DSM-5-TR Alternative Model
The Alternative Model for Personality Disorders (AMPD) describes personality pathology in two steps: how impaired the person is, and which traits shape the presentation [2]. It sits beside the categorical disorders on the Personality Disorders page, which remain the official approach.
Summaries here are original paraphrases for teaching, not quotations. Check the manual for exact wording [2].
Where it stands
The DSM-5-TR keeps the categorical Section II criteria as the official approach for diagnosis. The Alternative Model sits in Section III as an emerging model offered for further study, and it does not replace Section II.
What counts as a diagnosis
- Criterion A: at least moderate impairment (Level 2 or higher) in self functioning and interpersonal functioning.
- Criterion B: one or more pathological personality trait domains or facets.
- The impairments and traits are relatively stable across time and consistent across situations.
- They are not better explained by another mental disorder, by the effects of a substance or a medical condition, or as normal for the person's developmental stage or sociocultural environment.
Build a profile, see the closest match
- Below, drag each functioning dot in or out to set how impaired that area is (0 to 4).
- Then drag each trait-domain dot to set how elevated that domain is (0 to 3).
- Watch the match panel at the bottom. It updates as you drag.
- A match only appears once functioning reaches at least moderate impairment, level 2 or higher.
Drag a dot in or out to set that area's level of impairment, 0 to 4.
Drag a dot to sketch how elevated each trait domain is.
Closest match: No PD indicated
Criterion A: Level of Personality Functioning
Impairment is judged in two areas, each with two elements. Together they are rated on a single 0 to 4 scale.
How clearly the person experiences themselves as distinct from others, how stable their self-esteem and sense of self-worth are, and how well they can name and regulate the full range of their emotions.
The ability to set meaningful, coherent goals and pursue them, to hold constructive internal standards for behaviour, and to reflect on one's own inner life in a productive way.
How accurately the person understands other people's experiences and motives, how well they tolerate views that differ from their own, and how well they grasp the effect of their own behaviour on others.
The depth, length and closeness of connection with others, the wish and capacity to be close, and whether the person's conduct toward others is mutual and respectful.
- 0Little or no impairment
Self and interpersonal functioning are generally intact and adaptive. Not a personality disorder range.
- 1Some impairment
Mild, circumscribed difficulties, for example a somewhat over- or under-inflated self-view or some strain in closeness, that rarely derail daily life. Below the diagnostic threshold.
- 2Moderate impairment
Clear, recurring problems in how the person sees themselves and relates to others. This is the minimum severity for a personality disorder diagnosis in the model.
- 3Severe impairment
Pervasive difficulty. The sense of self is fragile or distorted, goals are hard to sustain, and relationships are marked by limited understanding of others and little real closeness.
- 4Extreme impairment
Profound disruption. Self-organisation is very poor, other people are hardly understood or are experienced as threats, and meaningful relationships are largely absent.
Criterion B: five trait domains, 25 facets
Frequent and intense distressing emotions such as anxiety, sadness and anger, with a matching pull toward emotional instability and a sense of insecurity.
- Emotional lability
- Feelings that shift quickly, are easily triggered, and are out of proportion to events.
- Anxiousness
- Strong feelings of nervousness, tension or dread, and worry about the effects of past or future events.
- Separation insecurity
- Fear of being alone and without the support of close others, with worry about rejection or losing independence.
- Submissiveness
- Adapting one's own behaviour to the real or imagined wishes of others, often at the cost of one's own needs.
- Hostility
- Persistent or frequent anger and irritability, responding to small slights with disproportionate resentment or meanness.
- Perseveration
- Staying stuck on a task or way of acting long after it stops being useful, and continuing despite repeated failure.
Pulling away from other people and from emotional experience, with limited capacity for closeness and for pleasure.
- Withdrawal
- Preference for being alone, reticence in social situations, and little initiation of contact.
- Intimacy avoidance
- Steering clear of close or romantic relationships and of emotionally or sexually intimate contact.
- Anhedonia
- Little enjoyment of, engagement in or energy for life experiences, and trouble feeling interest or pleasure.
- Depressivity
- Frequent low mood, hopelessness and shame, a sense of worthlessness, and sometimes suicidal thinking.
- Restricted affectivity
- Muted emotional reactions, little expressed feeling, and indifference or coldness in situations that would usually draw a response.
