PERSONALITY

DISORDERS.
Submitted by:
Rhodeliza Mae R. Perhis
BS Psychology 3-2
Submitted to:
Prof. Serafina Maxino.

Personality disorder: A personality disorder is an enduring pattern of

inner experience and behavior that deviates markedl y from the
expectations of the individual's culture, is pervasive and inflexible, has an
onset in adolescence or earl y adulthood, is stable over time, and leads to
distress or impairment. Personality disorders are conditions in which an
individual differs significantl y from an average person, in terms of how
the y think, perceive, feel or relate to others.
Changes in how a person feels and distorted beliefs about other people
can lead to odd behavior, which can be distressing and may upset others.
Common features include:

being overwhelmed b y negative feelings such as distress, anxiety,

worthlessness or anger
avoiding other people and feeling empty and emotionally
disconnected
difficulty managing negative feelings without self-harming (for
example, abusing drugs and alcohol, or taking overdoses) or, in rare
cases, threatening other people
odd behavior
difficulty maintaining stable and close relationships, especiall y with
partners, children and professional careers

Sometimes, periods of losing contact with reality. Symptoms typically get

worse with stress.
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.

GENER AL PERSON ALITY DISORDER

Criteria:

A. An enduring pattern of inner experience and behavior that deviates

markedl y from the expectations of the individuals culture. This pattern is
manifested in two (or more) of the following areas:
1. Cognition (i.e., wa ys of perceiving and interpreting self, other people,
and events). 2. Affectivity (i.e., the range, intensity, lability, and
appropriateness of emotional response). 3. Interpersonal functioning. 4.
Impulse control.
B. The enduring pattern is inflexible and pervasive across a broad range
of personal and social situations.
C. The enduring pattern leads to clinically significant distress or
impairment in social, occupational, or other important areas of functioning.
D. The pattern is stable and of long duration, and Its onset can be traced
back at least to adolescence or earl y adulthood.
E. The enduring pattern is not better explained as a manifestation or
consequence of another mental disorder.
F. The enduring pattern is not attributable to the physiological effects of a
substance (e.g., a drug of abuse, a medication) or another medical
condition (e.g., head trauma).

CLUSTER A PERSON ALITY DISORDER

Paranoid Personality Disorder: Persons with paranoid personality
disorder are characterized by long-standing suspiciousness and mistrust
of persons in general. The y refuse responsibility for their own feelings and
assign responsibility to others. They are often hostile, irritable, and angry.
Bigots, injustice collectors, pathologicall y jealous spouses, and litigious
cranks often have paranoid personality disorder.
DI AGNOSTIC CRITERI A:
A. A pervasive distrust and suspiciousness of others such that their
motives are interpreted as malevolent, beginning b y early adulthood and
present in a variety of contexts, as indicated b y four (or more) of the
following:
1. Suspects, without sufficient basis, that others are exploiting, harming,
or deceiving him or her.

2. Is preoccupied with unjustified doubts about the loyalty or

trustworthiness of friends or associates.
3. Is reluctant to confide in others because of unwarranted fear that the
information will be used maliciously against him or her.
4. Reads hidden demeaning or threatening meanings into benign remarks
or events.
5. Persistently bears grudges (i.e., is unforgiving of insults, injuries, or
slights).
6. Perceives attacks on his or her character or reputation that are not
apparent to others and is quick to react angril y or to counterattack.
7. Has recurrent suspicions, without justification, regarding fidelity of
spouse or sexual partner.
B. Does not occur exclusively during the course of schizophrenia, a
bipolar disorder or depressive disorder with psychotic features, or another
psychotic disorder and is not attributable to the physiological effects of
another medical condition.
Note: If criteria are met prior to the onset of schizophrenia, add
premorbid, i.e., paranoid personality disorder (premorbid).

CH AR AC TERISTICS:
Individuals with paranoid personality disorder are generally difficult to get
along with and often have problems with close relationships. Their
excessive suspiciousness and hostility may be expressed in overt
argumentativeness, in recurrent complaining, or by quiet, apparentl y
hostile aloofness. Because the y are h ypervigilant for potential threats,
the y may act in a guarded, secretive, or devious manner and appear to be
"cold" and lacking in tender feelings. Although the y may appear to be
objective, rational, and unemotional, the y more often displa y a labile
range of affect, with hostile, stubborn, and sarcastic expressions
predominating. Their combative and suspicious nature may elicit a hostile
response in others, which then serves to confirm their original
expectations. Because individuals with paranoid personality disorder lack
trust in others, they have an excessive need to be self-sufficient and a
strong sense of autonomy. They also need to have a high degree of

control over those around them. They are often rigid, critical of others,
and unable to collaborate, although they have great difficulty accepting
criticism themselves. The y may blame others for their own shortcomings.
Because of their quickness to counterattack in response to the threats
the y perceive around them, they may be litigious and frequently become
involved in legal disputes.

DEVELOPMENT AND COURSE.

Paranoid personality disorder may be first apparent in childhood and
adolescence with solitariness, poor peer relationships, social anxiety,
underachievement in school, hypersensitivity, peculiar thoughts and
language, and idiosyncratic fantasies. These children may appear to be
"odd" or "eccentric" and attract teasing. In clinical samples, this disorder
appears to be more commonly diagnosed in males.
humorless and serious. Although some premises of their arguments may
be false, their speech is goal directed and logical. Their thought content
shows evidence of projection, prejudice, and occasional ideas of
reference

Schizoid Personality Disorder: Schizoid personality disorder is

characterized by a lifelong pattern of social withdrawal. Persons with
schizoid personality disorder are often seen by others as eccentric,
isolated, or lonel y. Their discomfort with human interaction; their
introversion; and their bland, constricted affect are noteworth y.
DI AGNOSTIC CRITERI A:
A. A pervasive pattern of detachment from social relationships and a
restricted range of expression of emotions in interpersonal settings,
beginning by earl y adulthood and present in a variety of contexts, as
indicated by four (or more) of the following:
1. Neither desires nor enjoys close relationships, including being part of a
family.
2. Almost alwa ys chooses solitary activities.
3. Has little, if an y, interest in having sexual experiences with another
person.

