Personality Disorder  Instability of interpersonal relationships, self-

image, and affect, as well as marked impulsivity.

 Psychological Disorders that are believed to result from personalities that 3. Histrionic
developed improperly during childhood.  Excessive emotionally and attention seeking
 It is a persistent pattern of emotions, cognitions, and behavior that results in 4. Narcissistic
enduring emotional distress for the person affected and/or for others and  Grandiosity, need for admiration, and lack of
may cause difficulties with work and relationships (APA,2015) empathy
 Individuals with PD may not feel any subjective distress, however, indeed, it
may in fact be others who acutely feel distress because of the actions of the Cluster C
person with the disorder. (anxious/fearful)

Characteristics 1. Avoidant  Social inhibition, feelings of inadequacy, and

hypersensitivity to negative evaluation
 All personality disorders begin early in life.
 They are disturbing to the person or to others 2. Dependent  Excessive need to be taken care of, submissive
 Very difficult to treat behavior, and fears of separation
 Men diagnosed with a PD tend to display traits characterized as more
aggressive, structure4d, selfassertiveness, and detached, and women tend to 3. Obsessive-  Preoccupation with order, perfection, and
present with characteristics that are more submissive, emotional, and compulsive control
insecure.

CLUSTER A PERSONALITY DISORDERS

Key Features of the DSM-5-TR Personality Disorders
 Three personality disorders—paranoid, schizoid, and schizotypal— share
Key Features common features that resemble some of the psychotic symptoms seen in
Cluster A (odd/eccentric) schizophrenia. These odd or eccentric personality disorders are described
next.
1. Paranoid  Distrust and suspiciousness of others  It is rare for a person with Cluster A PDS to request/seek treatment except in
response to a crisis such as extreme depression or losing a job.
2. Schizoid  Detachment from social relationships and
restricted range of emotional expression
1. PARANOID
People with paranoid personality disorder are excessively mistrustful and
3. Schizotypal  Lack of capacity for close relationships,
suspicious of others, without any justification. They assume other people are out
cognitive distortions, and eccentric behavior
Cluster B to harm or trick them; therefore, they tend not to confide in others.
(dramatic/erratic)
 Disregard for and violation of the rights of DSM-5 Criteria for Paranoid Personality Disorder
1. Antisocial others change to self-image Presence of four or more of the following signs of distrust and suspiciousness,
2. Borderline beginning by early adulthood and shown in many contexts:
 Unjustified suspiciousness of being harmed, deceived, or exploited DSM-5 Criteria for Schizotypal Personality Disorder
 Unwarranted doubts about the loyalty or trustworthiness of friends or Presence of five or more of the following in many contexts beginning in early
associates adulthood:
 Reluctance to confide in others because of suspiciousness  Ideas of reference
 The tendency to read hidden meanings into the benign actions of others  Odd beliefs or magical thinking, e.g., belief in extrasensory perception
 Bears grudges for perceived wrongs  Unusual perceptions, e.g., distorted feelings about one’s body
 Angry reactions to perceived attacks on character or reputation  Odd patterns of thought and speech
 Unwarranted suspiciousness of the fidelity of partner  Suspiciousness or paranoia
 Inappropriate or restricted affect
 Odd or eccentric behavior or appearance
2. SCHIZOID PERSONALITY DISORDER  Lack of close friends
people with schizoid personality disorder do not desire or enjoy social  Anxiety around other people, which does not diminish with familiarity
relationships and usually have no close friends. They appear dull, bland, and aloof
and have no warm, tender feelings for other people. They rarely experience CLUSTER B PERSONALITY DISORDERS
strong emotions, are not interested in sex, and have few pleasurable activities.  Defined by overly dramatic behavior, emotional excess, and sexually
Indifferent to praise, criticism, and the sentiments of others, people with this provocative behavior. Self-centered, frequently seeking to be the centre of
disorder are loners who pursue solitary interests attention, manipulating others through exaggerated expression of emotions
and difficulties, superficially charming but lacking genuine concern for others,
DSM-5 Criteria for Schizoid Personality Disorder frequently angry outburst.
