Examples of Applying Proposed Personality Disorder Criteria

The following are case vignettes from the DSM-5 Web site describing how the newly proposed criteria for personality disorders might be used by clinicians.

• A 28-year-old single female who works as a manager for a city government has struggled with an unstable self-image, chronic feelings of emptiness, and difficulties maintaining close romantic relationships for all of her adult life. However, she has a few close female friends and is considered a good worker. Extremely self-critical, she attempts to boost her self-esteem by seeking the approval of others. She has been told that she is "needy and often seems desperate," which leads to some difficulties in maintaining romantic and other close relationships, although she often does not understand what she does that makes this impression. She experiences fluctuating strong emotions, such as panic, fear, depression, and anger in response to interpersonal disappointments. She has made several suicidal gestures by cutting herself in the past couple of years when stressed by the ending of a relationship.

• A 14-year-old female has a history of maltreatment and shows some prodromal signs and symptoms that may foretell a future diagnosis of borderline personality, but the patient's personality is not yet fully matured. The patient exhibits signs and symptoms compatible with borderline personality disorder, including emotional lability, physical self-harm, and intense, unstable interpersonal relationships, more so than would be typical for her age-matched peers.