Agent harnesses truncate file reads around ~60k characters, so the largest dsm5 reference files (up to 132k chars) were being cut off mid-file (reported: "The neurodevelopmental file was truncated"). - Split 15 reference files over 50k chars into a small index (original filename preserved, so all existing links keep resolving) plus part files of <= ~40k chars each, organized by disorder group - Updated SKILL.md routing rows to point at indexes and read the part for the condition; added large-file handling guidance - Updated dsm5/README.md What You Get table; documented the size convention in 00-overview-and-method.md (Maintaining this library) - Verified: no reference file exceeds 50k chars (66 files), all 466 relative links resolve, validators pass, lookup.py lists all parts Co-authored-by: factory-droid[bot] <138933559+factory-droid[bot]@users.noreply.github.com>
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Personality Disorders — DSM-5-TR Companion Reference
Summarized and paraphrased from DSM-5-TR (American Psychiatric Association, 2022). This file is for orientation and education; verify exact criteria wording, codes, and recording procedures against the official DSM-5-TR before any formal clinical, legal, insurance, or research use.
Chapter Overview
Personality disorders are enduring patterns of inner experience and behavior that deviate markedly from the expectations of the individual's culture, are pervasive and inflexible, have their onset in adolescence or early adulthood, are stable over time, and lead to distress or impairment. The chapter covers 10 specific personality disorders plus personality change due to another medical condition and the other specified/unspecified categories, all sharing one set of general criteria (below). The 10 are grouped into three clusters by descriptive similarity: Cluster A (paranoid, schizoid, schizotypal — often appearing odd or eccentric), Cluster B (antisocial, borderline, histrionic, narcissistic — often appearing dramatic, emotional, or erratic), and Cluster C (avoidant, dependent, obsessive-compulsive — often appearing anxious or fearful). The manual itself cautions that the cluster system, though useful in research and education, has serious limitations and has not been consistently validated: disorders or traits from different clusters frequently co-occur. The manual also acknowledges the dimensional perspective — personality disorders as maladaptive variants of personality traits merging imperceptibly into normality — and points to Section III for a full dimensional model (see 33-alternative-dsm-5-model-and-conditions-for-further-study.md).
A routine misunderstanding, for clinicians and the public alike, is that a personality disorder is a judgment about character or a synonym for "difficult personality." The diagnosis requires a long-standing, inflexible, pervasive pattern that causes clinically significant distress or impairment — prominent personality traits alone are not a disorder.
Disorders in this chapter
| Disorder | ICD-10-CM code(s) | One-line "what it is" |
|---|---|---|
| Paranoid Personality Disorder | F60.0 | Pervasive distrust and suspiciousness; others' motives read as malevolent |
| Schizoid Personality Disorder | F60.1 | Detachment from social relationships; restricted emotional expression |
| Schizotypal Personality Disorder | F21 | Acute discomfort in close relationships, cognitive/perceptual distortions, eccentricity |
| Antisocial Personality Disorder | F60.2 | Disregard for and violation of others' rights; impulsivity; failure to learn from experience |
| Borderline Personality Disorder | F60.3 | Instability in relationships, self-image, and affect; marked impulsivity |
| Histrionic Personality Disorder | F60.4 | Excessive emotionality and attention seeking |
| Narcissistic Personality Disorder | F60.81 | Grandiosity, need for admiration, lack of empathy |
| Avoidant Personality Disorder | F60.6 | Social inhibition, feelings of inadequacy, hypersensitivity to negative evaluation |
| Dependent Personality Disorder | F60.7 | Submissive, clinging behavior from an excessive need to be taken care of |
| Obsessive-Compulsive Personality Disorder | F60.5 | Preoccupation with orderliness, perfectionism, and control |
| Personality Change Due to Another Medical Condition | F07.0 | Persistent personality change that is a direct physiological consequence of a medical condition |
| Other Specified Personality Disorder | F60.89 | PD symptoms with distress/impairment; clinician states why criteria are unmet |
| Unspecified Personality Disorder | F60.9 | PD symptoms; reason criteria are unmet not specified |
General Personality Disorder (applies to all 10 specific disorders)
Core features
An enduring pattern of inner experience and behavior deviating markedly from the individual's culture's expectations, manifested in at least two of four areas: cognition (ways of perceiving and interpreting self, others, and events); affectivity (range, intensity, lability, and appropriateness of emotional response); interpersonal functioning; and impulse control. Personality traits become a personality disorder only when inflexible and maladaptive and causing significant functional impairment or subjective distress.
