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Personality disorder
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Personality disorders
Classification and external resources ICD-10 F#$ ICD-9 %$&.' DiseasesDB '((' MedlinePlus $$$'%' MeSH )$&$**+
Personality disorders Cluster A (odd)

Paranoid ,chi-oid ,chi-ot"pal

Cluster B (dramatic)

Antisocial .orderline Histrionic /arcissistic

Cluster C (anxious)

A0oidant )ependent

12sessi0e3compulsi0e ot s!eci"ied

)epressi0e ,adistic ,elf4defeating Ps"chopath"

Passi0e4aggressi0e

0 t e

Personality disorders are a class of mental disorders characterised 2" enduring maladapti0e patterns of 2eha0ior! cognition and inner e5perience! e5hi2ited across man" conte5ts and de0iating mar edl" from those accepted 2" the indi0idual6s culture. These patterns de0elop earl"! are infle5i2le and are associated with significant distress or disa2ilit".[&] The definitions ma" 0ar" some according to other sources.[7][%] 1fficial criteria for diagnosing personalit" disorders are listed in the Diagnostic and Statistical Manual of Mental Disorders! pu2lished 2" the American Ps"chiatric Association! and in the mental and 2eha0ioral disorders section of the International Statistical Classification of Diseases and Related Health Problems! pu2lished 2" the World Health 1rgani-ation. The ),84* pu2lished in 7$&% now lists personalit" disorders in e5actl" the same wa" as other mental disorders! rather than on a separate 6a5is6 as pre0iousl".[+] Personalit"! defined ps"chologicall"! is the set of enduring 2eha0ioral and mental traits that distinguish human 2eings. Hence! personalit" disorders are defined 2" e5periences and 2eha0iors that differ from societal norms and e5pectations. Those diagnosed with a personalit" disorder ma" e5perience difficulties in cognition! emoti0eness! interpersonal functioning or control of impulses. 9n general! personalit" disorders are diagnosed in +$3 #$ percent of ps"chiatric patients! ma ing them the most fre:uent of all ps"chiatric diagnoses.[*] These 2eha0ioral patterns in personalit" disorders are t"picall" associated with su2stantial distur2ances in some 2eha0ioral tendencies of an indi0idual! usuall" in0ol0ing se0eral areas of the personalit"! and are nearl" alwa"s associated with considera2le personal and social disruption. A person is classified as ha0ing a personalit" disorder if their a2normalities of 2eha0ior impair their social or occupational functioning. Additionall"! personalit" disorders are infle5i2le and per0asi0e across man" situations! due in large part to the fact that such 2eha0ior ma" 2e ego4s"ntonic ;i.e. the patterns are consistent with the ego integrit" of the indi0idual< and are! therefore! percei0ed to 2e appropriate 2" that indi0idual. This 2eha0ior can result in maladapti0e coping s ills! which ma" lead to personal pro2lems that induce e5treme an5iet"! distress or depression.

[#]

These patterns of 2eha0ior t"picall" are recogni-ed in adolescence and the 2eginning of adulthood and! in some unusual instances! childhood.[&] There are man" issues with classif"ing a personalit" disorder.[=] There are man" categories of definition![clarification needed] some mild and some e5treme.[=] .ecause the theor" and diagnosis of personalit" disorders stem from pre0ailing cultural e5pectations! their 0alidit" is contested 2" some e5perts on the 2asis of in0aria2le su2>ecti0it". The" argue that the theor" and diagnosis of personalit" disorders are 2ased strictl" on social! or e0en sociopolitical and economic considerations.[(]['][&$][&&]

Contents

& ?lassification o &.& World Health 1rgani-ation o &.7 American Ps"chiatric Association o &.% 1ther o &.+ 8illon6s description o &.* Additional classification factors 7 ,igns and s"mptoms o 7.& @elationship with other mental disorders % )iagnosis o %.& /ormal personalit" + ?auses * Apidemiolog" # ?omor2idit" = 8anagement o =.& ,pecific approaches o =.7 ?hallenges ( Histor" o (.& 7$th centur" ' ?hildren &$ @eferences && Further reading &7 A5ternal lin s

