Quick Guide to the Personality Disorders

Quick Guide to the Personality Disorders

Quick Guide to the Personality Disorders

DSM-5 retains the 10 specific personality disorders (PDs) that were listed in DSM-IV. Of these, perhaps 6 have been studied reasonably well and have a lot of support in the research community. The rest (paranoid, schizoid, histrionic, and dependent PDs), while perhaps less well founded in science, retain their positions in the diagnostic firmament because of their practical use and, frankly, tradition.

Speaking of tradition, ever since DSM-III in 1980 the personality disorders have been divided into three groups, called clusters. Heavily criticized for a lack of scientific validity, the clusters are perhaps most useful as a device to help us call to mind the full slate of PDs.

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Cluster A Personality Disorders

People with Cluster A PDs can be described as withdrawn, cold, suspicious, or irrational. (Here and throughout the Quick Guide, as usual, the link indicates where a more detailed discussion begins.)

Paranoid . These people are suspicious and quick to take offense. They often have few confidants and may read hidden meaning into innocent remarks.

Schizoid . These patients care little for social relationships, have a restricted emotional range, and seem indifferent to criticism or praise. Tending to be solitary, they avoid close (including sexual) relationships.

Schizotypal . Interpersonal relationships are so difficult for these people that they appear peculiar or strange to others. They lack close friends and are uncomfortable in social situations. They may show suspiciousness, unusual perceptions or thinking, eccentric speech, and inappropriate affect.

Cluster B Personality Disorders

Those with Cluster B PDs tend to be rather theatrical, emotional, and attention-seeking; their moods are labile and often shallow. They often have intense interpersonal conflicts.

Antisocial . The irresponsible, often criminal behavior of these people begins in childhood or early adolescence with truancy, running away, cruelty, fighting, destructiveness, lying, and theft. In addition to criminal behavior, as adults they may default on debts or otherwise behave irresponsibly; act recklessly or impulsively; and show no remorse for their behavior.

Borderline . These impulsive people engage in behavior harmful to themselves (sexual adventures, unwise spending, excessive use of substances or food). Affectively unstable, they often show intense, inappropriate anger. They feel empty or bored, and they frantically try to avoid abandonment. They are uncertain about who they are, and they lack the ability to maintain stable interpersonal relationships.

Histrionic . Overly emotional, vague, and desperate for attention, these people need constant reassurance about their attractiveness. They may be self-centered and sexually seductive.

Narcissistic . These people are self-important and often preoccupied with envy, fantasies of success, or ruminations about the uniqueness of their own problems. Their sense of entitlement and lack of compassion may cause them to take advantage of others. They vigorously reject criticism and need constant attention and admiration.

Cluster C Personality Disorders

Someone with a Cluster C PD will tend to be anxious and tense, often overcontrolled.

Avoidant . These timid people are so easily wounded by criticism that they hesitate to become involved with others. They may fear the embarrassment of showing emotion or of saying things that seem foolish. They may have no close friends, and they exaggerate the risks of undertaking pursuits outside their usual routines.

Dependent . These people so much need the approval of others that they have trouble making independent decisions or starting projects; they may even agree with others whom they know to be wrong. They fear abandonment, feel helpless when they are alone, and are miserable when relationships end. They are easily hurt by criticism and will even volunteer for unpleasant tasks to gain the favor of others.

Obsessive–Compulsive . Perfectionism and rigidity characterize these people. They are often workaholics, and they tend to be indecisive, excessively scrupulous, and preoccupied with detail They insist that others do things their way. They have trouble expressing affection, tend to lack generosity, and may even resist throwing away worthless objects they no longer need.

Other Causes of Long-Standing Character Disturbance

Personality change due to another medical condition . A medical condition can affect a patient’s personality for the worse. This would not qualify as a PD, because it may be less pervasive and not present from an early age.

Other mental disorders. When they persist for a long time (usually years), a variety of other mental conditions can distort the way a person behaves and relates to others. This can give the appearance of a personality disorder. Especially good examples include dysthymia, schizophrenia, social anxiety disorder, and cognitive disorders. Some studies find that patients with mood disorders are more likely to show personality traits or PDs when they are clinically depressed; this may be especially true of Cluster A and Cluster C traits. Personality pathology noted in depressed patients should be reevaluated once the depression has remitted.

Other specified, or unspecified, personality disorder . Use one of these categories for personality disturbances that do not meet the criteria for any of the disorders above, or for PDs that have not achieved official status.