Personality disorders
● Personality or Disorder?
- Personality: characteristics that describe how a person thinks and behaves
- Personality disorders: psychiatric conditions characterized by enduring maladaptive
patterns
- Persistent patterns that result in distress or impairment for the person affected and/or
others
- Prevalence: 7-8% (can be low because individuals are less likely to seek help)
- Comorbidity: mood disorders, anxiety disorders, substance use disorders
- Chronic, ego-syntonic: consistent with the ego of the individual
- Ego in the psychoanalytic sense: the individual views the disorder as part of
themselves (normal, typical) rather than pathological (poor insight)
- Adulthood disorders: cannot be diagnosed during childhood (but precursor symptoms
exist)
● Etiology
- Moderately heritable: influenced by genetic factors (40-60%)
- Trauma, stress
- PDs are diagnosed in adulthood, but origin of the disorder can come from childhood
trauma
● Personality Disorders + Clusters
- Cluster A (eccentric cluster): Awkward, odd, distorted thinking
- Paranoid Personality Disorder
- Schizoid Personality Disorder
- Schizotypal Personality Disorder
- Cluster B (dramatic cluster): Unpredictable, highly emotional
- Antisocial Personality Disorder
- Borderline Personality Disorder
- Histrionic Personality Disorder
- Narcissistic Personality Disorder
- Cluster C (anxious cluster): Anxious, fearful
- Avoidant Personality Disorder
- Obsessive-Compulsive Personality Disorder
- Dependent Personality Disorder
● Paranoid Personality Disorder
- A pervasive distrust and suspiciousness of others such that their motives are
interpreted as malevolent, as indicated by 4+ of the following:
1. Suspects, without sufficient basis, that others are exploiting, harming, or
deceiving them
2. Is preoccupied with unjustified doubts about the loyalty or trustworthiness of
others
3. Is reluctant to confide in others
4. Reads hidden demeaning or threatening meanings into benign events
, 5. Persistently holds grudges
6. Perceives attacks on their character or reputation that are not apparent to
others and is quick to react angrily or to counterattack
7. Has recurrent suspicions, without justification, regarding fidelity of spouse or
sexual partner
- Does not occur exclusively during the course of schizophrenia, a bipolar disorder or
depressive disorder with psychotic features, or another psychotic disorder and is not
attributable to the physiological effects of another medical condition
- Heritability estimated at 21-28%
- Childhood trauma: distorted schemas (interprets the world as “nobody can be
trusted”)
- No prescribed medication
- Psychotherapy (CBT + others), but individuals are resistant to treatment
- No neurobiological explanation
- Disadvantageous situational variables (e.g. reform prisoners, refugees, etc.)
● Schizoid Personality Disorder
- A pervasive pattern of detachment from social relationships and a restricted range of
expression of emotions in interpersonal settings, as indicated by 4+ of the following:
1. Neither desires nor enjoys close relationships (loners, solitary)
2. Almost always chooses solitary activities
3. Has little, if any interest in having sexual experiences with another person
4. Takes pleasure in few, if any, activities
5. Lacks close friends or confidants other than first-degree relatives
6. Appears indifferent to the praise or criticism
7. Shows emotional coldness, detachment, or flattened affectivity
- Does not occur exclusively during the course of schizophrenia, a bipolar disorder or
depressive disorder with psychotic features, another psychotic disorder, or autism
spectrum disorder and is not attributable to the physiological effects of another
medical condition
- Cognitive empathy rather emotional empathy (they understand others’ feelings, they
just don’t feel bad for them)
- Socially awkward
- Psychoanalytic view: ego is so split that they are mystified by themselves
- Heritability estimated at 28-30%
- Link with schizophrenia
- Introversion: also reward/novelty-seeking
- Abuse or neglect in childhood
● Schizotypal Personality Disorder
- 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, a indicated by 5+ of the
following:
1. Ideas of reference
2. Odd beliefs
● Personality or Disorder?
