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Chapter 10. Personality Disorders
Personality disorders
-Diagnosed on the Axis II, along with MR in the DSM-V, but no more in the current
DSM-IV.
-Definitions: An enduring pattern of cognition, affectivity, interpersonal functioning,
and/or impulse control that deviates form the expectations of the individual’s culture.
-Not dramatic or severely incapacitating, but long-standing, maladaptive, inflexible, and
habitual ways of living or functioning. Hard to change it.
-Unclear about a point at which personality style becomes a personality disorder.
Possibly when personality style causes clinically significant distress or impairment in
social important problems in social, occupational situations, or other important areas of
functioning.
-Early onset, pervasive, stable.
Cluster A Personality Disorders (odd and eccentric)
1. Paranoid Personality Disorder
A pervasive distrust and suspiciousness of others manifested by 4 or more of the
following:
(a) Interpret other’s motives as malevolent,
(b) Suspect that others are exploiting, harming, or hurting,
(c) Preoccupied with unjustified doubts about the royalty/trustworthiness of friends
or associates,
(d) Reluctant to confide in others due to unwarranted fear,
(e) Read hidden demeaning or threatening meanings into benign remarks or events,
(f) Persistently bears grudges,
(g) Perceives attacks on one’s character without apparent reasons,
(h) Recurrent suspicions without justifications regarding fidelity of spouse or sexual
partner).
2. Schizoid Personality disorder
A pervasive pattern of detachment from social relationship and a restricted range of
expression of emotions in interpersonal settings manifested by 4 or more of the
following:
(a) Neither desires nor enjoys close relationships
(b) Almost always chooses solitary activities
(c) Having little, if any, interest in sexual experiences
(d) Takes please in few, if any, activities.
(e) Lacks close friends or confidants other than 1st degree relatives
(f) Appears to indifferent to the praise or criticisms of others
(g) Shows emotional coldness, detachment, or flattened affect.
3. Schizotypal Personality disorder
A pervasive pattern of social and interpersonal deficits marked by acute discomfort with,
and reduced capacity for, close relationships as well as by cognitive or perceptual
distortions and eccentricities of behavior, indicated by 5 or more of the following:
(a) Ideas of reference (i.e., The feeling that casual incidents or events have a
particular or unusual meaning that is specific to the person)
(b) Odd beliefs or magical thinking (i.e., the erroneous belief that one’s thoughts,
words, or actions will cause or prevent a specific outcome in some way that defies
commonly understood laws of cause and effect).
(c) Unusual perceptual experiences (i.e., bodily illusions)
(d) Odd thinking or speech (i.e., vague, metaphorical, circumstantial, over-elaborate,
or stereotyped)
(e) Paranoid ideation
(f) Inappropriate or restricted affect
(g) Odd or eccentric behavior or appearance
(h) Lack of desire for close relationships
Excessive social anxiety
Cluster B Personality Disorders (dramatic-emotional)
4. Antisocial Personality disorder
A pervasive pattern of disregard for, and of the rights of others occurring since age 15, as
indicated by 3 or more of the following:
(a) Consistent irresponsibility (i.e., no financial obligation, unstable work)
(b) Deceitfulness (repeated lying, use of aliases, conning others)
(c) Failure to conform to social norms (i.e., repetitive arrests)
(d) Failure to plan ahead (i.e., impulsivity)
(e) Irritability and aggressiveness (i.e., physical fights and assaults)
(f) Lack of remorse.
(g) Reckless disregard for safety of self and others.
(h) At least age 18
(i) Evidence of conduct disorder before age 15.
5. Borderline Personality disorder
A pervasive pattern of instability of interpersonal relationships, self-image and affects,
and marked impulsivity, as indicated by 5 or more of the following:
(a) Identity disturbance (i.e., marked and unstable self-identity or sense of self)
(b) Chronic emptiness
(c) Frantic effort to avoid real or imagined abandonment
(d) Affective instability (i.e., irritability, intense dysphoria, anxiety).
(e) Inappropriate, intense anger or difficulty controlling anger
(f) Self-damaging impulsivity (i.e., binge eating, drug, reckless driving, spending,
sex).
