Criterion A as Developmental Severity: Reclaiming the Psychodynamic Core of Personality Functioning

The Alternative Model for Personality Disorders (AMPD) distinguishes severity of personality dysfunction (Criterion A) from maladaptive trait expression (Criterion B). Debates about whether the Level of Personality Functioning Scale (LPFS) is unidimensional or multidimensional have attracted considerable attention but largely miss the point. Personality functioning, as conceived within psychodynamic developmental theory, is singular by definition-not because factor analyses extract a dominant factor but because psychological development itself is one process. The DSM-5 Work Group constructed Criterion A from psychodynamic instruments that interpret personality pathology as failures to develop a stable, coherent sense of self, and the capacity for meaningful relationships. Evidence for this developmental achievement appears in identity, self-direction, empathy, and intimacy, but these domains reflect facets of a single capacity rather than separable dimensions. This commentary traces the psychodynamic roots of Criterion A, integrates contemporary trait research to clarify how Criteria A and B differ conceptually, addresses key psychometric critiques, and outlines treatment implications.