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Personality disorders (PD) are a class of mental health conditions characterized by enduring maladaptive patterns of behavior, cognition, and inner experience, exhibited across many contexts and deviating from those accepted by the culture.[rx] These patterns develop early, are inflexible, and are associated with significant distress or disability.[rx] The definitions vary by source and remain a matter of controversy. Official criteria for diagnosing personality disorders are listed in the sixth chapter of the International Classification of Diseases (ICD) and in the American Psychiatric Association‘s Diagnostic and Statistical Manual of Mental Disorders (DSM). [rx]
Personality, defined psychologically, is the set of enduring behavioral and mental traits that distinguish individual humans. Hence, personality disorders are characterized by experiences and behaviors that deviate from social norms and expectations. Those diagnosed with a personality disorder may experience difficulties in cognition, emotiveness, interpersonal functioning, or impulse control. For psychiatric patients, the prevalence of personality disorders is estimated between 40 and 60%. The behavior patterns of personality disorders are typically recognized by adolescence, the beginning of adulthood or sometimes even childhood and often have a pervasive negative impact on the quality of life
Types
There are many types of personality disorders, each with important differences. These disorders are organized into three groups, or clusters, with shared features and symptoms:
Group A personality disorders
Group A personality disorders have a consistently dysfunctional pattern of thinking and behavior that reflects suspicion or lack of interest in others. They include:
Paranoid personality disorder
- Lacks trust and is suspicious of others and the reasons for their actions.
- Believes that others are trying to do harm with no reason to feel this way.
- Doubts the loyalty of others.
- Is not willing to trust others.
- Hesitates to confide in others for fear that others will use that information against them.
- Takes innocent remarks or situations that are not threatening as personal insults or attacks.
- Becomes angry or hostile to what are believed to be slights or insults.
- Has a habit of holding grudges.
- Often suspects that a spouse or sexual partner is unfaithful with no reason to feel this way.
Schizoid personality disorder
- Appears to be cold to or not interested in others.
- Almost always chooses to be alone.
- Is limited in how emotions are expressed.
- Cannot take pleasure in most activities.
- Cannot pick up typical social cues.
- Has little to no interest in having sex with another person.
Schizotypal personality disorder
- Has unusual thinking, beliefs, speech or behavior.
- Feels or thinks strange things, such as hearing a voice whisper their name.
- Has flat emotions or emotional responses that are socially unusual.
- Has social anxiety, including not being comfortable making close connections with others or not having close relationships.
- Responds to others in ways that are not proper or shows suspicion or lack of interest.
- Has “magical thinking”— the belief that their thoughts can affect other people and events.
- Believes that some casual incidents or events have hidden messages.
Group B personality disorders
Group B personality disorders have a consistently dysfunctional pattern of dramatic, overly emotional thinking or unpredictable behavior. They include:
Borderline personality disorder
- Has a strong fear of being alone or abandoned.
- Has ongoing feelings of emptiness.
- Sees self as being unstable or weak.
- Has deep relationships that are not stable.
- Has up and down moods, often due to stress when interacting with others.
- Threatens self-harm or behaves in ways that could lead to suicide.
- Is often very angry.
- Shows impulsive and risky behavior, such as having unsafe sex, gambling or binge eating.
- Has stress-related paranoia that comes and goes.
Histrionic personality disorder
- Always seeks attention.
- Is overly emotional or dramatic or stirs up sexual feelings to get attention.
- Speaks dramatically with strong opinions but has few facts or details to back them up.
- Is easily led by others.
- Has shallow emotions that change quickly.
- Is very concerned with physical appearance.
- Thinks relationships with others are closer than they are.
Narcissistic personality disorder
- Has beliefs about being special and more important than others.
- Has fantasies about power, success and being attractive to others.
- Does not understand the needs and feelings of others.
- Stretches the truth about achievements or talents.
- Expects constant praise and wants to be admired.
- Feels superior to others and brags about it.
- Expects favors and advantages without a good reason.