4. Takes pleasure in few, if an y, activities.

5. Lacks close friends or confidants other than first-degree relatives.
6. Appears indifferent to the praise or criticism of others.
7. Shows emotional coldness, detachment, or flattened affectivity.
B. Does not occur exclusively during the course of schizophrenia, a
bipolar disorder or depressive disorder with psychotic features, another
psychotic disorder, or autism spectrum disorder and is not attributable to
the physiological effects of another medical condition. Note: If criteria are
met prior to the onset of schizophrenia, add premorbid, i.e., schizoid
personality disorder (premorbid).

CH AR AC TERISTICS:
Individuals with schizoid personality disorder may have particular difficulty
expressing anger, even in response to direct provocation, which
contributes to the impression that the y lack emotion. Their lives
sometimes seem directionless, and the y may appear to "drift" in their
goals. Such individuals often react passivel y to adverse circumstances
and have difficulty responding appropriatel y to important life events.
Because of their lack of social skills and lack of desire for sexual
experiences, individuals with this disorder have few friendships, date
infrequently, and often do not marry. Occupational functioning may be
impaired, particularly if interpersonal involvement is required, but
individuals with this disorder may do well when they work under conditions
of social isolation. Particularl y in response to stress, individuals with this
disorder may experience very brief psychotic episodes (lasting minutes to
hours). In some instances, schizoid personality disorder may appear as
the premorbid antecedent of delusional disorder or schizophrenia.
Individuals with this disorder may sometimes develop major depressive
disorder. Schizoid personality disorder most often co-occurs with
schizotypal, paranoid, and avoidant personality disorders. Persons with
schizoid personality disorder seem to be cold and aloof; they display a
remote reserve and show no involvement with everyday events and the
concerns of others. They appear quiet, distant, seclusive, and unsociable.
The y may pursue their own lives with remarkably little need or longing for
emotional ties, and they are the last to be aware of changes in popular
fashion. The life histories of such persons reflect solitary interests and

success at noncompetitive, lonel y jobs that others find difficult to tolerate.

Their sexual lives may exist exclusivel y in fantasy, and the y may postpone
mature sexuality indefinitely. Men may not marry because they are unable
to achieve intimacy; women may passively agree to marry an aggressive
man who wants the marriage. Persons with schizoid personality disorder
usually reveal a lifelong inability to express anger directl y. They can
invest enormous affective energ y in nonhuman interests, such as
mathematics and astronomy, and the y may be very attached to animals.
Dietary and health fads, philosophical movements, and social
improvement schemes, especially those that require no personal
involvement, often engross them. Although persons with schizoid
personality disorder appear self-absorbed and lost in daydreams, the y
have a normal capacity to recognize reality. Because aggressive acts are
rarel y included in their repertoire of usual responses, most threats, real or
imagined, are dealt with by fantasized omnipotence or resignation. They
are often seen as aloof, yet such persons can sometimes conceive,
develop, and give to the world genuinely original, creative ideas.

DEVELOPMENT AND COURSE.

Schizoid personality disorder may be first apparent in childhood and
adolescence with solitariness, poor peer relationships, and
underachievement in school, which mark these children or adolescents as
different and make them subject to teasing.

Schizotypal Personality Disorder: Persons with schizotypal personality

disorder are strikingly odd or strange, even to la ypersons. Magical
thinking, peculiar notions, ideas of reference, illusions, and derealization
are part of a schizotypal person's everyday world.
DI AGNOSTIC CRITERI A:
A. A pervasive pattern of social and interpersonal deficits marked by acute
discomfort with, and reduced capacity for, close relationships as well as
b y cognitive or perceptual distortions and eccentricities of behavior,
beginning by earl y adulthood and present in a variety of contexts, as
indicated by five (or more) of the following:
1. Ideas of reference (excluding delusions of reference).

2. Odd beliefs or magical thinking that influences behavior and is

inconsistent with subcultural norms (e.g., superstitiousness, belief in
clairvoyance, telepath y, or sixth sense: in children and adolescents,
bizarre fantasies or preoccupations).
3. Unusual perceptual experiences, including bodily illusions.
4. Odd thinking and speech (e.g., vague, circumstantial, metaphorical,
overelaborate, or stereotyped).
5. Suspiciousness or paranoid ideation.
6. Inappropriate or constricted affect.
7. Behavior or appearance that is odd, eccentric, or peculiar.
8. Lack of close friends or confidants other than first-degree relatives.
9. Excessive social anxiety that does not diminish with familiarity and
tends to be associated with paranoid fears rather than negative judgments
about self.
B. Does not occur exclusively during the course of schizophrenia, a
bipolar disorder or depressive disorder with psychotic features, another
psychotic disorder, or autism spectrum disorder.
Note: If criteria are met prior to the onset of schizophrenia, add
premorbid, e.g., schizotypal personality disorder (premorbid).

