The Definition of a Personality Disorder

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The Diagnostic and Statistical Manual of the American Psychiatric Association,(abbreviated, DSM-5), captures these differences between healthy and unhealthy personalities that we have been discussing. According to the definition of personality disorders in DMS-5 (APA 2013), the key elements of a personality disorder are:

1. A personality disorder is enduring pattern of inner experience and behavior. This pattern manifests in two or more of the following areas:


a. Thinking
b. Feeling
c. Interpersonal relationships
d. Impulse control

2. This pattern deviates markedly from cultural norms and expectations.

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3. This pattern is pervasive and inflexible.

4. It is stable over time.

5. It leads to distress or impairment

The Four Core Features of Personality Disorders1

The DSM-5 (APA, 2013) identifies and describes ten specific personality disorders. These ten diagnoses represent ten specific enduring patterns of thoughts, feelings, and behavior. However, each of these ten patterns can be distilled down to four core features of personality disorders:

1.    Rigid, extreme and distorted thinking patterns (thoughts)
2.    Problematic emotional response patterns (feelings)
3.    Impulse control problems (behavior)
4.    Significant interpersonal problems (behavior)

In fact, in order to diagnose a personality disorder a person must exhibit at least two of these four core features.

In this section we will review each of these four core features that are common to all personality disorders. Then in the next section, we will discuss the ten specific personality disorders diagnoses as described in DSM-IV-TR (APA, 2000). As you are reading about these disorders, you may find yourself wondering if they are accurate enough; if they have been defined with enough precision so as to easily distinguish between people who have personality disorders from those who do not.  As mentioned, personality disorders are a variant form of normal, healthy personality so such distinctions are often difficult.  If such thoughts occur to you, you are not alone.  Quite a few clinicians and researchers have raised concerns about this lack of specificity and precision.  Later, we will discuss alternatives to the current DSM diagnostic systems for the personality disorders that attempt to resolve this problem of imprecision.

Since the current diagnostic system for personality disorders is difficult to use for the reasons cited above, we want to caution you to refrain from trying to diagnose yourself, or someone else.  The diagnostic process for personality disorders is difficult enough, even for seasoned professionals; therefore, self-diagnosis is not recommended.  If you suspect a problem or interpersonal difficulty may be related to a personality disorder, we urge you to raise these concerns with a qualified mental health professional.  A professional experienced with the diagnosis and treatment of personality disorders is best able to make a correct diagnosis (having done it many times before).An experienced mental health professional will also be in the best position to recommend an effective treatment plan.. In the later part of this article, we will review effective, state-of-the-art treatments for personality disorders.

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