Stroke knowledge and awareness among adults in the West Bank: a cross-sectional study.

The dimensional perspective on personality disorders (PDs) has gained increasing empirical and theoretical support, as it aligns more closely with the complexity, heterogeneity, and continuity of personality pathology than traditional categorical models (). Contemporary dimensional frameworks, including the DSM-5 Alternative Model for Personality Disorders (AMPD) and the ICD-11 classification, conceptualize personality pathology in terms of impairments in personality functioning (severity) and maladaptive personality traits (style). Within these models, PDs are understood as maladaptive extremes of shared personality characteristics rather than discrete diagnostic entities (, ). Accumulating evidence indicates that impairments in personality functioning—reflecting difficulties in intrapersonal and interpersonal capacities—are the most robust predictors of PD presence, clinical severity, prognosis, and everyday functioning, whereas maladaptive traits primarily describe stylistic expressions of pathology (–). Whereas ICD-11 conceptualizes impaired personality functioning as the necessary and sufficient condition for a PD diagnosis, the DSM-5 AMPD requires both impaired functioning and the presence of one or more elevated maladaptive personality traits. The DSM-5 AMPD trait domains—negative affectivity, detachment, antagonism, disinhibition, and psychoticism—show substantial conceptual and empirical overlap with the Five-Factor Model (), a well-established framework for understanding normative personality variation across the lifespan. Evidence from both adult (, ) and adolescent samples () indicates that maladaptive personality traits largely represent extreme and negatively valenced variants of normative personality traits rather than qualitatively distinct constructs. This correspondence is particularly evident for negative affectivity, detachment, antagonism, and disinhibition, whereas psychoticism appears to show a less consistent relationship with normative personality dimensions, with evidence suggesting that it does not align closely with openness in the same manner as the other maladaptive trait domains correspond to Five-Factor Model dimensions (). Adolescence is widely recognized as a particularly sensitive developmental period for the emergence of personality pathology (). This period is characterized by rapid neurological and hormonal changes that influence emotion regulation strategies, impulse control, and cognitive control, alongside increasing autonomy and a developmental shift from parents toward peers (). These changes coincide with heightened instability in thinking, behavior, affect, and self-concept. Within this developmental context, identity formation represents a central task (, ), whereby normative identity confusion gradually resolves into a more coherent sense of self as neurodevelopment supports improvements in self-regulation and interpersonal functioning, including empathy and intimacy (). These developmental processes closely correspond to Criterion A of the DSM-5 AMPD, which captures impairments in identity, self-direction, empathy, and intimacy and provides a key developmental framework for understanding adolescent personality pathology (). Sharp’s developmental interpretation of the AMPD proposes that maladaptive personality traits reflect developmental continuity, whereas impairments in personality functioning represent a developmentally discontinuous shift that explains the emergence of PDs during adolescence (). As adolescents mature, capacities related to identity, self-direction, empathy, and intimacy become increasingly integrated through neurobiological development, advances in metacognitive and mentalizing abilities, and growing social demands. Personality pathology is proposed to arise when this integration fails, resulting in persistent impairments in self and interpersonal functioning. Longitudinal research supports this developmental framework. Impairments in self-functioning increase between ages 12 and 16 and subsequently decline in late adolescence (), while identity diffusion peaks in early adolescence and decreases into early adulthood (). Overall, personality pathology tends to emerge in early adolescence, peak in mid-adolescence, and decline into early adulthood for most individuals, although a smaller subgroup shows increasing and persistent difficulties that may reach diagnostic thresholds in adulthood (–). Severe impairments in personality functioning, particularly in the domain of the self, tend to remain stable and predict later PD diagnoses ().