Presence of four or more of the following signs of interpersonal detachment and  ' Usually comorbid with AsPD
restricted emotion are present from early adulthood across many contexts:
 Lack of desire for or enjoyment of close relationships 1. ANTISOCIAL PERSONALITY DISORDER
 Almost always prefers solitude to companionship Defined by the absence of concern for others' feelings or social norms and a
 Little interest in sex l Few or no pleasurable activities pervasive pattern of rule breaking. Smooth social skills and lack of guilt about
 Lack of friends l Indifference to praise or criticism violating social rules and laws and taking advantage of others.
 Flat affect, emotional detachment
DSM-5 Criteria for Antisocial Personality Disorder
3. SCHIZOTYPAL PERSONALITY DISORDER  Age at least 18
Schizotypal personality disorder is defined by unusual and eccentric thoughts  Evidence of conduct disorder before age 15
and behavior (psychoticism), interpersonal detachment, and suspiciousness.  Pervasive pattern of disregard for the rights of others since the age of 15 as
People with this disorder might have odd beliefs or magical thinking—for shown by at least three of the following:
instance, the belief that they can read other people’s minds and see into the 1. Repeated lawbreaking
future. It is also common for them to have ideas of reference (the belief that 2. Deceitfulness, lying
events have a particular and unusual meaning for them personally) and to show 3. Impulsivity
suspiciousness and paranoid ideation. 4. Irritability and aggressiveness
 5. Reckless disregard for own safety and that of others Presence of five or more of the following signs of excessive emotionality and
6. Irresponsibility as seen in unreliable employment or financial history attention seeking shown in many contexts by early adulthood:
7. Lack of remorse  Strong need to be the center of attention
 Inappropriate sexually seductive behavior
2. BORDERLINE PERSONALITY DISORDER  Rapidly shifting expression of emotions
Defined by intense emotionality, unstable sense of identity, an uncertain self-  Use of physical appearance to draw attention to self
image, extreme swings of mood and impulsivity; impulsive and unpredictable,  Speech that is excessively impressionistic and lacking in detail
unstable personal relationships, angry almost constantly need to be with others,  Exaggerated, theatrical emotional expression
lack of identity, feelings of emptiness.  Overly suggestible
 Misreads relationships as more intimate than they are
DSM-5 Criteria for Borderline Personality Disorder
Presence of five or more of the following in many contexts beginning by early ETIOLOGY OF HISTRIONIC
adulthood:  ' Researchers know relatively little about the roots of Histrionic PD.
 Frantic efforts to avoid abandonment  ' This PD is believed to be related to poor parenting.
 Unstable interpersonal relationships in which others are either idealized or
devalued
 Unstable sense of self l Self-damaging, impulsive behaviors in at least two 4. NARCISSISTIC PERSONALITY DISORDER
areas, such as spending, sex, substance abuse, reckless driving, and binge Defined as extreme selfishness and self-centeredness; a grandiose view of
eating one's uniqueness, achievements, and talents; an insatiable craving for admiration
 Recurrent suicidal behavior, gestures, or self-injurious behavior (e.g., cutting and approval from others; willingness to exploit others to achieve goals; and
self) expectation of much more from others than one is willing to give in return.
 Marked mood reactivity
 Chronic feelings of emptiness l Recurrent bouts of intense or poorly controlled ETIOLOGY OF NARCISSISTIC
anger  'According to self-psychology theory of narcissistic PD, parents who are cold
 During stress, a tendency to experience transient paranoid thoughts and and focused on their own worth fail to help the child develop a stable sense of
dissociative symptom self-worth.
 Parents failed to model empathy
3. HISTRIONIC PERSONALITY DISORDER  ' Accordingg to Social-Cognitive theory o proposes that the behavior of the
The key feature of histrionic personality disorder is overly dramatic and person with narcissistic PD is shaped by the goal of maintaining specialness
attentionseeking behavior. People with this disorder often use their physical and the belief that the purpose of interpersonal interactions is to bolter self-
appearance, such as unusual clothes, makeup, or hair color, to draw attention to esteem.
themselves. Despite displaying extravagant and intense emotions, they are
thought to be emotionally shallow.

