PERSONALITY DISORDERS

Personality Disorders

Cluster A: Odd/Eccentric

Odd, eccentric, socially awkward, and socially isolated behaviors, impaired social relationships, suspicious/mistrust.

Shared biological risk factors w/ schizophrenia.

50% of indiv. diagnosed with schizoid also meet criteria for schizotypal PD.

Paranoid PD

Primary feature is suspicion and hostility—believing others have malevolent intent, fear of betrayal.

Cluster A

Treatment: Therapy establishing a trusting atmosphere and challenging irrational/paranoid thoughts.

Schizoid PD

Primary feature is indifference and solitude—has zero desire for social or romantic connection. Shows anhedonia, flat affect.

Cluster A

Treatment: Social skills training

Schizotypal PD

Primary feature is cognitive/perceptual eccentricity—odd beliefs, magical thinking, ideas of reference, and peculiar behavior/speech. Interpersonal deficits, disorganized features.

Cluster A

Treatment: Low-dose antipsychotic medication, CBT, social skills training, and family therapy

Cluster B: Dramatic/Emotional/Erratic

Dramatic, highly emotional, erratic, impulse-driven, and disruptive interpersonal behavior.

High overlap across all four disorders, co-occurring with substance abuse and mood disruption.

Antisocial PD

Manipulates and exploits others for personal/material gain or thrill; lack of remorse and disregard for social/legal rules.

Cluster B

Treatment: Behavioral change, control, and rehabilitation

Borderline PD

Manipulates/acts out for emotional reassurance due to terror of abandonment; characterized by severe self-harm, emotional instability, and “splitting.”

Cluster B

Treatment: Dialectical Behavior Therapy (DBT), tranquilizers/antidepressants

Histrionic PD

Seeks to be the center of attention through theatricality, physical appearance, and dramatic/provocative emotional displays.

Cluster B

Treatment: CBT targeting attention-seeking behaviors & emotional depth

Narcissistic PD

Seeks admiration and status due to grandiosity and entitlement; marked by a total lack of empathy.

Cluster B

Treatment: Psychotherapy challenging distorted beliefs about self-worth

Cluster C: Anxious/Fearful

Pervasive anxiety, fearfulness, social inhibition, or rigid self-control.

Fear of loss of control.

Low to moderate diagnostic overlap

Avoidant PD

Reacts to fear of rejection by withdrawing completely from social situations (despite wanting connection) unless certain of being liked. Views self as inferior.

Cluster C

Treatment: Best treated PD, CBT techniques and graded group therapy.

Dependent PD

Reacts to fear of abandonment by clinging submissively to others and surrendering all autonomy. Difficulty making everyday decisions without advice.

Cluster C

Treatment: Time-limited short-term therapy to avoid falling into a “nurturer” role

Obsessive-Compulsive PD

Reacts to anxiety/uncertainty by exerting rigid control, perfectionism, and orderliness over their environment. Essential drivers are a need for control and intolerance of uncertainty.

Cluster C

Treatment: Cognitive & behavioral strategies to stop need for control, develop tolerance for uncertainty.

Egosyntonic Symptoms

Symptoms feel like an acceptable, natural part of the self.

Usually don’t seek treatment.

Syn: with/same

Egodystonic Symptoms

Symptoms feel alien, unwanted, intrusive, and distressing.

Individuals are aware of problem and seek relief.

Dys: Abnormal

Alternative Model of Personality Disorders (AMPD)

Dimensional proposal in the back of the DSM-5 evaluating continuum traits rather than binary (Yes/No) categories.

Criterion A: Personality Functioning

• Self: Identity/Self-direction

• Interpersonal: Empathy/Intimacy

Criterion B: 5 Pathological Personality Traits mapped onto the OCEAN Big-5 model:

• Negative Affectivity (vs. Emotional Stability)

• Detachment (vs. Extraversion)

PROS of AMPD

Reduces artificial comorbidity

Eliminates arbitrary cutoffs

Openness VS Closedness

High: Creative, curious, tolerant

Low; Down to earth, conservative, straightforward

Conscientiousness vs carelessness

High: Organized, reliable, consistent, enjoy planning

Low: Content, bold, carefree, easy going, creative

Extraversion vs Introversion

High: Outgoing, sociable, friendly, talkative

Low: Solitary, reserved, relaxed, serious

Agreeableness vs Antagonism

High: Friendly, compassionate, gullible, cooperative, trusting

Low: Assertive, skeptical, devious, indifferent, uncompromising

Neuroticism vs Emotional stability

High: Anxious, pensive, impulsive, self-conscious

Low: Calm, self-confident, bold, emotionally stable, carefree