Classi"ication
The two ma>or s"stems of classification! the 9?) and ),8! ha0e deli2eratel" merged their diagnoses to some e5tent! 2ut some differences remain. For e5ample! 9?)4&$ does not include narcissistic personalit" disorder as a distinct categor"! while ),84* does not include enduring personalit" change after catastrophic e5perience or after ps"chiatric illness. 9?)4&$ classifies the ),84* schi-ot"pal personalit" disorder as a form of schi-ophrenia rather than as a personalit" disorder. There are accepted diagnostic issues and contro0ersies with regard to distinguishing particular personalit" disorder categories

from each other.[&7] 9?) classifies Transse5ualism as a personalit" disorderB[&%] while ),84* addresses Cender d"sphoria.[&+]

#orld Healt$ %r&ani'ation

The 9?)4&$ section on mental and 2eha0ioral disorders includes categories of personalit" disorder and enduring personalit" changes. The" are defined as ingrained patterns indicated 2" infle5i2le and disa2ling responses that significantl" differ from how the a0erage person in the culture percei0es! thin s and feels! particularl" in relating to others.
[&*]

The specific personalit" disorders are: paranoid! schi-oid! dissocial! emotionall" unsta2le ;2orderline t"pe and impulsi0e t"pe<! histrionic! anan astic! an5ious ;a0oidant< and dependent.[&#] There is also an 61thers6 categor" in0ol0ing conditions characteri-ed as eccentric! haltlose ;deri0ed from DhaltlosD ;German< E drifting! aimless and irresponsi2le<![&=] immature! narcissistic! passi0e4aggressi0e or ps"choneurotic. An additional categor" is for unspecified personalit" disorder! including character neurosis and pathological personalit". There is also a categor" for 8i5ed and other personalit" disorders! defined as conditions that are often trou2lesome 2ut do not demonstrate the specific pattern of s"mptoms in the named disorders. Finall" there is a categor" of Anduring personalit" changes! not attri2uta2le to 2rain damage and disease. This is for conditions that seem to arise in adults without a diagnosis of personalit" disorder! following catastrophic or prolonged stress or other ps"chiatric illness.

American Psyc$iatric Association

The )iagnostic and ,tatistical 8anual of 8ental )isorders ;currentl" the ),84*< pro0ides a definition of a Ceneral personalit" disorder that stress such disorders are an enduring and infle5i2le pattern of long duration that lead to significant distress or impairment and are not due to use of su2stances or another medical condition. ),84* lists ten personalit" disorders! grouped into three clusters. The ),84* also contains three diagnoses for personalit" patterns that do not match these ten disorders! 2ut ne0ertheless e5hi2it characteristics of a personalit" disorder.[&(] Cluster A (odd disorders)

Paranoid !ersonality disorder( characteri-ed 2" a pattern of irrational suspicion and mistrust of others! interpreting moti0ations as male0olent Sc$i'oid !ersonality disorder( lac of interest and detachment from social relationships! and restricted emotional e5pression Sc$i'oty!al !ersonality disorder( a pattern of e5treme discomfort interacting sociall"! distorted cognitions and perceptions

Cluster B (dramatic) emotional or erratic disorders)

Antisocial !ersonality disorder( a per0asi0e pattern of disregard for and 0iolation of the rights of others! lac of empath" Borderline !ersonality disorder( per0asi0e pattern of insta2ilit" in relationships! self4image! identit"! 2eha0ior and affects often leading to self4harm and impulsi0it" Histrionic !ersonality disorder( per0asi0e pattern of attention4see ing 2eha0ior and e5cessi0e emotions arcissistic !ersonality disorder( a per0asi0e pattern of grandiosit"! need for admiration! and a lac of empath"

Cluster C (anxious or "ear"ul disorders)

A*oidant !ersonality disorder( per0asi0e feelings of social inhi2ition and inade:uac"! e5treme sensiti0it" to negati0e e0aluation De!endent !ersonality disorder( per0asi0e ps"chological need to 2e cared for 2" other people. %+sessi*e-com!ulsi*e !ersonality disorder (not t$e same as o+sessi*ecom!ulsi*e disorder)( characteri-ed 2" rigid conformit" to rules! perfectionism and control

%t$er !ersonality disorders

Personality c$an&e due to anot$er medical condition 3 is a personalit" distur2ance due to the direct effects of a medical condition %t$er s!eci"ied !ersonality disorder 3 s"mptoms characteristic of a personalit" disorder 2ut fails to meet the criteria for a specific disorder! with the reason gi0en Personality disorder not ot$er,ise s!eci"ied

