756 vII. APPLICATIONS  AND  IMPLICATIONS
cits (Criterion A) and a set of maladaptive 
personality traits (Criterion B). The self and 
interpersonal deficits were obtained from 
psychodynamic literature, which has sug -
gested that fundamental and unique to all 
personality disorders are deficits in the sense 
of self and interpersonal relatedness (Kern -
berg, 2012). The traits were obtained from 
the dimensional trait model.
The hybrid proposal for DSM-5 was ap -
proved by the DSM-5 Task Force but ulti -
mately rejected by a scientific oversight com -
mittee (Skodol, Morey, Bender, & Oldham, 
2013; Widiger, 2013). That was not particu -
larly surprising given the absence of any re -
search on the hybrid model. In the end, all 
of the DSM-IV (American Psychiatric As -
sociation, 1994) diagnoses were retained for 
DSM-5, unchanged. However, the proposed 
revisions were included in a Section III ap -
pendix (for emerging measures and models; 
American Psychiatric Association, 2013, 
p. 729).
An even more radical proposal was made 
for the personality disorders section of the 
World Health Organization’s (WHO) 11th 
edition of the International Classification 
of Diseases  (i.e., ICD-11). The ICD is the 
authoritative classification for the diagno -
sis of mental disorders for its 194 member 
states, which includes the United States. 
Each member country can alter the ICD 
in a manner that will be optimal for that 
particular country. Indeed, DSM-IV was 
America’s version of ICD-10. Proposed for 
ICD-11 was the deletion of all of the per -
sonality disorder categories, to be replaced 
by a five-  domain dimensional trait model, 
along with a rating of overall level of sever -
ity (Tyrer et al., 2011). This proposal met 
substantial opposition in the final year of 
its consideration (Herpertz et al., 2017). 
However, an approved compromise revision 
(Reed, 2018) comprised a modified version 
of the level of severity (now including self– 
interpersonal deficits comparable to those 
included in Criterion A of DSM-5 Sec -
tion III), the five-  domain dimensional trait 
model, and a borderline syndrome (Tyrer, 
Mulder, Kim, & Crawford, 2019). In sum -
mary, the forthcoming ICD-11 will retain 
only one of the personality disorder syn -
dromes of ICD-10 (WHO, 1992), replacing 
(for instance) the antisocial, dependent, his -trionic, and paranoid personality disorders 
with a dimensional trait model.
Our purpose in this chapter is to famil -
iarize the reader with DSM-5 Section II per -
sonality disorders, as these are the current 
official diagnoses within the United States. 
We cover as well, though, an understanding 
of these syndromes from the perspective of 
general personality structure, particularly 
the five-  factor model. Also considered will 
be the forthcoming ICD-11 personality dis -
orders section, along with the comparable 
proposal for DSM-5 that was placed in Sec -
tion III of the diagnostic manual.
DSM -5 Section II Personality Disorders
There is a significant body of research con -
cerning some of the DSM-5 Section II per -
sonality disorders, more specifically, the an -
tisocial, schizotypal, borderline, dependent, 
and narcissistic personality disorders. There 
are many studies involving the other five, but 
much of this research involves matters com -
mon to all 10 personality disorders. There 
is relatively little research addressing issues 
specific to or particularly important for the 
histrionic, avoidant, schizoid, paranoid, or 
obsessive–  compulsive disorders. There are 
some exceptions (e.g., research concerning 
the effort to differentiate avoidant personal -
ity disorder from generalized social phobia, 
and research concerning potential gender 
bias for histrionic disorder), but relative to 
the antisocial, schizotypal, borderline, de -
pendent, and narcissistic disorders, this re -
search literature is sparse. Another way to 
consider this point is that there are research -
ers (and edited texts) devoted specifically 
to the antisocial personality disorder (e.g., 
Robert Hare and David Cooke), the schizo -
typal (e.g., Larry Siever), the borderline (e.g., 
John Gunderson and Marsha Linehan), the 
dependent (e.g., Robert Bornstein), and the 
narcissistic (e.g., Elsa Ronningstam), but 
this has not been the case for the other five.
It is not really clear why the schizoid, par -
anoid, histrionic, avoidant, and obsessive– 
compulsive personality disorders have not 
generated as much research interest. Border -
line, schizotypal, and narcissistic disorders 
were new additions to DSM-III (American 
Psychiatric Association, 1980), reflecting at 