Table 2, pp. 775—778) uses each of these elements to differentiate five levels of impairment, ranging from little or no impairment (i.e., healthy, adaptive functioning; Level 0) to some (Level 1), moderate (Level 2), severe (Level 3), and extreme (Level 4) impairment.
TABLE 1 Elements of personality tunctioning
Self: 1. Identity: Experience of oneself as unique, with clear boundaries between self and others; sta— bility of self—esteem and accuracy of self—appraisal; capacity for, and ability to regulate, a range of emotional experience.
2. Self-direction:1’ursuit of coherent and meaningful short-term and life goals; utilization of constructive and prosocial internal standards of behavior; ability to self-reﬂect productively.
Interpersonal: 1. Empathy: Comprehension and appreciation of others’ experiences and motivations; tolerance of differing perspectives; understanding the effects of one’s own behavior on others.
2. Intimacy: Depth and duration of connection with others; desire and capacity for closeness; mutuality of regard reﬂected in interpersonal behavior.
Impairment in personality functioning predicts the presence of a personality disorder, and the severity of impairment predicts whether an individual has more than one person- ality disorder or one of the more typically severe personality disorders. A moderate level of impairment in personality functioning is required for the diagnosis of a personality dis- order; this threshold is based on empirical evidence that the moderate level of impairment maximizes the ability of clinicians to accurately and efficiently identify personality disor- der pathology.
Crlterion B: Pathological Personallty Traits
Pathological personality traits are organized into five broad domains: Negative Affectiv- ity, Detachment, Antagonism, Disinhibition, and Psychoticism. Within the five broad trait domains are 25 specific trait facets that were developed initially from a review of existing trait models and subsequently through iterative research with samples of persons who sought mental health services. The full trait taxonomy is presented in Table 3 (see pp. 779— 781). The B criteria for the specific personality disorders comprise subsets of the 25 trait facets, based on meta-analytic reviews and empirical data on the relationships of the traits to DSM-IV personality disorder diagnoses.
Criteria C and D: Pervasiveness and Stability
Impairments in personality functioning and pathological personality traits are relatively per- vasive across a range of personal and social contexts, as personality is defined as a pattern of perceiving, relating to, and thinking about the environment and oneself. The term relatively reﬂects the fact that all except the most extremely pathological personalities show some de- gree of adaptability. The pattern in personality disorders is maladaptive and relatively inﬂex- ible, which leads to disabilities in social, occupational, or other important pursuits, as individuals are unable to modify their thinking or behavior, even in the face of evidence that their approach is not working. The impairments in functioning and personality traits are also relatively stable. Personality traits—the dispositions to behave or feel in certain ways—are more stable than the symptomatic expressions of these dispositions, but personality traits can also change. Impairments in personality functioning are more stable than symptoms.
Criteria E, F, and G: Alternative Explanations for