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Table 4 Examples of specific disturbances in personality functioning

From: Application of the ICD-11 classification of personality disorders

Mild Personality Disorder Moderate Personality Disorder Severe Personality Disorder
The individual’s sense of self may be somewhat contradictory and inconsistent with how others view them. The individual’s sense of self may become incoherent in times of crisis. The individual’s self-view is very unrealistic and typically is highly unstable or internally contradictory.
The individual has difficulty recovering from injuries to self-esteem. The individual has considerable difficulty maintaining positive self-esteem or, alternatively, has an unrealistically positive self-view that is not modified by evidence to the contrary. The individual has serious difficulty with regulation of self-esteem, emotional experience and expression, and impulses, as well as other aspects of behaviour (e.g., perseveration, indecision).
The individual’s ability to set appropriate goals and to work towards them is compromised; the individual has difficulty handling even minor setbacks. The individual exhibits poor emotion regulation in the face of setbacks, often becoming highly upset and giving up easily. Alternatively, the individual may persist unreasonably in pursuit of goals that have no chance of success. The individual is largely unable to set and pursue realistic goals.
The individual may have conflicts with supervisors and co-workers, but is generally able to sustain employment. The individual may exhibit little genuine interest in or efforts toward sustained employment. The individual is unwilling or unable to sustain regular work due to lack of interest or effort, poor performance (e.g., failure to complete assignments or perform expected roles, unreliability), interpersonal difficulties, or inappropriate behaviour (e.g., fits of temper, insubordination).
The individual’s limitations in the ability to understand and appreciate others’ perspectives create difficulties in developing close and mutually satisfying relationships. Major limitations in the ability to understand and appreciate others’ perspectives hinder developing close and mutually satisfying relationships. The individual’s interpersonal relationships, if any, lack mutuality; are shallow, extremely one-sided, unstable, and/or highly conflictual, often to the point of violence.
There may be estrangement in some relationships, but relationships are more commonly characterized by intermittent or frequent, minor conflicts that are not so severe that they cause serious and long-standing disruption. Alternatively, relationships may be characterized by dependence and avoidance of conflict by giving in to others, even at some cost to themselves. Problems in those relationships that do exist are common and persistent; may involve frequent, serious, and volatile conflict; and typically are quite one-sided (e.g., very strongly dominant or highly submissive). Family relationships are absent (despite having living relatives) or marred by significant conflict.
The individual has extreme difficulty acknowledging unwanted emotions (e.g., does not recognize or acknowledge experiencing anger, sadness, or other emotion).
Under stress, there may be some distortions in the individual’s situational and interpersonal appraisals but reality testing remains intact. Under stress there are marked distortions in the individual’s situational and interpersonal appraisals. There may be mild dissociative states or psychotic-like beliefs or perceptions (e.g., paranoid ideas). Under stress, there are extreme distortions in the individual’s situational and interpersonal appraisals. There are often dissociative states or psychotic-like beliefs or perceptions (e.g., extreme paranoid reactions).
  1. Note. The examples should be accompanied with the diagnostic guideline provided in Table 3. Adapted from the ICD-11 Clinical Descriptions and Diagnostic Guidelines for Personality Disorder. All five levels of personality functioning are described and exemplified in Additional file 1