CH AR AC TERISTICS.
Individuals with schizotypal personality disorder often seek treatment for
the associated symptoms of anxiety or depression rather than for the
personality disorder features per se. Particularly in response to stress,
individuals with this disorder may experience transient psychotic episodes
(lasting minutes to hours), although the y usuall y are insufficient in
duration to warrant an additional diagnosis such as brief psychotic
disorder or schizophreniform disorder. In some cases, clinically significant
psychotic symptoms may develop that meet criteria for brief psychotic
disorder, schizophreniform disorder, delusional disorder, or schizophrenia.
Over half may have a history of at least one major depressive episode.
From 30% to 50% of individuals diagnosed with this disorder have a
concurrent diagnosis of major depressive disorder when admitted to a

clinical setting. There is considerable cooccurrence with schizoid,

paranoid, avoidant, and borderline personality disorders. Patients with
schizotypal personality disorder exhibit disturbed thinking and
communicating. Although frank thought disorder is absent, their speech
may be distinctive or peculiar, may have meaning only to them, and often
needs interpretation. As with patients with schizophrenia, those with
schizotypal personality disorder may not know their own feelings and yet
are exquisitel y sensitive to, and aware of, the feelings of others,
especiall y negative affects such as anger. These patients may be
superstitious or claim powers of clairvo yance and may believe that they
have other special powers of thought and insight. Their inner world may
be filled with vivid imaginary relationships and child-like fears and
fantasies. They may admit to perceptual illusions or macropsia and
confess that other persons seem wooden and all the same. Because
persons with schizotypal personality disorder have poor interpersonal
relationships and may act inappropriately, the y are isolated and have few,
if an y, friends. Patients may show features of borderline personality
disorder, and indeed, both diagnoses can be made. Under stress, patients
with schizotypal personality disorder may decompensate and have
psychotic symptoms, but these are usuall y brief. Patients with severe
cases of the disorder may exhibit anhedonia and severe depression.

DEVELOPMENT AND COURSE.

Schizotypal personality disorder has a relatively stable course, with onl y a
small proportion of individuals going on to develop schizophrenia or
another psychotic disorder. Schizotypal personality disorder may be first
apparent in childhood and adolescence with solitariness, poor peer
relationships, social anxiety, underachievement in school, hypersensitivity,
peculiar thoughts and language, and bizarre fantasies. These children
may appear "odd" or "eccentric" and attract teasing.

CLUSTER B PERSON ALITY DISORDER

Antisocial Personality Disorder: Antisocial personality disorder is an

inability to conform to the social norms that ordinaril y govern many
aspects of a person's adolescent and adult behavior. Although
characterized by continual antisocial or criminal acts, the disorder is not
synon ymous with criminality.
DI AGNOSTIC CRITERI A:
A. A pervasive pattern of disregard for and violation of the rights of others,
occurring since age 15 years, as indicated by three (or more) of the
following:
1. Failure to conform to social norms with respect to lawful behaviors, as
indicated by repeatedly performing acts that are grounds for arrest.
2. Deceitfulness, as indicated by repeated lying, use of aliases, or
conning others for personal profit or pleasure.
3. Impulsivity or failure to plan ahead.
4. Irritability and aggressiveness, as indicated by repeated physical fights
or assaults.
5. Reckless disregard for safety of self or others.
6. Consistent irresponsibility, as indicated by repeated failure to sustain
consistent work behavior or honor financial obligations.
7. Lack of remorse, as indicated by being indifferent to or rationalizing
having hurt, mistreated, or stolen from another.
B. The individual is at least age 18 years. C. There is evidence of conduct
disorder with onset before age 15 years. D. The occurrence of antisocial
behavior is not exclusivel y during the course of schizophrenia or bipolar
disorder.

CH AR AC TERISTICS.
Individuals with antisocial personality disorder frequently lack empath y
and tend to be callous, cynical, and contemptuous of the feelings, rights,
and sufferings of others. They may have an inflated and arrogant selfappraisal (e.g., feel that ordinary work is beneath them or lack a realistic
concern about their current problems or their future) and may be

excessively opinionated, self-assured, or cocky. The y may displa y a glib,

superficial charm and can be quite voluble and verbally facile (e.g., using
technical terms or jargon that might impress someone who is unfamiliar
with the topic). Lack of empathy, inflated selfappraisal, and superficial
charm are features that have been commonly included in traditional
conceptions of psychopath y that may be particularly distinguishing of the
disorder and more predictive of recidivism in prison or forensic settings,
where criminal, delinquent, or aggressive acts are likel y to be nonspecific.
These individuals may also be irresponsible and exploitative in their
sexual relationships. They may have a history of many sexual partners
and may never have sustained a monogamous relationship. The y may be
irresponsible as parents, as evidenced by malnutrition of a child, an
illness in the child resulting from a lack of minimal hygiene, a child's
dependence on neighbors or nonresident relatives for food or shelter, a
failure to arrange for a caretaker for a young child when the individual is
away from home, or repeated squandering of mone y required for
household necessities. These individuals may receive dishonorable
discharges from the armed services, may fail to be self-supporting, may
become impoverished or even homeless, or may spend man y years in
penal institutions. Individuals with antisocial personality disorder are more
likel y than people in the general population to die prematurely by violent
means (e.g., suicide, accidents, homicides). Individuals with antisocial
personality disorder may also experience dysphoria, including complaints
of tension, inability to tolerate boredom, and depressed mood. They may
have associated anxiety disorders, depressive disorders, substance use
disorders, somatic symptom disorder, gambling disorder, and other
disorders of impulse control. Individuals with antisocial personality
disorder also often have personality features that meet criteria for other
personality disorders, particularly borderline, histrionic, and narcissistic
personality disorders. The likelihood of developing antisocial personality
disorder in adult life is increased if the individual experienced childhood
onset of conduct disorder (before age 10 years) and accompanying
attention-deficit/h yperactivity disorder. Child abuse or neglect, unstable or
erratic parenting, or inconsistent parental discipline may increase the
likelihood that conduct disorder will evolve into antisocial personality
disorder. Patients with antisocial personality disorder can fool even the
most experienced clinicians. In an interview, patients can appear
composed and credible, but beneath the veneer (or, to use Hervey
Cleckley's term, the mask of sanity) lurks tension, hostility, irritability, and
rage. A stress interview, in which patients are vigorously confronted with
inconsistencies in their histories, may be necessary to reveal the