%t$er
,ome t"pes of personalit" disorder were in pre0ious 0ersions of the diagnostic manuals 2ut ha0e 2een deleted. This includes two t"pes that were in the ),849994@ appendi5 as DProposed diagnostic categories needing further stud"D without specific criteria! namel" ,adistic personalit" disorder ;a per0asi0e pattern of cruel! demeaning and aggressi0e 2eha0ior< and ,elf4defeating personalit" disorder ;masochistic personalit" disorder< ;characterised 2" 2eha0iour conse:uentl" undermining the person6s pleasure and goals<. [&'] The ps"chologist Theodore 8illon and others consider some relegated diagnoses to 2e e:uall" 0alid disorders! and ma" also propose other personalit" disorders or su2t"pes! including mi5tures of aspects of different categories of the officiall" accepted diagnoses.
[7$]

Personality disorder dia&noses in eac$ edition o" American Psyc$iatric Association-s Dia&nostic Manual./10 DSM-I DSM-II DSM-III DSM-III-1 DSM-I2(DSM-2

31) Personality Pattern disturbance: 9nade:uate ,chi-oid ?"cloth"mic Paranoid Personality Trait disturbance: Amotionall" unsta2le ?ompulsi0e Passi e! aggressi e: Passi0e4 depressi0e su2t"pe Passi0e4 aggressi0e su2t"pe Aggressi0e su2t"pe

Pro!osals

9nade:uate ,chi-oid ,chi-oid ,chi-oid ?"cloth"mic Paranoid Paranoid Paranoid ,chi-ot"pal ,chi-ot"pal

,chi-oid Paranoid ,chi-ot"pal

,chi-ot"palF

H"sterical 12sessi0e4 compulsi0e

Histrionic .orderline

Histrionic

Histrionic .orderline 12sessi0e4 compulsi0e .orderline 12sessi0e4 compulsi0e

.orderline 12sessi0e4 ?ompulsi0e compulsi0e

)ependent Passi0e4 aggressi0e Passi0e4 aggressi0e

)ependent Passi0e4 aggressi0e

)ependent

A5plosi0e Asthenic A0oidant A0oidant /arcissistic /arcissistic Socio"athic "ersonality Disturbance: Antisocial reaction )"ssocial reaction ,e5ual de0iation #ddiction A0oidant /arcissistic A0oidant /arcissisticFF

Antisocial

Antisocial

Antisocial

Antisocial

Antisocial4 ps"chopathic

#""endix: ,elf4

#""endix: #""endix: /egati0istic )ependent

defeating ,adistic

)epressi0e

Histrionic Paranoid ,chi-oid /egati0istic )epressi0e

$ % &ot actually to be classified as a "ersonality disorder' classified instead as a form of schi(o"hrenia!s"ectrum disorder) $$ % *riginally "ro"osed for deletion' status remains unclear for DSM!+)

Millon-s descri!tion
Ps"chologist Theodore 8illon! who has written numerous popular wor s on personalit"! proposed the following description of personalit" disorders: Millon-s +rie" descri!tion o" !ersonality disorders.//0 3y!e o" !ersonality disorder Paranoid Descri!tion Cuarded! defensi0e! distrustful and suspiciousness. H"per0igilant to the moti0es of others to undermine or do harm. Alwa"s see ing confirmator" e0idence of hidden schemes. Feels righteous! 2ut persecuted. Apathetic! indifferent! remote! solitar"! distant! humorless. /either desires nor needs human attachments. Withdrawal from relationships and prefer to 2e alone. Gittle interest in others! often seen as a loner. 8inimal awareness of feelings of self or others. Few dri0es or am2itions! if an". Accentric! self4estranged! 2i-arre! a2sent. A5hi2its peculiar mannerisms and 2eha0iors. Thin s can read thoughts of others. Preoccupied with odd da"dreams and 2eliefs. .lurs line 2etween realit" and fantas". 8agical thin ing and strange 2eliefs. 9mpulsi0e! irresponsi2le! de0iant! unrul". Acts without due consideration. 8eets social o2ligations onl" when self4ser0ing. )isrespects societal customs! rules! and standards. ,ees self as free and independent. Unpredicta2le! manipulati0e! unsta2le. Franticall" fears a2andonment and isolation. A5periences rapidl" fluctuating moods. ,hifts rapidl" 2etween lo0ing and hating. ,ees self and others alternati0el" as all4 good and all42ad. Unsta2le and fre:uentl" changing moods. )ramatic! seducti0e! shallow! stimulus4see ing! 0ain. 10erreacts to minor e0ents. A5hi2itionistic as a means of securing attention and fa0ors. ,ees self as attracti0e and charming. ?onstant see ing for others6 attention.

