Psychopathology Exam 2

What is a personality disorder?

enduring pattern of inner experience and behavior that deviates markedly from the norms and expectations of the individual’s culture, is pervasive and inflexible, has an onset in adolescence or early adulthood, is stable over time, and leads to distress or impairment

Pattern of distrust and suspiciousness such that others’ motives are interpreted as malevolent describes…

Paranoid personality disorder

Pattern of detachment from social relationships and a restricted range of emotional expression describes…

Schizoid personality disorder

Pattern of acute discomfort in close relationships, cognitive or perceptual distortions, and eccentricities of behavior describes…

Schizotypal personality disorder

Pattern of disregard for, and violation of, the rights of others, criminality, impulsivity, and a failure to learn from experience describes…

Antisocial personality disorder

Pattern of instability in interpersonal relationships, self-image, and affects, and marked impulsivity describes…

Borderline personality disorder

Pattern of excessive emotionality and attention seeking describes…

Histrionic personality disorder

Pattern of grandiosity, need for admiration, and lack of empathy describes…

Narcissistic personality disorder

Pattern of social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation describes…

Avoidant personality disorder

Pattern of submissive and clinging behavior related to an excessive need to be taken care of describes…

Dependent personality disorder

Pattern of preoccupation with orderliness, perfectionism, and control describes…

Obsessive-compulsive personality disorder

Persistent personality disturbance that is judged to be the direct pathophysiological consequence of another medical condition describes…

Personality change due to another medical condition

Which personality cluster is described as “often appear odd and eccentric”?

Cluster A

Which personality disorders are included in Cluster A?

Paranoid, schizoid, and schizotypal

Which personality cluster is described as “often appear dramatic, emotional, or erratic”?

Cluster B

Which personality disorders are included in Cluster B?

Antisocial, borderline, histrionic, and narcissistic

Which personality cluster is described as “often appear anxious or fearful”?

Cluster C

Which personality disorders are included in Cluster C?

Avoidant, dependent, obsessive-compulsive

General Personality Disorder

• A - An enduring pattern of inner experience and behavior that deviates markedly from the expectations of the individual’s culture. Manifested in two or more of the following areas:

  • Cognition (ways of perceiving and interpreting the self, other people, and events)

  • Affectivity (range, intensity, lability, and appropriateness of the emotional response)

  • Interpersonal functioning

  • Impulse control

• B - enduring pattern is inflexible and pervasive across a broad range of personal and social situations

• C - enduring pattern leads to clinically significant distress or impairment in social, occupational, or other important areas of functioning

• D - a pattern is stable and of long duration, and its onset can be traced abc at least to adolescence or early adulthood

• E - enduring pattern is not better explained as a manifestation or consequence of another mental disorder

  • F - enduring pattern is not attributable to the physiological effects of a substance or another  medical condition

Paranoid Personality Disorder

• A - A pervasive distrust and suspiciousness of others such that their motives are interpreted as malevolent, beginning by early adulthood and present in a variety of contexts, as indicated by four or more of the following:

  • Suspects, without sufficient basis, that others are exploiting, harming, or deceiving them

  • Preoccupied with unjustified doubts about the loyalty or trustworthiness of friends or associates

  • Is reluctant to confide in others because of unwarranted fear that the information will be used maliciously against them

  • Reads hidden demeaning or threatening meanings into benign remarks or events

  • Persistently bears grudges (is unforgiving of insults, injuries, or slights)

  • Perceives attacks on their character or reputation that are not apparent to others and is quick to react angrily or to counterattack

  • Has recurrent suspicions, without justification, regarding fidelity of spouse or sexual partner

• B - Does not occur exclusively during the course of schizophrenia, a bipolar 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 schizophrenia onset, add “premorbid” to this diagnosis - paranoid personality disorder (premorbid)

