Prominent personality traits or patterns

Description

Trait domain qualifiers may be applied to Personality Disorders or Personality Difficulty to describe the characteristics of the individual’s personality that are most prominent and that contribute to personality disturbance. Trait domains are continuous with normal personality characteristics in individuals who do not have Personality Disorder or Personality Difficulty. Trait domains are not diagnostic categories, but rather represent a set of dimensions that correspond to the underlying structure of personality. As many trait domain qualifiers may be applied as necessary to describe personality functioning. Individuals with more severe personality disturbance tend to have a greater number of prominent trait domains. [1]

Diagnostic requirements

WHO clinical descriptions and diagnostic requirements [1,2].

Subcategories

• 6D11.0 Negative affectivity in personality disorder or personality difficulty

  The core feature of the Negative Affectivity trait domain is the tendency to experience a broad range of negative emotions. Common manifestations of Negative Affectivity, not all of which may be present in a given individual at a given time, include: experiencing a broad range of negative emotions with a frequency and intensity out of proportion to the situation; emotional lability and poor emotion regulation; negativistic attitudes; low self-esteem and self-confidence; and mistrustfulness. [1]

  The core feature of the Negative Affectivity trait domain (sometimes referred to as Neuroticism) is the tendency to experience a broad range of negative emotions. Common manifestations of Negative Affectivity, not all of which may be present in a given individual at a given time, include the following:

  • Experiencing a broad range of negative emotions with a frequency and intensity out of proportion to the situation. Common negative emotions include but are not limited to anxiety, worry, depression, vulnerability, fear, anger, hostility, guilt, and shame. The particular negative emotions that are most characteristic of any particular person vary across individuals and are largely dependent on the presence or degree of other trait domains. For example, individuals high on Dissociality are more likely to experience ‘externalizing’ negative emotions (e.g., anger, hostility, contempt), whereas those high on Detachment are more likely to experience ‘internalizing’ negative emotions (e.g., anxiety, depression, pessimism, guilt).
  • Emotional lability and poor emotion regulation. Individuals high on Negative Affectivity are overreactive to both their own negative cognitions and to external events. They can become overwrought through their own thought processes, such as by ruminating over their shortcomings or past mistakes, over real or perceived threats, slights, or insults; or over potential future problems. They are overreactive to external threats or criticism, problems, and setbacks. They have low frustration tolerance and easily become visibly upset over even minor issues. They often experience and display multiple emotions simultaneously or vacillate among a range of emotions in a short period of time. Once upset, they have difficulty regaining their composure and must rely on others or on leaving the situation to calm down.
  • Negativistic attitudes. Individuals high on Negative Affectivity typically reject others’ suggestions or advice, arguing that enacting others’ ideas would be too complicated or difficult; or that the suggested actions would not lead to the desired outcomes or have a high likelihood of negative consequences. The manner of rejection is largely dependent on the individual’s other traits. For example, those high on Detachment are most likely to blame themselves for the likely difficulties or poor outcomes, whereas those high on Dissociality are most likely to blame others for offering such bad ideas.
  • Low self-esteem and self-confidence. Individuals high on Negative Affectivity may exhibit low self-esteem and self-confidence in several different ways. These include: avoidance of situations and activities that either are judged to be too difficult (e.g., intellectually, physically, socially, interpersonally, emotionally, etc.), even despite evidence to the contrary; dependency, which may be manifested in frequent reliance on others for advice, direction, and other kinds of help; envy of others’ abilities and indicators of success; and, in more severe cases of low self-esteem, believing themselves to be useless, to have lived a worthless life, to be incapable of accomplishing anything of value, which may be associated with suicidal ideation or behaviours.
  • Mistrustfulness. Interpersonally, this is typically manifested as suspicion that others have ill intent, and that neutral or even benign remarks and positive behaviours are hidden threats, slights, or insults. Individuals high on Negative Affectivity tend to hold grudges and be unforgiving even over long time periods. In non-interpersonal situations, this mistrustfulness typically takes the form of bitterness and cynicism (e.g., the belief that the ‘system is rigged’).
• 6D11.1 Detachment in personality disorder or personality difficulty