DSM-5 Criteria for Histrionic Personality Disorder

CLUSTER C PERSONALITY DISORDERS  Extremely low self-esteem coupled with a fear of rejection
 The anxious/fearful cluster includes avoidant personality disorder, dependent  These individuals feel chronically rejected by others and are pessimistic about
personality disorder, and obsessive-compulsive personality disorder. People their future.
with these disorders are prone to worry and distress
2. DEPENDENT PERSONALITY DISORDER
ETIOLOGY OF CLUSTER C The core features of dependent personality disorder are an overreliance on
 'Social theories focus on parenting o Avoidant PD- might result from the others and a lack of self-confidence. People with dependent personality disorder
transmission of fear from parent to child via modeling. have an intense need to be taken care of, which often leads them to feel
 Dependent PD- might be caused by disruptions of the parent-child uncomfortable when alone. They subordinate their own needs to ensure that they
relationship and overprotectiveness, that lead the person to fear losing other do not break up the protective relationships they have established. When a close
relationships in adulthood. relationship ends, they urgently seek another relationship to replace it. They see
themselves as weak, and they turn to others for support and decision-making. The
1. AVOIDANT PERSONALITY DISORDER clinical case history of Matthew provides an example of dependent personality
People with avoidant personality disorder are so fearful of criticism, rejection, disorder.
and disapproval that they will avoid jobs or relationships to protect themselves
from negative feedback. In social situations they are restrained because of an DSM-5 Criteria for Dependent Personality Disorder
extreme fear of saying something foolish, being embarrassed, blushing, or An excessive need to be taken care of, as shown by the presence of at least five of
showing other signs of anxiety. They believe they are incompetent and inferior to the following beginning by early adulthood and shown in many contexts: l
others and are reluctant to take risks or try new activities.  Difficulty making decisions without excessive advice and reassurance from
others
DSM-5 Criteria for Avoidant Personality Disorder  Need for others to take responsibility for most major areas of life
A pervasive pattern of social inhibition, feelings of inadequacy, and  Difficulty disagreeing with others for fear of losing their support
hypersensitivity to criticism as shown by four or more of the following starting by  Difficulty doing things on own or starting projects because of lack of self-
early adulthood in many contexts: confidence
 Avoidance of occupational activities that involve significant interpersonal  Doing unpleasant things as a way to obtain the approval and support of
contact, because of fears of criticism or disapproval others
 Unwilling to get involved with people unless certain of being liked  Feelings of helplessness when alone because of fears of being unable to care
 Restrained in intimate relationships because of the fear of being shamed or for self
ridiculed l Preoccupation with being criticized or rejected  Urgently seeking new relationship when one ends
 Inhibited in new interpersonal situations because of feelings of inadequacy  Preoccupation with fears of having to take care of self
 Views self as socially inept or inferior
 Unusually reluctant to try new activities because they may prove ETIOLOGY OF DEPENDENT PD
embarrassing  Early death of a parent or neglect or rejection by caregivers could cause
people to grow up fearing abandonment.
ETIOLOGY OF AVOIDANT
  Treatment of schizotypal personality disorder is parallel with the treatment of
schizophrenia; antipsychotic medication, and sometimes antidepressant
3. OBSESSIVE-COMPULSIVE PERSONALITY DISORDER medication, can be helpful.
The person with obsessive-compulsive personality disorder is a perfectionist,  Treatment of avoidant personality disorder is parallel with the treatment of
preoccupied with details, rules, and schedules. People with this disorder often pay social anxiety disorder; antidepressants and cognitive behavioral treatment
so much attention to detail that they fail to finish projects. They are more can be helpful.
oriented toward work than pleasure. Their interpersonal relationships are often  Psychopathy, formerly considered virtually untreatable, might respond to
troubled because they demand that everything be done the right way—their way. long-term psychoanalytic treatment.
They often become known as “control freaks.”  Some promising evidence is emerging for the utility of dialectical behavior
The personality disorder does not include the obsessions and compulsion. therapy, mentalization-based therapy, and schema-focused therapy for
borderline personality disorder
DSM-5 Criteria for Obsessive-Compulsive Personality Disorder
Intense need for order, perfection, and control, as shown by the presence of at
least four of the following beginning by early adulthood and evidenced in many
contexts:
 Preoccupation with rules, details, and organization to the extent that the
point of an activity is lost
 Extreme perfectionism interferes with task completion
 Excessive devotion to work to the exclusion of leisure and friendships
 Inflexibility about morals and values
 Difficulty discarding worthless items
 Reluctance to delegate unless others conform to one’s standards
 Miserliness l Rigidity and stubbornness

Treatment of Personality Disorders

 Personality disorders are usually comorbid with other disorders such as
depression and anxiety disorders, and they predict poorer outcomes for these
disorders.
 Psychodynamic, cognitive behavioral, and pharmacological treatments are all
used for personality disorders. Research on day treatment programs is
promising. Relatively little research has been conducted regarding the
treatment of personality disorders, and the gap in knowledge is particularly
severe for some personality disorders.