. Glossary of Cultural Concepts of Distress: Located in the Appendix, this glossary pro- vides examples of well-studied cultural concepts of distress that illustrate the relevance of cultural information for clinical diagnosis and some of the interrelationships among cultural syndromes, idioms of distress, and causal explanations.
The current approach to personality disorders appears in Section II of DSM-S, and an alternative model developed for DSM-S is presented here in Section III. The inclu- sion of both models in DSM-S reﬂects the decision of the APA Board of Trustees to pre- serve continuity with current clinical practice, while also introducing a new approach that aims to address numerous shortcomings of the current approach to personality disorders.
For example, the typical patient meeting criteria for a specific personality disorder fre- quently also meets criteria for other personality disorders. Similarly, other specified or un- specified personality disorder is often the correct (but mostly uninformative) diagnosis, in the sense that patients do not tend to present with patterns of symptoms that correspond with one and only one personality disorder.
In the following alternative DSM~5 model, personality disorders are characterized by impairments in personalityfunctioning and pathological personality traits. The specific personality disorder diagnoses that may be derived from this model include antisocial, avoidant, borderline, narcissistic, obsessive-compulsive, and schizotypal personality dis- orders. This approach also includes a diagnosis of personality disorder—trait specified (PD-TS) that can be made when a personality disorder is considered present but the crite- ria for a specific disorder are not met.
The essential features of a personality disorder are
A. Moderate or greater impairment in personality (self/interpersonal) functioning.
B. One or more pathological personality traits.
C. The impairments in personality functioning and the individual’s personality trait expres- sion are relatively inflexible and pervasive across a broad range of personal and social situations.
D. The impairments in personality functioning and the individual's personality trait expres- sion are relatively stable across _time, with onsets that can be traced back to at least adolescence or early adulthood.
E. The impairments in personality functioning and the individual’s personality trait expres- sion are not better explained by another mental disorder.
F. The impairments in personality functioning and the individual’s personality trait expres- sion are not solely attributable to the physiological effects of a substance or another medical condition (e.g., severe head trauma).
G. The impairments in personality functioning and the individual’s personality trait expres- sion are not better understood as normal for an individual’s developmental stage or so- ciocultural environment.
A diagnosis of a personality disorder requires two determinations: 1) an assessment of the level of impairment in personality functioning, which is needed for Criterion A, and 2) an evaluation of pathological personality traits, which is required for Criterion B. The im- pairments in personality functioning and personality trait expression are relatively inﬂex- ible and pervasive across a broad range of personal and social situations (Criterion C); relatively stable across time, with onsets that can be traced back to at least adolescence or
E); not attributable to the effects of a substance or another medical condition (Criterion F); and not better understood as normal for an individual’s developmental stage or sociocul- tural environment (Criterion G). All Section III personality disorders described by criteria sets, as well as PD-TS, meet these general criteria, by definition.
Crlterion A: Level of Personality Functioning
Disturbances in self and interpersonal functioning constitute the core of personality psy- chopathology and in this alternative diagnostic model they are evaluated on a continuum.
empathy and intimacy (see Table 1). The Level of Personality Functioning Scale (LPFS; see