 chapter of primary psychotic disorders, contrary to DSM-5 which classifies schizotypal disorder as a personality disorder.}}</ref> {{TOC limit|1}}
== Conceptual approaches == {{Personality disorders sidebar}} Personality disorder classification can generally be broken down into a ''categorical approach'' and a ''dimensional approach''. The categorical approach views personality disorders as discrete entities that are distinct from each other as well as from normal personality. In contrast, the dimensional approach suggests that personality disorders exist on a continuum, with traits varying in degree rather than kind.<ref name=":31">{{Cite journal |last1=Monaghan |first1=Conal |last2=Bizumic |first2=Boris |date=2023-03-07 |title=Dimensional models of personality disorders: Challenges and opportunities |journal=Frontiers in Psychiatry |language=English |volume=14 |article-number=1098452 |doi=10.3389/fpsyt.2023.1098452 |issn=1664-0640 |pmc=10028270 |pmid=36960458 |doi-access=free}} {{Creative Commons text attribution notice|cc=by4|from this source=yes}}</ref> There has been a sustained movement toward replacing categorical models of personality disorder classification with dimensional approaches.<ref name=":29" /><ref name=":30" /> This dimensional perspective may allow for more nuanced understanding and flexible diagnostic practices.
=== Categorical approach === Classical views of personality disorder as discrete categories have had benefits for understanding and communicating psychopathology throughout history, such as for: a contained organization of symptoms to facilitate standardized research, organizing public awareness and stigma reduction campaigns, allocating public health funding and appropriate treatment intensities, and normalizing clear labels for communicating patient formulations (a description of symptoms and their inter-relationships) to professionals and families.<ref name=":31" />
Since its inception, the categorical system has steadily accumulated criticism. Attempts to reproduce the factor structure of the DSM-IV-TR's categorical model have been unsuccessful, suggesting that the categorical structure cannot robustly describe the architecture of personality psychopathology.<ref name=":31" /> Such issues are exacerbated by the substantial symptom overlap between disorders that facilitates their excessive and unwarranted comorbidity,<ref name=":31" /><ref name=":29">{{Cite journal |last1=Day |first1=Nicholas J. S. |last2=Green |first2=Ava |last3=Denmeade |first3=Georgia |last4=Bach |first4=Bo |last5=Grenyer |first5=Brin F. S. |date=2024 |title=Narcissistic personality disorder in the ICD-11: Severity and trait profiles of grandiosity and vulnerability |journal=Journal of Clinical Psychology |language=en |volume=80 |issue=8 |pages=1917–1936 |doi=10.1002/jclp.23701 |issn=1097-4679 |pmid=38742471|doi-access=free }}</ref><ref name=":30">{{Cite journal |last1=McCabe |first1=Gillian A. |last2=Widiger |first2=Thomas A. |date=January 2020 |title=A comprehensive comparison of the ICD-11 and DSM–5 section III personality disorder models. |url=https://doi.apa.org/doi/10.1037/pas0000772 |journal=Psychological Assessment |language=en |volume=32 |issue=1 |pages=72–84 |doi=10.1037/pas0000772 |pmid=31580095 |issn=1939-134X|url-access=subscription }}</ref> with the majority of people with a PD being eligible for another PD diagnosis.<ref>{{Cite journal |last1=Morey |first1=Leslie C. |last2=Benson |first2=Kathryn T. |last3=Busch |first3=Alexander J. |last4=Skodol |first4=Andrew E. |date=April 2015 |title=Personality Disorders in DSM-5: Emerging Research on the Alternative Model |url=http://link.springer.com/10.1007/s11920-015-0558-0 |journal=Current Psychiatry Reports |language=en |volume=17 |issue=4 |article-number=24 |doi=10.1007/s11920-015-0558-0 |pmid=25749746 |issn=1523-3812|url-access=subscription }}</ref> As a result, individuals are substantially more likely to be diagnosed with several PDs than a singular one, contradicting the notion that categories provide neat constellations of inter-related symptoms.<ref name=":31" />