- Personality: characteristics that describe how a person thinks and behaves
- Personality disorders: psychiatric conditions characterized by enduring maladaptive
patterns
- Persistent patterns that result in distress or impairment for the person affected and/or
others
- Prevalence: 7-8% (can be low because individuals are less likely to seek help)
- Comorbidity: mood disorders, anxiety disorders, substance use disorders
- Chronic, ego-syntonic: consistent with the ego of the individual
- Ego in the psychoanalytic sense: the individual views the disorder as part of
themselves (normal, typical) rather than pathological (poor insight)
- Adulthood disorders: cannot be diagnosed during childhood (but precursor symptoms
exist)
● Etiology
- Moderately heritable: influenced by genetic factors (40-60%)
- Trauma, stress
- PDs are diagnosed in adulthood, but origin of the disorder can come from childhood
trauma
● Personality Disorders + Clusters
- Cluster A (eccentric cluster): Awkward, odd, distorted thinking
- Paranoid Personality Disorder
- Schizoid Personality Disorder
- Schizotypal Personality Disorder
- Cluster B (dramatic cluster): Unpredictable, highly emotional
- Antisocial Personality Disorder
- Borderline Personality Disorder
- Histrionic Personality Disorder
- Narcissistic Personality Disorder
- Cluster C (anxious cluster): Anxious, fearful
- Avoidant Personality Disorder
- Obsessive-Compulsive Personality Disorder
- Dependent Personality Disorder
● Paranoid Personality Disorder
- A pervasive distrust and suspiciousness of others such that their motives are
interpreted as malevolent, as indicated by 4+ of the following:
1. Suspects, without sufficient basis, that others are exploiting, harming, or
deceiving them
2. Is preoccupied with unjustified doubts about the loyalty or trustworthiness of
others
3. Is reluctant to confide in others
4. Reads hidden demeaning or threatening meanings into benign events
, 5. Persistently holds grudges
6. Perceives attacks on their character or reputation that are not apparent to
others and is quick to react angrily or to counterattack
7. Has recurrent suspicions, without justification, regarding fidelity of spouse or
sexual partner
- Does not occur exclusively during the course of schizophrenia, a bipolar disorder or
depressive disorder with psychotic features, or another psychotic disorder and is not
attributable to the physiological effects of another medical condition
- Heritability estimated at 21-28%
- Childhood trauma: distorted schemas (interprets the world as “nobody can be
trusted”)
- No prescribed medication
- Psychotherapy (CBT + others), but individuals are resistant to treatment
- No neurobiological explanation
- Disadvantageous situational variables (e.g. reform prisoners, refugees, etc.)
● Schizoid Personality Disorder
- A pervasive pattern of detachment from social relationships and a restricted range of
expression of emotions in interpersonal settings, as indicated by 4+ of the following:
1. Neither desires nor enjoys close relationships (loners, solitary)
2. Almost always chooses solitary activities
3. Has little, if any interest in having sexual experiences with another person
4. Takes pleasure in few, if any, activities
5. Lacks close friends or confidants other than first-degree relatives
6. Appears indifferent to the praise or criticism
7. Shows emotional coldness, detachment, or flattened affectivity
- Does not occur exclusively during the course of schizophrenia, a bipolar disorder or
depressive disorder with psychotic features, another psychotic disorder, or autism
spectrum disorder and is not attributable to the physiological effects of another
medical condition
- Cognitive empathy rather emotional empathy (they understand others’ feelings, they
just don’t feel bad for them)
- Socially awkward
- Psychoanalytic view: ego is so split that they are mystified by themselves
- Heritability estimated at 28-30%
- Link with schizophrenia
- Introversion: also reward/novelty-seeking
- Abuse or neglect in childhood
● Schizotypal Personality Disorder
- 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, a indicated by 5+ of the
following:
1. Ideas of reference
2. Odd beliefs
