-Personality disorder is diagnosed when personality traits are so inflexible and maladaptive across a wide range of situations they cause significant distress and impairment of social, occupational, and role functioning
-The DSM 5 includes 10 personality disorders grouped in three clusters based on similar qualities
-The DSM 5 includes 10 personality disorders grouped in three clusters based on similar qualities
-Cluster A-Individuals are odd and eccentric
1. Paranoid
2. Schizoid
3. Schizotypal
-Cluster B-Individuals are often dramatic, emotional, or erratic in their emotions and behavior
1. Histrionic
2. Narcissistic
3. Antisocial
4. Borderline
-Cluster C- Individuals often appear anxious or fearful
1. Avoidant
2. Dependent
3. Obsessive-compulsive
-The consistence of certain behaviors beginning in mid to late adolescence and continuing to adult life are suggestive of personality disorder
-Paranoid Personality Disorder DSM 5 Diagnostic Criteria:
1. A distrust and suspiciousness of other such that their motives are interpreted as malevolent, beginning by early adulthood, and present in a variety of context, as indicated by 4 or more of the following:
a. Suspects without basis that others are exploiting, harming or deceiving him or her.
b. Is occupied with unjustified doubts about the loyalty or trustworthiness of friends or associates
c. Is reluctant to confide in others because of unwarranted fear that information will be used against him or her
d. Reads hidden demeaning or threatening meanings not benign remarks or events
e. Persistent bears grudges
f. Perceives attacks on his or her character or reputation that are not apparent to others and is quick to react or to counterattack
2. Does not occur exclusively during the course of schizophrenia, bipolar disorder, or depressive disorder with psychotic features and is not attributable to another medical condition
-Schizoid Personality Diorder DSM 5 Diagnostic Criteria:
1. A pervasive pattern of detachment from social relationships and is a restricted range of expression of emotions in interpersonal settings, beginning by early adulthood and present in a variety of contexts, as indicated by 4 or more of the following:
a. Neither desires nor enjoys close relationships, including being part of a family
b. Almost always chooses solitary activities
c. Has little interest in having sexual experiences with another person
d. Takes pleasure in a few, if any activities
e. Lacks close friends or confidants other than first degree relatives
f. Appears indifferent to the praise or criticism of others
g. Shows emotional coldness, detachments, or flattened activity
2. Does not occur exclusively during the course of schizophrenia, bipolar disorder, or depressive disorder with psychotic features and is not attributable to another medical condition
-Histrionic Personality Disorder DSM 5 Diagnostic Criteria-
1. A pervasive pattern of excessive emotionality and attention seeking, beginning in early adulthood and present in variety of contexts as indicated by 2 or more of the following:
a. Is uncomfortable in situations in which he or she is not the center of attention
b. Interaction with others is often characterized by inappropriate sexuality seductive or provocative behavior
c. Displays rapidly shifting and shallow expression of emotions
d. Consistently uses physical appearance to draw attention to self
e. Has a style of speech that is excessively impressionistic and lacking in detail
f. Shows self dramatization, theoretically and exaggerated expression of emotion
g. Is suggestible
h. Considers relationships to be more intimate than what they are
-Narcissistic Personality Disorder DSM 5 Diagnostic Criteria-
1, A pervasive pattern of excessive emotionality and attention seeking, beginning in early adulthood and present in variety of contexts as indicated by 5 or more of the following:
a. Has grandiose sense of self importance
b. Is preoccupied with fantasies of unlimited success, power, brilliance, beauty, or ideal love
c. Believes he or she is "special" and unique and can only be understood by, or should associate with, other special or high status people
d. Requires excessive admiration
e. Has a sense of entitlement or favorable treatment or automatic compliance with his or her expectations
f. Is interpersonally exploitive (takes advance of others too achieve his own ends)
g. Lacks empathy
h. Is often envious of others believes others are envious of him or her
i. Shows arrogant, haughty behavior
-Avoidant Personality Diorder DSM 5 Criteria-
1. A pervasive pattern of excessive emotionality and attention seeking, beginning in early adulthood and present in variety of contexts as indicated by 4 or more of the following:
a. Avoids occupational activities that involve significant interpersonal conduct because of fears of criticism, disapproval, or rejection
b. Is unwilling to get involved with people unless certain of being liked
c. Shows restraint within intimate relationships because of the fear of being shamed or ridiculed
d. Is preoccupied with being criticized or rejected in social situations
e. Is inhibited in new interpersonal situations because of feelings of inadequacy
f. Views self as socially inept, personally unappealing and inferior to others
g. Is usually reluctant to take personal risks or to engage in any other new activities because they may prove to be embarrassing
-Dependent Personality Disorder DSM 5 Criteria-
1. A pervasive pattern of excessive emotionality and attention seeking, beginning in early adulthood and present in variety of contexts as indicated by 5 or more of the following:
a. Has difficulty making everyday decisions without excessive amount of advice from others
b. Needs others to assume responsibility for most major areas of his or her life
c. Has difficulty expressing disagreement with others because of fear of loss of support or approval
d. Has difficulty initiating projects or doing things on his or her own because of lack of confidence in own judgement
e. Goes to excessive lengths to obtain nurturance and support from others, to the point of volunteering to do things that are unpleasant
f. Feels uncomfortable or helpless when alone because of exaggerated fear of being unable to care for self
g. Urgently seeks another relationship as a source of care and support when a close relationship ends.
h. Is unrealistically preoccupied with fears of being left to take care of themselves.