pathology. A diagnostic workup should include a thorough neurological

examination. Because patients often show abnormal EEG results and soft
neurological signs suggesting minimal brain damage in childhood, these
findings can be used to confirm the clinical impression.

DEVELOPMENT AND COURSE.

Antisocial personality disorder has a chronic course but may become less
evident or remit as the individual grows older, particularly by the fourth
decade of life. Although this remission tends to be particularly evident
with respect to engaging in criminal behavior, there is likel y to be a
decrease in the full spectrum of antisocial behaviors and substance use.
B y definition, antisocial personality cannot be diagnosed before age 18
years.

Borderline Personality Disorder: Patients with borderline personality

disorder stand on the border between neurosis and psychosis, and the y
are characterized by extraordinarily unstable affect, mood, behavior,
object relations, and self-image. The disorder has also been called
ambulatory schizophrenia, as-if personality (a term coined by Helene
Deutsch), pseudoneurotic schizophrenia (described by Paul Hoch and
Phillip Politan), and psychotic character disorder (described by John
Frosch). The 10th revision of the International Classification of Diseases
10 (ICD-10) uses the term emotionall y unstable personality disorder.
DI AGNOSTIC CRITERI A:
A pervasive pattern of instability of interpersonal relationships, self-image,
and affects, and marked impulsivity, beginning b y early adulthood and
present in a variety of contexts, as indicated b y five (or more) of the
following:
1. Frantic efforts to avoid real or imagined abandonment. (Note: Do not
include suicidal or self-mutilating behavior covered in Criterion 5.)
2. A pattern of unstable and intense interpersonal relationships
characterized by alternating between extremes of idealization and
devaluation. 3. Identity disturbance: markedly and persistently unstable
self-image or sense of self.

4. Impulsivity in at least two areas that are potentially self-damaging (e.g.,

spending, sex, substance abuse, reckless driving, binge eating). (Note: Do
not include suicidal or self- mutilating behavior covered in Criterion 5.)
5. Recurrent suicidal behavior, gestures, or threats, or self-mutilating
behavior.
6. Affective instability due to a marked reactivity of mood (e.g., intense
episodic dysphoria, irritability, or anxiety usuall y lasting a few hours and
onl y rarely more than a few days).
7. Chronic feelings of emptiness.
8. Inappropriate, intense anger or difficulty controlling anger (e.g.,
frequent displays of temper, constant anger, recurrent ph ysical fights).
9. Transient, stress-related paranoid ideation or severe dissociative
symptoms.

CH AR AC TERISTICS.
Persons with borderline personality disorder almost always appear to be
in a state of crisis. Mood swings are common. Patients can be
argumentative at one moment, depressed the next, and later complain of
having no feelings. Patients can have short-lived psychotic episodes (socalled micropsychotic episodes) rather than full-blown psychotic breaks,
and the psychotic symptoms of these patients are almost always
circumscribed, fleeting, or doubtful. The behavior of patients with
borderline personality disorder is highly unpredictable, and their
achievements are rarel y at the level of their abilities. The painful nature of
their lives is reflected in repetitive self-destructive acts. Such patients
may slash their wrists and perform other self-mutilations to elicit help from
others, to express anger, or to numb themselves to overwhelming affect.
Because the y feel both dependent and hostile, persons with this disorder
have tumultuous interpersonal relationships. They can be dependent on
those with whom the y are close and, when frustrated, can express
enormous anger toward their intimate friends. Patients with borderline
personality disorder cannot tolerate being alone, and the y prefer a frantic
search for companionship, no matter how unsatisfactory, to their own
compan y. To assuage loneliness, if only for brief periods, they accept a

stranger as a friend or behave promiscuousl y. The y often complain about

chronic feelings of emptiness and boredom and the lack of a consistent
sense of identity (identity diffusion); when pressed, they often complain
about how depressed the y usually feel, despite the flurry of other affects.
Otto Kemberg described the defense mechanism of projective
identification that occurs in patients with borderline personality disorder.
In this primitive defense mechanism, intolerable aspects of the self are
projected onto another; the other person is induced to play the projected
role, and the two persons act in unison. Therapists must be aware of this
process so they can act neutrall y toward such patients. Most therapists
agree that these patients show ordinary reasoning abilities on structured
tests, such as the Wechsler Adult Intelligence Scale, and show deviant
processes only on unstructured projective tests, such as the Rorschach
test. Functionally, patients with borderline personality disorder distort
their relationships b y considering each person to be either all good or all
bad. They see persons as either nurturing attachment figures or as
hateful, sadistic figures who deprive them of security needs and threaten
them with abandonment whenever the y feel dependent. As a result of this
splitting, the good person is idealized and the bad person devalued. Shifts
of allegiance from one person or group to another are frequent. Some
clinicians use the concepts of panphobia, pananxiety, panambivalence,
and chaotic sexuality to delineate these patients' characteristics.