Schizoid Personality Disorder

• A - A pervasive pattern of detachment from social relationships and a restricted range of expression of emotions in interpersonal settings, beginning by early adulthood and present in a variety of contexts, as indicated by four or more of the following:

  • 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

• B - does not occur exclusively during the course of schizophrenia, a bipolar disorder or depressive disorder with psychotic features, another psychotic disorder, or ASD 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”

Schizotypal Personality Disorder

• A - a pervasive pattern of social and interpersonal deficits marked by acute discomfort with, and reduced capacity for, close relationships as well as by cognitive or perceptual distortions and eccentricities of behavior, beginning by early adulthood and present in a variety of contexts, as indicated by five or more of the following:

  • Ideas of reference (excluding delusions of reference)

  • Odd beliefs or magical thinking that influences behavior and is inconsistent with subcultural norms (superstitious beliefs in clairvoyance, telepathy, or sixth sense; in children or adolescents, bizarre fantasies or preoccupations)

  • Unusual perceptual experiences, including bodily illusions

  • Odd thinking and speech (vague, circumstantial, metaphorical, overelaborate, or stereotyped)

  • 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

• B - Does not occur exclusively during the course of schizophrenia, a bipolar disorder or depressive disorder with psychotic features, another psychotic disorder, or ASD

Antisocial Personality Disorder

• 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:

  • Failure to conform to social norms with respect to lawful behaviors, as indicated by repeatedly performing acts that are grounds for arrest

  • Deceitfulness, as indicated by repeated lying, use of aliases, or conning others for personal profit or pleasure

  • Impulsivity or failure to plan ahead

  • Irritability and aggressiveness, as indicated by repeated physical fights or assaults

  • Reckless disregard for safety of self or others

  • Consistent irresponsibility, as indicated by repeated failure to sustain consistent work behavior or honor financial obligations

  • Lack of remorse, as indicated by being indifferent to or rationalizing having hurt, mistreated, or stolen from another

• B - individual is at least 18 years of age

• C - there is evidence of conduct disorder with onset before age 15 years

• D - occurrence of antisocial behavior is not exclusively during the course of schizophrenia or bipolar disorder

Borderline Personality Disorder

• A pervasive pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsivity, beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following:

  • Frantic efforts to avoid real or imagined abandonment (Do not include suicidal or self-mutilating behavior covered in pattern 5)

  • 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) (Don’t include suicidal or self-mutilating behavior)

  • Recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior

  • Affective instability due to marked reactivity of mood (intense episodic dysphoria, irritability, or anxiety usually lasting a few hours and only rarely more than a few days)

  • Chronic feelings of emptiness

  • Inappropriate intense anger or difficulty controlling anger (frequent displays of temper, constant anger, recurrent physical fights)

  • Transient, stress-related paranoid ideation or severe dissociative symptoms

Histrionic Personality Disorder

• A pervasive pattern of excessive emotionality and attention seeking, beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following:

  • Is 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 expression of emotions

  • Consistently uses physical appearance to draw attention to self

  • Has a style of speech that is excessively impressionistic and lacking in detail

  • Is suggestible (easily influenced by others or circumstances)

  • Considers relationships to be more intimate than they actually are

Narcissistic Personality Disorder

• A pervasive pattern of grandiosity (in fantasy or behavior), need for admiration, and lack of empathy, beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following:

  • Has a sense of grandiose sense of self-importance (e.g., exaggerates achievements and talents, expects to be recognized as superior without commensurate achievements)

  • Is preoccupied with fantasies of unlimited success, power, brilliance, beauty, or ideal love

  • Believes they are “special” and unique and can only be understood by, or should associate with, other special or high-status people or institutions

  • Requires excessive admiration

  • Has a sense of entitlement (unreasonable expectations of others, especially favorable treatment or automatic compliance with their expectations)

  • Is interpersonally exploitative (takes advantage of others to achieve their own ends)

  • Lacks empathy, is unwilling to recognize or identify with the feelings and needs of others

