Problems with the DSM-IV’s exclusively categorical approach to personality disorder diagnosis have been well-documented. These include extensive co-occurrence; extreme heterogeneity within personality disorder categories; criteria made up of inconsistent amalgams of impairments, traits, and symptomatic behaviors; temporal instability of diagnoses at rates incompatible with the basic definition of personality disorder; arbitrary diagnostic thresholds with little or no empirical basis; poor coverage of personality pathology; poor convergent validity; and limited predictive validity and clinical utility. Furthermore, the General Criteria for Personality Disorder (GCPD) were introduced in DSM-IV without justification or indication of any empirical basis; they do not appear to be specific to personality disorders, as other chronic mental disorders are also likely to meet them, leading to problems in differential diagnosis. As a consequence of these myriad problems, DSM-IV personality disorder diagnoses have not been used (e.g., “Diagnosis Deferred on Axis II”), have been under-used (e.g., “Personality Disorder Not Otherwise Specified” [PD-NOS] is the most frequent diagnosis), or have been erroneously used (e.g., diagnoses often made on the basis of too few of the required criteria). Despite these long-recognized and significant shortcomings, however, the criteria for personality disorders in Section II of DSM-5 have not changed from those in DSM-IV.