Medicine:Classification of personality disorders

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Classification of personality disorders occurs mainly in accordance with two diagnostic frameworks: namely, the International Classification of Diseases (ICD) and the Diagnostic and Statistical Manual of Mental Disorders (DSM), the latest editions of which are the ICD-11 and DSM-5-TR, respectively, as of 2025.

While the DSM-5-TR standard model diagnoses personality disorders as distinct categories, the ICD-11 diagnoses a single personality disorder dimensionally according to severity, with the possibility to additionally diagnose trait domains.[1] In the case of the Alternative DSM-5 Model for Personality disorders, the approach chosen is a hybrid dimensional–categorical model,[2] in which diagnosis can consist of either predefined categories based on specific combinations of traits and functioning levels,[3] or of a general diagnosis called personality disorder – trait specified.[3] The ICD-11 classifies schizotypal disorder among primary psychotic disorders rather than as a personality disorder as in the DSM-5.[4]

Conceptual approaches

Personality disorders
Cluster A (odd)
Cluster B (dramatic)
Cluster C (anxious)
Not specified

Personality disorder classification can generally be broken down into a categorical approach and a dimensional approach. The categorical approach views personality disorders as discrete entities that are distinct from each other as well as from normal personality. In contrast, the dimensional approach suggests that personality disorders exist on a continuum, with traits varying in degree rather than kind.[5] There has been a sustained movement toward replacing categorical models of personality disorder classification with dimensional approaches.[6][7] This dimensional perspective may allow for more nuanced understanding and flexible diagnostic practices.

Categorical approach

Classical views of personality disorder as discrete categories have had benefits for understanding and communicating psychopathology throughout history, such as for: a contained organization of symptoms to facilitate standardized research, organizing public awareness and stigma reduction campaigns, allocating public health funding and appropriate treatment intensities, and normalizing clear labels for communicating patient formulations (a description of symptoms and their inter-relationships) to professionals and families.[5]

Since its inception, the categorical system has steadily accumulated criticism. Attempts to reproduce the factor structure of the DSM-IV-TR's categorical model have been unsuccessful, suggesting that the categorical structure cannot robustly describe the architecture of personality psychopathology.[5] Such issues are exacerbated by the substantial symptom overlap between disorders that facilitates their excessive and unwarranted comorbidity,[5][6][7] with the majority of people with a PD being eligible for another PD diagnosis.[8] As a result, individuals are substantially more likely to be diagnosed with several PDs than a singular one, contradicting the notion that categories provide neat constellations of inter-related symptoms.[5]

Equally, this approach appears unable to accurately capture the full range of personality psychopathology. Estimates of patients who do not fit neatly into current categories range from 21 to 49%, accordingly given the general diagnosis of Personality Disorder – Not Otherwise Specified (PD-NOS). PD-NOS also appears to be in regular usage to describe mixed or complex presentations given the difficulties in classifying individuals within the current framework.[5] It has been found that "many patients in clinical practice misleadingly receive multiple PD diagnoses, a 'not otherwise specified' PD diagnosis, or no PD diagnosis at all, even if a PD diagnosis is relevant to the presentation".[9] Another issue is the heterogeneity within categories.[7]

Setting standardized diagnostic thresholds (based upon polythetic symptoms) is difficult particularly when each symptom is given equal weighting. This means that individuals with the same number of symptoms can have substantially different levels of distress. Between each PD, diagnostic thresholds occur at different levels of pathology. Due to these issues, it is likely that many clinicians use their clinical judgment based upon an internalized representation of the disorder when making diagnoses. The current categorical approach falls short of fully representing personality psychopathology and providing a scientifically robust understanding of what personality is and what disorders of personality are.[5]

Dimensional approach

Main article: Philosophy:Dimensional models of personality disorders

In response to observed deficiencies in the categorical approach, dimensional models, which suggest that humans differ in degree not in kind,[5] have been developed, assessing personality disorders in terms of severity of impairment and maladaptive personality traits.[6] Within this perspective, PD occurs at maladaptive extremes of the standard personality traits all humans share and as specific combinations of these trait extremes. The degree of life impairment forms the basis for a PD diagnosis. This approach has gained substantial support, with broad calls and movements toward mainstream adoption.[5]

