Review of Personality Disorders

Personality Disorders: Overview

• Definition: Personality disorders are enduring patterns of behavior, cognition, and inner experience that deviate from cultural expectations, causing significant impairment or distress.

DSM-V General Criteria for Personality Disorders

• Enduring behavior pattern: Stable and of long duration.
• Pervasive and inflexible: Occurs in a wide range of personal and social situations.
• Clinically significant distress or impairment: Affects functionality.
• Manifest in two or more areas: Cognition, affectivity, interpersonal functioning, impulse control.

Importance of Clusters

Personality Disorders Clusters:

• Cluster A (Odd / Eccentric):
  1. Paranoid
  2. Schizoid
  3. Schizotypal
• Cluster B (Dramatic / Erratic):
  1. Histrionic
  2. Narcissistic
  3. Antisocial
  4. Borderline
• Cluster C (Fearful / Anxious):
  1. Avoidant
  2. Dependent
  3. Obsessive-Compulsive
• Other Specified/Unspecified: Other Specified Personality Disorder and Unspecified Personality Disorder.

Facts & Statistics

• Prevalence: 3% to 15% of the general population; higher rates in clinical settings.
• Onset: Disorders usually begin in childhood and typically run a chronic course.
• Co-morbidity: High rates of co-occurring diagnoses.

Treatment Considerations

• No one-size-fits-all: Treatment varies based on the specific disorder and individual needs.
• Therapeutic Approaches: Combination therapies often used, including psychotherapy and potentially pharmacotherapy.

Detailed Review of Specific Personality Disorders

Cluster A: Odd or Eccentric Disorders

1. Paranoid Personality Disorder:

   • Characterized by a pervasive suspicion and distrust of others, believing harm is imminent.
   • Symptoms: Suspicions about others' motives, bears grudges, hostile affect.
   • Treatment: No empirically supported treatments available.

2. Schizoid Personality Disorder:

   • Characterized by detachment from social relationships and a limited range of emotional expression.
   • Symptoms: Preference for solitary activities, lack of close friendships, indifferent to praise or criticism.
   • Treatment: Minimal research on effective treatment options.

3. Schizotypal Personality Disorder:

   • Pattern of discomfort in close relationships, cognitive distortions, and eccentric behavior.
   • Symptoms: Odd beliefs, magical thinking, inappropriate affect.
   • Treatment Options: Antipsychotic medications and community support.

Cluster B: Dramatic, Emotional, or Erratic Disorders

1. Antisocial Personality Disorder:

   • Disregard for the rights of others, impulsivity, deceitfulness.
   • Symptoms: Chronic violation of laws, remorselessness, irritability.
   • Causes: Genetic and environmental factors.
   • Treatment: Difficult; early intervention programs may be beneficial.

2. Borderline Personality Disorder:

   • Instability in interpersonal relationships, self-image, and affect.
   • Symptoms: Fear of abandonment, impulsivity, self-injury.
   • Biosocial Theory: Interaction of biological factors and invalidating environments, leading to emotional dysregulation.
   • Treatment: Dialectical Behavior Therapy (DBT) is the first-line treatment; combines therapy with practical skills training.

3. Histrionic Personality Disorder:

   • Excessive emotionality and attention-seeking.
   • Symptoms: Provocative behavior, suggestible, theatrical emotional expressions.
   • Causes: Limited research; potentially linked with antisocial personality traits.

4. Narcissistic Personality Disorder:

   • Grandiosity, need for admiration, lack of empathy.
   • Symptoms: Sense of entitlement, exploitative relationships, fragile self-esteem.
   • Effects and Treatment: Common comorbidities include depression, limited effective treatments.

Cluster C: Anxious or Fearful Disorders

1. Avoidant Personality Disorder:

   • Social inhibition, feelings of inadequacy, hypersensitivity to criticism.
   • Symptoms: Avoiding occupations involving significant interpersonal contact, feelings of ineptness.
   • Treatment: Addressing underlying anxiety through cognitive-behavioral approaches.

2. Dependent Personality Disorder:

   • Excessive need for care, leading to submissive behavior.
   • Symptoms: Difficulty making decisions, preoccupation with fears of being left alone.
   • Treatment: Limited effective treatments; focus on building independence.

3. Obsessive-Compulsive Personality Disorder:

   • Preoccupation with orderliness, perfectionism, and control.
   • Symptoms: Excessive focus on details leading to impaired task completion.
   • Treatment: Consider cognitive-behavioral techniques though limited evidence of efficacy.

Conclusion

• Diagnosis & Stigma: Awareness of the stigma associated with personality disorders and the importance of precise diagnosis to mitigate the impact on treatment and social functioning.
• Consequences of Misdiagnosis:
  • Under-diagnosis can lead to suicide risk and social difficulties; over-diagnosis can lead to stigma and influence future care.