Specifiers. Trait and personality functioning specifiers may be used to record additional personality features that may be present in narcissistic personality disorder but are not re- quired for the diagnosis. For example, other traits of Antagonism (e.g., manipulativeness, de- ceitfulness, callousness) are not diagnostic criteria for narcissistic personality disorder (see
Criterion B) but can be specified when more pervasive antagonistic features (e.g., ”malignant narcissism”) are present. Other traits of Negative Affectivity (e.g., depressivity, anxiousness) can be specified to record more "vulnerable” presentations. Furthermore, although moderate or greater impairment in personality functioning is required for the diagnosis of narcissistic personality disorder (Criterion A), the level of personality functioning can also be specified.
Typical features of obsessive-compulsive personality disorder are difficulties in establish- ing and sustaining close relationships, associated with rigid perfectionism, inﬂexibility, and restricted emotional expression. Characteristic difficulties are apparent in identity, self—direction, empathy, and / or intimacy, as described below, along with specific mal- adaptive traits in the domains of Negative Affectivity and/ or Detachment.
A. Moderate or greater impairment in personality functioning, manifested by characteristic difficulties in two or more of the following four areas: 1. Identity: Sense of self derived predominantly from work or productivity; constricted experience and expression of strong emotions.
2. SeIf-direction: Difficulty completing tasks and realizing goals, associated with rigid and unreasonably high and inflexible internal standards of behavior; overly consci- entious and moralistic attitudes.
3. Empathy: Difficulty understanding and appreciating the ideas, feelings, or behav- iors of others.
4. Intimacy: Relationships seen as secondary to work and productivity; rigidity and stubbornness negatively affect relationships with others.
B. Three or more of the following four pathological personality traits, one of which must be (1) Rigid perfectionism: 1. Rigid perfectionism (an aspect of extreme Conscientiousness [the opposite pole of DetachmentD: Rigid insistence on everything being flawless, perfect, and without errors or faults, including one’s own and others’ performance; sacrificing of timeli- ness to ensure correctness in every detail; believing that there is only one right way to do things; difficulty changing ideas and/or viewpoint; preoccupation with details, organization, and order.
2. Perseveration (an aspect of Negative Affectivity): Persistence at tasks long after the behavior has ceased to be functional or effective; continuance of the same be- havior despite repeated failures.
3. Intimacy avoidance (an aspect of Detachment): Avoidance of close or romantic relationships, interpersonal attachments, and intimate sexual relationships.
4. Restricted affectivity (an aspect of Detachment): Little reaction to emotionally or coldness.
Specifiers. Trait and personality functioning specifiers may be used to record additional not required for the diagnosis. For example, other traits of Negative Affectivity (e.g., anxious- ness) are not diagnostic criteria for obsessive-compulsive personality disorder (see Criterion B) but can be specified when appropriate. Furthermore, although moderate or greater impair- ment in personality functioning is required for the diagnosis of obsessive-compulsive person- ality disorder (Criterion A), the level of personality functioning can also be specified.
Typical features of schizotypal personality disorder are impairments in the capacity for so- cial and close relationships and eccentricities in cognition, perception, and behavior that are associated with distorted self—image and incoherent personal goals and accompanied by suspiciousness and restricted emotional expression. Characteristic difficulties are ap- parent in identity, self—direction, empathy, and / or intimacy, along with specific maladap- tive traits in the domains of Psychoticism and Detachment.