- Suspiciousness
- Expecting to be mistreated or harmed, doubting others' loyalty and intentions, and feeling easily slighted.
Behaviour that sets the person against others: an inflated sense of self-importance together with little regard for others' feelings, often with exploitation as a result.
- Manipulativeness
- Using subterfuge, charm or indirect influence to get one's way with others.
- Deceitfulness
- Dishonesty and fraud, including misrepresenting oneself and embellishing or fabricating events.
- Grandiosity
- A belief that one is better than others and deserves special treatment, with condescension toward them.
- Attention seeking
- Acting to be the focus of notice and admiration, and drawing others' attention to oneself.
- Callousness
- Lack of concern for others' feelings or problems and little guilt about the harm one causes, sometimes with cruelty.
A pull toward immediate gratification and acting on the moment, with little weight given to past lessons or future consequences. Its opposite pole is compulsivity.
- Irresponsibility
- Disregard for obligations and commitments, and failure to honour agreements or promises.
- Impulsivity
- Acting on the spur of the moment, without a plan or thought for outcomes, and difficulty holding back.
- Distractibility
- Trouble concentrating and staying on task, with attention pulled away by whatever else is happening.
- Risk taking
- Engaging in dangerous, needless activities without concern for consequences, and not recognising one's own limits.
- Rigid perfectionism (lack of)
- Placed here as the opposite pole of disinhibition. Insisting on flawless, rule-bound performance and sacrificing flexibility, timeliness and efficiency for it. Used to describe obsessive-compulsive features.
Odd, eccentric or unusual behaviours, thoughts and perceptions that depart from what is culturally typical.
- Unusual beliefs and experiences
- Thinking that one has odd or unusual experiences, such as feeling that thoughts are controlled by outside forces, or beliefs that are not culturally shared.
- Eccentricity
- Odd, peculiar or strange behaviour, appearance or speech, and saying unexpected or inappropriate things.
- Perceptual dysregulation
- Experiences that feel unreal or not one's own, or perceptions that are distorted in ways others would not share.
Some facets also load on a second domain in the manual (hostility on Antagonism, for example). Each is listed once here under its primary domain.
Types retained in the model
Click a type to see its trait-domain levels, 0 to 3, alongside the Criterion B domains above.
Typical traits: Antagonism (manipulativeness, callousness, deceitfulness, hostility) and Disinhibition (irresponsibility, impulsivity, risk taking).
Categorical pageTypical traits: Negative Affectivity (anxiousness) and Detachment (withdrawal, intimacy avoidance, anhedonia).
Categorical pageTypical traits: Negative Affectivity (emotional lability, anxiousness, separation insecurity, depressivity), Disinhibition (impulsivity, risk taking) and Antagonism (hostility).
Categorical pageTypical traits: Antagonism (grandiosity, attention seeking).
Categorical pageTypical traits: Rigid perfectionism (the compulsivity end of the Disinhibition axis), with Negative Affectivity (perseveration) and Detachment (intimacy avoidance, restricted affectivity).
Categorical pageTypical traits: Psychoticism (unusual beliefs and experiences, eccentricity, perceptual dysregulation), with Detachment (restricted affectivity, withdrawal) and suspiciousness.
Categorical pageUsed when Criterion A impairment and pathological traits are present but the pattern does not match one of the six specific types. The clinician records the level of functioning and the prominent trait domains and facets, so the diagnosis is the profile itself.
The paranoid, schizoid, histrionic and dependent types have no separate entry in the model. Those presentations are described with Criterion A and a trait profile.
How it differs in use
Categorical (Section II)Does the person meet enough listed criteria for a named disorder?
Alternative Model (Section III)How impaired is the person, and which traits describe how it shows up?
Categorical (Section II)A yes or no for each disorder, judged by a criteria count.
Alternative Model (Section III)A severity rating (Level 0 to 4) plus a trait profile across domains and facets.
Categorical (Section II)Frequent comorbidity and a large 'unspecified' group.
Alternative Model (Section III)Shared traits are described once, which reduces forced multiple diagnoses.
Categorical (Section II)Section II, the official diagnostic system used for diagnosis and coding.
Alternative Model (Section III)Section III, emerging measures and models, included for further study.