5. Psychoticism (vs. Lucidity): Exhibiting a wide range of culturally incongruent odd, eccentric, or unusual behaviors and cognitions, including both process (e.g., per- ception, dissociation) and content (e.g., beliefs).
Subtypes. Because personality features vary continuously along multiple trait dimen- sions, a comprehensive set of potential expressions of PD-TS can be represented by DSM- 5’s dimensional model of maladaptive personality trait variants (see Table 3, pp. 779—781).
Thus, subtypes are unnecessary for PD-TS, and instead, the descriptive elements that con- stitute personality are provided, arranged in an empirically based model. This arrange- ment allows clinicians to tailor the description of each individual’s personality disorder profile, considering all five broad domains of personality trait variation and drawing on the descriptive features of these domains as needed to characterize the individual.
Specifiers. The specific personality features of individuals are always recorded in eval- uating Criterion'B, so the combination of personality features characterizing an individual directly constitutes the specifiers in each case. For example, two individuals who are both characterized by emotional lability, hostility, and depressivity may differ such that the first individual is characterized additionally by callousness, whereas the second is not.
The requirement for any two of the tour A criteria for each of the six personality disorders was based on maximizing the relationship of these criteria to their corresponding person- ality disorder. Diagnostic thresholds for the B criteria were also set empirically to minimize change in prevalence of the disorders from DSM-IV and overlap with other personality disorders, and to maximize relationships with functional impairment. The resulting diag- nostic criteria sets represent clinically useful personality disorders with high fidelity, in terms of core impairments in personality functioning of varying degrees of severity and constellations of pathological personality traits.
Individuals who have a pattern of impairment in personality functioning and maladaptive traits that matches one of the six defined personality disorders should be diagnosed with that personality disorder. If an individual also has one or even several prominent traits that may have clinical relevance in addition to those required for the diagnosis (e.g., see narcis- sistic personality disorder), the option exists for these to be noted as specifiers. Individuals whose personality functioning or trait pattern is substantially different from that of any of the six specific personality disorders should be diagnosed with PD—TS. The individual may not meet the required number of A or B criteria and, thus, have a subthreshold presentation of a personality disorder. The individual may have a mix of features of personality disorder types or some features that are less characteristic of a type and more accurately considered a mixed or atypical presentation. The specific level of impairment in personality function- ing and the pathological personality traits that characterize the individual’s personality can be specified for PD-TS, using the Level of Personality Functioning Scale (Table 2) and the pathological trait taxonomy (Table 3). The current diagnoses of paranoid, schizoid, histri- onic, and dependent personality disorders are represented also by the diagnosis of PD—TS; these are defined by moderate or greater impairment in personality functioning and can be specified by the relevant pathological personality trait combinations.
Level of Personality Functioning
Like most human tendencies, personality functioning is distributed on a continuum. Cen- tral to functioning and adaptation are individuals’ characteristic ways of thinking about and understanding themselves and their interactions with others. An optimally function- ing individual has a complex, fully elaborated, and well—integrated psychological world that includes a mostly positive, volitional, and adaptive self—concept; a rich, broad, and ap- propriately regulated emotional life; and the capacity to behave as a productive member of society with reciprocal and fulfilling interpersonal relationships. At the opposite end of the continuum, an individual with severe personality pathology has an impoverished, dis- organized, and/ or conﬂicted psychological world that includes a weak, unclear, and mal- adaptive self—concept; a propensity to negative, dysregulated emotions; and a deficient capacity for adaptive interpersonal functioning and social behavior.