Personality Disorders.
Lecture 1 – Learning Goals
A student should be able to:
o To identify the characteristics of a personality disorder (PD)
o To distinguish between personality traits vs. personality disorders
o To identify the various etiologies of PD
o To compare and distinguish the different PDs and their characteristics,
including:
o Three clusters
o Diagnostic criteria and (associated) features
o Prevalence, development and course
o Risk and prognostic factors
o Culture- and gender-related diagnostic issues
o Differential diagnosis
o To apply knowledge of PDs and their characteristics to clinical examples
Article – Personality Disorders (psychiatry online)
• There are 10 specific personality disorders.
• Definition:
“A personality disorder is an enduring pattern of inner experience and
behavior that deviates markedly from the norms and expectations of the
individual’s culture, is pervasive and inflexible, has an onset in adolescence
or early adulthood, is stable over time, and leads to distress or
impairment.”
• The following personality disorders are included in this chapter.
Paranoid personality disorder is a pattern of distrust and suspiciousness
such that others’ motives are interpreted as malevolent.
Schizoid personality disorder is a pattern of detachment from social
relationships and a restricted range of emotional expression.
Schizotypal personality disorder is a pattern of acute discomfort in close
relationships, cognitive or perceptual distortions, and eccentricities of
behavior.
Antisocial personality disorder is a pattern of disregard for, and violation of,
the rights of others, criminality, impulsivity, and a failure to learn from
experience.
Borderline personality disorder is a pattern of instability in interpersonal
relationships, self-image, and affects, and marked impulsivity.
Histrionic personality disorder is a pattern of excessive emotionality and
attention seeking.
, Narcissistic personality disorder is a pattern of grandiosity, need for
admiration, and lack of empathy.
Avoidant personality disorder is a pattern of social inhibition, feelings of
inadequacy, and hypersensitivity to negative evaluation.
Dependent personality disorder is a pattern of submissive and clinging
behavior related to an excessive need to be taken care of.
Obsessive-compulsive personality disorder is a pattern of preoccupation
with orderliness, perfectionism, and control.
Personality change due to another medical condition is a persistent
personality disturbance that is judged to be the direct pathophysiological
consequence of another medical condition (e.g., frontal lobe lesion).
Other specified personality disorder is a category provided for two
situations:
1) the individual’s personality pattern meets the general criteria for a
personality disorder, and traits of several different personality disorders are
present, but the criteria for any specific personality disorder are not met;
or
2) the individual’s personality pattern meets the general criteria for a
personality disorder, but the individual is considered to have a personality
disorder that is not included in the DSM-5 classification (e.g., passive-
aggressive personality disorder).
Unspecified personality disorder is for presentations in which symptoms
characteristic of a personality disorder are present but there is insufficient
information to make a more specific diagnosis.
• The personality disorders are grouped into three clusters based on descriptive
similarities.
Cluster A→ includes:
-paranoid,
-schizoid, and
-schizotypal personality disorders.
Individuals with these disorders often appear odd or eccentric.
Cluster B→ includes:
-antisocial,
-borderline,
-histrionic, and
-narcissistic personality disorders.
Individuals with these disorders often appear dramatic, emotional, or
erratic.
, Cluster C→ includes:
-avoidant,
-dependent, and
-obsessive-compulsive personality disorders.
Individuals with these disorders often appear anxious or fearful.
• It should be noted that this clustering system, although useful in some research
and educational situations, has serious limitations and has not been
consistently validated.
• For instance, two or more disorders from different clusters, or traits from
several of them, can often co-occur and vary in intensity and
pervasiveness.
• A review of epidemiological studies from several countries found a median
prevalence of 3.6% for disorders in Cluster A, 4.5% for Cluster B, 2.8% for
Cluster C, and 10.5% for any personality disorder.
Dimensional Models for Personality Disorders:
• There is a categorical perspective that personality disorders are qualitatively
distinct clinical syndromes.
• An alternative to the categorical approach is the dimensional perspective that
personality disorders represent maladaptive variants of personality traits that
merge imperceptibly into normality and into one another.
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