The following are case vignettes from the DSM-5 Web site describing how the newly proposed criteria for personality disorders might be used by clinicians.

• A 28-year-old single female who works as a manager for a city government has struggled with an unstable self-image, chronic feelings of emptiness, and difficulties maintaining close romantic relationships for all of her adult life. However, she has a few close female friends and is considered a good worker. Extremely self-critical, she attempts to boost her self-esteem by seeking the approval of others. She has been told that she is "needy and often seems desperate," which leads to some difficulties in maintaining romantic and other close relationships, although she often does not understand what she does that makes this impression. She experiences fluctuating strong emotions, such as panic, fear, depression, and anger in response to interpersonal disappointments. She has made several suicidal gestures by cutting herself in the past couple of years when stressed by the ending of a relationship.

This patient would likely meet criteria in DSM-5 for borderline personality disorder, but her level of personality functioning might be rated as less impaired than that of the more typical borderline patient, with enhanced prospects for successful treatment.

• A 14-year-old female has a history of maltreatment and shows some prodromal signs and symptoms that may foretell a future diagnosis of borderline personality, but the patient's personality is not yet fully matured. The patient exhibits signs and symptoms compatible with borderline personality disorder, including emotional lability, physical self-harm, and intense, unstable interpersonal relationships, more so than would be typical for her age-matched peers.

In the proposed DSM-5 system, this presentation could be recorded in the chart as a low level of personality functioning and the presence of specific personality traits (such as emotional lability). In this way, these potentially important clinical features are noted and can be followed as the patient matures, without requiring the potentially inappropriate use of a formal diagnosis of borderline personality disorder.

Clinicians are urged to visit <www.dsm5.org/ProposedRevision/Pages/PersonalityDisorders.aspx> for other case vignettes and comprehensive information about the newly proposed criteria.