Equally, this approach appears unable to accurately capture the full range of personality psychopathology. Estimates of patients who do not fit neatly into current categories range from 21 to 49%, accordingly given the general diagnosis of Personality Disorder – Not Otherwise Specified (PD-NOS). PD-NOS also appears to be in regular usage to describe mixed or complex presentations given the difficulties in classifying individuals within the current framework.<ref name=":31" /> It has been found that "many patients in clinical practice misleadingly receive multiple PD diagnoses, a 'not otherwise specified' PD diagnosis, or no PD diagnosis at all, even if a PD diagnosis is relevant to the presentation".<ref name=":5">{{Cite journal |last1=Zimmermann |first1=Johannes |last2=Kerber |first2=André |last3=Rek |first3=Katharina |last4=Hopwood |first4=Christopher J. |last5=Krueger |first5=Robert F. |date=2019-08-13 |title=A Brief but Comprehensive Review of Research on the Alternative DSM-5 Model for Personality Disorders |url=https://doi.org/10.1007/s11920-019-1079-z |journal=Current Psychiatry Reports |language=en |volume=21 |issue=9 |pages=92 |doi=10.1007/s11920-019-1079-z |pmid=31410586 |issn=1535-1645|url-access=subscription |doi-access=free }}</ref> Another issue is the heterogeneity within categories.<ref name=":30" />
Setting standardized diagnostic thresholds (based upon polythetic symptoms) is difficult particularly when each symptom is given equal weighting. This means that individuals with the same number of symptoms can have substantially different levels of distress. Between each PD, diagnostic thresholds occur at different levels of pathology. Due to these issues, it is likely that many clinicians use their clinical judgment based upon an internalized representation of the disorder when making diagnoses. The current categorical approach falls short of fully representing personality psychopathology and providing a scientifically robust understanding of what personality is and what disorders of personality are.<ref name=":31" />
=== Dimensional approach === {{Main|Dimensional models of personality disorders}} In response to observed deficiencies in the categorical approach, dimensional models, which suggest that humans differ in degree not in kind,<ref name=":31" /> have been developed, assessing personality disorders in terms of severity of impairment and maladaptive personality traits.<ref name=":29" /> Within this perspective, PD occurs at maladaptive extremes of the standard personality traits all humans share and as specific combinations of these trait extremes. The degree of life impairment forms the basis for a PD diagnosis. This approach has gained substantial support, with broad calls and movements toward mainstream adoption.<ref name=":31" />
The shift towards dimensional models is reflected in the inclusion of the AMPD in Section III of the DSM-5, and in the ICD-11's adoption of a dimensional system. These are believed to ameliorate several shortcomings of the categorical model,<ref name=":30" /> as well as improve clinical utility<ref name=":31" /> and potentially reduce stigma,<ref name=":29" /><ref name=":31" /> although no research has so far specifically examined the effect on stigma.<ref name=":31" /> Emerging research indicates that dimensional models may also facilitate the personalization of psychotherapy by aligning treatment strategies with underlying trait dimensions rather than diagnostic categories.<ref>Zimmermann, J., Kerber, A., Rek, K., Hopwood, C. J., & Krueger, R. F. (2019). Integrating clinical and personality assessment: Toward the development of a shared framework. ''Journal of Personality Assessment'', 101(3), 292–304. doi:10.1080/00223891.2018.1483373.</ref> Despite some important differences in the prevailing approaches, dimensional models of PD typically consider two key criteria: ''severity'' and ''style''.<ref name=":31" />
{| class="wikitable floatright" |+Mapping of ICD-11 PD classification to the AMPD<ref name=":04" /><ref name=":13">{{Cite journal |last=Mulder |first=Roger T. |date=2021-05-10 |title=ICD-11 Personality Disorders: Utility and Implications of the New Model |journal=Frontiers in Psychiatry |language=English |volume=12 |article-number=655548 |doi=10.3389/fpsyt.2021.655548 |issn=1664-0640 |pmc=8141634 |pmid=34040555 |doi-access=free}}</ref> !'''ICD-11''' !'''AMPD''' |- !Severity level !Criterion A |- |None |No impairment (0) |- |Personality difficulty |Mild impairment (1) |- |Mild personality disorder |Moderate impairment (2) |- |Moderate personality disorder |Severe impairment (3) |- |Severe personality disorder |Extreme impairment (4) |- !Traits and patterns !Criterion B |- |Negative affectivity |Negative Affectivity |- |Detachment |Detachment |- |Disinhibition |Disinhibition |- |Dissociality |Antagonism |- |Anankastia |(Rigid perfectionism){{Efn|Conceptualized as low level of Disinhibition in the AMPD.}} |- |(Schizotypal disorder) |Psychoticism |}