The shift towards dimensional models is reflected in the inclusion of the AMPD in Section III of the DSM-5, and in the ICD-11's adoption of a dimensional system. These are believed to ameliorate several shortcomings of the categorical model,[7] as well as improve clinical utility[5] and potentially reduce stigma,[6][5] although no research has so far specifically examined the effect on stigma.[5] Emerging research indicates that dimensional models may also facilitate the personalization of psychotherapy by aligning treatment strategies with underlying trait dimensions rather than diagnostic categories.[10] Despite some important differences in the prevailing approaches, dimensional models of PD typically consider two key criteria: severity and style.[5]

Severity

Mapping of ICD-11 PD classification to the AMPD[1][11]
ICD-11 AMPD
Severity level Criterion A
None No impairment (0)
Personality difficulty Mild impairment (1)
Mild personality disorder Moderate impairment (2)
Moderate personality disorder Severe impairment (3)
Severe personality disorder Extreme impairment (4)
Traits and patterns Criterion B
Negative affectivity Negative Affectivity
Detachment Detachment
Disinhibition Disinhibition
Dissociality Antagonism
Anankastia (Rigid perfectionism)[lower-alpha 1]
(Schizotypal disorder) Psychoticism

Severity captures the core distress that is common to all PDs, its impact on the individual's self-direction and identity (intrapersonal functioning), as well as their ability to form close relationships and empathize with others (interpersonal functioning). Indices of global severity are robust predictors of both the presence of a personality disorder and prognosis, and track with fluctuations in clinical functioning. According to the ICD-11, severity is the key and sole requirement for making a diagnosis of PD. The central placement of impairment is grounded in research that global severity ratings are sensitive and specific predictors of PD, and provide better estimates of clinician-rated psychosocial impairment than specific categorical diagnoses do. The severity of personality disorder (i.e., mild, moderate, severe) may be more indicative of dysfunction and outcomes than the specific typology of the disorder.[5]

Style

The second criterion describes the stylistic features of the presentation, largely in relation to some derivation of the Five-Factor Model (FFM) of personality. The DSM-5's Alternative Model of Personality Disorders (AMPD) Criterion B comprises the traits of negative affectivity (continua from emotional stability to neuroticism), detachment (introversion to extroversion), antagonism (agreeableness to antagonism), disinhibition (conscientiousness to impulsivity), and psychoticism (closed to experience to open to experience). The DSM-5's approach to diagnosing PD in the AMPD differs from the ICD-11 as it requires the presence of one or more elevated traits. Nevertheless, there is a growing interest in using only Criterion A for understanding, diagnosing, and managing PD. The FFM has the ability to explain all personality variation, with current dimensional PD models capturing dysfunctional versions or extremes of these traits.[5]

DSM-5 (section II)

Book cover of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision
The cover of the latest DSM edition

In the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, a categorical classification was retained for personality disorders. Located in Section II (Diagnostic Criteria and Codes; where official diagnoses are listed),[12] it contains ten specific personality disorders grouped into three clusters (A, B, and C), as well as three other diagnoses. Thus, it lists personality disorders in the same way as other mental disorders, rather than on a separate 'axis', as previously.[13] The clusters are based on descriptive similarity between the disorders they encompass, and it is not proven that they possess clinical utility.[14]

The clusters, as well as definition of personality disorders being done through specific sets of criteria, have been part of the DSM since the DSM-III (1980).[15] The classification system was retained from the DSM-IV (1994) due to the Board of Trustees of the American Psychiatric Association having decided to reject the AMPD.[16][17] This system was carried forward in the more recent DSM-5-TR.

