Pervasive
The pattern appears across many personal and social situations rather than in one isolated context.
DSM-5-TR · personality · differential diagnosis
Could I have a personality disorder?
A personality disorder is not simply a personality trait. In DSM-5-TR, it is an enduring, inflexible and pervasive pattern of thinking, feeling or behaving that causes significant distress or impairment.
DSM-5-TR describes 10 specific personality disorders, traditionally organised into Clusters A, B and C. The clusters are useful for presentation, but they do not replace individual clinical assessment.
General DSM-5-TR requirements
When does a personality pattern become a disorder?
Diagnosis requires an enduring pattern that deviates markedly from cultural expectations in at least two domains: cognition, affectivity, interpersonal functioning or impulse control.
Inflexible and stable
It is long-standing and can be traced back at least to adolescence or early adulthood.
Clinically significant
It causes significant distress or impairment in social, occupational or other important areas.
Differential diagnosis
The pattern is not better explained by another mental disorder, a substance/medication effect or a medical condition.
Under age 18: a personality disorder may be diagnosed when the pattern has been present for at least one year and is not simply a developmental stage. Exception: antisocial personality disorder is not diagnosed before age 18.
A
Cluster A
Mistrust, detachment or eccentricity
Paranoid personality disorderA long-standing pattern of mistrust and suspiciousness in which other people’s motives are often interpreted as malicious.Schizoid personality disorderA persistent detachment from social relationships and a limited range of emotional expression in interpersonal settings.Schizotypal personality disorderMarked discomfort with close relationships together with cognitive or perceptual peculiarities and eccentric behaviour.
B
Cluster B
Dramatic, emotional or erratic patterns
Antisocial personality disorderA persistent disregard for the rights of others and social norms, with repeated patterns of rule-breaking, deceit or irresponsibility.Borderline personality disorderA persistent pattern of instability in relationships, self-image and emotions together with marked impulsivity.Histrionic personality disorderA persistent pattern of marked emotionality and attention seeking.Narcissistic personality disorderA persistent pattern of grandiosity, need for admiration and lack of empathy.
C
Cluster C
Anxious or fearful patterns
Avoidant personality disorderPersistent social inhibition, feelings of inadequacy and strong sensitivity to criticism or rejection.Dependent personality disorderA persistent and excessive need to be taken care of, leading to submissive or highly dependent behaviour and fears of separation.Obsessive-compulsive personality disorderA persistent preoccupation with order, perfectionism and control, often at the expense of flexibility and sometimes efficiency.
An important clarification
Ten specific disorders — not eleven
DSM-5-TR’s main categorical system contains ten specific personality disorders. Personality change due to another medical condition is a separate diagnosis related to the physiological effects of a medical condition; it is not an eleventh specific personality disorder.
Assessment
How is a personality disorder diagnosed?
A checklist or a few matching traits are not enough. Diagnosis requires clinical interviewing, review of the person’s long-term pattern and its impact across settings, and differential diagnosis. Personality questionnaires and tests can support the assessment.
Do several profiles seem to fit?
That is common: some traits overlap across personality disorders and can also occur in other conditions. The purpose of assessment is precisely to avoid starting from a predetermined answer.