DEVELOPMENT AND COURSE.

Borderline personality disorder is fairly stable; patients change little over
time. Longitudinal studies show no progression toward schizophrenia, but
patients have a high incidence of major depressive disorder episodes. The
diagnosis is usuall y made before the age of 40 years, when patients are
attempting to make occupational, marital, and other choices and are
unable to deal with the normal stages of the life cycle.

Histrionic Personality Disorder: Persons with histrionic personality

disorder are excitable and emotional and behave in a colorful, dramatic,
extroverted fashion. Accompan ying their flamboyant aspects, however, is
often an inability to maintain deep, long-lasting attachments.
DI AGNOSTIC CRITERI A:

A pervasive pattern of excessive emotionality and attention seeking,

beginning by earl y adulthood and present in a variety of contexts, as
indicated by five (or more) of the following:
1. Is uncomfortable in situations in which he or she is not the center of
attention.
2. Interaction with others is often characterized by inappropriate sexually
seductive or provocative behavior.
3. Displa ys rapidl y shifting and shallow expression of emotions.
4. Consistentl y uses ph ysical appearance to draw attention to self.
5. Has a style of speech that is excessivel y impressionistic and lacking in
detail.
6. Shows self-dramatization, theatricality, and exaggerated expression of
emotion.
7. Is suggestible (i.e., easil y influenced b y others or circumstances).
8. Considers relationships to be more intimate than the y actuall y are.

CH AR AC TERISTICS.
Individuals with histrionic personality disorder may have difficulty
achieving emotional intimacy in romantic or sexual relationships. Without
being aware of it, the y often act out a role (e.g., "victim" or "princess") in
their relationships to others. They may seek to control their partner
through emotional manipulation or seductiveness on one level, while
displaying a marked dependency on them at another level. Individuals with
this disorder often have impaired relationships with same-sex friends
because their sexually provocative interpersonal style may seem a threat
to their friends' relationships. These individuals may also alienate friends
with demands for constant attention. The y often become depressed and
upset when the y are not the center of attention. They may crave novelty,
stimulation, and excitement and have a tendency to become bored with
their usual routine. These individuals are often intolerant of, or frustrated
b y, situations that involve dela yed gratification, and their actions are often
directed at obtaining immediate satisfaction. Although they often initiate a
job or project with great enthusiasm, their interest may lag quickly.
Longer-term relationships may be neglected to make wa y for the

excitement of new relationships. The actual risk of suicide is not known,

but clinical experience suggests that individuals with this disorder are at
increased risk for suicidal gestures and threats to get attention and coerce
better caregiving. Histrionic personality disorder has been associated with
higher rates of somatic symptom disorder, conversion disorder (functional
neurological symptom disorder), and major depressive disorder.
Borderline, narcissistic, antisocial, and dependent personality disorders
often co-occur.

DEVELOPMENT AND COURSE.

With age, persons with histrionic personality disorder show fewer
symptoms, but because the y lack the energ y of earlier years, the
difference in number of symptoms may be more apparent than real.
Persons with this disorder are sensation seekers, and they may get into
trouble with the law, abuse substances, and act promiscuously.

Narcissistic Personality Disorder: Persons with narcissistic personality

disorder are characterized by a heightened sense of self-importance, lack
of empath y, and grandiose feelings of uniqueness. Underneath, however,
their self-esteem is fragile and vulnerable to even minor criticism.
DI AGNOSTIC CRITERI A:
A pervasive pattern of grandiosity (in fantasy or behavior), need for
admiration, and lack of empathy, beginning by earl y adulthood and
present in a variety of contexts, as indicated b y five (or more) of the
following:
1. Has a grandiose sense of self-importance (e.g., exaggerates
achievements and talents, expects to be recognized as superior without
commensurate achievements).
2. Is preoccupied with fantasies of unlimited success, power, brilliance,
beauty, or ideal love.

3. Believes that he or she is special and unique and can only be

understood b y, or should associate with, other special or high-status
people (or institutions).
4. Requires excessive admiration.
5. Has a sense of entitlement (i.e., unreasonable expectations of
especiall y favorable treatment or automatic compliance with his or her
expectations).
6. Is interpersonally exploitative (i.e., takes advantage of others to
achieve his or her own ends).
7. Lacks empathy: is unwilling to recognize or identify with the feelings
and needs of others.
8. Is often envious of others or believes that others are envious of him or
her.
9. Shows arrogant, haughty behaviors or attitudes.

CH AR AC TERISTICS.
Persons with narcissistic personality disorder have a grandiose sense of
self-importance; the y consider themselves special and expect special
treatment. Their sense of entitlement is striking. They handle criticism
poorl y and may become enraged when someone dares to criticize them, or
the y may appear completel y indifferent to criticism. Persons with this
disorder want their own wa y and are frequentl y ambitious to achieve fame
and fortune. Their relationships are tenuous, and they can make others
furious by their refusal to obe y conventional rules of behavior.
Interpersonal exploitiveness is commonplace. They cannot show empathy,
and they feign sympath y only to achieve their own selfish ends. Because
of their fragile self-esteem, they are susceptible to depression.
Interpersonal difficulties, occupational problems, rejection, and loss are
among the stresses that narcissists commonl y produce by their behaviorstresses the y are least able to handle.

DEVELOPMENT AND COURSE.

Narcissistic personality disorder is chronic and difficult to treat. Patients
with the disorder must constantly deal with blows to their narcissism
resulting from their own behavior or from life experience. Aging is handled
poorl y; patients value beauty, strength, and youthful attributes, to which
the y cling inappropriately. The y may be more vulnerable, therefore, to
midlife crises than are other groups.