The DSM-5 and the more recent DSM-5-TR provide a definition and six criteria for general personality disorder. Any of its ten personality disorder diagnoses[18] is subject to this definition, which requires that a differential diagnosis is performed in order to verify that the disturbance is not the result of other mental disorders, medical conditions or substances, and that the disturbance is stable over time and "inflexible and pervasive across a broad range of personal and social situations", having evident continuity since "at least to adolescence or early adulthood". Additionally, disturbance must be evident in regards to at least two of four specified aspects of functioning, namely: cognition, affectivity, interpersonal functioning and impulse control.[18][19]

Cluster A

People with these disorders can be paranoid and have difficulty being understood by others, as they often have odd or eccentric modes of speaking and an unwillingness and inability to form and maintain close relationships.[20] Significant evidence suggests a small proportion of people with Cluster A personality disorders, especially schizotypal personality disorder, have the potential to develop schizophrenia and other psychotic disorders. These disorders also have a higher probability of occurring among individuals whose first-degree relatives have either schizophrenia or a Cluster A personality disorder.[21]

This section is an excerpt from Paranoid personality disorder[ edit ]
This section is an excerpt from Schizoid personality disorder[ edit ]
This section is an excerpt from Schizotypal personality disorder[ edit ]

Cluster B

Cluster B personality disorders are characterized by dramatic, impulsive, self-destructive, emotional behavior and sometimes incomprehensible interactions with others.[20]

This section is an excerpt from Antisocial personality disorder[ edit ]
This section is an excerpt from Borderline personality disorder[ edit ]
This section is an excerpt from Histrionic personality disorder[ edit ]
This section is an excerpt from Narcissistic personality disorder[ edit ]

Cluster C

Cluster C personality disorders are characterised by a consistent pattern of anxious thinking or behavior.[20]

This section is an excerpt from Avoidant personality disorder[ edit ]
This section is an excerpt from Dependent personality disorder[ edit ]
This section is an excerpt from Obsessive–compulsive personality disorder[ edit ]

Other personality disorders

The DSM-5 chapter on personality disorders also contains three diagnoses for conditions not matching these ten disorders,[22] which nevertheless exhibit characteristics of a personality disorder:

  • Personality change due to another medical condition – personality disturbance due to the direct effects of a medical condition[23]
  • Other specified personality disorder – used when recording the presence of personality disorder along with the reasons for the condition not being classified as one of the specific personality disorders.[22]
  • Unspecified personality disorder – used when a patient presents with personality disorder symptoms that cause distress or impairment, but the clinician either chooses not to indicate the specific reason these criteria are not met for any one disorder, or there isn't enough information available to make a more precise diagnosis.[22]

DSM-5 (section III; AMPD)

Main article: Medicine:Alternative DSM-5 model for personality disorders

Introduced in section III of the DSM-5, the Alternative DSM-5 Model for Personality Disorders (AMPD) is a dimensional–categorical hybrid,[2] yielding diagnoses based on combinations of ratings of impairment in personality functioning (criterion A) and pathological personality traits (criterion B).[9][24] Created with the aim of ameliorating issues such as arbitrary thresholds and excessive comorbidity,[25] it was intended to replace the categorical model in the at the time upcoming DSM-5; however, upon its rejection, it was instead placed in Section III (Emerging Measures and Models).[16]

Personality functioning (criterion A) is assessed across self and interpersonal domains. The self domain encompasses identity and self-direction, while the interpersonal domain consists of empathy and intimacy.[26] Clinicians rate the degree of impairment using the Level of Personality Functioning Scale (LPFS), which ranges from 0 (little or no impairment) to 4 (extreme impairment).[27] Criterion B is based on five pathological trait domains, that characterize pathological personality expression: Negative Affectivity, Detachment, Antagonism, Disinhibition, and Psychoticism.[28] These domains are further divided into 25 specific trait facets,[28] such as irresponsibility and risk taking within the domain of disinhibition.[9]

