Personality Disorders Overview

Personality Disorders

• Defined by the presence of chronic, maladaptive traits that deviate from cultural norms.
• Traits relate to cognition, affect, interpersonal functioning, and/or impulse control.
• Traits become a disorder when they:
  • Impede a fulfilling life
  • Alienate others, leading to loneliness
  • Result in moral or criminal violations
• Disorders have varying severity.
• Point prevalence across cultures is 10.5%.
• Formerly called "character disorders," once believed to only respond to long-term therapy.
• DSM-5-TR criteria for personality disorders often overlap, and inter-rater reliability is low compared to other diagnoses.

Personality Disorder Clusters

• Cluster A ("Odd, Eccentric"):

  • Point prevalence: ~3.6%
  • Characterized by cognitive distortions or perceptual abnormalities, emotional detachment, and discomfort with social relationships.
  • Includes Paranoid, Schizoid, and Schizotypal Personality Disorders

• Cluster B ("Dramatic, Emotional, Unstable"):

  • Point prevalence: ~4.5%
  • Characterized by dramatic and emotional instability, unstable or manipulative relationships, and a lack of empathy.
  • Includes Borderline, Antisocial, Narcissistic, and Histrionic Personality Disorders

• Cluster C ("Anxious, Apprehensive"):

  • Point prevalence: ~2.8%
  • Characterized by issues relating to social adequacy, inhibition, neediness, and control.
  • Includes Avoidant, Dependent, Obsessive-Compulsive, and Passive-Aggressive Personality Disorders

Borderline Personality Disorder

• Prevalence: ~2%, slightly more common in female clinical samples compared to community samples.
• Characterized by pervasive instability in relationships, impulsivity, dramatic emotionality, and behaviors that can cause self-harm.
  • Frequent mood swings, intense anger, and "splitting" (idealizing then devaluing people)
  • Disproportionate intense anger and transient psychotic episodes
  • Self-harm behaviors (e.g., cutting)
  • Impulsivity, leading to reckless behavior (e.g., sex, substance abuse)
• High comorbidity with other disorders, particularly major depression, substance abuse, and eating disorders.

Antisocial Personality Disorder

• Individuals with APD come under the mental health system (or judicial) because of repeated moral offenses or criminal acts.
• Can be categorized into sociopaths, psychopaths, or other types.
• APD is related to early childhood trauma and low socioeconomic status but not a direct cause.
• Characterized by a disregard for the rights of others.
• Often charming, manipulative, lacking remorse and empathy, and have a pattern of irresponsible behavior.
• Often have a history of conduct disorder before age 18, and exhibit traits of impulsivity, irritability, and aggressiveness.

Psychopathy

• A subgroup of Antisocial PD individuals
• Often labeled as "charismatic psychopaths", also "pro-social."
• Features such as superficial charm, pathological lying, impulsivity, lack of remorse.
• Associated with certain brain structures and functions, but not proven cause.

Narcissistic Personality Disorder

• Prevalence: ~1%, slightly more common in men
• Characterized by a grandiose sense of self-importance, a need for admiration, and a lack of empathy.
• Individuals with NPD tend to overestimate abilities, expect special treatment, lack empathy, and devalue other people's perspectives.

Histrionic Personality Disorder

• Prevalence: 0.9-1.8%, more common in women
• Individuals with HPD tend to be overly dramatic and attention-seeking, and use their appearance to attract attention.
• Behavior is easily influenced by others and prone to self-dramatization to get attention.

Paranoid Personality Disorder

• Prevalence ~2-4%, no strong gender preference.
• Characterized by pervasive distrust and suspicion of others.
• Individuals with PPD tend to be suspicious of others' motives, and suspect plots to harm them
• They can hold grudges and are unforgiving
• Often misinterpret benign remarks/events as threatening

Schizoid Personality Disorder

• Prevalence ~1-4%, no strong gender preference.
• Characterized by a detachment from social relationships.
• Individuals are not interested in social interactions, often prefer solitude, and have a limited range of emotions

Schizotypal Personality Disorder

• Prevalence ~0.6-3.9%, slightly more common in men.
• Characterized by unusual thoughts, appearance, beliefs, and behavior.
• Features include eccentric behaviors, such as odd beliefs, magical thinking, perceptual distortions, and social anxiety.

Avoidant Personality Disorder

• Prevalence ~1%, no strong gender preference.
• Characterized by a hypersensitivity to rejection and social criticism.
• People with avoidant personality disorder commonly withdraw from social situations, fearing rejection.

Dependent Personality Disorder

• Prevalence ~2%, no strong gender preference.
• Characterized by a need to be taken care of and a fear of being alone.
• People with dependent personality disorder tend to rely heavily on others for decisions and support.

Obsessive-Compulsive Personality Disorder

• Prevalence ~2%, slightly more common in men.
• Characterized by preoccupation with orderliness, perfectionism, and control.
• People with OCPD tend to be perfectionistic, meticulous, and inflexible.

Passive-Aggressive Personality Disorder

• A behavior pattern, not a formal diagnosis.
• Characterized by indirect expressions of hostility, resistance to demands, and a pattern of procrastination or other passive-aggressive behaviors.

Treatments for Personality Disorders (general)

• Treatment methods vary depending on the specific disorder and individual needs
• Psychotherapy is a common treatment approach, often focusing on symptom management and coping mechanisms.
• Medications (e.g., antidepressants, anti-anxiety, antipsychotics) might be used to address co-occurring conditions such as depression or anxiety.