776 Alternative DSM-5 Model for Personality Disorders2—Moderate 
impairmentDepends excessively on others 
for identity definition, with 
compromised boundary delin-
eation.
Has vulnerable self-esteem con-
trolled by exaggerated concern 
about external evaluation, with 
a wish for approval. Has sense 
of incompleteness or inferior-
ity, with compensatory 
inflated, or deflated, 
self-appraisal.
Emotional regulation depends 
on positive external appraisal. 
Threats to self-esteem may 
engender strong emotions such 
as rage or shame.Goals are more often a means 
of gaining external approval 
than self-generated, and 
thus may lack coherence 
and/or stability.
Personal standards may be 
unreasonably high (e.g., a 
need to be special or please 
others) or low (e.g., not con-
sonant with prevailing 
social values). Fulfillment is 
compromised by a sense of 
lack of authenticity.
Has impaired capacity to 
reflect on internal experi-
ence.Is hyperattuned to the experi-
ence of others, but only with 
respect to perceived rele-
vance to self.
Is excessively self-referential; 
significantly compromised 
ability to appreciate and 
understand others’ experi-
ences and to co nsider alterna-
tive perspectives.
Is generally unaware of or 
unconcerned about effect of 
own behavior on others, or 
unrealistic appraisal of own 
effect.Is capable of forming and desires to 
form relationships in personal and 
community life, but connections 
may be largely superficial.
Intimate relationships are predomi-