Alternative DSM-5 Model for Personality Disorders 7773—Severe 
impairmentHas a weak sense of autonomy/
agency; experience of a lack of 
identity, or emptiness. Bound-
ary definition is poor or rigid: 
may show overidentification 
with others, overemphasis on 
independence from others, or 
vacillation between these.
Fragile self-esteem is easily influ-
enced by events, and self-image 
lacks coherence. Self-appraisal 
is un-nuanced: self-loathing, 
self-aggrandizing, or an illogi-
cal, unrealistic combination.
Emotions may be rapidly shifting 
or a chronic, unwavering feel-
ing of despair.Has difficulty establishing 
and/or achieving personal 
goals.
Internal standards for behav-
ior are unclear or contradic-
tory. Life is experienced as 
meaningless or dangerous.
Has significantly compro-
mised ability to reflect on 
and understand own mental 
processes.Ability to consider and under-
stand the thoughts, feelings, 
and behavior of other people 
is significantly limited; may 
discern very specific aspects 
of others’ experience, particu-
larly vulnerabilities and suf-
fering.
Is generally unable to consider 
alternative perspectives; 
highly threatened by differ-
ences of opinion or alterna-
tive viewpoints.
Is confused about or unaware 
of impact of own actions on 
others; often bewildered 
about peoples’ thoughts and 
actions, with destructive 
motivations frequently 
misattributed to others.Has some desire to form relation-
ships in community and personal 
life is present, but capacity for pos-
itive and enduring connections is 
significantly impaired.