 36. Personality and Personality Disorder  767
intimacy; American Psychiatric Associa -
tion, 2013). ICD-11 also includes a level of 
severity, but it was never conceptualized to 
be distinct from the personality traits. In 
fact, its official assessment is provided by 
the Standardized Assessment of Severity 
of Personality Disorder (SASPD; Olajide et 
al., 2017), whose items were taken from the 
trait model. The level of severity was subse -
quently revised to include a bit of the self– 
interpersonal deficits of the LPF, but they 
only constitute a small part of the ICD-11 
level of severity.
The LPF deficits were derived from the 
psychoanalytic literature that does indeed 
consider them to define the core of all 
personality disorders (Bender, Morey, & 
Skodol, 2011; Kernberg, 2012). If the hy -
potheses that the LPF does identify the core 
of all personality disorders and is distinct 
from the maladaptive trait model, then this 
would render the trait model as largely an 
ancillary component in the understanding, 
diagnosis, and treatment of personality dis -
order (e.g., Hopwood, 2018). There has long 
been considerable opposition to conceptual -
izing the personality disorders as maladap -
tive variants of a dimensional trait model 
(e.g., Clarkin & Huprich, 2011; Gunderson, 
2013; Hopwood, 2011; Shedler et al., 2010). 
This debate has now largely shifted from 
coverage of the DSM-IV syndromes to the 
importance of the LPF and whether it is in 
fact distinct from the trait model (e.g., Few 
et al., 2013; J. Oltmanns & Widiger, 2016; 
see Widiger et al., 2019, for a review of this 
literature).
Conclusions
Personality is the result of an interaction 
between genetic dispositions and environ -
mental experiences. Such a process would 
certainly result in both adaptive and mal -
adaptive personality traits. It then seems 
only reasonable to have a nomenclature of 
personality disorders that is aligned with the 
nomenclature of general personality struc -
ture, allowing for a fully integrated dimen -
sional trait model of normal and abnormal 
personality functioning (Widiger & Costa, 
1994). Significant steps toward such a model 
have been implemented for ICD-11 (Tyrer et al., 2019) and proposed for DSM-5 (Krueger 
& Markon, 2014), but there remains sub -
stantial opposition to any such paradigm 
shift.
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