==== Severity ==== Severity captures the core distress that is common to all PDs, its impact on the individual's self-direction and identity (intrapersonal functioning), as well as their ability to form close relationships and empathize with others (interpersonal functioning). Indices of global severity are robust predictors of both the presence of a personality disorder and prognosis, and track with fluctuations in clinical functioning. According to the ICD-11, severity is the key and sole requirement for making a diagnosis of PD. The central placement of impairment is grounded in research that global severity ratings are sensitive and specific predictors of PD, and provide better estimates of clinician-rated psychosocial impairment than specific categorical diagnoses do. The severity of personality disorder (i.e., mild, moderate, severe) may be more indicative of dysfunction and outcomes than the specific typology of the disorder.<ref name=":31" />
==== Style ==== The second criterion describes the stylistic features of the presentation, largely in relation to some derivation of the Five-Factor Model (FFM) of personality. The DSM-5's Alternative Model of Personality Disorders (AMPD) Criterion B comprises the traits of negative affectivity (continua from emotional stability to neuroticism), detachment (introversion to extroversion), antagonism (agreeableness to antagonism), disinhibition (conscientiousness to impulsivity), and psychoticism (closed to experience to open to experience). The DSM-5's approach to diagnosing PD in the AMPD differs from the ICD-11 as it requires the presence of one or more elevated traits. Nevertheless, there is a growing interest in using only Criterion A for understanding, diagnosing, and managing PD. The FFM has the ability to explain all personality variation, with current dimensional PD models capturing dysfunctional versions or extremes of these traits.<ref name=":31" />
== {{Anchor|DSM-5}}DSM-5 (section II) == alt=Book cover of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision|thumb|The cover of the latest DSM edition In the fifth edition of the ''Diagnostic and Statistical Manual of Mental Disorders'', a categorical classification was retained for personality disorders. Located in Section II (''Diagnostic Criteria and Codes''; where official diagnoses are listed),<ref name=":6">{{Cite journal |last=Clark |first=Lee Anna |author-link=Lee Anna Clark |date=2025-05-01 |title=Wherefrom and Whither PD? Recent Developments and Future Possibilities in DSM-5 and ICD-11 Personality Disorder Diagnosis |journal=Current Psychiatry Reports |language=en |volume=27 |issue=5 |pages=267–277 |doi=10.1007/s11920-025-01602-y |issn=1535-1645 |pmc=12003573 |pmid=40108080}}</ref> it contains ten specific personality disorders grouped into three ''clusters'' (A, B, and C), as well as three other diagnoses. Thus, it lists personality disorders in the same way as other mental disorders, rather than on a separate 'axis', as previously.<ref>{{Cite web |last1=Stetka |first1=Bret S. |last2=Correll |first2=Christoph U. |title=A Guide to DSM-5 |url=https://www.medscape.com/viewarticle/803884_8 |url-status=live |archive-url=https://web.archive.org/web/20130610015630/https://www.medscape.com/viewarticle/803884_8 |archive-date=2013-06-10 |access-date=2025-10-25 |website=Medscape |page=8 |language=en}}</ref> The clusters are based on descriptive similarity between the disorders they encompass, and it is not proven that they possess clinical utility.<ref>{{Cite web |title=Overview of Personality Disorders - Psychiatric Disorders |url=https://www.merckmanuals.com/professional/psychiatric-disorders/personality-disorders/overview-of-personality-disorders |access-date=2025-10-26 |website=Merck Manual Professional Edition |language=en-US}}</ref>
