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Personality disorders: Diagnostic criteria

Types of personality disorders

There are 10 specific personality disorders in the DSM-5. They have a varying degree of research supporting their diagnosis. The most commonly diagnosed personality disorders are antisocial personality disorder and borderline personality disorder. Another personality disorder that primary care providers sometimes find difficult to diagnose and treat is narcissistic personality disorder.

Borderline personality disorder

When considering borderline personality disorder, the diagnosis must fulfil five out of nine criteria. These can best be recalled by the mnemonic IMPULSIVE:

Impulsiveness in two potentially damaging areas (e.g., sex, substance use, shopping)

Mood instability due to marked reactivity

Paranoia or dissociation under stress

Unstable self-image

Labile intense relationships

Suicidal gestures

Inappropriate anger

Vulnerability to abandonment, frantic efforts to avoid real or imagined abandonment

Emptiness, chronic feelings of emptiness

Antisocial personality disorder

Antisocial personality disorder involves a pervasive pattern of disregard for and violation of the rights of others that has occurred since age 15. The person must meet three or more of the following criteria:

  • engagement in illegal activity
  • deceitfulness
  • impulsivity
  • irritability and aggressiveness
  • reckless disregard for safety of self or others
  • consistent irresponsibility
  • lack of remorse

The person must be at least 18 years old and there must be evidence that the person developed conduct disorder before age 15.

Narcissistic personality disorder

People with narcissistic personality disorder have chronic, maladaptive and persistent personality styles characterized by a pervasive pattern of grandiosity, a need for admiration and a lack of empathy beginning by early adulthood and presenting in various contexts.

At least five of the following characteristics need to be present:

  • grandiose sense of self-importance
  • preoccupation with fantasies of unlimited success, power and brilliance; belief that the person is special and unique and can only be understood by or associate with other special or high-status people
  • need for excessive admiration and feeling a sense of entitlement
  • interpersonally exploitive behaviour (i.e., taking advantage of others to achieve one's ends)
  • lack of empathy
  • envy of others or belief that others envy the person, arrogance
  • haughty behaviours or attitudes

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Frequently asked questions