  The core feature of the Detachment trait domain is the tendency to maintain interpersonal distance (social detachment) and emotional distance (emotional detachment). Common manifestations of Detachment, not all of which may be present in a given individual at a given time, include: social detachment (avoidance of social interactions, lack of friendships, and avoidance of intimacy); and emotional detachment (reserve, aloofness, and limited emotional expression and experience). [1]

  The core feature of the Detachment trait domain is the tendency to maintain interpersonal distance (social detachment) and emotional distance (emotional detachment). Common manifestations of Detachment, not all of which may be present in a given individual at a given time, include the following:

  • Social detachment. Social detachment is characterized by avoidance of social interactions, lack of friendships, and avoidance of intimacy. Individuals high on Detachment do not enjoy social interactions and avoid all kinds of social contact and social situations to the extent possible. They engage in little to no ‘small talk’ even if initiated by others (e.g., at store check-out counters), seek out employment that does not involve interactions with others, and even refuse promotions if these would entail more interaction with others. They have few to no friends or even casual acquaintances. Their interactions with family members tend to be minimal and superficial. They rarely, if ever, engage in any intimate relationships and are not particularly interested in sexual relations.
  • Emotional detachment. Emotional detachment is characterized by reserve, aloofness, and limited emotional expression and experience. Individuals high on Detachment keep to themselves to the extent possible, even in obligatory social situations. They are typically aloof and respond to direct attempts at social engagement only briefly and in ways that discourage further conversation. Emotional detachment also encompasses emotional inexpressiveness, both verbally and non-verbally. Individuals high on Detachment do not talk about their feelings and it is difficult to discern what they might be feeling from their behaviours. In extreme cases, there is a lack of emotional experience itself and they are non-reactive to either negative or positive events, with a limited capacity for enjoyment.
• 6D11.2 Dissociality in personality disorder or personality difficulty

  The core feature of the Dissociality trait domain is disregard for the rights and feelings of others, encompassing both self-centeredness and lack of empathy. Common manifestations of Dissociality, not all of which may be present in a given individual at a given time, include: self-centeredness (e.g., sense of entitlement, expectation of others’ admiration, positive or negative attention-seeking behaviours, concern with one's own needs, desires and comfort and not those of others); and lack of empathy (i.e., indifference to whether one’s actions inconvenience or hurt others, which may include being deceptive, manipulative, and exploitative of others, being mean and physically aggressive, callousness in response to others' suffering, and ruthlessness in obtaining one’s goals). [1]

  The core feature of the Dissociality trait domain is disregard for the rights and feelings of others, encompassing both self-centeredness and lack of empathy. Common manifestations of Dissociality, not all of which may be present in a given individual at a given time, include the following:

  • Self-centeredness. Self-centeredness in individuals high on Dissociality is manifested in a sense of entitlement, believing and acting as if they deserve—without further justification—whatever they want, preferentially above what others may want or need, and that this ‘fact’ should be obvious to others. Self-centeredness can be manifested both actively/intentionally and passively/unintentionally. Active—and usually intentional—manifestations of self-centeredness include expectation of others’ admiration, attention-seeking behaviours to ensure being the center of others’ focus, and negative behaviours (e.g., anger, ‘temper tantrums,’ denigrating others) when the admiration and attention that the individual expects are not granted. Typically, such individuals believe that they have many admirable qualities, that their accomplishments are outstanding, that they have or will achieve greatness, and that others should admire them. Passive and unintentional manifestations of self-centeredness reflect a kind of obliviousness that other individuals matter as much as oneself. In this aspect of Dissociality, the individuals’ concern is with their own needs, desires, and comfort, and those of others simply are not considered.
  • Lack of empathy. Lack of empathy is manifested as indifference to whether one’s actions inconvenience others or hurt them in any way (e.g., emotionally, socially, financially, physically, etc.). As a result, individuals high on Dissociality are often deceptive and manipulative, exploiting people and situations to get what they want and think they deserve. This may include being mean and physically aggressive. In the extreme, this aspect of Dissociality can be manifested as callousness with regard to others’ suffering, and ruthlessness in obtaining one’s goals, such that these individuals may be physically violent with little to no provocation and may even take pleasure in inflicting pain and harm. Note that this aspect of Dissociality does not necessarily imply that individuals high on Dissociality do not cognitively understand the feelings of others, only that they are not concerned about them and instead are likely to use this understanding to exploit others.
• 6D11.3 Disinhibition in personality disorder or personality difficulty