The AMPD includes six specific personality disorders, which are defined by specific combinations of criteria A and B;[9] these are: antisocial, avoidant, borderline, narcissistic, obsessive-compulsive, and schizotypal.[3] It excludes four personality disorder categories (dependent, histrionic, paranoid, and schizoid) that are present in the standard model.[29] For cases that don't meet criteria for specific disorders but still show significant impairment, the model provides the Personality Disorder-Trait Specified (PD-TS) category, which documents the particular pattern of functional impairment and pathological traits.[30]

For diagnosis, the AMPD requires that the disturbance must be pervasive across situations and stable over time, typically emerging in adolescence or early adulthood. The disturbances cannot be better explained by other mental disorders, substance use, medical conditions, or attributed to developmental stages or sociocultural contexts.[27]

ICD-11

Logo of the ICD-11
Logo of the ICD-11

Departing from the categorical classification in the ICD-10, the ICD-11 classification of personality disorders implements a dimensional model containing a single personality disorder (6D10), which can be coded as mild, moderate, severe, or severity unspecified.[1] Personality disorder as well as personality difficulty may be further described by qualifiers for five trait domains as well as a borderline pattern, similar to borderline personality disorder; in contrast to the AMPD, no categorical PD types were retained in the ICD-11.[24]

Severity levels

Once the presence of personality disorder is established, its severity may be determined; classified as mild, moderate, or severe, it is based on how pervasive and disabling the disturbances are. The evaluation considers impairments in several areas of functioning, such as identity and self-direction, interpersonal relationships, emotional and behavioural problems, the extent of psychosocial dysfunction or distress, and risk of harm to self or others. These indicators serve as guidelines for global clinical judgment rather than as fixed diagnostic criteria.[31] Severity may also be coded as unspecified (6D10.Z).[1]

  • Mild Personality Disorder (6D10.0): Disturbance is limited to certain aspects of personality functioning. The person may struggle with decisions, relationships, or handling criticism while retaining a coherent identity and overall reality testing. Distress and impairment are present but circumscribed, and harm to self or others is uncommon.[32]
  • Moderate Personality Disorder (6D10.1): Disturbance extends across multiple domains, such as self-concept, relationships, and moderation of behaviour, yet some capacities remain intact. Harm to self or others may occur but is typically moderate.[32]
  • Severe Personality Disorder (6D10.2): There are profound disturbances in identity and interpersonal functioning. The person may lack a stable sense of self, display rigid or chaotic self-concepts, and experience pervasive conflict or exploitation in relationships. Social and occupational functioning is severely compromised, and significant risk of self-injury or violence is common.[32]

Trait and pattern qualifiers

In addition to coding severity, clinicians may use trait and pattern qualifiers to describe the specific stylistic dimensions and configurations of personality disturbance.[31] These qualifiers indicate prominent traits contributing to the overall dysfunction but do not represent distinct categories or syndromes. Although the traits exist dimensionally, for coding purposes they are recorded as either present or absent.[1] The combination and number of trait qualifiers typically reflect the individual's global severity, with more complex or numerous traits often accompanying greater impairment.[1][31]

  • Negative Affectivity (6D11.0): Involves a tendency to experience frequent and intense negative emotions, such as anxiety, anger, guilt, or shame, accompanied by impaired emotional self-regulation. Common problems are excessive dependency on others, suicidal ideation and hopelessness.[32]
  • Detachment (6D11.1): Characterized by social withdrawal and emotional detachment, anhedonia, and avoidance of intimacy or social engagement.[32]
  • Dissociality (6D11.2): Characterized by self-centeredness, lack of empathy, and disregard for the rights and feelings of others. Individuals often display grandiosity, entitlement, and manipulativeness, pursuing their own needs and comfort without concern for others, or expecting attention or admiration from them. Lack of empathy may be manifested in callousness, aggression, and exploitation, and sometimes in taking pleasure in others' suffering.[1][32]
  • Disinhibition (6D11.3): Involves impulsivity, recklessness, and poor self-control, with actions driven by immediate desires without regard for long-term consequences.[32]
  • Anankastia (6D11.4): Marked by perfectionism, rigidity, and excessive orderliness, accompanied by a preoccupation with rules, control, and moral standards.[32]
  • Borderline Pattern (6D11.5): A pattern qualifier corresponding closely to the DSM-5 borderline personality disorder diagnosis.[31]

