psychiatric diagnoses.

Notably, knowing the level of an individual’s personality functioning and

his or her pathological trait profile also provides the clinician with a rich base of information and
is valuable in treatment planning and in predicting the course and outcome of many mental
disorders in addition to personality disorders. Therefore, assessment of personality functioning
and pathological personality traits may be relevant whether an individual has a personality
disorder or not.

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TABLE 2 Level of Personality Functioning Scale

SELF INTERPERSONAL
Level of
impairment Identity Self-direction Empathy Intimacy
0—Little or Has ongoing awareness Sets and aspires to Is capable of accurately Maintains multiple
no of a unique self; reasonable goals understanding others’ satisfying and enduring
impairment maintains role- based on a realistic experiences and relationships in personal
appropriate assessment of motivations in most and community life.
boundaries. personal capacities. situations. Desires and engages in a
Has consistent and Utilizes appropriate Comprehends and number of caring, close,
self-regulated standards of appreciates others’ and reciprocal
positive self-esteem, behavior, attaining perspectives, even if relationships.
with accurate self- fulfillment in disagreeing. Strives for cooperation and
appraisal. multiple realms. Is aware of the effect of mutual benefit and flexibly
Is capable of Can reflect on, and own actions on others. responds to a range of
experiencing, make constructive others’ ideas, emotions,
tolerating, and meaning of, internal and behaviors.
regulating a full experience.
range of emotions.
1—Some Has relatively intact Is excessively goal- Is somewhat compromised Is able to establish enduring
impairment sense of self, with directed, somewhat in ability to appreciate relationships in personal
some decrease in goal-inhibited, or and understand others’ and community life, with
clarity of boundaries conflicted about experiences; may tend to some limitations on
when strong goals. see others as having degree of depth and
emotions and mental May have an unreasonable satisfaction.
distress are unrealistic or expectations or a wish Is capable of forming and
experienced. socially for control. desires to form intimate
Self-esteem diminished inappropriate set of Although capable of and reciprocal
at times, with overly personal standards, considering and relationships, but may be
critical or somewhat limiting some understanding different inhibited in meaningful
distorted self- aspects of perspectives, resists expression and sometimes
appraisal. fulfillment. doing so. constrained if intense
Strong emotions may Is able to reflect on Has inconsistent awareness emotions or conflicts
be distressing, internal experiences, of effect of own behavior arise.
associated with a but may on others. Cooperation may be
restriction in range of overemphasize a inhibited by unrealistic
emotional single (e.g., standards; somewhat
experience. intellectual, limited in ability to respect
emotional) type of or respond to others’ ideas,
self-knowledge. emotions, and behaviors.

896 Depends excessively Goals are more often a Is hyperattuned to the Is capable of forming and
on others for identity means of gaining experience of others, but desires to form
2—Moderate definition, with external approval only with respect to relationships in personal
impairment compromised than self-generated, perceived relevance to and community life, but
boundary and thus may lack self. connections may be
delineation. coherence and/or Is excessively self- largely superficial.
Has vulnerable self- stability. referential; significantly Intimate relationships are
 esteem controlled by Personal standards compromised ability to predominantly based on
exaggerated concern may be appreciate and meeting self-regulatory
about external unreasonably high understand others’ and self-esteem needs,
evaluation, with a (e.g., a need to be experiences and to with an unrealistic
wish for approval. special or please consider alternative expectation of being
Has sense of others) or low (e.g., perspectives. perfectly understood by
incompleteness or not consonant with Is generally unaware of or others.
inferiority, with prevailing social unconcerned about effect Tends not to view
compensatory values). Fulfillment of own behavior on relationships in reciprocal
inflated, or deflated, is compromised by others, or unrealistic terms, and cooperates
self-appraisal. a sense of lack of appraisal of own effect. predominantly for personal
Emotional regulation authenticity. gain.
depends on positive Has impaired capacity
external appraisal. to reflect on internal
Threats to self- experience.
esteem may engender
strong emotions such
as rage or shame.