(g) A pattern of unstable and intense interpersonal relationships (i.e., alternating
between extremes of idealization and devaluation).
(h) Transient, stress-related paranoid ideation or severe dissociative symptoms.
(i) Recurrent suicidal behaviors, gestures, or threats, or self-mutilating behavior.
6. Histrionic Personality disorder
A pervasive pattern of excessive emotionality and attention seeking, as indicated by 5 or
more of the following:
(a)
(b)
(c)
(d)
(e)
(f)
(g)
(h)
Uncomfortable in situations in which he or she is not the center of attention
Consistently use physical appearance to draw attention to self.
Inappropriate sexually seductive or provocative behavior
A style of speech that is excessively impressionistic and lacking in detail
Self-dramatization or exaggerated expression of emotion
Displays rapidly shifting and shallow expression of emotions.
Considers relationships to be more intimate that they actually are
Very suggestible
7. Narcissistic Personality disorder
A pervasive pattern of grandiosity, need for admiration, and lack of empathy, as indicate
by 5 or more of the following:
(a) Believes that she or he is special, unique, and can be understood by special or
high-status people.
(b) Preoccupied with fantasies of unlimited success, power, beauty, or ideal love.
(c) A grandiose sense of self-importance (i.e., exaggerates achievements and expects
to be recognized as superior).
(d) Requires excessive admiration
(e) Has a sense of entitlement
(f) Interpersonally exploitative
(g) Often envious of others or believes that others are envious of him or her
(h) Lacks empathy
(i) Shows arrogant, haughty behaviors or attitudes.
Cluster C Personality Disorders (anxious-fearful)
8. Avoidant Personality disorder
A pervasive pattern of feelings of inadequacy, hypersensitivity to negative evaluations,
and social inhibition, as indicated by 4 or more of the following:
(a) Preoccupied with being criticized, rejected, ridiculed, disapproved, or shamed in
social situations
(b) Views self as socially inept, unappealing, or inferior to others
(c) Avoids occupational activities involving significant interpersonal contact
(d) Unwilling to get involved with people unless certain of being liked
(e) Inhibited in new interpersonal situations
(f) Shows restraint within intimate relationships
(g) Unwilling to take personal risks or to engage in any new activities because they
may prove embarrassing.
9. Dependent Personality disorder
A pervasive and excessive need to be taken care of that leads to submissiveness, clinging
behavior and fear of separation, as indicated by 5 or more of the following:
(a) Excessively feels uncomfortable or helpless when alone (i.e., fear of being unable
to care for oneself)
(b) Unrealistically preoccupied with fears of being left to take care of oneself
(c) Needs others to assume responsibility for most major areas of one’s life
(d) Urgently seeks another relationship as a source of care and support when a
relationship ends
(e) Goes to excessive lengths to obtain nurturance and support from others to the
point of volunteering to do things that are unpleasant
(f) Has difficulty expressing disagreement
(g) Has difficulty initiating projects or doing things on one’s own (i.e., lack of
confidence in judgment or abilities)
(h) Has difficulty making everyday decisions
10. Obsessive-Compulsive Personality disorder
A pervasive pattern of preoccupation with orderliness, perfectionism, and mental and
interpersonal control, at the expense of flexibility, openness, and efficiency, as indicated
by 4 or more of the following:
(a) Preoccupied with details, rules, lists, order, organization, or schedules to the
extent that the major point of the activity is lost
(b) Shows perfectionism that interferes with task completion
(c) Over-conscientious, scrupulous, and inflexible about matters of morality, ethics,
or values
(d) Excessively devoted to work and productivity to the exclusion of leisure activities
and friendships
(e) Unable to discard worn-out or worthless objects even when they have no
sentimental value
(f) Reluctant to delegate tasks or to work with others unless they submit to exactly
one’s own way of doing things
(g) Adopts a miserly spending toward both self and others
(h) Shows rigidity and stubbornness
-Measures: MMPI-II, MCMI-II (Millon Clinical Multiaxial Inventory).
-More prevalent in men: Antisocial, Narcissistic, Schizoid.
-More prevalent in women: Histrionic, dependent, Borderline.
-Relatively more prevalent personality disorders in both men and women are Dependent,
Borderline, and Compulsive.