The clusters, as well as definition of personality disorders being done through specific sets of criteria, have been part of the DSM since the DSM-III (1980).<ref>{{Cite journal |last=Crocq |first=Marc-Antoine |date=2013-06-30 |title=Milestones in the history of personality disorders |journal=Dialogues in Clinical Neuroscience |volume=15 |issue=2 |pages=147–153 |doi=10.31887/DCNS.2013.15.2/macrocq |pmid=24174889|pmc=3811086 |doi-access=free }}</ref> The classification system was retained from the DSM-IV (1994) due to the Board of Trustees of the American Psychiatric Association having decided to reject the AMPD.<ref name=":1">{{Cite journal |last1=Sharp |first1=Carla |author-link1=Carla Sharp |last2=Clark |first2=Lee Anna |author-link2=Lee Anna Clark |last3=Balzen |first3=Kennedy M. |last4=Widiger |first4=Tom |author-link4=Thomas Widiger |last5=Stepp |first5=Stephanie |last6=Zimmerman |first6=Mark |last7=Krueger |first7=Robert F. |author-link7=Robert F. Krueger |date=2025 |title=The validity, reliability and clinical utility of the Alternative DSM-5 Model for Personality Disorders (AMPD) according to DSM-5 revision criteria |journal=World Psychiatry |language=en |volume=24 |issue=3 |pages=319–340 |doi=10.1002/wps.21339 |issn=2051-5545 |pmc=12434376 |pmid=40948060}}</ref><ref name=":0">{{Cite journal |last1=Skodol |first1=Andrew E. |author-link=Andrew E. Skodol |last2=Morey |first2=Leslie C. |author-link2=Leslie Morey |last3=Bender |first3=Donna S. |last4=Oldham |first4=John M. |author-link4=John Oldham (psychiatrist) |date=2015-07-01 |title=The Alternative DSM-5 Model for Personality Disorders: A Clinical Application |url=https://psychiatryonline.org/doi/10.1176/appi.ajp.2015.14101220 |journal=American Journal of Psychiatry |language=en |volume=172 |issue=7 |pages=606–613 |doi=10.1176/appi.ajp.2015.14101220 |issn=0002-953X |pmid=26130200}}</ref> This system was carried forward in the more recent DSM-5-TR.
The DSM-5 and the more recent DSM-5-TR provide a definition and six criteria for ''general personality disorder''. Any of its ten personality disorder diagnoses<ref name=":8">{{Cite book |title=Diagnostic and statistical manual of mental disorders: DSM-5 |date=2013 |publisher=American Psychiatric Association |isbn=978-0-89042-554-1 |editor-last=American Psychiatric Association |edition=5th |location=Washington, D.C |pages=645–649 |chapter=Personality Disorders |quote=This chapter begins with a general definition of personality disorder that applies to each of the 10 specific personality disorders. |editor-last2=American Psychiatric Association}}</ref> is subject to this definition, which requires that a differential diagnosis is performed in order to verify that the disturbance is not the result of other mental disorders, medical conditions or substances, and that the disturbance is stable over time and "inflexible and pervasive across a broad range of personal and social situations", having evident continuity since "at least to adolescence or early adulthood". Additionally, disturbance must be evident in regards to at least two of four specified aspects of functioning, namely: cognition, affectivity, interpersonal functioning and impulse control.<ref name=":8" /><ref>{{Citation |last1=Fariba |first1=Kamron A. |title=Personality Disorder |date=2025 |work=StatPearls |url=https://www.ncbi.nlm.nih.gov/books/NBK556058/ |access-date=2025-06-18 |place=Treasure Island (FL) |publisher=StatPearls Publishing |pmid=32310518 |last2=Gupta |first2=Vikas |last3=Torrico |first3=Tyler J. |last4=Kass |first4=Ethan}}</ref>
=== Cluster A === People with these disorders can be paranoid and have difficulty being understood by others, as they often have odd or eccentric modes of speaking and an unwillingness and inability to form and maintain close relationships.<ref name="mayoclinic.org2">{{cite web |title=Personality disorders - Symptoms and causes |url=https://www.mayoclinic.org/diseases-conditions/personality-disorders/symptoms-causes/syc-20354463 |access-date=26 January 2019 |website=Mayo Clinic}}</ref> Significant evidence suggests a small proportion of people with Cluster A personality disorders, especially schizotypal personality disorder, have the potential to develop schizophrenia and other psychotic disorders. These disorders also have a higher probability of occurring among individuals whose first-degree relatives have either schizophrenia or a Cluster A personality disorder.