ICD-10

The specific personality disorders (F60) are: paranoid, schizoid, dissocial, emotionally unstable (borderline type and impulsive type), histrionic, anankastic, anxious (avoidant) and dependent.[33] This category also includes Other specific personality disorders (includes PDs characterized as eccentric, haltlose, immature, narcissistic, passive–aggressive, or psychoneurotic), as well as Personality disorder, unspecified (includes "character neurosis" and "pathological personality"). In addition to specific PDs, there are also the following categories:

  • Mixed and other personality disorders (F61; defined as conditions that are often troublesome but do not demonstrate the specific pattern of symptoms in the named disorders).
  • Enduring personality changes, not attributable to brain damage and disease (F62; for conditions that seem to arise in adults without a diagnosis of personality disorder, following catastrophic or prolonged stress or other psychiatric illness).

Notes

  1. ↑ Conceptualized as low level of Disinhibition in the AMPD.

References

  1. ↑ 1.0 1.1 1.2 1.3 1.4 1.5 1.6 Bach, Bo; First, Michael B. (2018-10-29). "Application of the ICD-11 classification of personality disorders". BMC Psychiatry 18 (1): 351. doi:10.1186/s12888-018-1908-3. ISSN 1471-244X. PMID 30373564.   This article incorporates text from this source, which is available under the CC BY 4.0 license.
  2. ↑ 2.0 2.1 Oldham, John M. (October 2022). "How Will Clinicians Utilize the Alternative DSM-5-TR Section III Model for Personality Disorders in Their Clinical Work?" (in en). Focus 20 (4): 411–412. doi:10.1176/appi.focus.20220053. ISSN 1541-4094. PMID 37200885. 
  3. ↑ 3.0 3.1 3.2 Clark, Lee Anna; Vanderbleek, Emily N.; Shapiro, Jaime L.; Nuzum, Hallie; Allen, Xia; Daly, Elizabeth; Kingsbury, Thomas J.; Oiler, Morgan et al. (2015-02-01). "The Brave New World of Personality Disorder-Trait Specified: Effects of Additional Definitions on Coverage, Prevalence, and Comorbidity" (in EN). Psychopathology Review a2 (1): 52–82. doi:10.5127/pr.036314. ISSN 2051-8315. PMID 26097740. 
  4. ↑ Department of Psychiatry and Psychotherapy, Medical Faculty, LVR-Klinikum Düsseldorf, Heinrich-Heine-University, Düsseldorf, Germany; Gaebel, Wolfgang; WHO Collaborating Centre on Quality Assurance and Empowerment in Mental Health, Düsseldorf, Germany; Kerst, Ariane; Department of Psychiatry and Psychotherapy, Medical Faculty, LVR-Klinikum Düsseldorf, Heinrich-Heine-University, Düsseldorf, Germany; WHO Collaborating Centre on Quality Assurance and Empowerment in Mental Health, Düsseldorf, Germany; Stricker, Johannes; Department of Psychiatry and Psychotherapy, Medical Faculty, LVR-Klinikum Düsseldorf, Heinrich-Heine-University, Düsseldorf, Germany et al. (2020-12-24). "Classification and Diagnosis of Schizophrenia or Other Primary Psychotic Disorders: Changes from Icd-10 to Icd-11 and Implementation in Clinical Practice". Psychiatria Danubina 32 (3–4): 320–324. doi:10.24869/psyd.2020.320. PMID 33370728. http://www.psychiatria-danubina.com/UserDocsImages/pdf/dnb_vol32_no3-4/dnb_vol32_no3-4_320.pdf. "Schizotypal disorder is defined as an enduring pattern of unusual speech, perceptions, beliefs, and behaviours of insufficient intensity to meet requirements for another psychotic disorder in ICD-10 and in ICD11. Yet, schizotypal disorder may be a possible predecessor of schizophrenia (Jablensky 2011, Stein et al. 2020) and is therefore kept in the ICD-11 chapter of primary psychotic disorders, contrary to DSM-5 which classifies schizotypal disorder as a personality disorder.". 