  • Is often envious of others or believes that others are envious of them

  • Shows arrogant, haughty behaviors or attitudes

Avoidant Personality Disorder

• A pervasive pattern of social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation, beginning by early adulthood and present in a variety of contexts, as indicated by four (or more) of the following:

  • Avoids occupational activities that involve significant interpersonal contact because of fears of criticism, disapproval, or rejection

  • Is unwilling to get involved with people unless certain of being liked

  • Shows restraint within intimate relationships because of the fear of being shamed or ridiculed

  • Is preoccupied with being criticised or rejected in social situations

  • Is inhibited in new interpersonal situations because of feelings of inadequacy

  • Views self as socially inept, personally unappealing, or inferior to others

  • Is unusually reluctant to take personal risks or to engage in any new activities because they may prove embarrassing

Dependent Personality Disorder

• A pervasive and excessive need to be taken care of that leads to submissive and clinging behavior and fears of separation beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following:

  • Has difficulty making everyday decisions without an excessive amount of advice and reassurance from others

  • Needs others to assume responsibility for major areas of their life

  • Has difficulty expressing disagreement with others because of fear of loss of support or approval (don’t include realistic fears of retribution)

  • Has difficulty initiating projects or doing things on their own (because of a lack of self-confidence in judgment or ability rather than a lack of motivation)

  • Goes to excessive lengths to obtain nurturance and support from others, to the point of volunteering to do things that are unpleasant

  • Feels uncomfortable or helpless when alone because of exaggerated fears of being unable to care for themself

  • Urgently seeks another relationship as a source of care and support when a close relationship ends

  • Is unrealistically preoccupied with fears of being left to take care of themself

Obsessive-Compulsive Personality Disorder

• A pervasive pattern of preoccupation with orderliness, perfectionism, and mental and interpersonal 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:

  • Is preoccupied with details, rules, lists, order, organization, or schedules to the extent that the major point of the activity is lost

  • Shows perfectionism that interferes with task completion (is unable to complete a project because their overly strict standards are not met)

  • Is excessively devoted to work and productivity to the exclusion of leisure activities and friendships (not accounted for by obvious economic necessity)

  • Is overconscientious, scrupulous, and inflexible about matters of morality, ethics, and values (not accounted for by cultural or religious identification)

  • Is unable to discard worn-out or worthless objects even when they have no sentimental value

  • Is reluctant to delegate tasks or to work with others unless they submit to exactly their way of doing things

  • Adopts a miserly spending style toward both self and others; money is viewed as something to be hoarded for future catastrophes

  • Shows rigidity and stubbornness

Personality Change Due to Another Medical Condition

• A - persistent personality disturbance that represents a change from the individual’s previous characteristic personality pattern

  • NOTE - children, disturbance involves a marked deviation in normal development or a significant change in the child’s usual behavioral patterns, lasting at least a year

• B - there is evidence from the history, physical examination, or laboratory findings that the disturbance is the direct pathophysiological consequence of another medical condition

• C - the disturbance is not better explained by another mental disorder (including another mental disorder due to another medical condition)

• D - the disturbance does not occur exclusively during the course of a delirium

• E - the disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning

• Specifiers

  • Labile type - predominant feature is affective lability

  • Disinhibited type - predominant feature is poor impulse control as evidenced by sexual indiscretions, etc

  • Aggressive type - if the predominant feature is aggressive behavior

  • Apathetic type - the predominant feature is marked apathy and indifference

  • Paranoid type - if the predominant feature is suspiciousness or paranoid ideation

  • Other type - if the presentation is not characterized by any of the above subtypes

  • Combined type - if more than one feature predominates in the clinical picture

  • Unspecified

Negative affectivity (vs emotional stability)

Emotional lability, anxiousness, separation insecurity, submissiveness, hostility, perseveration, depressivity, suspiciousness

Detachment (vs extraversion)