Sc$i'oid

Sc$i'oty!al

Antisocial

Borderline

Histrionic

arcissistic

A*oidant

De!endent %+sessi*e4 com!ulsi*e De!ressi*e Passi*e4 a&&ressi*e ( e&ati*istic) Sadistic Sel"-de"eatin& (Masoc$istic)

Agotistical! arrogant! grandiose! insouciant. Preoccupied with fantasies of success! 2eaut"! or achie0ement. ,ees self as admira2le and superior! and therefore entitled to special treatment. Hesitant! self4conscious! em2arrassed! an5ious. Tense in social situations due to fear of re>ection. Plagued 2" constant performance an5iet". ,ees self as inept! inferior! or unappealing. Feels alone and empt". Helpless! incompetent! su2missi0e! immature. Withdraws from adult responsi2ilities. ,ees self as wea or fragile. ,ee s constant reassurance from stronger figures. @estrained! conscientious! respectful! rigid. 8aintains a rule42ound lifest"le. Adheres closel" to social con0entions. ,ees the world in terms of regulations and hierarchies. ,ees self as de0oted! relia2le! efficient! and producti0e. ,om2er! discouraged! pessimistic! 2rooding! fatalistic. Presents self as 0ulnera2le and a2andoned. Feels 0alueless! guilt"! and impotent. Hudges self as worth" onl" of criticism and contempt. @esentful! contrar"! s eptical! discontented. @esists fulfilling othersI e5pectations. )eli2eratel" inefficient. Jents anger indirectl" 2" undermining othersI goals. Alternatel" mood" and irrita2le! then sullen and withdrawn. A5plosi0el" hostile! a2rasi0e! cruel! dogmatic. Gia2le to sudden out2ursts of rage. Feels selfsatisfied through dominating! intimidating and humiliating others. 9s opinionated and close4minded. )eferential! pleasure4pho2ic! ser0ile! 2lameful! self4effacing. Ancourages others to ta e ad0antage. )eli2eratel" defeats own achie0ements. ,ee s condemning or mistreatful partners.

Additional classi"ication "actors

A5cept for classif"ing 2" categor" and cluster! it is possi2le to classif" personalit" disorders using such additional factors as se0erit"! impact on social functioning! and attri2ution.[7%] Se*erity This in0ol0es 2oth the notion of personalit" difficult" as a measure of su2threshold scores for personalit" disorder using standard inter0iews and the e0idence that those with the most se0ere personalit" disorders demonstrate a Kripple effectL of personalit" distur2ance across the whole range of mental disorders. 9n addition to su2threshold ;personalit" difficult"< and single cluster ;simple personalit" disorder<! this also deri0es comple5 or diffuse personalit" disorder ;two or more clusters of personalit" disorder present< and can also deri0e se0ere personalit" disorder for those of greatest ris . Dimensional System o" Classi"yin& Personality Disorders./50

6e*el o" Se*erity 0 1 / 7 5

Descri!tion /o Personalit" )isorder Personalit" )ifficult" ,imple Personalit" )isorder ?omple5 ;)iffuse< Personalit" )isorder ,e0ere Personalit" )isorder

De"inition +y Cate&orical System )oes not meet actual or su2threshold criteria for an" personalit" disorder 8eets su24threshold criteria for one or se0eral personalit" disorders 8eets actual criteria for one or more personalit" disorders within the same cluster 8eets actual criteria for one or more personalit" disorders within more than one cluster 8eets criteria for creation of se0ere disruption to 2oth indi0idual and to man" in societ"

There are se0eral ad0antages to classif"ing personalit" disorder 2" se0erit": [7%]

9t not onl" allows for 2ut also ta es ad0antage of the tendenc" for personalit" disorders to 2e comor2id with each other. 9t represents the influence of personalit" disorder on clinical outcome more satisfactoril" than the simple dichotomous s"stem of no personalit" 0ersus personalit" disorder. This s"stem accommodates the new diagnosis of se0ere personalit" disorder! particularl" Ddangerous and se0ere personalit" disorderD ;),P)<. Politicians and the pu2lic 2oth want to now who comprise the most dangerous group.