Diagnostic criteria (summarized)
- Criterion A: An enduring pattern deviating markedly from the expectations of the individual's culture, manifested in two (or more) of: (1) cognition; (2) affectivity; (3) interpersonal functioning; (4) impulse control.
- Criterion B: The pattern is inflexible and pervasive across a broad range of personal and social situations.
- Criterion C: The pattern leads to clinically significant distress or impairment in social, occupational, or other important areas of functioning.
- Criterion D: The pattern is stable and of long duration, with onset traceable at least to adolescence or early adulthood.
- Criterion E: Not better explained as a manifestation or consequence of another mental disorder.
- Criterion F: Not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition (e.g., head trauma).
Development and course (chapter-level)
Features usually become recognizable in adolescence or early adult life. Antisocial and borderline types tend to become less evident or remit with age; this is less true for obsessive-compulsive and schizotypal types. In individuals younger than 18 years, features must have been present for at least 1 year; antisocial personality disorder cannot be diagnosed before age 18. A personality change arising in middle adulthood or later warrants evaluation for personality change due to another medical condition or an unrecognized substance use disorder. Because traits are often ego-syntonic, more than one interview spaced over time and collateral information from other informants are frequently needed.
Differential diagnosis (chapter-level)
- Other mental disorders and personality traits: a personality disorder is diagnosed only when defining characteristics appeared before early adulthood, typify long-term functioning, and do not occur exclusively during an episode of another mental disorder. Traits alone are not a disorder.
- Psychotic disorders: paranoid, schizoid, and schizotypal carry an exclusion — the pattern must not have occurred exclusively during schizophrenia, a bipolar or depressive disorder with psychotic features, or another psychotic disorder; if a preexisting personality disorder preceded a persistent psychotic disorder, record it followed by "(premorbid)" (see 11-schizophrenia-spectrum-and-other-psychotic.md).
- Anxiety and depressive disorders: be cautious diagnosing a personality disorder during an episode, since cross-sectional symptoms can mimic personality traits (see 13-depressive-disorders.md, 14-anxiety-disorders.md).
- Posttraumatic stress disorder: when personality changes emerge and persist after extreme stress, consider PTSD (see 16-trauma-and-stressor-related-disorders.md).
- Substance use disorders: do not diagnose a personality disorder based solely on behaviors that are consequences of intoxication, withdrawal, or substance-sustaining activity (see 25-substance-related-and-addictive-disorders.md).
- Personality change due to another medical condition: consider when enduring changes arise from the physiological effects of a medical condition.
Parts of this chapter reference
This chapter reference is split into parts (each ≤ 40,000 characters) so it loads without truncation. The chapter overview, disorder index table, general personality disorder criteria, and chapter-level conversation notes remain here; the specific personality disorders are in the parts below.
| Part | Covers |
|---|---|
| Clusters A and C personality disorders | General PD culture/sex considerations and conversation guide; paranoid, schizoid, and schizotypal (cluster A); avoidant, dependent, and obsessive-compulsive (cluster C) personality disorders |
| Cluster B and other personality disorders | Antisocial, borderline, histrionic, and narcissistic (cluster B) personality disorders; personality change due to another medical condition; other specified and unspecified personality disorder |
Chapter-level conversation notes
- Destigmatize the category: personality disorder diagnoses describe patterns, not worth; language like "manipulative" or "toxic" in notes and conversation increases stigma and harms care. Frame around behavior, function, and change.
- Traits are not disorders: the manual is explicit that personality traits constitute a disorder only when inflexible, maladaptive, and persisting with significant functional impairment or subjective distress — use this repeatedly with patients and families.
- Substance and medical rule-outs: never diagnose a personality disorder from behavior that is a consequence of intoxication, withdrawal, substance-seeking, or a medical condition's physiological effects.
- Avoid labeling children: personality disorders are generally diagnosed from adolescence/early adulthood; under-18 diagnoses need 1 year of features, antisocial personality disorder requires age 18+, and transient adolescent turmoil is not a personality disorder.