37.2: DSM-5 Personality Disorders

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When personality traits result in significant distress, social impairment, and/or occupational impairment, they are considered to be a personality disorder (American Psychiatric Association [APA], 2013). The authoritative manual for what constitutes a personality disorder is provided by the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM), the current version of which is DSM-5 (APA, 2013). The DSM provides a common language and standard criteria for the classification and diagnosis of mental disorders. This manual is used by clinicians, researchers, health insurance companies, and policymakers. DSM-5 includes ten personality disorders: antisocial, avoidant, borderline, dependent, histrionic, narcissistic, obsessive-compulsive, paranoid, schizoid, and schizotypal.

This list of ten, though, does not fully cover all of the different ways in which a personality can be maladaptive. DSM-5 also includes a “wastebasket” diagnosis of other specified personality disorder (OSPD) and unspecified personality disorder (UPD). This diagnosis is used when a clinician believes that a patient has a personality disorder but the traits that constitute this disorder are not well covered by one of the ten existing diagnoses. OSPD and UPD—or, as they used to be referred to in previous editions, PDNOS (personality disorder not otherwise specified)—are often one of the most frequently used diagnoses in clinical practice, suggesting that the current list of ten is not adequately comprehensive (Widiger & Trull, 2007).