  5. ↑ 5.00 5.01 5.02 5.03 5.04 5.05 5.06 5.07 5.08 5.09 5.10 5.11 5.12 5.13 5.14 Monaghan, Conal; Bizumic, Boris (2023-03-07). "Dimensional models of personality disorders: Challenges and opportunities" (in English). Frontiers in Psychiatry 14. doi:10.3389/fpsyt.2023.1098452. ISSN 1664-0640. PMID 36960458.   This article incorporates text from this source, which is available under the CC BY 4.0 license.
  6. ↑ 6.0 6.1 6.2 6.3 Day, Nicholas J. S.; Green, Ava; Denmeade, Georgia; Bach, Bo; Grenyer, Brin F. S. (2024). "Narcissistic personality disorder in the ICD-11: Severity and trait profiles of grandiosity and vulnerability" (in en). Journal of Clinical Psychology 80 (8): 1917–1936. doi:10.1002/jclp.23701. ISSN 1097-4679. PMID 38742471. https://onlinelibrary.wiley.com/doi/abs/10.1002/jclp.23701. 
  7. ↑ 7.0 7.1 7.2 7.3 McCabe, Gillian A.; Widiger, Thomas A. (January 2020). "A comprehensive comparison of the ICD-11 and DSM–5 section III personality disorder models." (in en). Psychological Assessment 32 (1): 72–84. doi:10.1037/pas0000772. ISSN 1939-134X. https://doi.apa.org/doi/10.1037/pas0000772. 
  8. ↑ Morey, Leslie C.; Benson, Kathryn T.; Busch, Alexander J.; Skodol, Andrew E. (April 2015). "Personality Disorders in DSM-5: Emerging Research on the Alternative Model" (in en). Current Psychiatry Reports 17 (4). doi:10.1007/s11920-015-0558-0. ISSN 1523-3812. http://link.springer.com/10.1007/s11920-015-0558-0. 
  9. ↑ 9.0 9.1 9.2 9.3 Zimmermann, Johannes; Kerber, André; Rek, Katharina; Hopwood, Christopher J.; Krueger, Robert F. (2019-08-13). "A Brief but Comprehensive Review of Research on the Alternative DSM-5 Model for Personality Disorders" (in en). Current Psychiatry Reports 21 (9): 92. doi:10.1007/s11920-019-1079-z. ISSN 1535-1645. PMID 31410586. 
  10. ↑ Zimmermann, J., Kerber, A., Rek, K., Hopwood, C. J., & Krueger, R. F. (2019). Integrating clinical and personality assessment: Toward the development of a shared framework. Journal of Personality Assessment, 101(3), 292–304. doi:10.1080/00223891.2018.1483373.
  11. ↑ Mulder, Roger T. (2021-05-10). "ICD-11 Personality Disorders: Utility and Implications of the New Model" (in English). Frontiers in Psychiatry 12. doi:10.3389/fpsyt.2021.655548. ISSN 1664-0640. PMID 34040555. 
  12. ↑ Clark, Lee Anna (2025-05-01). "Wherefrom and Whither PD? Recent Developments and Future Possibilities in DSM-5 and ICD-11 Personality Disorder Diagnosis" (in en). Current Psychiatry Reports 27 (5): 267–277. doi:10.1007/s11920-025-01602-y. ISSN 1535-1645. PMID 40108080. 
  13. ↑ Stetka, Bret S.; Correll, Christoph U.. "A Guide to DSM-5" (in en). p. 8. https://www.medscape.com/viewarticle/803884_8. 
  14. ↑ "Overview of Personality Disorders - Psychiatric Disorders" (in en-US). https://www.merckmanuals.com/professional/psychiatric-disorders/personality-disorders/overview-of-personality-disorders. 
  15. ↑ Crocq, Marc-Antoine (2013-06-30). "Milestones in the history of personality disorders". Dialogues in Clinical Neuroscience 15 (2): 147–153. doi:10.31887/DCNS.2013.15.2/macrocq. PMID 24174889. 
