What Is Personality Disorder-Trait Specified (PD-TS)?

Personality disorders are mental health conditions that involve long-lasting, unhealthy patterns in how someone feels, thinks, acts, and relates to others. People with personality disorders typically have maladaptive (inappropriate or inadequate to the particular situation) personality traits that impair their daily functioning in areas like work, school, and relationships.

Someone who exhibits these maladaptive traits but doesn’t meet all of the criteria for a specific personality disorder may be diagnosed with personality disorder-trait specified (PD-TS). Learn more about PD-TS, including symptoms, diagnosis, causes, and treatment options.

Definition

A personality disorder is a serious mental health condition involving long-term patterns of thinking and behavior that interfere with a person’s ability to function normally in day-to-day life. Many people with personality disorders experience emotional distress, social isolation, chaotic or broken relationships, and/or problems at work and school.

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) lists 10 personality disorders. Each of the following conditions involves different maladaptive traits and behaviors:

• Borderline personality disorder (BPD)
• Narcissistic personality disorder (NPD)
• Histrionic personality disorder (HPD)
• Antisocial personality disorder (ASPD)
• Dependent personality disorder (DPD)
• Avoidant personality disorder (AVPD)
• Schizotypal personality disorder (STPD)
• Schizoid personality disorder (SPD)
• Obsessive-compulsive personality disorder (OCPD)
• Paranoid personality disorder (PPD)

Someone may be diagnosed with personality disorder-trait specified (PD-TS) if they don’t meet all the criteria for any of the other personality disorders in the DSM-5. People with PD-TS exhibit maladaptive traits (also called pathological personality traits) that cause significant impairments in their relationships and/or self-concept.

PD-TS is sometimes called mixed personality disorder. It was previously known as personality disorder not otherwise specified (PD-NOS) in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-4).

Symptoms

Like people with any personality disorder, people with PD-TS experience significant, long-lasting problems in major areas of their life. These impairments may affect their relationship with themselves (in terms of their self-image or identity, for example), relationships with others, or both. 

People with PD-TS also exhibit maladaptive personality traits that persist over time. The broader categories are called trait domains, and each of the specific traits is called a facet. Some people may have all of the pathological traits in a given domain or multiple domains. Others may exhibit only one or two facets within a domain.

The trait domains and facets associated with PD-TS include:

• Negative affectivity: Emotional instability, anxiousness, separation insecurity, depression, submissiveness, passivity, suspiciousness
• Antagonism: Manipulativeness, hostility, callousness, dishonesty, attention-seeking, inflated ego, selfishness
• Disinhibition versus compulsivity: Impulsivity, risk-taking, inattentiveness, irresponsibility, or rigid perfectionism
• Detachment: Withdrawal, avoidance of intimacy, apathy, limited emotional range, low empathy
• Psychoticism: Eccentricity, unusual or odd beliefs, behaving in ways that violate cultural norms, disturbances in thinking and perception
  

Diagnosis

A psychiatrist or other healthcare provider can diagnose you with PD-TS using the criteria in the DSM-5. They may ask you about your personal and medical history, family, relationships, childhood experiences, and day-to-day life and perform psychological and behavioral assessments.

To meet the diagnostic criteria for personality disorder-not specified, your personality traits and problems with daily functioning must:

• Be at least moderately severe in one or more areas 
• Be stable and consistent over time and in a variety of contexts
• Not be more easily explained by age, developmental stage, another medical condition, or substance use

While some symptoms of personality disorders may be apparent among adolescents, most people are not diagnosed with a personality disorder until after the age of 18.

Causes

The exact cause of personality disorders remains unknown. However, ongoing research suggests that many interacting factors can contribute to developing a personality disorder. These include:

• Trauma: Childhood trauma—such as emotional, sexual, or physical abuse—is a significant risk factor for personality disorders, including PD-TS. Studies suggest that early emotional abuse is often linked to negative affectivity later in life. Meanwhile, childhood sexual abuse is often associated with traits like psychoticism and antagonism. 
• Genetics: Some personality disorders are passed down in families. According to twin and family studies, genetic factors account for between 21% and 66% of the variance in certain types of maladaptive traits.
• Neurological differences: Brain imaging studies have found that many people with personality disorders have abnormal activity levels in parts of the brain that are involved in emotional processing, decision-making, and impulsivity. Studies have also discovered differences in brain structure, size, and function among people with personality disorders.
• Other mental health conditions: Most people with personality disorders have comorbid (co-occurring) mental health conditions. Major depressive disorder (MDD), bipolar disorder, anxiety disorders, substance use disorders (SUDs), and eating disorders (EDs) are particularly common.
  

Treatment

Treatment for PD-TS and other personality disorders typically involves psychotherapy, either individually or in a group setting. 

Therapy options for people with personality disorders include:

• Cognitive behavioral therapy (CBT): Through cognitive behavioral therapy, people with personality disorders can improve their decision-making and problem-solving skills, understand the impact of their behavior on others, and identify their negative thought patterns.
• Dialectical behavioral therapy (DBT): Dialectical behavioral therapy draws from CBT and mindfulness practices. DBT allows people with personality disorders to improve emotional regulation, resist harmful impulses, and stay present in the moment.
• Transference-focused therapy (TFP): Transference-focused therapy is a type of psychodynamic therapy (PDT) that allows people to gain insight into their emotions and motivations. TFP can help people with PD-TS and other personality disorders to develop a more coherent identity and cohesive self-image.
• Mentalization-based therapy (MBT): Mentalization-based therapy, another type of psychodynamic therapy, can work to improve interpersonal relationships and boost empathy.
• Marriage and family therapy: Many people with personality disorders have trouble maintaining healthy relationships with their loved ones. Therapy can help couples and families learn to resolve conflicts and communicate more effectively.
• Psychoeducation: Psychoeducation is a short-term intervention that provides family members with a deeper understanding of personality disorder symptoms so they can offer more effective support.
• Social skills training: People with personality disorders can often improve their ability to read social cues and get along with others through social skills training.

Medication is typically not the first-line treatment for people with personality disorders. However, some people with PD-TS may be prescribed medication (such as antianxiety drugs, antipsychotics, antidepressants, or mood stabilizers) to help with the symptoms of comorbid mental health conditions.

Summary

Personality disorders are mental health conditions that involve ongoing unhealthy patterns in thinking, behavior, feelings, and relationships.

The DSM-5 lists 10 personality disorders. People who don’t meet the criteria for one of the personality disorders in the DSM-5 are sometimes diagnosed with personality disorder-trait specified (PD-TS).

People with PD-TS have maladaptive personality traits that cause significant impairments in daily functioning. These pathological personality traits fall into one or more categories: negative affectivity, disinhibition versus compulsivity, antagonism, psychoticism, and detachment.

Researchers haven’t identified one particular cause of PD-TS. Genetics, environment, and trauma often interact to increase the likelihood that someone will develop a personality disorder. Treatment for personality disorders typically involves psychotherapy.

A Word From Verywell

You're not alone if you think you may have a personality disorder. Personality disorders are common and treatable. Reach out to your healthcare provider to learn more about available resources, treatment, and support.