CLUSTER C PERSON ALITY DISORDERS

Avoidant Personality Disorder: Persons with avoidant personality
disorder show extreme sensitivity to rejection and may lead sociall y
withdrawn lives. Although shy, the y are not asocial and show a great
desire for companionship, but the y need unusually strong guarantees of
uncritical acceptance. Such persons are commonly described as having an
inferiority complex.
DI AGNOSTIC CRITERI A:
A pervasive pattern of social inhibition, feelings of inadequacy, and
h ypersensitivity to negative evaluation, beginning b y early adulthood and
present in a variety of contexts, as indicated b y four (or more) of the
following:
1. Avoids occupational activities that involve significant interpersonal
contact because of fears of criticism, disapproval, or rejection.
2. Is unwilling to get involved with people unless certain of being liked.
3. Shows restraint within intimate relationships because of the fear of
being shamed or ridiculed.
4. Is preoccupied with being criticized or rejected in social situations.
5. Is inhibited in new interpersonal situations because of feelings of
inadequacy.
6. Views self as socially inept, personally unappealing, or inferior to
others.
7. Is unusuall y reluctant to take personal risks or to engage in an y new
activities because they may prove embarrassing.

CH AR AC TERISTICS.
Hypersensitivity to rejection b y others is the central clinical feature of
avoidant personality disorder, and patients' main personality trait is
timidity. These persons desire the warmth and security of human
companionship but justify their avoidance of relationships by their alleged
fear of rejection. When talking with someone, the y express uncertainty,
show a lack of self-confidence, and may speak in a self-effacing manner.
Because the y are hypervigilant about rejection, they are afraid to speak
up in public or to make requests of others. The y are apt to misinterpret
other persons' comments as derogatory or ridiculing. The refusal of any
request leads them to withdraw from others and to feel hurt. In the
vocational sphere, patients with avoidant personality disorder often take
jobs on the sidelines. The y rarely attain much personal advancement or
exercise much authority but seem shy and eager to please. These persons
are generall y unwilling to enter relationships unless they are given an
unusuall y strong guarantee of uncritical acceptance. Consequentl y, they
often have no close friends or confidants.

DEVELOPMENT AND COURSE.

The avoidant behavior often starts in infancy or childhood with sh yness,
isolation, and fear of strangers and new situations. Although shyness in
childhood is a common precursor of avoidant personality disorder, in most
individuals it tends to gradually dissipate as the y get older. In contrast,
individuals who go on to develop avoidant personality disorder may
become increasingl y shy and avoidant during adolescence and early
adulthood, when social relationships with new people become especially
important. There is some evidence that in adults, avoidant personality
disorder tends to become less evident or to remit with age. This diagnosis
should be used with great caution in children and adolescents, for whom
sh y and avoidant behavior may be developmentall y appropriate.

Dependent Personality Disorder: Persons with dependent personality

disorder subordinate their own needs to those of others, get others to
assume responsibility for major areas of their lives, lack self-confidence,
and may experience intense discomfort when alone for more than a brief
period. The disorder has been called passive-dependent personality.

Freud described an oral-dependent personality dimension characterized

b y dependence, pessimism, fear of sexuality, self doubt, passivity,
suggestibility, and lack of perseverance; his description is similar to the
DSM-5 categorization of dependent personality disorder.
DI AGNOSTIC CRITERI A:
A pervasive and excessive need to be taken care of that leads to
submissive and clinging behavior and fears of separation, beginning by
earl y adulthood and present in a variety of contexts, as indicated by five
(or more) of the following:
1. Has difficulty making everyday decisions without an excessive amount
of advice and reassurance from others.
2. Needs others to assume responsibility for most major areas of his or
her life.
3. Has difficulty expressing disagreement with others because of fear of
loss of support or approval. (Note: Do not include realistic fears of
retribution.)
4. Has difficulty initiating projects or doing things on his or her own
(because of a lack of self-confidence in judgment or abilities rather than a
lack of motivation or energy).
5. Goes to excessive lengths to obtain nurturance and support from
others, to the point of volunteering to do things that are unpleasant.
6. Feels uncomfortable or helpless when alone because of exaggerated
fears of being unable to care for himself or herself.
7. Urgently seeks another relationship as a source of care and support
when a close relationship ends.
8. Is unrealistically preoccupied with fears of being left to take care of
himself or herself.

CH AR AC TERISTICS.
Dependent personality disorder is characterized b y a pervasive pattern of
dependent and submissive behavior. Persons with the disorder cannot
make decisions without an excessive amount of advice and reassurance

from others. They avoid positions of responsibility and become anxious if

asked to assume a leadership role. They prefer to be submissive. When
on their own, they find it difficult to persevere at tasks but may find it easy
to perform these tasks for someone else. Because persons with the
disorder do not like to be alone, the y seek out others on whom they can
depend; their relationships, thus, are distorted by their need to be
attached to another person. In folie a deux (shared psychotic disorder),
one member of the pair usuall y has dependent personality disorder; the
submissive partner takes on the delusional system of the more
aggressive, assertive partner on whom he or she depends. Pessimism,
self-doubt, passivity, and fears of expressing sexual and aggressive
feelings all typify the behavior of persons with dependent personality
disorder. An abusive, unfaithful, or alcoholic spouse may be tolerated for
long periods to avoid disturbing the sense of attachment.

DEVELOPMENT AND COURSE.