  16. ↑ 16.0 16.1 Sharp, Carla; Clark, Lee Anna; Balzen, Kennedy M.; Widiger, Tom; Stepp, Stephanie; Zimmerman, Mark; Krueger, Robert F. (2025). "The validity, reliability and clinical utility of the Alternative DSM-5 Model for Personality Disorders (AMPD) according to DSM-5 revision criteria" (in en). World Psychiatry 24 (3): 319–340. doi:10.1002/wps.21339. ISSN 2051-5545. PMID 40948060. PMC 12434376. https://onlinelibrary.wiley.com/doi/abs/10.1002/wps.21339. 
  17. ↑ Skodol, Andrew E.; Morey, Leslie C.; Bender, Donna S.; Oldham, John M. (2015-07-01). "The Alternative DSM-5 Model for Personality Disorders: A Clinical Application" (in en). American Journal of Psychiatry 172 (7): 606–613. doi:10.1176/appi.ajp.2015.14101220. ISSN 0002-953X. PMID 26130200. https://psychiatryonline.org/doi/10.1176/appi.ajp.2015.14101220. 
  18. ↑ 18.0 18.1 American Psychiatric Association, ed (2013). "Personality Disorders". Diagnostic and statistical manual of mental disorders: DSM-5 (5th ed.). Washington, D.C: American Psychiatric Association. pp. 645–649. ISBN 978-0-89042-554-1. "This chapter begins with a general definition of personality disorder that applies to each of the 10 specific personality disorders." 
  19. ↑ Fariba, Kamron A.; Gupta, Vikas; Torrico, Tyler J.; Kass, Ethan (2025), "Personality Disorder", StatPearls (Treasure Island (FL): StatPearls Publishing), PMID 32310518, https://www.ncbi.nlm.nih.gov/books/NBK556058/, retrieved 2025-06-18 
  20. ↑ 20.0 20.1 20.2 "Personality disorders - Symptoms and causes". https://www.mayoclinic.org/diseases-conditions/personality-disorders/symptoms-causes/syc-20354463. 
  21. ↑ "Cluster A Personality Disorders: Schizotypal, Schizoid and Paranoid Personality Disorders in Childhood and Adolescence". Journal of Psychopathology and Behavioral Assessment 32 (4): 515–528. December 2010. doi:10.1007/s10862-010-9183-8. PMID 21116455. 
  22. ↑ 22.0 22.1 22.2 "Personality Disorders". Diagnostic and statistical manual of mental disorders: DSM-5 (5th ed.). Washington, D.C: American Psychiatric Association. 2013. pp. 682–684. ISBN 978-0-89042-554-1. 
  23. ↑ Diagnostic and statistical manual of mental disorders: DSM-5 (5th ed.). Washington, D.C: American Psychiatric Association. 2013. p. 683. ISBN 978-0-89042-554-1. "The essential feature of a personality change due to another medical condition is a persistent personality disturbance that is judged to be due to the direct pathophysiological effects of a medical condition." 
  24. ↑ 24.0 24.1 García, Luis F.; Gutiérrez, Fernando; García, Oscar; Aluja, Anton (2024-07-12). "The Alternative Model of Personality Disorders: Assessment, Convergent and Discriminant Validity, and a Look to the Future" (in en). Annual Review of Clinical Psychology 20 (1): 431–455. doi:10.1146/annurev-clinpsy-081122-010709. ISSN 1548-5943. PMID 38211624. https://www.annualreviews.org/content/journals/10.1146/annurev-clinpsy-081122-010709. "The AMPD regards PDs as extreme variants of normal-range personality dimensions, just as the eleventh revision of the International Classification of Diseases (ICD-11; WHO 2022) did a few years later. It takes as a reference framework the FFM, which in fact had been proposed as an early dimensional alternative to categories (Widiger & Costa 2013, Widiger & Simonsen 2005).". 