- Often takes advantage of others.
- Is jealous of others or believes that others are jealous of them.
Antisocial personality disorder
- Has little, if any, concern for the needs or feelings of others.
- Often lies, steals, uses false names and cons others.
- Has repeated run-ins with the law.
- Often violates the rights of others.
- Is aggressive and often violent.
- Has little, if any, concern for personal safety or the safety of others.
- Behaves impulsively.
- Is often reckless.
- Has little, if any, regret for how their behavior negatively affects others.
Group C personality disorders
Group C personality disorders have a consistently dysfunctional pattern of anxious thinking or behavior. They include:
Avoidant personality disorder
- Is very sensitive to criticism or rejection.
- Does not feel good enough, important or attractive.
- Does not take part in work activities that include contact with others.
- Is isolated.
- Does not try new activities and does not like meeting new people.
- Is extremely shy in social settings and in dealing with others.
- Fears disapproval, embarrassment or being made fun of.
Dependent personality disorder
- Relies on others too much and feels the need to be taken care of.
- Is submissive or clingy toward others.
- Fears having to take care of self if left alone.
- Lacks confidence in abilities.
- Needs a lot of advice and comforting from others to make even small decisions.
- Finds it hard to start or do projects due to lack of self-confidence.
- Finds it hard to disagree with others, fearing they will not approve.
- Endures poor treatment or abuse, even when other options are available.
- Has an urgent need to start a new relationship when a close one ends.
Obsessive-compulsive personality disorder
- Focuses too much on details, orderliness and rules.
- Thinks everything needs to be perfect and gets upset when perfection is not achieved.
- Cannot finish a project because reaching perfection is not possible.
- Needs to be in control of people, tasks and situations.
- Cannot assign tasks to others.
- Ignores friends and enjoyable activities because of too much focus on work or a project.
- Cannot throw away broken or worthless objects.
- Is rigid and stubborn.
- Is not flexible about morality, ethics or values.
- Holds very tight control over budgeting and spending money.
Obsessive-compulsive personality disorder is not the same as obsessive-compulsive disorder, which is an anxiety disorder.
Other personality types and Millon’s description
Some types of personality disorder were in previous versions of the diagnostic manuals but have been deleted. Examples include sadistic personality disorder (pervasive pattern of cruel, demeaning, and aggressive behavior) and self-defeating personality disorder or masochistic personality disorder (characterized by behavior consequently undermining the person’s pleasure and goals). They were listed in the DSM-III-R appendix as “Proposed diagnostic categories needing further study” without specific criteria.[29] Psychologist Theodore Millon, a researcher on personality disorders, and other researchers consider some relegated diagnoses to be equally valid disorders, and may also propose other personality disorders or subtypes, including mixtures of aspects of different categories of the officially accepted diagnoses.[30] Millon proposed the following description of personality disorders:
| Type of personality disorder | DSM-5 inclusion | Description |
|---|---|---|
| Paranoid | Yes | Guarded, defensive, distrustful and suspicious. Hypervigilant to the motives of others to undermine or do harm. Always seeking confirmatory evidence of hidden schemes. Feel righteous, but persecuted. Experience a pattern of pervasive distrust and suspicion of others that lasts a long time. They are generally difficult to work with and are very hard to form relationships with. They are also known to be argumentative and hypersensitive.[rx] |
| Schizoid | Yes | Apathetic, indifferent, remote, solitary, distant, humorless, contempt, odd fantasies. Neither desire nor need human attachments. Withdrawn from relationships and prefer to be alone. Little interest in others, often seen as a loner. Minimal awareness of the feelings of themselves or others. Few drives or ambitions, if any. Is an uncommon condition in which people avoid social activities and consistently shy away from interaction with others. It affects more males than females. To others, they may appear somewhat dull or humorless. Because they do not tend to show emotion, they may appear as though they do not care about what’s going on around them.[rx] |