Little is known about the course of dependent personality disorder.
Occupational functioning tends to be impaired because persons with the
disorder cannot act independently and without close supervision. Social
relationships are limited to those on whom the y can depend, and many
suffer ph ysical or mental abuse because they cannot assert themselves.
The y risk major depressive disorder if they lose the person on whom the y
depend, but with treatment, the prognosis is favorable.

Obsessive-compulsive Personality Disorder: Obsessive-compulsive

personality disorder is characterized by emotional constriction,
orderliness, perseverance, stubbornness, and indecisiveness. The
essential feature of the disorder is a pervasive pattern of perfectionism
and inflexibility.
DI AGNOSTIC CRITERI A:
A pervasive pattern of preoccupation with orderliness, perfectionism, and
mental and intrapersonal control, at the expense of flexibility, openness,
and efficiency, beginning by early adulthood and present in a variety of
contexts, as indicated by four (or more) of the following:

1. Is preoccupied with details, rules, lists, order, organization, or

schedules to the extent that the major point of the activity is lost.
2. Shows perfectionism that interferes with task completion (e.g., is
unable to complete a project because his or her own overly strict
standards are not met).
3. Is excessively devoted to work and productivity to the exclusion of
leisure activities and friendships (not accounted for by obvious economic
necessity).
4. Is overconscientious, scrupulous, and inflexible about matters of
morality, ethics, or values (not accounted for b y cultural or religious
identification).
5. Is unable to discard worn-out or worthless objects even when the y have
no sentimental value.
6. Is reluctant to delegate tasks or to work with others unless they submit
to exactl y his or her wa y of doing things.
7. Adopts a miserl y spending style toward both self and others; money is
viewed as something to be hoarded for future catastrophes.
8. Shows rigidity and stubbornness.

CH AR AC TERISTICS.
Persons with obsessive-compulsive personality disorder are preoccupied
with rules, regulations, orderliness, neatness, details, and the
achievement of perfection. These traits account for the general
constriction of the entire personality. The y insist that rules be followed
rigidly and cannot tolerate what they consider infractions. Accordingl y,
the y lack flexibility and are intolerant. The y are capable of prolonged
work, provided it is routinized and does not require changes to which they
cannot adapt. Persons with obsessive-compulsive personality disorder
have limited interpersonal skills. They are formal and serious and often
lack a sense of humor. The y alienate persons, are unable to compromise,
and insist that others submit to their needs. The y are eager to please
those whom they see as more powerful than the y are, however, and they
carry out these persons' wishes in an authoritarian manner. Because the y
fear making mistakes, they are indecisive and ruminate about making

decisions. Although a stable marriage and occupational adequacy are

common, persons with obsessive-compulsive personality disorder have
few friends. Anything that threatens to upset their perceived stability or
the routine of their lives can precipitate much anxiety otherwise bound up
in the rituals that the y impose on their lives and try to impose on others.
5 C ATEGORIES OF OCD.
Washers (people who are terrified of contamination)
Checkers (people who are afraid that something terrible could happen
because the y forgot to take some action)
Doubters and sinners (people who are afraid of being less than perfect
and are waiting to be caught and punished for mistakes)
Counters and arrangers (people who have an obsession with order and
symmetry. They are often very superstitious, too)
Hoarders (people who cant throw anything awa y). Thus, the y
compulsivel y store things the yll never use such as newspapers, receipts
and old medicine bottles.

DEVELOPMENT AND COURSE.

The course of obsessive-compulsive personality disorder is variable and
unpredictable. From time to time, persons may develop obsessions or
compulsions in the course of their disorder. Some adolescents with
obsessive-compulsive personality disorder evolve into warm, open, and
loving adults; in others, the disorder can be either the harbinger of
schizophrenia or-decades later and exacerbated b y the aging processmajor depressive disorder. Persons with obsessive-compulsive personality
disorder may flourish in positions demanding methodical, deductive, or
detailed work, but the y are vulnerable to unexpected changes, and their
personal lives may remain barren. Depressive disorders, especially those
of late onset, are common.

OTHER SPECIFIED PERSON ALITY DISORDER.

Passive-aggressive Personality: Although no longer an official
diagnosis, persons with this personality type are not uncommon. Persons

with passive-aggressive personality are characterized by covert

obstructionism, procrastination, stubbornness, and inefficiency. Such
behavior is a manifestation of passivel y expressed underl ying aggression.

CH AR AC TERISTICS.
Patients with passive-aggressive personality characteristicall y
procrastinate, resist demands for adequate performance, find excuses for
dela ys, and find fault with those on whom the y depend, yet they refuse to
extricate themselves from the dependent relationships. The y usually lack
assertiveness and are not direct about their own needs and wishes. They
fail to ask needed questions about what is expected of them and may
become anxious when forced to succeed or when their usual defense of
turning anger against themselves is removed. In interpersonal
relationships, these persons attempt to manipulate themselves into a
position of dependence, but others often experience this passive, self
detrimental behavior as punitive and manipulative. Persons with this
personality type expect others to do their errands and to carry out their
routine responsibilities. Friends and clinicians may become enmeshed in
trying to assuage the patients' many claims of unjust treatment. The close
relationships of persons with passive-aggressive personality, however, are
rarel y tranquil or happy. Because they are bound to their resentment more
closel y than to their satisfaction, the y may never even formulate goals for
finding enjo yment in life. Persons with passive-aggressive personality lack
self-confidence and are typicall y pessimistic about the future.

DEVELOPMENT AND COURSE.

