- Clinical science
Personality disorders are characterized by deeply rooted, egosyntonic behavioral traits that differ significantly from the expected and accepted norms of an individual's culture. Consequently, regional and cultural characteristics should always be considered before diagnosing a patient with a personality disorder. Personality disorders usually arise during adolescence and are difficult to treat. A key feature of personality disorders is that they must cause impairment in social and/or occupational functioning. Personality disorders are associated with a higher risk of developing other psychiatric disorders, especially in times of stress.
Pervasive, inflexible, and maladaptive personality patterns that lead to significant distress or functional impairment and are stable over time.
Multifactorial: due to a combination of hereditary (e.g., personality disorders in parents) and psychosocial factors (e.g., child neglect, abuse)
- Age of onset: late childhood or adolescence
- Antisocial and narcissistic personality disorders are more commonly diagnosed in males.
- Histrionic and borderline personality disorders are more commonly diagnosed in females.
The DSM-5 divides personality disorders into three clusters based on similar characteristics.
|Prevalence||Characteristic behavior||Personality disorders||Family history association|
|Cluster A|| || || |
|Cluster B|| || || |
|Cluster C|| || |
- symptoms (individuals lack insight as to their symptoms, considering them to be normal and not a problem)
- Thinking and behavior that significantly differ from cultural expectations
- See the individual disorders below.
At least two or more of the following deviate significantly from cultural expectations:
- Cognition (e.g., perceives events, others, or self in an inappropriate way)
- Interpersonal functioning
- Impulse control
- Begins in early adulthood and is stable over time
- Leads to significant distress and impaired functioning in important areas of life (e.g., social, occupational)
- Is not caused by another mental disorder, substance abuse, or other medical condition
- Can be diagnosed in individuals < 18 years of age if features have been present for ≥ 1 year (except antisocial personality disorder)  DSM V page 647
- Psychotherapy, dialectical behavior therapy, group therapy, and/or cognitive therapy
- Symptomatic medical therapy
- Mood stabilizers: valproate, topiramate, and lamotrigine have been shown to decrease symptoms, such as affective dysregulation, impulsivity, and aggression.
- Antipsychotics: especially for symptoms of delusion
- Antidepressants: selective serotonin reuptake inhibitors (SSRIs) are the drug of choice, especially in depressive episodes, anxiety disorders, and obsessive-compulsive disorders.
Personality disorders are associated with an increased risk of developing other psychiatric disorders, especially during times of stress!
- Pervasive distrust of others
- Preoccupation with the loyalty of friends and family
- Strong reactions to perceived attacks
- Holding grudges
- Superficial relationships
- Voluntary detachment from social relationships (unlike avoidant personality disorder)
- Restricted emotional expression
- Indifference to praise or criticism
- No interest in sexual relationships
- Odd and eccentric behavior
- Magical thinking
- Excessive social anxiety
- Ideas of reference
- Unusual perceptual experiences
- Constricted affect
- Preference for social isolation because of paranoia and suspicion of others
- More common in men
- Must be preceded by a history of conduct disorder
Three or more of the following are present after the age of 15 years:
- A history of repeated aggression
- Repeatedly engaging in criminal activity
- Impulsivity/failure to plan ahead
- A reckless disregard for one's own safety and/or the safety of others
- A failure to fulfill work-related or financial obligations
- A lack of remorse and/or emotional indifference to the plight of others
- Cannot be diagnosed before 18 years of age; if the patient is less than 18 years of age, the diagnosis is .
- Extremely difficult to treat
- Prevention of conduct disorder progression
- Older patients are typically incarcerated
- More common in women
- Presents with:
- Unstable personal relationships
- Fear of abandonment
- Lack of impulse control
- Intense anger
- Suicidal behavior
- Feelings of emptiness
- : defense mechanism in which relationships are categorically good or bad
- Treatment: dialectical behavior therapy
- Attention-seeking, excessively emotional behavior
- Exhibiting inappropriate, sexually provocative, and/or seductive behavior during interactions with others
- Drawing attention to self by way of physical appearance
- Overestimating the degree of intimacy in relationships
- Uncomfortable when not the center of attention
- Attention-seeking behavior, grandiosity, and a need for admiration
- Difficulty dealing with criticism
- Lack of empathy
- Important to distinguish from manic or hypomanic episodes in bipolar disorder
- Three subtypes
- Grandiose, overt
- Fear of rejection and feelings of inadequacy resulting in involuntary social withdrawal
- Strong desire for social relationships (unlike schizoid personalities), but limited by extreme shyness and social anxiety
- Difficulty making everyday decisions; often requiring others to assume responsibility
- Difficulty initiating projects (e.g., applying for jobs) because of a lack of self-confidence
- Feelings of helplessness when alone; urgently seeking new relationships when one fails
- Both afraid of being abandoned and afraid to abandon their partner
- Often stuck in abusive relationships
- Associated with an increased risk of suicide
- Perfectionism and obsession with control that is often egosyntonic (in contrast to )
- Rigid routines
- Features often occur at the expense of occupational success (e.g., missing deadlines), social relationships (e.g., excluding social activities to complete tasks), and pleasurable activities (e.g., not taking vacation)
- In contrast to OCD, intrusive thoughts and repetitive behaviors are not present.
- Cluster A
- Cluster B
- Cluster C
The differential diagnoses listed here are not exhaustive.