| Schizotypal | Yes | Eccentric, self-estranged, bizarre, absent. Exhibit peculiar mannerisms and behaviors. Think they can read thoughts of others. Preoccupied with odd daydreams and beliefs. Blur line between reality and fantasy. Magical thinking and strange beliefs. People with schizotypal personality disorder are often described as odd or eccentric and usually have few, if any, close relationships. They think others think negatively of them.[rx] |
| Antisocial | Yes | Impulsive, irresponsible, deviant, unruly. Act without due consideration. Meet social obligations only when self-serving. Disrespect societal customs, rules, and standards. See themselves as free and independent. People with antisocial personality disorder depict a long pattern of disregard for other people’s rights. They often cross the line and violate these rights.[rx] |
| Borderline | Yes | Frantic efforts to avoid abandonment. Identity disturbance; unstable sense of self-image or sense of self. Impulsivity — spending, sex, substance abuse, binge eating. Unstable mood; fluctuation between highs and lows. Feelings of emptiness. Ideation and devaluation of interpersonal relationships. Intense or inappropriate anger. Suicidal-behaviour.[rx] |
| Histrionic | Yes | Hysteria, dramatic, seductive, shallow, egocentric, attention-seeking, vain. Overreact to minor events. Exhibitionistic as a means of securing attention and favors. See themselves as attractive and charming. Constantly seeking others’ attention. Disorder is characterized by constant attention-seeking, emotional overreaction, and suggestibility. Their tendency to over-dramatize may impair relationships and lead to depression, but they are often high-functioning.[rx] |
| Narcissistic | Yes | Egotistical, arrogant, grandiose, insouciant. Preoccupied with fantasies of success, beauty, or achievement. See themselves as admirable and superior, and therefore entitled to special treatment. Is a mental disorder in which people have an inflated sense of their own importance and a deep need for admiration. Those with narcissistic personality disorder believe that they are superior to others and have little regard for other people’s feelings. |
| Avoidant | Yes | Hesitant, self-conscious, embarrassed, anxious. Tense in social situations due to fear of rejection. Plagued by constant performance anxiety. See themselves as inept, inferior, or unappealing. They experience long-standing feelings of inadequacy and are very sensitive of what others think about them.[rx] |
| Dependent | Yes | Helpless, incompetent, submissive, immature. Withdrawn from adult responsibilities. See themselves as weak or fragile. Seek constant reassurance from stronger figures. They have the need to be taken care of by others. They fear being abandoned or separated from important people in their life.[rx] |
| Obsessive–compulsive | Yes | Restrained, conscientious, respectful, rigid. Maintain a rule-bound lifestyle. Adhere closely to social conventions. See the world in terms of regulations and hierarchies. See themselves as devoted, reliable, efficient, and productive. |
| Depressive | No | Somber, discouraged, pessimistic, brooding, fatalistic. Present themselves as vulnerable and abandoned. Feel valueless, guilty, and impotent. Judge themselves as worthy only of criticism and contempt. Hopeless, suicidal, restless. This disorder can lead to aggressive acts and hallucinations.[rx] |
| Passive–aggressive (Negativistic) | No | Resentful, contrary, skeptical, discontented. Resist fulfilling others’ expectations. Deliberately inefficient. Vent anger indirectly by undermining others’ goals. Alternately moody and irritable, then sullen and withdrawn. Withhold emotions. Will not communicate when there is something problematic to discuss.[rx] |
| Sadistic | No | Explosively hostile, abrasive, cruel, dogmatic. Liable to sudden outbursts of rage. Gain satisfaction through dominating, intimidating and humiliating others. They are opinionated and closed-minded. Enjoy performing brutal acts on others. Find pleasure in abusing others. Would likely engage in a sadomasochist relationship, but will not play the role of a masochist.[rx] |
| Self-defeating (Masochistic) | No | Deferential, pleasure-phobic, servile, blameful, self-effacing. Encourage others to take advantage of them. Deliberately defeat own achievements. Seek condemning or mistreatful partners. They are suspicious of people who treat them well. Would likely engage in a sadomasochist relationship.[rx] |
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