897 Has a weak sense of Has difficulty Ability to consider and Has some desire to form
autonomy/agency; establishing and/or understand the thoughts, relationships in
3—Severe experience of a lack achieving personal feelings, and behavior of community and personal
impairment of identity, or goals. other people is life, but capacity for
emptiness. Boundary Internal standards for significantly limited; positive and enduring
definition is poor or behavior are unclear may discern very connections is
rigid: may show or contradictory. specific aspects of significantly impaired.
overidentification Life is experienced others’ experience, Relationships are based on a
with others, as meaningless or particularly strong belief in the
overemphasis on dangerous. vulnerabilities and absolute need for the
independence from suffering. intimate other(s), and/or
others, or vacillation Has significantly
compromised ability Is generally unable to expectations of
between these. consider alternative abandonment or abuse.
to reflect on and
Fragile self-esteem is understand own perspectives; highly Feelings about intimate
easily influenced by mental processes. threatened by differences involvement with others
events, and self- of opinion or alternative alternate between
image lacks viewpoints. fear/rejection and
coherence. Self- Is confused about or desperate desire for
appraisal is un- unaware of impact of connection.
nuanced: self- own actions on others; Little mutuality: others are
loathing, self- often bewildered about conceptualized primarily
aggrandizing, or an people’s thoughts and in terms of how they affect
illogical, unrealistic actions, with destructive the self (negatively or
combination. motivations frequently positively); cooperative
Emotions may be misattributed to others. efforts are often disrupted
rapidly shifting or a due to the perception of
chronic, unwavering slights from others.
feeling of despair.

898 Experience of a unique Has poor Has pronounced inability to Desire for affiliation is
self and sense of differentiation of consider and understand limited because of
4—Extreme agency/autonomy thoughts from others’ experience and profound disinterest or
impairment are virtually absent, actions, so goal- motivation. expectation of harm.
or are organized setting ability is Attention to others’ Engagement with others is
around perceived severely perspectives is virtually detached, disorganized, or
external persecution. compromised, with absent (attention is consistently negative.
Boundaries with unrealistic or hypervigilant, focused Relationships are
others are confused incoherent goals. on need fulfillment and conceptualized almost
or lacking. Internal standards for harm avoidance). exclusively in terms of
Has weak or distorted behavior are Social interactions can be their ability to provide
self-image easily virtually lacking. confusing and comfort or inflict pain and
threatened by Genuine fulfillment disorienting. suffering.
interactions with is virtually Social/interpersonal behavior
others; significant inconceivable. is not reciprocal; rather, it
 distortions and Is profoundly unable to seeks fulfillment of basic
confusion around constructively needs or escape from pain.
self-appraisal. reflect on own
Emotions not congruent experience. Personal
with context or motivations may be
internal experience. unrecognized and/or
Hatred and experienced as
aggression may be external to self.
dominant affects,
although they may be
disavowed and
attributed to others.

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TABLE 3 Definitions of DSM-5 personality disorder trait domains and facets

DOMAINS (Polar
Opposites) and Facets Definitions

NEGATIVE AFFECTIVITY Frequent and intense experiences of high levels of a wide range of negative emotions (e.g.,
(vs. Emotional Stability) anxiety, depression, guilt/shame, worry, anger) and their behavioral (e.g., self-harm) and
interpersonal (e.g., dependency) manifestations.
Emotional lability Instability of emotional experiences and mood; emotions that are easily aroused, intense, and/or
out of proportion to events and circumstances.
Anxiousness Feelings of nervousness, tenseness, or panic in reaction to diverse situations; frequent worry
about the negative effects of past unpleasant experiences and future negative possibilities;
feeling fearful and apprehensive about uncertainty; expecting the worst to happen.
Separation insecurity Fears of being alone due to rejection by—and/or separation from—significant others, based in a
lack of confidence in one’s ability to care for oneself, both physically and emotionally.
Submissiveness Adaptation of one’s behavior to the actual or perceived interests and desires of others even when
doing so is antithetical to one’s own interests, needs, or desires.
Hostility Persistent or frequent angry feelings; anger or irritability in response to minor slights and
insults; mean, nasty, or vengeful behavior. See also Antagonism.
Perseveration Persistence at tasks or in a particular way of doing things long after the behavior has ceased to
be functional or effective; continuance of the same behavior despite repeated failures or clear
reasons for stopping.
Depressivity See Detachment.
Suspiciousness See Detachment.
Restricted affectivity (lack of) The lack of this facet characterizes low levels of Negative Affectivity. See Detachment for
definition of this facet.
DETACHMENT (vs. Avoidance of socioemotional experience, including both withdrawal from interpersonal
Extraversion) interactions (ranging from casual, daily interactions to friendships to intimate relationships)
and restricted affective experience and expression, particularly limited hedonic capacity.
Withdrawal Preference for being alone to being with others; reticence in social situations; avoidance of
social contacts and activity; lack of initiation of social contact.
Intimacy avoidance Avoidance of close or romantic relationships, interpersonal attachments, and intimate sexual
relationships.
Anhedonia Lack of enjoyment from, engagement in, or energy for life’s experiences; deficits in the capacity
to feel pleasure and take interest in things.
Depressivity Feelings of being down, miserable, and/or hopeless; difficulty recovering from such moods;
pessimism about the future; pervasive shame and/or guilt; feelings of inferior self-worth;
thoughts of suicide and suicidal behavior.
Restricted affectivity Little reaction to emotionally arousing situations; constricted emotional experience and
expression; indifference and aloofness in normatively engaging situations.
Suspiciousness Expectations of—and sensitivity to signs of—interpersonal ill-intent or harm; doubts about
Suspiciousness Expectations of—and sensitivity to signs of—interpersonal ill-intent or harm; doubts about
loyalty and fidelity of others; feelings of being mistreated, used, and/or persecuted by others.