8""ect on social "unctionin& ,ocial function is affected 2" man" other aspects of mental functioning apart from that of personalit". Howe0er! whene0er there is persistentl" impaired social functioning in conditions in which it would normall" not 2e e5pected! the e0idence suggests that this is more li el" to 2e created 2" personalit" a2normalit" than 2" other clinical 0aria2les.[7*] The Personalit" Assessment ,chedule[7#] gi0es social function priorit" in creating a hierarch" in which the personalit" disorder creating the greater social d"sfunction is gi0en primac" o0er others in a su2se:uent description of personalit" disorder. Attri+ution 8an" who ha0e a personalit" disorder do not recogni-e an" a2normalit" and defend 0aliantl" their continued occupanc" of their personalit" role. This group ha0e 2een termed the T"pe @! or treatment4resisting personalit" disorders! as opposed to the T"pe , or treatment4see ing ones! who are een on altering their personalit" disorders and sometimes clamor for treatment.[7%] The classification of #( personalit" disordered patients on the caseload of an asserti0e communit" team using a simple scale showed a % to & ratio 2etween T"pe @ and T"pe , personalit" disorders with ?luster ? personalit"

disorders 2eing significantl" more li el" to 2e T"pe ,! and paranoid and schi-oid ;?luster A< personalit" disorders significantl" more li el" to 2e T"pe @ than others.[7=]

Si&ns and sym!toms

)epending on the diagnosis! se0erit" and indi0idual! and the >o2 itself! personalit" disorders can 2e associated with difficult" coping with wor or the wor place4 potentiall" leading to pro2lems with others 2" interfering with interpersonal relationships. 9ndirect effects also pla" a roleB for e5ample! impaired educational progress or complications outside of wor ! such as su2stance a2use and co4mor2id mental diseases! can plague sufferers. Howe0er! personalit" disorders can also 2ring a2out a2o0e4a0erage wor a2ilities 2" increasing competiti0e dri0e or causing the sufferer to e5ploit his or her co4 wor ers.[7(][7'] 9n 7$$*! ps"chologists .elinda .oard and Matarina Frit-on at the Uni0ersit" of ,urre"! UM! inter0iewed and ga0e personalit" tests to high4le0el .ritish e5ecuti0es and compared their profiles with those of criminal ps"chiatric patients at .roadmoor Hospital in the UM. The" found that three out of ele0en personalit" disorders were actuall" more common in e5ecuti0es than in the distur2ed criminals:

Histrionic personalit" disorder: including superficial charm! insincerit"! egocentricit" and manipulation /arcissistic personalit" disorder: including grandiosit"! self4focused lac of empath" for others! e5ploitati0eness and independence. 12sessi0e4compulsi0e personalit" disorder: including perfectionism! e5cessi0e de0otion to wor ! rigidit"! stu22ornness and dictatorial tendencies.[%$]

According to leading leadership academic 8anfred F.@. Mets de Jries! it seems almost ine0ita2le these da"s that there will 2e some personalit" disorders in a senior management team.[%&]

1elations$i! ,it$ ot$er mental disorders

The disorders in each of the three clusters ma" share some underl"ing common 0ulnera2ilit" factors in0ol0ing cognition! affect and impulse control! and 2eha0ioral maintenance or inhi2ition! respecti0el"! and ma" ha0e a spectrum relationship to certain s"ndromal mental disorders:[%7]

Paranoid or schi-ot"pal personalit" disorders ma" 2e o2ser0ed to 2e premor2id antecedents of delusional disorders or schi-ophrenia. .orderline personalit" disorder is seen in association with mood and an5iet" disorders and with impulse control disorders! eating disorders! A)H)! or a su2stance use disorder. A0oidant personalit" disorder is seen with social an5iet" disorder.

Dia&nosis
The ),849J lists Ceneral diagnostic criteria for a personalit" disorder! which must 2e met in addition to the specific criteria for a particular named personalit" disorder. This re:uires that there 2e ;to paraphrase<:[%%]

An enduring pattern of ps"chological e5perience and 2eha0ior that differs prominentl" from cultural e5pectations! as shown in two or more of: cognition ;i.e. percei0ing and interpreting the self! other people or e0ents<B affect ;i.e. the range! intensit"! la2ilit"! and appropriateness of emotional response<B interpersonal functioningB or impulse control. The pattern must appear infle5i2le and per0asi0e across a wide range of situations! and lead to clinicall" significant distress or impairment in important areas of functioning. The pattern must 2e sta2le and long4lasting! ha0e started as earl" as at least adolescence or earl" adulthood. The pattern must not 2e 2etter accounted for as a manifestation of another mental disorder! or to the direct ph"siological effects of a su2stance ;e.g. drug or medication< or a general medical condition ;e.g. head trauma<.