Withdrawal, intimacy avoidance, anhedonia, depressivity, restricted affectivity, suspiciousness

Antagonism (vs agreeableness)

Manipulativeness, deceitfulness, grandiosity, attention seeking, callousness, hostility

Disinhibition (vs conscientiousness*)

irresponsibility, impulsivity, distractibility, risk taking, (lack of) rigid perfectionism

Psychoticism (vs lucidity)

Unusual beliefs and experiences, eccentricity, cognitive and perceptual dysregulation

The “self” component of Criterion A for the continuous model of personality disorders includes…

Identity, self-direction

Identity

unique, boundaries of self and others, stability of self-esteem  and accurate self-appraisal, regulation of emotion

Self-direction

pursue coherent and meaningful goals, prosocial internal standards of behavior, self reflect productively

The “interpersonal” component of Criterion A for the continuous model of personality disorders includes…

empathy, intimacy

Empathy

appreciate others and their experiences and motivation, tolerance of differing perspective, understand effect of behavior on others

Intimacy

connected to others, desire closeness, mutuality of regard

Continuous General Personality Disorder Criteria

A - moderate or greater impairment in personality (self/interpersonal) functioning

B - one or more pathological personality traits

C - the impairments in personality functioning and the individual’s personality trait expression are relatively inflexible and pervasive across a broad range of personal and social situations

D - impairment in personality functioning and the personality trait are relatively stable across time, with onsets that can be traced back to at least adolescence and early adulthood

E -the impairments in personality functioning and the individual’s personality trait expression are not better explained by another mental disorder

F - the impairments in personality functioning and the individual’s personality trait expression are not solely attributable to the physiological effects of a substance or another medical condition (severe head trauma)

G - the impairments in personality functioning and the individual’s personality trait expression are not better understood as normal for an individual’s developmental state and sociocultural environment

Schizotypal (Continuous Model)

• High end of detachment

  • Restricted affectivity

  • Withdrawal

  • suspiciousness

• High end of psychoticism

  • Cognitive and perceptual dysregulation

  • Unusual beliefs

  • Eccentricity

Antisocial (Continuous Model)

• High end of disinhibition

  • Risk taking

  • Impulsivity

  • irresponsibility

• High end of antagonism

  • Manipulativeness

  • Callousness

  • Deceitfulness

  • Hostility

Borderline (Continuous Model)

• High end of disinhibition

  • Risk taking*

  • impulsivity*

• High end of antagonism

  • hostility*

• High end of negative affectivity

  • Emotional lability

  • Anxiousness

  • Separation insecurity

    • Depressiveness

Narcissistic (Continuous Model)

• High end of antagonism

  • Grandiosity

    • Attention and admiration seeking

Avoidant (Continuous Model)

• High end of negative affectivity

  • anxiousness*

• High end of detachment

  • Withdrawal

  • Anhedonia

    • Intimacy avoidance

Obsessive-compulsive (Continuous model)

• High end of detachment

  • Intimacy avoidance

  • Restricted affectivity

• Low end of disinhibition (high conscientiousness)

  • Rigid perfectionism*

• High end of negative affectivity

  • Perseveration

According to Sharp et al. (2025), what are pros and cons of the personality disorders as dimensional?

Pros - greater empirical support, Diagnostic types can be translated into dimensions or a hybrid model, Better discriminant validity and psychometric properties, Clinical utility, Focus treatment on trait problems, Engenders greater compassionate understanding of PD and less stigma, We all have these personality traits

Cons - Limited consensus on number of dimensions or facets, More complex personality picture = more difficult to comprehend and communicate to other clinicians

According to Sharp et al. (2025), what are pros and cons of the personality disorders as categorical?

Pros - Familiar language, facilitates communication between professionals

Cons - Heterogeneity with criteria (4/8 criteria, potentially little symptom overlap), Comorbidity of PDs, PD U/O Specified