On some occasions, what appears to be a personality disorder may be better explained by another mental disorder, the effects of a substance or another medical condition, or a nor— mal developmental stage (e.g., adolescence, late life) or the individual’s sociocultural en- vironment. When another mental disorder is present, the diagnosis of a personality disorder is not made, if the manifestations of the personality disorder clearly are an ex- pression of the other mental disorder (e.g., it features of schizotypal personality disorder are present only in the context of schizophrenia). On the other hand, personality disorders can be accurately diagnosed in the presence of another mental disorder, such as major de- pressive disorder, and patients with other mental disorders should be assessed for comor- bid personality disorders because personality disorders often impact the course of other mental disorders. Therefore, it is always appropriate to assess personality functioning and pathological personality traits to provide a context for other psychopathology.
Section 111 includes diagnostic criteria for antisocial, avoidant, borderline, narcissistic, ob— sessive-compulsive, and schizotypal personality disorders. Each personality disorder is pathological personality traits (Criterion B): 0 Typical features of antisocial personality disorder are a failure to conform to lawful and ethical behavior, and an egocentric, callous lack of concern for others, accompanied by deceitfulness, irresponsibility, manipulativeness, and / or risk taking.
0 Typical features of avoidant personality disorder are avoidance of social situations and inhibition in interpersonal relationships related to feelings of ineptitude and inade- quacy, anxious preoccupation with negative evaluation and rejection, and fears of rid- icule or embarrassment.
0 Typical features of borderline personality disorder are instability of self—image, per- sonal goals, interpersonal relationships, and affects, accompanied by impulsivity, risk taking, and / 0r hostility.
0 Typical features of narcissistic personality disorder are variable and vulnerable self- esteem, with attempts at regulation through attention and approval seeking, and either overt or covert grandiosity.
0 Typical features of obsessive-compulsive personality disorder are difficulties in estab- lishing and sustaining close relationships, associated with rigid perfectionism, inﬂexi- bility, and restricted emotional expression.
' Typical features of schizotypal personality disorder are impairments in the capacity for social and close relationships, and eccentricities in cognition, perception, and behav- ior that are associated with distorted self—image and incoherent personal goals and ac- companied by suspiciousness and restricted emotional expression.
The A and B criteria for the six specific personality disorders and for PD-TS follow. All personality disorders also meet criteria C through G of the General Criteria for Personality
Disorder.
Typical features of antisocial personality disorder are a failure to conform to lawful and ethical behavior, and an egocentric, callous lack of concern for others, accompanied by de- ceitfulness, irresponsibility, manipulativeness, and/ or risk taking. Characteristic difficul- ties are apparent in identity, self-direction, empathy, and / or intimacy, as described below, along with specific maladaptive traits in the domains of Antagonism and Disinhibition.
A. Moderate or greater impairment in personality functioning, manifested by characteristic difficulties in two or more of the following four areas: 1. Identity: Egocentrism; seIf-esteem derived trom personal gain, power, or pleasure.
2. SeIt-direction: Goal setting based on personal gratification; absence of prosocial internal standards, associated with failure to conform to lawful or culturally norma- tive ethical behavior.
3. Empathy: Lack of concern for feelings, needs, or suffering of others; lack of re- morse after hurting or mistreating another.
4. Intimacy: Incapacity for mutually intimate relationships, as exploitation is a primary means of relating to others, including by deceit and coercion; use of dominance or intimidation to control others.