<ref name="ClusterA">{{cite journal |vauthors=Esterberg ML, Goulding SM, Walker EF |date=December 2010 |title=Cluster A Personality Disorders: Schizotypal, Schizoid and Paranoid Personality Disorders in Childhood and Adolescence |journal=Journal of Psychopathology and Behavioral Assessment |volume=32 |issue=4 |pages=515–528 |doi=10.1007/s10862-010-9183-8 |pmc=2992453 |pmid=21116455}}</ref> * {{Excerpt|Paranoid personality disorder|only=paragraph|hat=no|inline=yes}} * {{Excerpt|Schizoid personality disorder|only=paragraph|hat=no|inline=yes}} * {{Excerpt|Schizotypal personality disorder|only=paragraph|hat=no|inline=yes}}
=== Cluster B === Cluster B personality disorders are characterized by dramatic, impulsive, self-destructive, emotional behavior and sometimes incomprehensible interactions with others.<ref name="mayoclinic.org2" /> * {{Excerpt|Antisocial personality disorder|only=paragraph|hat=no|inline=yes}} * {{Excerpt|Borderline personality disorder|only=paragraph|hat=no|inline=yes}} * {{Excerpt|Histrionic personality disorder|only=paragraph|hat=no|inline=yes}} * {{Excerpt|Narcissistic personality disorder|only=paragraph|hat=no|inline=yes}}
=== Cluster C === Cluster C personality disorders are characterised by a consistent pattern of anxious thinking or behavior.<ref name="mayoclinic.org2" /> Earlier, this cluster has included passive–aggressive personality disorder in the DSM-III-R.<ref>{{Cite journal |last=Morey |first=Leslie C. |author-link=Leslie C. Morey |date=1988 |title=The categorical representation of personality disorder: A cluster analysis of DSM-III—R personality features. |url=https://doi.apa.org/doi/10.1037/0021-843X.97.3.314 |journal=Journal of Abnormal Psychology |language=en |volume=97 |issue=3 |pages=314–321 |doi=10.1037/0021-843X.97.3.314 |issn=1939-1846|url-access=subscription }}</ref> * {{Excerpt|Avoidant personality disorder|only=paragraph|hat=no|inline=yes}} * {{Excerpt|Dependent personality disorder|only=paragraph|hat=no|inline=yes}} * {{Excerpt|Obsessive–compulsive personality disorder|only=paragraph|hat=no|inline=yes}}
=== Other personality disorders === The DSM-5 chapter on personality disorders also contains three diagnoses for conditions not matching these ten disorders,<ref name=":9">{{Cite book |title=Diagnostic and statistical manual of mental disorders: DSM-5 |title-link=DSM-5 |date=2013 |publisher=American Psychiatric Association |isbn=978-0-89042-554-1 |edition=5th |location=Washington, D.C |pages=682–684 |chapter=Personality Disorders}}</ref> which nevertheless exhibit characteristics of a personality disorder:
* Personality change due to another medical condition{{dash}}personality disturbance due to the direct effects of a medical condition<ref>{{Cite book |title=Diagnostic and statistical manual of mental disorders: DSM-5 |title-link=DSM-5 |date=2013 |publisher=American Psychiatric Association |isbn=978-0-89042-554-1 |edition=5th |location=Washington, D.C |page=683 |quote=The essential feature of a personality change due to another medical condition is a persistent personality disturbance that is judged to be due to the direct pathophysiological effects of a medical condition.}}</ref> * Other specified personality disorder{{dash}}used when recording the presence of personality disorder along with the reasons for the condition not being classified as one of the specific personality disorders.<ref name=":9" /> * Unspecified personality disorder{{dash}}used when a patient presents with personality disorder symptoms that cause distress or impairment, but the clinician either chooses not to indicate the specific reason these criteria are not met for any one disorder, or there isn't enough information available to make a more precise diagnosis.<ref name=":9" />
