Severe personality disorder

Essential (Required) Features:

• All general diagnostic requirements for Personality Disorder are met.
• There are severe disturbances in multiple areas of functioning of the self (e.g., sense of self may be so unstable that individuals report not having a sense of who they are or so rigid that they refuse to participate in any but an extremely narrow range of situations; self view may be characterized by self-contempt or be grandiose or highly eccentric; See Table 6.18).
• Problems in interpersonal functioning seriously affect virtually all relationships and the ability and willingness to perform expected social and occupational roles is severely compromised or absent.
• Specific manifestations of personality disturbance are severe (see below for examples) and affect most, if not all, areas of personality functioning.
• Severe Personality Disorder is often associated with harm to self or others.
• Severe Personality Disorder is associated with severe impairment in all or nearly all areas of life, including personal, family, social, educational, occupational, and other important areas of functioning.

Examples of specific personality disturbances in Severe Personality Disorder

Note: This list of examples is not exhaustive and not intended to suggest that all items will be present in any single individual.

• The individual’s self-view is very unrealistic and typically is highly unstable or contradictory.
• The individual has serious difficulty with regulation of self-esteem, emotional experience and expression, and impulses, as well as other aspects of behaviour (e.g., perseveration, indecision).
• The individual is largely unable to set and pursue realistic goals.
• The individual’s interpersonal relationships, if any, lack mutuality; are shallow, extremely one-sided, unstable, or highly conflictual, often to the point of violence. Family relationships are absent (despite having living relatives) or marred by significant conflict.
• The individual has extreme difficulty acknowledging difficult or unwanted emotions (e.g., does not recognize or acknowledge experiencing anger, sadness, or other emotions).
• The individual is unwilling or unable to sustain regular work due to lack of interest or effort, poor performance (e.g., failure to complete assignments or perform expected roles, unreliability), interpersonal difficulties, or inappropriate behaviour (e.g., fits of temper, insubordination).
• Under stress, there are extreme distortions in the individual’s situational and interpersonal appraisals. There are often dissociative states or psychotic-like beliefs or perceptions (e.g., extreme paranoid reactions).