A. Moderate or greater impairment in personality functioning, manifested by characteristic
difficulties in two or more of the following four areas:
1. Identity: Egocentrism; self-esteem derived from personal gain, power, or pleasure.
2. Self-direction: Goal setting based on personal gratification; absence of prosocial
internal standards, associated with failure to conform to lawful or culturally normative
3. Empathy: Lack of concern for feelings, needs, or suffering of others; lack of remorse
after hurting or mistreating another.
4. Intimacy: Incapacity for mutually intimate relationships, as exploitation is a primary
means of relating to others, including by deceit and coercion; use of dominance or
intimidation to control others.
B. Six or more of the following seven pathological personality traits:
1. Manipulativeness (an aspect of Antagonism): Frequent use of subterfuge to influence
or control others; use of seduction, charm, glibness, or ingratiation to
achieve one’s ends.
2. Callousness (an aspect of Antagonism): Lack of concern for feelings or problems
of others; lack of guilt or remorse about the negative or harmful effects of one’s actions
on others; aggression; sadism.
3. Deceitfulness (an aspect of Antagonism): Dishonesty and fraudulence; misrepresentation
of self; embellishment or fabrication when relating events.
4. Hostility (an aspect of Antagonism): Persistent or frequent angry feelings; anger or
irritability in response to minor slights and insults; mean, nasty, or vengeful behavior.
5. Risk taking (an aspect of Disinhibition): Engagement in dangerous, risky, and potentially
self-damaging activities, unnecessarily and without regard for consequences;
boredom proneness and thoughtless initiation of activities to counter boredom; lack of
concern for one’s limitations and denial of the reality of personal danger.
6. Impulsivity (an aspect of Disinhibition): Acting on the spur of the moment in response
to immediate stimuli; acting on a momentary basis without a plan or consideration
of outcomes; difficulty establishing and following plans.7. Irresponsibility (an aspect of Disinhibition): Disregard for—and failure to honor—
financial and other obligations or commitments; lack of respect for—and lack of follow-
through on—agreements and promises.
Note. The individual is at least 18 years of age.