== {{Anchor|AMPD}}DSM-5 (section III; AMPD) == {{Main|Alternative DSM-5 model for personality disorders}} Located in section III of the DSM-5, the ''Alternative DSM-5 Model for Personality Disorders'' (AMPD) is a dimensional–categorical hybrid,<ref name=":4" /> yielding diagnoses based on combinations of ratings of impairment in personality functioning (criterion A) and pathological personality traits (criterion B).<ref name=":5" /><ref name=":3">{{Cite journal |last1=García |first1=Luis F. |last2=Gutiérrez |first2=Fernando |last3=García |first3=Oscar |last4=Aluja |first4=Anton |date=2024-07-12 |title=The Alternative Model of Personality Disorders: Assessment, Convergent and Discriminant Validity, and a Look to the Future |url=https://www.annualreviews.org/content/journals/10.1146/annurev-clinpsy-081122-010709 |journal=Annual Review of Clinical Psychology |language=en |volume=20 |issue=1 |pages=431–455 |doi=10.1146/annurev-clinpsy-081122-010709 |hdl=10486/720357 |issn=1548-5943 |pmid=38211624 |hdl-access=free}}</ref> Created with the aim of ameliorating issues such as arbitrary thresholds and excessive comorbidity,<ref name=":4">{{Cite journal |last1=Rodriguez-Seijas |first1=Craig |last2=Ruggero |first2=Camilo |last3=Eaton |first3=Nicholas R. |last4=Krueger |first4=Robert F. |date=2019-12-01 |title=The DSM-5 Alternative Model for Personality Disorders and Clinical Treatment: a Review |url=https://hanberghuis.nl/resources/5cb46547770cd3/d559706f5e/file-object/Rodriguez-Seijas%202019%20TheDSM-5AlternativeModelCurr%20Treatment%20Options%20Psychiatry.pdf |url-status=live |journal=Current Treatment Options in Psychiatry |language=en |volume=6 |issue=4 |pages=284–298 |doi=10.1007/s40501-019-00187-7 |issn=2196-3061 |archive-url=https://web.archive.org/web/20240416043330/https://hanberghuis.nl/resources/5cb46547770cd3/d559706f5e/file-object/Rodriguez-Seijas%202019%20TheDSM-5AlternativeModelCurr%20Treatment%20Options%20Psychiatry.pdf |archive-date=16 April 2024}}</ref> it was intended to replace the categorical model in the at the time upcoming DSM-5; however, upon its rejection, it was instead placed in Section III (''Emerging Measures and Models'').<ref name=":1" /> alt=Flowchart showing the steps of establishing an AMPD diagnosis|thumb|Overview diagram showing the steps of assessing a personality disorder using the AMPD|312x312pxAssessed across self and interpersonal domains, the level of personality functioning (criterion A) consists of four elements, namely: identity, self-direction, empathy and intimacy; the first two of these constitute self functioning, while the other two comprise interpersonal functioning.<ref name=":6" /> Supposed to capture fundamental problems specific and common to personality disorders,<ref name=":3" /> the level of functioning is rated on the Level of Personality Functioning Scale (LPFS), which ranges from 0 (little or no impairment) to 4 (extreme impairment).<ref name=":7" /> Describing the manner in which the disorder is manifested, criterion B encompasses the assessment of pathological personality traits; these are grouped into the following five domains: ''Negative Affectivity'', ''Detachment'', ''Antagonism'', ''Disinhibition'', and <!-- Please do not Wikilink to Psychoticism at this moment as the article is about a very different concept then the one used in the AMPD -->''Psychoticism''.<ref name=":4" /> These domains consist of twenty-five specific trait facets, such as ''irresponsibility'' and ''risk taking'' within the domain of disinhibition.<ref name=":5" />
Defined by combinations of criteria A and B, available in the AMPD are both six ''specific personality disorders'' and a ''trait specified'' diagnosis.<ref name=":5" /><ref name=":6" /> The six specific ones – based on diagnoses from the categorical system in the DSM-IV – are: antisocial, avoidant, borderline, narcissistic, obsessive-compulsive, and schizotypal; while ''personality disorder–trait specified'' is available for presentations differing a lot from the predefined categories.<ref name=":10">{{Cite journal |last1=Krueger |first1=Robert F. |author-link1=Robert F. Krueger |last2=Hobbs |first2=Kelsey A. |date=2020 |title=An Overview of the DSM-5 Alternative Model of Personality Disorders |journal=Psychopathology |language=en |volume=53 |issue=3–4 |pages=126–132 |doi=10.1159/000508538 |issn=0254-4962 |pmc=7529724 |pmid=32645701}}</ref> This applies to mixed presentations and categorical diagnoses which were not specifically included in the alternative model.<ref name=":6" /> Additional requirements for diagnosis are defined in criteria C–G, which require that the disturbance has affected the individual broadly and continuously since they were young, and that it is not better explained by substances, medical conditions or other mental disorders; nor may it be considered normal for the individual's social environment or developmental stage.<ref name=":7">{{Cite journal |last1=Sharp |first1=Carla |author-link1=Carla Sharp |last2=Wall |first2=Kiana |date=2021-05-07 |title=DSM-5 Level of Personality Functioning: Refocusing Personality Disorder on What It Means to Be Human |url=https://www.annualreviews.org/content/journals/10.1146/annurev-clinpsy-081219-105402 |journal=Annual Review of Clinical Psychology |language=en |volume=17 |pages=313–337 |doi=10.1146/annurev-clinpsy-081219-105402 |pmid=33306924 |issn=1548-5943|url-access=subscription }}</ref>