  The core feature of the Disinhibition trait domain is the tendency to act rashly based on immediate external or internal stimuli (i.e., sensations, emotions, thoughts), without consideration of potential negative consequences. Common manifestations of Disinhibition, not all of which may be present in a given individual at a given time, include: impulsivity; distractibility; irresponsibility; recklessness; and lack of planning. [1]

  The core feature of the Disinhibition trait domain is the tendency to act rashly based on immediate external or internal stimuli (i.e., sensations, emotions, thoughts), without consideration of potential negative consequences. Common manifestations of Disinhibition, not all of which may be present in a given individual at a given time, include the following:

  • Impulsivity. Individuals high on Disinhibition tend to act rashly based on whatever is compelling at the moment, without consideration of negative consequences for oneself or others, including putting oneself or others at physical risk. They have difficulty delaying reward or satisfaction and tend to pursue immediately available short-term pleasures or potential benefits. In this way, the trait is strongly associated with such behaviours as substance use, gambling, and impulsive sexual activity.
  • Distractibility. Individuals high on Disinhibition also have difficulty staying focused on important and necessary tasks that require sustained effort. They quickly become bored or frustrated with difficult, routine, or tedious tasks, and are easily distracted by extraneous stimuli, such as others’ conversations. Even in the absence of distractions, they have difficulty keeping their attention focused and persisting on tasks, and tend to scan the environment for more enjoyable options.
  • Irresponsibility. Individuals high on Disinhibition are unreliable and lack a sense of accountability for their actions. As a result, they often do not complete work assignments or perform expected duties; they fail to meet deadlines, do not follow through on commitments and promises, and are late to or miss formal and informal appointments and meetings because they allow themselves to become engaged in something more compelling that has caught their attention.
  • Recklessness. Individuals high on Disinhibition lack an appropriate sense of caution. They tend to overestimate their abilities and thus frequently do things that are beyond their skill level, without considering potential safety risks. Individuals high on Disinhibition may engage in reckless driving or dangerous sports, or perform other activities that put them or others in physical danger without sufficient preparation or training.
  • Lack of planning. Individuals high on Disinhibition prefer spontaneous over planned activities, leaving their options open should a more attractive opportunity arise. They tend to focus on immediate feelings, sensations, and thoughts, with relatively little attention paid to longer term or even short-term goals. When they do make plans, they often fail to follow through on them, thus they seldom are able to reach long-term goals and often fail to achieve even short-term goals.
• 6D11.4 Anankastia in personality disorder or personality difficulty

  The core feature of the Anankastia trait domain is a narrow focus on one’s rigid standard of perfection and of right and wrong, and on controlling one’s own and others’ behaviour and controlling situations to ensure conformity to these standards. Common manifestations of Anankastia, not all of which may be present in a given individual at a given time, include: perfectionism (e.g., concern with social rules, obligations, and norms of right and wrong, scrupulous attention to detail, rigid, systematic, day-to-day routines, hyper-scheduling and planfulness, emphasis on organisation, orderliness, and neatness); and emotional and behavioural constraint (e.g., rigid control over emotional expression, stubbornness and inflexibility, risk-avoidance, perseveration, and deliberativeness). [1]

  The core feature of the Anankastia trait domain is a narrow focus on one’s rigid standard of perfection and of right and wrong, and on controlling one’s own and others’ behaviour and controlling situations to ensure conformity to these standards. Common manifestations of Anankastia, not all of which may be present in a given individual at a given time, include:

  • Perfectionism. Perfectionism is manifested in concern with social rules, obligations, norms of right and wrong; scrupulous attention to detail; rigid, systematic, day-to-day routines; excessive scheduling and planning; and an emphasis on organization, orderliness, and neatness. Individuals high on Anankastia have a very clear and detailed personal sense of perfection and imperfection that also extends beyond community standards to encompass the individual’s idiosyncratic notions of what is perfect and right. They believe strongly that everyone should follow all rules exactly and meet all obligations. Individuals with high on Anankastia may redo the work of others because it does not meet their perfectionistic standards. They have difficulty in interpersonal relationships because they hold others to the same standards as themselves and are inflexible in their views.
  • Emotional and behavioural constraint. Emotional and behavioural constraint is manifested in rigid control over emotional expression, stubbornness and inflexibility, risk-avoidance, perseveration, and deliberativeness. Individuals with prominent Anankastic traits tightly control their own emotional expression and disapprove of others’ displays of emotion. They are inflexible and lack spontaneity, stubbornly insisting on following set schedules and adhering to plans. Their risk-avoidance includes both refusal to engage in obviously risky activities and a more general over-concern about avoiding potential negative consequences of any activity. They often perseverate and have difficulty disengaging from tasks because they are perceived as not yet perfect down to the last detail. They are highly deliberative and have difficulty making decisions due to concern that they have not considered every aspect and all alternatives to ensure that the right decision is made.
• 6D11.5 Borderline pattern

  The Borderline pattern specifier may be applied to individuals whose pattern of personality disturbance is characterised by a pervasive pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsivity, as indicated by many of the following: Frantic efforts to avoid real or imagined abandonment; A pattern of unstable and intense interpersonal relationships; Identity disturbance, manifested in markedly and persistently unstable self-image or sense of self; A tendency to act rashly in states of high negative affect, leading to potentially self-damaging behaviours; Recurrent episodes of self-harm; Emotional instability due to marked reactivity of mood; Chronic feelings of emptiness; Inappropriate intense anger or difficulty controlling anger; Transient dissociative symptoms or psychotic-like features in situations of high affective arousal. [1]

  Note: The Borderline pattern specifier has been included to enhance the clinical utility of the classification of Personality Disorder. There is considerable overlap between this pattern and information contained in the trait domain specifiers (most typically Negative Affectivity, Dissociality and Disinhibition). However, use of this specifier may facilitate the identification of individuals who may respond to certain psychotherapeutic treatments.

  The Borderline pattern specifier may be applied to individuals whose pattern of personality disturbance is characterized by a pervasive pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsivity, as indicated by five (or more) of the following:

  • Frantic efforts to avoid real or imagined abandonment.
  • A pattern of unstable and intense interpersonal relationships, which may be characterized by vacillations between idealization and devaluation, typically associated with both strong desire for and fear of closeness and intimacy.
  • Identity disturbance, manifested in markedly and persistently unstable self-image or sense of self.
  • A tendency to act rashly in states of high negative affect, leading to potentially self-damaging behaviours (e.g., risky sexual behaviour, reckless driving, excessive alcohol or substance use, binge eating).
  • Recurrent episodes of self-harm (e.g., suicide attempts or gestures, self-mutilation).
  • Emotional instability due to marked reactivity of mood. Fluctuations of mood may be triggered either internally (e.g., by one’s own thoughts) or by external events. As a consequence, the individual experiences intense dysphoric mood states, which typically last for a few hours but may last for up to several days.
  • Chronic feelings of emptiness.
  • Inappropriate intense anger or difficulty controlling anger manifested in frequent displays of temper (e.g., yelling or screaming, throwing or breaking things, getting into physical fights).
  • Transient dissociative symptoms or psychotic-like features (e.g., brief hallucinations, paranoia) in situations of high affective arousal.

  Other manifestations of Borderline pattern, not all of which may be present in a given individual at a given time, include the following:

  • A view of the self as inadequate, bad, guilty, disgusting, and contemptible.
  • An experience of the self as profoundly different and isolated from other people; a painful sense of alienation and pervasive loneliness.
  • Proneness to rejection hypersensitivity; problems in establishing and maintaining consistent and appropriate levels of trust in interpersonal relationships; frequent misinterpretation of social signals.

References

1. World Health Organization. International Classification of Diseases, 11th Revision, for Mortality and Morbidity Statistics (ICD-11 MMS), 2026-01 release. World Health Organization; 2026.
2. World Health Organization. Clinical Descriptions and Diagnostic Requirements for ICD-11 Mental, Behavioural or Neurodevelopmental Disorders (CDDR). World Health Organization; 2024.

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