In a follow-up stud y averaging 11 years of 1 00 inpatients diagnosed with
passive-aggressive disorder, Ivor Small found that the primary diagnosis
in 54 was passive-aggressive personality disorder; 18 were also alcohol
abusers, and 30 could be clinicall y labeled as depressed. Of the 73 former
patients located, 58 (79 percent) had persistent psychiatric difficulties,
and 9 (12 percent) were considered symptom free. Most seemed irritable,
anxious, and depressed; somatic complaints were numerous. Onl y 32 ( 44
percent) were emplo yed full time as workers or homemakers. Although
neglect of responsibility and suicide attempts were common, only one
patient had committed suicide in the interim. Twenty-eight (38 percent)

had been readmitted to a hospital, but only three had been diagnosed as
having schizophrenia.

Depressive Personality: Persons with depressive personality are

characterized by lifelong traits that fall along the depressive spectrum.
The y are pessimistic, anhedonic, duty bound, self-doubting, and
chronicall y unhapp y. Melancholic personality was described by earl y 20 t h
century European psychiatrists such as Ernst Kretschmer.
CH AR AC TERISTICS.
Patients with depressive personality feel little of the normal jo y of living
and are inclined to be lonely and solemn, gloomy, submissive, pessimistic,
and self-deprecatory. They are prone to express regrets and feelings of
inadequacy and hopelessness. The y are often meticulous, perfectionistic,
overconscientious, and preoccupied with work; feel responsibility keenly;
and are easily discouraged under new conditions. They are fearful of
disapproval; tend to suffer in silence; and perhaps to cry easily, although
usually not in the presence of others. A tendency to
hesitation, indecision, and caution betrays an inherent feeling of
insecurity. More recently, Hagop Akiskal described seven groups of
depressive traits:
(1) quiet, introverted, passive, and nonassertive;
(2) gloomy, pessimistic,
serious, and incapable of fun;
(3) self-critical, self-reproachful,
and self-derogatory;
( 4) skeptical, critical of others, and hard to please;
(5) conscientious, responsible, and self-disciplined;
(6) brooding and
given to worry; and
(7) preoccupied with negative events, feelings of

inadequacy, and personal shortcomings.

Patients with depressive personality complain of chronic feelings of
unhappiness. The y admit to low self-esteem and difficulty finding anything
in their lives about which they are joyful, hopeful, or optimistic. They are
self-critical and derogatory and are likel y to denigrate their work,
themselves, and their relationships with others. Their physiognomy often
reflects their mood-poor posture, depressed facies, hoarse voice, and
psychomotor retardation.

Sadistic Personality: Sadistic personality is not included in DSM-5, but it

still appears in the literature and may be of descriptive use. Beginning in
earl y adulthood, persons with sadistic personality show a pervasive
pattern of cruel, demeaning, and aggressive behavior that is directed
toward others. Physical cruelty or violence is used to inflict pain on
others, not to achieve another goal, such as mugging a person to steal.
Persons with sadistic personality like to humiliate or demean persons in
front of others and have usually treated or disciplined persons
uncommonly harshl y, especially children. In general, persons with sadistic
personality are fascinated b y violence, weapons, injury, or torture. To be
included in this category, such persons cannot be motivated solely by the
desire to derive sexual arousal from their behavior; if the y are so
motivated, the paraphilia of sexual sadism should be diagnosed.

Self-defeating Personality Disorder (Masochistic): Self-defeating

Personality Disorder is a pervasive pattern of self-defeating behavior,
beginning by earl y adulthood and present in a variety of contexts. The
person may often avoid or undermine pleasurable experiences, be drawn
to situations or relationships in which he or she will suffer, and prevent
others from helping him or her, as indicated b y at least five of the
following:
1. Chooses people and situations that lead to disappointment, failure, or
mistreatment even when better options are clearl y available.
2. Rejects or renders ineffective the attempts of others to help him of her.

3. Following positive personal events (e.g., new achievement), responds

with depression, guilt, or a behavior that produces pain ( e.g., an
accident).
4. Incites angry or rejecting responses from others and then feels hurt,
defeated, or humiliated (e.g., makes fun of spouse in public, provoking an
angry retort, then feels devastated).
5. Rejects opportunities for pleasure, or is reluctant to acknowledge
enjo ying himself or herself (despite having adequate social skills and the
capacity for pleasure).
6. Fails to accomplish tasks crucial to his or her personal objectives
despite demonstrated ability to do so, (e.g., helps fellow students write
papers , but is unable to write his or her own).
7. Is uninterested in or rejects people who consistentl y treat him or her
well, (e.g., is not attracted to caring sexual partners).
8. Engages in excessive self-sacrifice that is unsolicited by the intended
recipients of the sacrifice;
9. The behaviors do not occur exclusivel y in response to, or in anticipation
of , being physically, sexually, or psychologically abused.
10. The behaviors do not occur onl y when the person is depressed.
11. The behaviors do not occur exclusivel y in response to, or in
anticipation of , being ph ysicall y, sexuall y, or psychologicall y abused.
Differential Diagnosis.
Some disorders have similar or even overlapping symptoms. The
clinician, therefore, in his diagnostic attempt has to differentiate against
the following disorders which need to be ruled out to establish a precise
diagnosis.People with self-defeating personalities are drawn to situations
and relationships in which they are subject to failure, humiliation,
suffering, and distress. Although sexual masochism may be present, it has
no necessary connection with this disorder.
Cause.
There is no clear cause for sadistic personality disorder; some theories
suggest that it is a function of how one is brought up, but biological

factors are likel y as well. This disorder is fairl y uncommon and there is
little information about occurrence by gender or about famil y pattern.