== ICD-11 == {{Main|ICD-11 classification of personality disorders}}
alt=Logo of the ICD-11|thumb|423x423px|Example of an ICD-11 severity and trait profile of an individual's personality disorder Departing from the categorical classification in the ICD-10, the ICD-11 classification of personality disorders implements a dimensional model containing a single ''personality disorder'' ({{ICD11|6D10}}), which can be coded as ''mild'', ''moderate'', ''severe'', or ''severity unspecified''.<ref name=":04" /> Personality disorder as well as ''personality difficulty'' may be further described by qualifiers for five trait domains as well as a ''borderline pattern'', similar to borderline personality disorder; in contrast to the AMPD, no categorical PD types were retained in the ICD-11.<ref name=":3" />
=== Severity levels === Once the presence of personality disorder is established, its severity may be determined; classified as mild, moderate, or severe, it is based on how pervasive and disabling the disturbances are. The evaluation considers impairments in several areas of functioning, such as identity and self-direction, interpersonal relationships, emotional and behavioural problems, the extent of psychosocial dysfunction or distress, and risk of harm to self or others. These indicators serve as guidelines for global clinical judgment rather than as fixed diagnostic criteria.<ref name=":24">{{Cite journal |last1=Bach |first1=Bo |last2=Kramer |first2=Ueli |last3=Doering |first3=Stephan |last4=di Giacomo |first4=Ester |last5=Hutsebaut |first5=Joost |last6=Kaera |first6=Andres |last7=De Panfilis |first7=Chiara |last8=Schmahl |first8=Christian |last9=Swales |first9=Michaela |last10=Taubner |first10=Svenja |last11=Renneberg |first11=Babette |date=2022-04-01 |title=The ICD-11 classification of personality disorders: a European perspective on challenges and opportunities |journal=Borderline Personality Disorder and Emotion Dysregulation |volume=9 |issue=1 |page=12 |doi=10.1186/s40479-022-00182-0 |issn=2051-6673 |pmc=8973542 |pmid=35361271 |doi-access=free}} {{Creative Commons text attribution notice|cc=by4|from this source=yes}}</ref> Severity may also be coded as unspecified ({{ICD11|6D10.Z}}).<ref name=":04" />
* ''Mild Personality Disorder'' ({{ICD11|6D10.0}}): Disturbance is limited to certain aspects of personality functioning. The person may struggle with decisions, relationships, or handling criticism while retaining a coherent identity and overall reality testing. Distress and impairment are present but circumscribed, and harm to self or others is uncommon.<ref name=":35">{{Cite journal |last=Swales |first=Michaela A. |date=December 2022 |title=Personality Disorder Diagnoses in ICD-11: Transforming Conceptualisations and Practice |journal=Clinical Psychology in Europe |volume=4 |issue=Spec Issue |doi=10.32872/cpe.9635 |issn=2625-3410 |pmc=9881116 |pmid=36760321 |article-number=e9635}} {{Creative Commons text attribution notice|cc=by4|from this source=yes}}</ref> * ''Moderate Personality Disorder'' ({{ICD11|6D10.1}}): Disturbance extends across multiple domains, such as self-concept, relationships, and moderation of behaviour, yet some capacities remain intact. Harm to self or others may occur but is typically moderate.<ref name=":35" /> * ''Severe Personality Disorder'' ({{ICD11|6D10.2}}): There are profound disturbances in identity and interpersonal functioning. The person may lack a stable sense of self, display rigid or chaotic self-concepts, and experience pervasive conflict or exploitation in relationships. Social and occupational functioning is severely compromised, and significant risk of self-injury or violence is common.<ref name=":35" />
