Understanding Personality Disorders

• Personality disorders are enduring patterns of inner experience and behavior that deviate from cultural expectations.
• These patterns are pervasive, inflexible, have an onset in adolescence or early adulthood, are stable over time, and lead to distress or impairment.
• Personality disorders were formerly known as character disorders, which are personality types deviating from societal expectations.
• The American Psychiatric Association (APA) defines personality disorders as enduring patterns of inner experience and behavior that deviate from the individual's culture.

Causes of Personality Disorders

• Genetic factors can contribute to personality disorders.
• Environmental factors, such as childhood trauma, neglect, or inconsistent caregiving, can influence maladaptive personality traits.
• Neurobiological factors, including brain structure and function and neurotransmitter imbalances, can contribute to personality disorders.
• Cognitive and behavioral factors, like dysfunctional patterns of thinking and emotional regulation, reinforce maladaptive personality traits.
• Cultural and social factors, including societal norms, cultural influences, and family dynamics, also play a role.

Defining Features

• Personality disorders are defined by deviations in experience and behavior from cultural expectations, manifested in two or more of the following areas: cognition, affect, interpersonal functioning, and impulse control.

Personality Disorder Clusters

• Cluster A personality disorders are characterized by odd, eccentric behaviors and are often described as "weird."
• Cluster A includes Paranoid, Schizoid, and Schizotypal Personality Disorders.
• Cluster B personality disorders involve dramatic, emotional, and erratic behaviors and are characterized as "wired."
• Cluster B includes Antisocial, Borderline, Histrionic, and Narcissistic Personality Disorders.
• Cluster C personality disorders are marked by anxious, fearful behaviors and are often described as "wimpy."
• Cluster C includes Avoidant, Dependent, and Obsessive-Compulsive Personality Disorders.

Paranoid Personality Disorder

• Is characterized by pervasive distrust and suspiciousness of others, with motives interpreted as malevolent.
• Four or more of the following criteria must be met:
• Suspecting, without sufficient basis, that others are exploiting, harming, or deceiving them.
• Preoccupation with unjustified doubts about the loyalty or trustworthiness of friends or associates.
• Reluctance to confide in others due to unwarranted fear that the information will be used maliciously.
• Reading hidden demeaning or threatening meanings into benign remarks or events.
• Persistently bearing grudges (unforgiving of insults, injuries, or slights).
• Perceiving attacks on character or reputation not apparent to others, reacting angrily or counterattacking.
• Recurrent suspicions, without justification, regarding the fidelity of spouse or sexual partner.

Schizoid Personality Disorder

• Involves a pattern of detachment from social relationships and a restricted range of emotional expression.
• Four or more of the following criteria must be met:
• Neither desires nor enjoys close relationships, including being part of a family.
• Almost always chooses solitary activities.
• Has little, if any, interest in having sexual experiences with another person.
• Takes pleasure in few, if any, activities.
• Lacks close friends or confidants other than first-degree relatives.
• Appears indifferent to the praise or criticism of others.
• Shows emotional coldness, detachment, or flattened affectivity.

Guntrip Criteria

• This may also be referred to as Schizoid traits and includes specific criteria for Schizoid Personality Disorder.
• Introversion
• Withdrawnness
• Narcissism
• Self-sufficiency
• A sense of superiority
• Loss of affect
• Loneliness
• Depersonalization
• Regression

Schizotypal Personality Disorder

• Features acute discomfort in close relationships, cognitive or perceptual distortions, and eccentricities of behavior.
• Five or more of the following criteria must be met:
• Ideas of reference (excluding delusions of reference).
• Odd beliefs or magical thinking that influences behavior and is inconsistent with subcultural norms.
• Unusual perceptual experiences, including bodily illusions.
• Odd thinking and speech (e.g., vague, circumstantial, metaphorical, over-elaborate).
• Suspiciousness or paranoid ideation.
• Inappropriate or constricted affect.
• Behavior or appearance that is odd, eccentric, or peculiar.
• Lack of close friends or confidants other than first-degree relatives.
• Excessive social anxiety that does not diminish with familiarity and tends to be associated with paranoid fears rather than negative judgments about self.

Antisocial Personality Disorder

• It includes a pattern of disregard for and violation of the rights of others.
• Three or more of the following criteria must be met:
• Failure to conform to social norms concerning lawful behaviors, indicated by repeatedly performing acts that are grounds for arrest.
• Deceitfulness, indicated by repeated lying, use of aliases, or conning others for personal profit or pleasure.
• Impulsivity or failure to plan ahead.
• Irritability and aggressiveness, indicated by repeated physical fights or assaults.
• Reckless disregard for the safety of self or others.
• Consistent irresponsibility, indicated by repeated failure to sustain consistent work behavior or honor financial obligations.
• Lack of remorse, indicated by being indifferent to or rationalizing having hurt, mistreated, or stolen from another.

Borderline Personality Disorder

• Involves a pattern of instability in interpersonal relationships, self-image, affects, and marked impulsivity.
• Five or more of the following criteria must be met:
• Frantic efforts to avoid real or imagined abandonment.
• A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation.
• Identity disturbance: markedly and persistently unstable self-image or sense of self.
• Impulsivity in at least two areas that are potentially self-damaging (e.g., spending, sex, substance abuse, reckless driving, binge eating).
• Recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior.
• Affective instability due to a marked reactivity of mood (e.g., intense episodic dysphoria, irritability, or anxiety).
• Chronic feelings of emptiness.
• Inappropriate, intense anger or difficulty controlling anger.
• Transient, stress-related paranoid ideation or severe dissociative symptoms.

Narcissistic Personality Disorder

• Includes a pattern of grandiosity (in fantasy or behavior), a need for admiration, and a lack of empathy.
• Five or more of the following criteria must be met:
• A grandiose sense of self-importance (exaggerates achievements and talents, expects to be recognized as superior without commensurate achievements).
• Preoccupation with fantasies of unlimited success, power, brilliance, beauty, or ideal love.
• Believing they are "special" and unique and can only be understood by, or should associate with, other special or high-status people (or institutions).
• Requiring excessive admiration.
• A sense of entitlement (unreasonable expectations of especially favorable treatment or automatic compliance with their expectations).
• Being interpersonally exploitative (taking advantage of others to achieve their own goals).
• Lacking empathy (unwilling to recognize or identify with the feelings and needs of others).
• Being often arrogant, haughty, or having a sense of superiority.

Histrionic Personality Disorder

• Includes a pattern of excessive emotionality and attention-seeking behavior.
• Five or more of the following criteria must be met:
• Uncomfortable in situations in which they are not the center of attention.
• Interaction with others is often characterized by inappropriate sexually seductive or provocative behavior.
• Displays rapidly shifting and shallow expressions of emotion.
• Consistently uses physical appearance to draw attention to self.
• Has a style of speech that is excessively impressionistic and lacking in detail.
• Shows self-dramatization, theatricality, and exaggerated expression of emotion.
• Is easily influenced by others or circumstances.
• Considers relationships to be more intimate than they actually are.

Mnemonic for Histrionic Personality Disorder

• PRAISE ME
• P: Provocative (or seductive) behavior
• R: Relationships, considered more intimate than they are
• A: Attention, must be at center of
• I: Influenced easily
• S: Speech (style) - wants to impress, lacks detail
• E: Emotional lability, shallowness
• M: Make-up - physical appearance used to draw attention to self
• E: Exaggerated emotions – theatrical