Personality theory in formulation and nosology (MEQ)

(i) Definitions and threshold. Personality: relatively enduring patterns of thinking, feeling, relating, and behaving. Traits: measurable dimensional individual differences (FFM/OCEAN as the dominant descriptive map).^[1] Personality disorder threshold: pervasive, inflexible patterns leading to clinically significant distress or impairment in self and/or interpersonal functioning — not eccentricity or single-context conflict alone.^[13]

(ii) FFM and AMPD map. High neuroticism fits internalising vulnerability and affective instability; low conscientiousness fits impulsivity/disorganisation; antagonism facets fit interpersonal conflict — continuous with maladaptive trait domains rather than a separate species of person.^[1][8][10] AMPD A: impaired identity, self-direction, and intimacy (and likely empathy fluctuations). AMPD B: elevations expected in negative affectivity, antagonism, and disinhibition (PID-5 domain language).^[10][15]

(iii) ICD-11 vs stacked categories. ICD-11 rates severity of personality dysfunction first, then applies trait qualifiers (and borderline pattern qualifier where appropriate), avoiding three quasi-independent categorical labels that largely describe one severity problem with mixed traits.^[13][14]

(iv) 4P sketch. Predisposing: high N, low C, antagonism, possible attachment adversity. Precipitating: rejection/loss cues. Perpetuating: idealisation–devaluation cycles, avoidance of abandonment, secondary depression. Protective: help-seeking, residual strengths, any supportive relationships. Treat depression actively while planning structured psychotherapy matched to emotion dysregulation and mentalising/identity problems.^[8][13]

(v) Pitfalls. State–trait: do not finalise PD severity solely in the depths of untreated major depression — restabilise and reassess longitudinal patterns.^[8] Stigma/care denial: personality formulation guides engagement and therapy selection; it never justifies refusing risk assessment or evidence-based care.^[13]