  25. ↑ Rodriguez-Seijas, Craig; Ruggero, Camilo; Eaton, Nicholas R.; Krueger, Robert F. (2019-12-01). "The DSM-5 Alternative Model for Personality Disorders and Clinical Treatment: a Review" (in en). Current Treatment Options in Psychiatry 6 (4): 284–298. doi:10.1007/s40501-019-00187-7. ISSN 2196-3061. 
  26. ↑ Buer Christensen, Tore; Hummelen, Benjamin; Paap, Muirne C. S.; Eikenaes, Ingeborg; Selvik, Sara Germans; Kvarstein, Elfrida; Pedersen, Geir; Bender, Donna S. et al. (December 2020). "Evaluation of Diagnostic Thresholds for Criterion A in the Alternative DSM-5 Model for Personality Disorders". Journal of Personality Disorders 34 (Supplement C): 40–61. doi:10.1521/pedi_2019_33_455. ISSN 0885-579X. PMID 31682197. https://guilfordjournals.com/doi/10.1521/pedi_2019_33_455. 
  27. ↑ 27.0 27.1 American Psychiatric Association, ed (2013). Diagnostic and statistical manual of mental disorders: DSM-5 (5th ed.). Washington, D.C: American Psychiatric Association. pp. 761–763. ISBN 978-0-89042-554-1. 
  28. ↑ 28.0 28.1 Mulay, Abby L.; Cain, Nicole M.; Waugh, Mark H.; Hopwood, Christopher J.; Adler, Jonathan M.; Garcia, Darren J.; Kurtz, John E.; Lenger, Katherine A. et al. (2018-11-02). "Personality Constructs and Paradigms in the Alternative DSM-5 Model of Personality Disorder" (in en). Journal of Personality Assessment 100 (6): 593–602. doi:10.1080/00223891.2018.1477787. ISSN 0022-3891. PMID 29902081. https://www.tandfonline.com/doi/full/10.1080/00223891.2018.1477787. 
  29. ↑ Porter, Jeffrey S.; Risler, Edwin (January 2014). "The New Alternative DSM-5 Model for Personality Disorders: Issues and Controversies" (in en). Research on Social Work Practice 24 (1): 50–56. doi:10.1177/1049731513500348. ISSN 1049-7315. https://journals.sagepub.com/doi/10.1177/1049731513500348. 
  30. ↑ American Psychiatric Association, ed (2013). Diagnostic and statistical manual of mental disorders: DSM-5 (5th ed.). Washington, D.C: American Psychiatric Association. pp. 770–771. ISBN 978-0-89042-554-1. "The current diagnoses of paranoid, schizoid, histrionic, and dependent personality disorders are represented also by the diagnosis of PD-TS; these are defined by moderate or greater impairment in personality functioning and can be specified by the relevant pathological personality trait combinations." 
  31. ↑ 31.0 31.1 31.2 31.3 Bach, Bo; Kramer, Ueli; Doering, Stephan; di Giacomo, Ester; Hutsebaut, Joost; Kaera, Andres; De Panfilis, Chiara; Schmahl, Christian et al. (2022-04-01). "The ICD-11 classification of personality disorders: a European perspective on challenges and opportunities". Borderline Personality Disorder and Emotion Dysregulation 9 (1): 12. doi:10.1186/s40479-022-00182-0. ISSN 2051-6673. PMID 35361271.   This article incorporates text from this source, which is available under the CC BY 4.0 license.
  32. ↑ 32.0 32.1 32.2 32.3 32.4 32.5 32.6 32.7 Swales, Michaela A. (December 2022). "Personality Disorder Diagnoses in ICD-11: Transforming Conceptualisations and Practice". Clinical Psychology in Europe 4 (Spec Issue). doi:10.32872/cpe.9635. ISSN 2625-3410. PMID 36760321.   This article incorporates text from this source, which is available under the CC BY 4.0 license.
  33. ↑ "International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10) Version for 2010 (Online Version)". Apps.who.int. Retrieved on 16 April 2013.

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