762 Alternative DSM-5 Model for Personality Disorders
A diagnosis of a personality disorder requires  two determinations: 1) an assessment of
the level of impairment in personality functi oning, which is needed for Criterion A, and 2)
an evaluation of pathological personality trai ts, which is required for Criterion B. The im-
pairments in personality functioning and person ality trait expression are relatively inflex-
ible and pervasive across a broad range of pers onal and social situations (Criterion C);
relatively stable across time, with onsets that can be traced back to at least adolescence or
early adulthood (Criterion D); not better explained by another mental disorder (Criterion
E); not attributable to the effects of a substance or another medical condition (Criterion F);
and not better understood as normal for an individual’s developmental stage or sociocul-
tural environment (Criterion G). All Section II I personality disorders described by criteria
sets, as well as PD-TS, meet these general criteria, by definition.
Criterion A: Level of Personality Functioning
Disturbances in self  and interpersonal  functioning constitute the core of personality psy-
chopathology and in this alternative diagnostic  model they are evaluated on a continuum.
Self functioning involves identity and sel f-direction; interpersonal functioning involves
empathy and intimacy (see Table 1). The Level of Personality Functioning Scale (LPFS; see
Table 2, pp. 775–778) uses each of these elements to differentiate five levels of impairment,
ranging from little or no impair ment (i.e., healthy, adaptive functioning; Level 0) to some
(Level 1), moderate (Level 2), severe (Lev el 3), and extreme (Level 4) impairment.
Impairment in personality functioning predicts the presence of a personality disorder,