900 Behaviors that put the individual at odds with other people, including an exaggerated sense of
self-importance and a concomitant expectation of special treatment, as well as a callous
ANTAGONISM (vs. antipathy toward others, encompassing both an unawareness of others’ needs and feelings and
Agreeableness) a readiness to use others in the service of self-enhancement.
Manipulativeness Use of subterfuge to influence or control others; use of seduction, charm, glibness, or
ingratiation to achieve one’s ends.
Deceitfulness Dishonesty and fraudulence; misrepresentation of self; embellishment or fabrication when
relating events.
Grandiosity Believing that one is superior to others and deserves special treatment; self-centeredness;
feelings of entitlement; condescension toward others.
Attention seeking Engaging in behavior designed to attract notice and to make oneself the focus of others’
attention and admiration.
Callousness Lack of concern for the feelings or problems of others; lack of guilt or remorse about the
negative or harmful effects of one’s actions on others.
Hostility See Negative Affectivity.
DISINHIBITION (vs. Orientation toward immediate gratification, leading to impulsive behavior driven by current
Conscientiousness) thoughts, feelings, and external stimuli, without regard for past learning or consideration of
future consequences.
Irresponsibility Disregard for—and failure to honor—financial and other obligations or commitments; lack of
respect for—and lack of follow-through on—agreements and promises; carelessness with
others’ property.
Impulsivity Acting on the spur of the moment in response to immediate stimuli; acting on a momentary
basis without a plan or consideration of outcomes; difficulty establishing and following plans;
a sense of urgency and self-harming behavior under emotional distress.
Distractibility Difficulty concentrating and focusing on tasks; attention is easily diverted by extraneous stimuli;
difficulty maintaining goal-focused behavior, including both planning and completing tasks.
Risk taking Engagement in dangerous, risky, and potentially self-damaging activities, unnecessarily and
without regard to consequences; lack of concern for one’s limitations and denial of the reality
of personal danger; reckless pursuit of goals regardless of the level of risk involved.
Rigid perfectionism (lack of) Rigid insistence on everything being flawless, perfect, and without errors or faults, including
one’s own and others’ performance; sacrificing of timeliness to ensure correctness in every
detail; believing that there is only one right way to do things; difficulty changing ideas and/or
viewpoint; preoccupation with details, organization, and order. The lack of this facet
characterizes low levels of Disinhibition.

901 Exhibiting a wide range of culturally incongruent odd, eccentric, or unusual behaviors and
cognitions, including both process (e.g., perception, dissociation) and content (e.g., beliefs).
PSYCHOTICISM (vs.
Lucidity)
Unusual beliefs and Belief that one has unusual abilities, such as mind reading, telekinesis, thought-action fusion;
experiences unusual experiences of reality, including hallucination-like experiences.
Eccentricity Odd, unusual, or bizarre behavior, appearance, and/or speech; having strange and unpredictable
thoughts; saying unusual or inappropriate things.
Cognitive and perceptual Odd or unusual thought processes and experiences, including depersonalization, derealization,
dysregulation and dissociative experiences; mixed sleep-wake state experiences; thought-control
experiences.

902