-Obsessive Compulsive Personality Disorder DSM 5 Criteria-
1. A pervasive pattern of excessive emotionality and attention seeking, beginning in early adulthood and present in variety of contexts as indicated by 4 or more of the following:
f. Feels uncomfortable or helpless when alone because of exaggerated fear of being unable to care for self
g. Urgently seeks another relationship as a source of care and support when a close relationship ends.
h. Is unrealistically preoccupied with fears of being left to take care of themselves.
-Obsessive Compulsive Personality Disorder DSM 5 Criteria-
1. A pervasive pattern of excessive emotionality and attention seeking, beginning in early adulthood and present in variety of contexts as indicated by 4 or more of the following:
a. Is preoccupied with details, rules, list order, organization or schedules to the extent the major point of the activity is lost.
b. Shows perfectionism that interferes with task completion
c. Is excessively devoted to work and productivity to the exclusion of leisure activities and friendships
d. Is overconscientious, scrupulous, and inflexible about matters of morality, ethics, or values
e. Is unable to discard worn out or worthless objects even when they have no sentimental value
f. Is reluctant to delegate tasks to work with others unless they submit exactly to his or her way of doing things
g. Adopts miserly spending style toward both self and others, money is viewed as something to be hoarded for future catastrophies
h. Shows rigidity and stubbornness
-Schizotypal Personality Disorder DSM 5 Criteria-
1. A pervasive pattern of excessive emotionality and attention seeking, beginning in early adulthood and present in variety of contexts as indicated by 5 or more of the following:
a. Ideas of reference (excluding delusions of reference)
b. Odd beliefs of magical thinking that influences behavior and is inconsistent with subcultural norms
c. Unusual perceptual experiences including bodily illusions
d. Odd thinking and speech
e. Suspicious or paranoid ideation
f. Inappropriate or constricted affect
g. Behavior or appearance that is odd, eccentric, or peculiar
h. Lack of close friends or confidants other than first degree relatives
i. Excessive social anxiety that does not diminish with familiarity and tends to be associated with paranoid fears rather than negative judgements about self
2. Does not occur exclusively during a schizophrenia course, a bipolar disorder or depressive disorder with psychotic features rather than negative judgements about self
-Antisocial Personality Disorder DSM 5 Criteria-
1. A pervasive pattern of disregard for and violation to the rights of others, occurring since the age of 15, as indicated by three or more of the following:
a. Failure to conform to social norms with respect to lawful behaviors, as indicated by repeatedly performing acts that are grounds for arrest
b. Deceitfulness, as indicated by repeated lying, and use of aliases or conning others for personal profit or pleasure
c. Impulsivity or failure to plan ahead
d. Irritability and aggressiveness, as indicated by repeated physical fights or assaults
e. Reckless disregard for safety or self or others
f. Consistent irresponsibility, as indicated by repeated failure to sustain consistent work behavior or honor financial obligations
2. The individual is at least 18 years of age
3. There is evidence of conduct disorder with onset before the age of 15 years
4. The occurrence of antisocial behavior is not exclusively during the course of schizophrenia or bipolar disorder
-Borderline Personality Disorder DSM 5 Criteria-
1. There is 3 homogenous components or dimensions of the disorder:
a. Impaired relatedness- unstable relationships with others, identity disturbance, and chronic emptiness
b. Affective dysregulation-affective lability, excessive anger, and efforts to avoid abandonment
c. Behavior dysregulation-impulsivity, suicidality, and self injurious behavior
b. Odd beliefs of magical thinking that influences behavior and is inconsistent with subcultural norms
c. Unusual perceptual experiences including bodily illusions
d. Odd thinking and speech
e. Suspicious or paranoid ideation
f. Inappropriate or constricted affect
g. Behavior or appearance that is odd, eccentric, or peculiar
h. Lack of close friends or confidants other than first degree relatives
i. Excessive social anxiety that does not diminish with familiarity and tends to be associated with paranoid fears rather than negative judgements about self
2. Does not occur exclusively during a schizophrenia course, a bipolar disorder or depressive disorder with psychotic features rather than negative judgements about self
-Antisocial Personality Disorder DSM 5 Criteria-
1. A pervasive pattern of disregard for and violation to the rights of others, occurring since the age of 15, as indicated by three or more of the following:
a. Failure to conform to social norms with respect to lawful behaviors, as indicated by repeatedly performing acts that are grounds for arrest
b. Deceitfulness, as indicated by repeated lying, and use of aliases or conning others for personal profit or pleasure
c. Impulsivity or failure to plan ahead
d. Irritability and aggressiveness, as indicated by repeated physical fights or assaults
e. Reckless disregard for safety or self or others
f. Consistent irresponsibility, as indicated by repeated failure to sustain consistent work behavior or honor financial obligations
2. The individual is at least 18 years of age
3. There is evidence of conduct disorder with onset before the age of 15 years
4. The occurrence of antisocial behavior is not exclusively during the course of schizophrenia or bipolar disorder
-Borderline Personality Disorder DSM 5 Criteria-
1. There is 3 homogenous components or dimensions of the disorder:
a. Impaired relatedness- unstable relationships with others, identity disturbance, and chronic emptiness
b. Affective dysregulation-affective lability, excessive anger, and efforts to avoid abandonment
c. Behavior dysregulation-impulsivity, suicidality, and self injurious behavior
-General Treatment of Personality Disorders-
1. Psychotherapy is generally regarded as first line treatment for patients with personality disorder
2. Pharmacotherapy is used as augmentation targeted at specific symptoms such as anxiety, depression, and insomnia
3. Benzodiazepines should be avoided whenever possible
4. Schizotypal patients may benefit from social training skills