=== Trait and pattern qualifiers === In addition to coding severity, clinicians may use trait and pattern qualifiers to describe the specific stylistic dimensions and configurations of personality disturbance.<ref name=":24" /> These qualifiers indicate prominent traits contributing to the overall dysfunction but do not represent distinct categories or syndromes. Although the traits exist dimensionally, for coding purposes they are recorded as either present or absent.<ref name=":04" /> The combination and number of trait qualifiers typically reflect the individual's global severity, with more complex or numerous traits often accompanying greater impairment.<ref name=":04" /><ref name=":24" />
* ''Negative Affectivity'' ({{ICD11|6D11.0}}): Involves a tendency to experience frequent and intense negative emotions, such as anxiety, anger, guilt, or shame, accompanied by impaired emotional self-regulation. Common problems are excessive dependency on others, suicidal ideation and hopelessness.<ref name=":35" /> * ''Detachment'' ({{ICD11|6D11.1}}): Characterized by social withdrawal and emotional detachment, anhedonia, and avoidance of intimacy or social engagement.<ref name=":35" /> * ''Dissociality'' ({{ICD11|6D11.2}}): Characterized by self-centeredness, lack of empathy, and disregard for the rights and feelings of others. Individuals often display grandiosity, entitlement, and manipulativeness, pursuing their own needs and comfort without concern for others, or expecting attention or admiration from them. Lack of empathy may be manifested in callousness, aggression, and exploitation, and sometimes in taking pleasure in others' suffering.<ref name=":04" /><ref name=":35" /> * ''Disinhibition'' ({{ICD11|6D11.3}}): Involves impulsivity, recklessness, and poor self-control, with actions driven by immediate desires without regard for long-term consequences.<ref name=":35" /> * ''Anankastia'' ({{ICD11|6D11.4}}): Marked by perfectionism, rigidity, and excessive orderliness, accompanied by a preoccupation with rules, control, and moral standards.<ref name=":35" /> * ''Borderline Pattern'' ({{ICD11|6D11.5}}): A pattern qualifier corresponding closely to the DSM-5 ''borderline personality disorder'' diagnosis.<ref name=":24" />
== History == {{Expand section|history of classification with contextualization in the form of prose|date=November 2025}}
=== ICD-10 === In the ICD-10, personality disorders were grouped as ''specific'' or ''mixed and other''. The former grouping ({{ICD10|F60}}) includes the following categories: paranoid, schizoid, dissocial, emotionally unstable (borderline type and impulsive type), histrionic, anankastic, anxious (avoidant) and dependent.<ref name=":2">[https://web.archive.org/web/20181210205620/http://behaviouralsciences.net/classifications/icd10/browse/2010/en#/F60-F69 "International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10) Version for 2010 (Online Version)"]. Apps.who.int. Retrieved on 16 April 2013. {{Dead link|date=June 2025}}</ref> Moreover, this group contains o''ther specific personality disorders'', which includes PDs characterized as eccentric, ''haltlose'', immature, narcissistic, passive–aggressive, or psychoneurotic; additionally, it contains ''personality disorder, unspecified,'' which includes "character neurosis" and "pathological personality".
On the other hand, ''mixed and other personality disorders'' ({{ICD10|F61}}) denotes conditions that are often troublesome but do not demonstrate the specific pattern of symptoms that characterize the named disorders. Finally, there is also ''enduring personality changes, not attributable to brain damage and disease'' ({{ICD10|F62}}), used for conditions that seem to arise in adults without a diagnosis of personality disorder, following catastrophic or prolonged stress or other psychiatric illness.
== See also ==
* Classification of mental disorders
== Notes == {{Notelist}}
== References == <references />
==Sources== * * {{cite book|author=American Psychiatric Association|title=Diagnostic and Statistical Manual of Mental Disorders|title-link=Diagnostic and Statistical Manual of Mental Disorders|publisher=American Psychiatric Publishing|year=2013|isbn=978-0-89042-555-8|edition=5th}}
{{Personality disorder classification}} Category:Psychopathology Category:Personality disorders Category:Classification of mental disorders