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OBJECTIVES

Objectives

After studying this chapter, the student should be able to:

  • Understand what distinguishes personality disorders from other psychiatric disorders.

  • Recognize the clinical presentation and prevalence of the 10 recognized personality disorders.

  • Describe the potential interventions for personality disorders.

Personality disorders are characterized by trait-like, inflexible, and unhealthy patterns of thought and behavior that deviate from cultural norms and are associated with significant distress or impaired social or occupational function. A key feature is that they are enduring, with typical onset in adolescence or early adulthood and persistence over a long duration and across a variety of contexts.

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V) classifies personality disorders into 3 categories. Cluster A is the odd or eccentric group, and includes paranoid, schizoid, and schizotypal personality disorders. Cluster B is the dramatic, emotional, or erratic group, and includes antisocial, borderline, histrionic, and narcissistic personality disorders. Cluster C is the anxious or fearful group, and includes avoidant, dependent, and obsessive-compulsive personality disorders. In practice, patients do not usually present with a single, clearly defined personality disorder, and the lines between these syndromes are not precise. In fact, the majority of personality disorders probably go undiagnosed, often until some predisposing event or other medical or psychiatric issue brings them into the healthcare system.

Prior editions of the DSM classified personality disorders as Axis II disorders, in contrast to Axis I disorders such as major depressive disorder or schizophrenia. Although DSM-5 does not use this axis categorization, personality disorders are still sometimes referred to as Axis II disorders.

PREVALENCE & BURDEN

Personality disorders are common, affecting a little under 10% of the adult population. On the whole, they are equally common in men and women, although certain personality disorders are more common in one sex or the other. The most common personality disorder varies by country. In the United States, the most common personality disorders are obsessive-compulsive, narcissistic, and borderline personality disorder.

By definition, personality disorders are associated with impaired functioning in work, relationships, and society. Personality disorders are often comorbid with other psychiatric diagnoses. Anxiety disorders are particularly common (over half of patients with personality disorders), and substance use disorders occur in approximately 25% of patients with personality disorders. The suicide rate in borderline personality disorder, in particular, is much higher than that of the general population.

CLUSTER A: ODD OR ECCENTRIC PERSONALITY DISORDERS

Paranoid personality disorder is characterized by a pervasive and enduring distrust and cynical view of the world. Furthermore, the disorder is also characterized by hypervigilance to physical, verbal, or interpersonal threats. As a result, individuals with paranoid personality tend to have few if any close or intimate connections. Their interpersonal style is best described as detached and distrustful. They often appear guarded and secretive, as well as inflexible. Moreover, ...

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