15.11 Personality Disorders

Personality disorders are complex mental health conditions that affect how people think, feel, and behave. These disorders involve long-standing patterns that differ significantly from cultural norms and cause problems in various areas of life.

There are ten main types of personality disorders, grouped into three clusters based on similar characteristics. These include odd or eccentric disorders, dramatic or emotional disorders, and anxious or fearful disorders. Each type has unique features and challenges.

Overview of Personality Disorders

Defining Characteristics

• Enduring pattern of inner experience and behavior that deviates markedly from cultural norms
  • Pervasive across contexts (e.g., work, relationships) and stable over time
  • Begins in adolescence or early adulthood (e.g., by age 18-25)
• Inflexible and maladaptive, causing significant distress or impairment in functioning (e.g., difficulty maintaining relationships or employment)
• Not better explained by another mental disorder (e.g., depression), substance abuse (e.g., alcohol dependence), or medical condition (e.g., brain injury)

Types of Personality Disorders

Clusters

• Cluster A (odd or eccentric disorders)
  • Paranoid personality disorder
    • Pervasive distrust and suspiciousness of others
    • Unjustified doubts about loyalty or trustworthiness of others (e.g., believing friends are plotting against them without evidence)
  • Schizoid personality disorder
    • Detachment from social relationships
    • Restricted range of emotional expression (e.g., appearing cold or indifferent)
  • Schizotypal personality disorder
    • Acute discomfort in close relationships
    • Cognitive or perceptual distortions (e.g., magical thinking, unusual perceptual experiences)
    • Eccentricities of behavior (e.g., odd speech or mannerisms)
• Cluster B (dramatic, emotional, or erratic disorders)
  • Antisocial personality disorder
    • Disregard for and violation of the rights of others
    • Impulsivity, irritability, and aggressiveness (e.g., repeated physical fights)
  • Borderline personality disorder
    • Instability in interpersonal relationships, self-image, and affects
    • Marked impulsivity (e.g., reckless driving, risky sexual behavior)
  • Histrionic personality disorder
    • Excessive emotionality and attention-seeking
    • Suggestible and easily influenced by others (e.g., rapidly changing opinions based on latest friend's views)
  • Narcissistic personality disorder
    • Grandiosity, need for admiration, and lack of empathy
    • Preoccupation with fantasies of unlimited success, power, or beauty (e.g., believing they deserve special treatment)
• Cluster C (anxious or fearful disorders)
  • Avoidant personality disorder
    • Social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation
    • Avoidance of occupational activities involving significant interpersonal contact (e.g., turning down a promotion requiring more interaction)
  • Dependent personality disorder
    • Excessive need to be taken care of, leading to submissive and clinging behavior
    • Difficulty making everyday decisions without excessive advice and reassurance (e.g., unable to choose what to wear without help)
  • Obsessive-compulsive personality disorder
    • Preoccupation with orderliness, perfectionism, and control
    • Rigid, stubborn, and inflexible (e.g., unable to delegate tasks, hoarding worn-out objects)

Borderline and Antisocial

• Borderline personality disorder (BPD)
  • Key features
    • Frantic efforts to avoid real or imagined abandonment
    • Pattern of unstable and intense interpersonal relationships (e.g., idealizing partner one day, devaluing them the next)
    • Identity disturbance and unstable self-image (e.g., sudden shifts in goals, values, career plans)
    • Impulsivity in potentially self-damaging areas (e.g., spending, sex, substance abuse, reckless driving)
    • Recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior (e.g., cutting)
    • Affective instability and intense episodic dysphoria, irritability, or anxiety (e.g., mood swings lasting a few hours to a few days)
    • Chronic feelings of emptiness
    • Inappropriate, intense anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger)
    • Transient, stress-related paranoid ideation or severe dissociative symptoms (e.g., feeling cut off from oneself, as if in a dream)
  • Causal factors
    • Genetic vulnerabilities (e.g., first-degree relatives have higher rates of BPD)
    • Neurotransmitter dysfunction (e.g., serotonin, dopamine)
    • Adverse childhood experiences (e.g., abuse, neglect, invalidating environment where emotions are not validated)
    • Insecure attachment styles (e.g., anxious-preoccupied, fearful-avoidant)
• Antisocial personality disorder (ASPD)
  • Key features
    • Failure to conform to social norms with respect to lawful behaviors (e.g., repeatedly performing acts that are grounds for arrest)
    • Deceitfulness, repeated lying, or conning others for personal profit or pleasure
    • Impulsivity or failure to plan ahead
    • Irritability and aggressiveness, often with physical fights or assaults
    • Reckless disregard for the safety of self or others (e.g., speeding, driving while intoxicated)
    • Consistent irresponsibility and failure to sustain consistent work or honor financial obligations (e.g., defaulting on debts)
    • Lack of remorse, indifference to or rationalization of having hurt, mistreated, or stolen from another
  • Causal factors
    • Genetic influences (e.g., heritability estimates around 50%)
    • Neurotransmitter and brain abnormalities (e.g., reduced prefrontal gray matter volume, amygdala reactivity to emotional stimuli)
    • Adverse environmental factors (e.g., childhood maltreatment, inconsistent discipline, association with deviant peers)
    • Low arousal levels and sensation-seeking tendencies (e.g., engaging in risky behaviors to increase stimulation)