2. Anxiousness (an aspect of Negative Affectivity): Intense feelings of nervous- ness, tenseness, or panic, often in reaction to interpersonal stresses; worry about the negative effects of past unpleasant experiences and future negative possibili- ties; feeling fearful, apprehensive, or threatened by uncertainty; fears of falling apart or losing control.
3. Separation insecurity (an aspect of Negative Affectivity): Fears of rejection by— and/or separation from—significant others, associated with tears of excessive de- pendency and complete loss of autonomy.
4. Depressivity (an aspect of Negative Affectivity): Frequent feelings of being down, miserable, and/or hopeless; difficulty recovering from such moods; pessimism about the future; pervasive shame; feelings of inferior seIt-worth; thoughts of sui- cide and suicidal behavior.
5. Impulsivity (an aspect of Disinhibition): Acting on the spur of the moment in re- sponse to immediate stimuli; acting on a momentary basis without a plan or consid- eration of outcomes; difficulty establishing or following plans; a sense of urgency and seIt-harming behavior under emotional distress.
6. Risk taking (an aspect of Disinhibition): Engagement in dangerous, risky, and po- tentially selt-damaging activities, unnecessarily and without regard to conse- quences; lack of concern for one's limitations and denial of the reality of personal danger.
7. Hostility (an aspect of Antagonism): Persistent or frequent angry feelings; anger or irritability in response to minor slights and insults.
Specifiers. Trait and level of personality functioning specifiers may be used to record ad- not required for the diagnosis. For example, traits of Psychoticism (e.g., cognitive and per- ceptual dysregulation) are not diagnostic criteria for borderline personality disorder (see
Criterion B) but can be specified when appropriate. Furthermore, although moderate or greater impairment in personality functioning is required for the diagnosis of borderline personality disorder (Criterion A), the level of personality functioning can also be specified.
Typical features of narcissistic personality disorder are variable and vulnerable self-esteem, with attempts at regulation through attention and approval seeking, and either overt 0r covert grandiosity. Characteristic difficulties are apparent in identity, self—direction, em- pathy, and/ or intimacy, as described below, along with specific maladaptive traits in the domain of Antagonism.
A. Moderate or greater impairment in personality functioning, manifested by characteristic difficulties in two or more of the following tour areas: 1. Identity: Excessive reference to others for seIt-detinition and seif-esteem regula- tion; exaggerated seli—appraisal inflated or deflated, or vaciilating between extremes; emotional regulation mirrors fluctuations in self-esteem.
2. SeIt-direction: Goat setting based on gaining approval from others; personal stan- dards unreasonably high in order to see oneselt as exceptional, or too low based on a sense of entitlement; often unaware of own motivations.
3. Empathy: Impaired ability to recognize or identify with the feelings and needs of others; excessively attuned to reactions of others, but only if perceived as relevant to self; over- or underestimate of own effect on others.
4. Intimacy: Relationships largely superficial and exist to serve seli-esteem regula- dominance of a need for personal gain.
B. Both of the following pathological personality traits: 1 . Grandiosity (an aspect of Antagonism): Feelings of entitlement, either overt or co- vert; selt-centeredness; firmly holding to the belief that one is better than others; condescension toward others. ' 2. Attention seeking (an aspect of Antagonism): Excessive attempts to attract and be the focus of the attention of others; admiration seeking.