The 9?)4&$ 6clinical descriptions and diagnostic guidelines6 introduces its specific personalit" disorder diagnoses with some general guideline criteria that are similar. To :uote:[%+]

8ar edl" disharmonious attitudes and 2eha0ior! generall" in0ol0ing se0eral areas of functioningB e.g. affecti0it"! arousal! impulse control! wa"s of percei0ing and thin ing! and st"le of relating to othersB The a2normal 2eha0ior pattern is enduring! of long standing! and not limited to episodes of mental illnessB The a2normal 2eha0ior pattern is per0asi0e and clearl" maladapti0e to a 2road range of personal and social situationsB The a2o0e manifestations alwa"s appear during childhood or adolescence and continue into adulthoodB The disorder leads to considera2le personal distress 2ut this ma" onl" 2ecome apparent late in its courseB The disorder is usuall"! 2ut not in0aria2l"! associated with significant pro2lems in occupational and social performance.

The 9?) adds: DFor different cultures it ma" 2e necessar" to de0elop specific sets of criteria with regard to social norms! rules and o2ligations.D 9n clinical practice! indi0iduals are generall" diagnosed 2" an inter0iew with a ps"chiatrist 2ased on a mental status e5amination! which ma" ta e into account o2ser0ations 2" relati0es and others. 1ne tool of diagnosing personalit" disorders is a process in0ol0ing inter0iews with scoring s"stems. The patient is as ed to answer

:uestions! and depending on their answers! the trained inter0iewer tries to code what their responses were. This process is fairl" time consuming.

ormal !ersonality
The issue of the relationship 2etween normal personalit" and personalit" disorders is one of the important issues in personalit" and clinical ps"cholog". The personalit" disorders classification ;),8 9J T@ and 9?)4&$< follows a categorical approach that 0iews personalit" disorders as discrete entities that are distinct from each other and from normal personalit". 9n contrast! the dimensional approach is an alternati0e approach that personalit" disorders represent maladapti0e e5tensions of the same traits that descri2e normal personalit". Thomas Widiger[%*] and his colla2orators ha0e contri2uted to this de2ate significantl". He discussed the constraints of the categorical approach and argued for the dimensional approach to the personalit" disorders. ,pecificall"! he proposed that Fi0e Factor 8odel of personalit" is alternati0e to the classification of personalit" disorders. For e5ample! this 0iew specifies that .orderline Personalit" )isorder can 2e understood as a com2ination of emotional la2ilit" ;i.e.! high neuroticism<! impulsi0it" ;i.e.! low conscientiousness<! and hostilit" ;i.e.! low agreea2leness<. 8an" studies across cultures ha0e e5plored the relationship 2etween personalit" disorders and the Fi0e Factor 8odel[%#] This research has demonstrated that personalit" disorders largel" correlate in e5pected wa"s with measures of the Fi0e Factor 8odel[%=] and has set the stage for including the Fi0e Factor 8odel within the upcoming ),84*.[%(] DSM-I2-31 Personality Disorders "rom t$e Pers!ecti*e o" t$e 9i*e-9actor Model o" :eneral Personality 9unctionin&.7/0 S'P StP ASP BP HP P A*P DP %CP PAP D!P 9actors PPD D D D D D D D D D D D &euroticism , s) emotional stabilityAn5iousness ;0s. Hig nNa nNa High Gow nNa nNa High High High nNa nNa unconcerned< h Angr" hostilit" Hig Hig nNa nNa High nNa High nNa nNa nNa High nNa ;0s. dispassionate< h h )epressi0eness Hig nNa nNa nNa nNa nNa nNa nNa nNa nNa nNa High ;0s. optimistic< h ,elf4 consciousness ;0s. nNa nNa High Gow nNa Gow Gow High High nNa nNa High shameless< 9mpulsi0it" ;0s. Hig nNa nNa nNa High High nNa Gow nNa Gow nNa nNa restrained< h Julnera2ilit" ;0s. Hig nNa nNa nNa Gow nNa nNa High High nNa nNa nNa fearless< h .xtra ersion , s) intro ersion-

Warmth ;0s. Gow Gow coldness< Cregariousness Gow Gow ;0s. withdrawal< Asserti0eness ;0s. nNa nNa su2missi0eness< Acti0it" ;0s. nNa Gow passi0it"< A5citement see ing ;0s. nNa Gow lifeless< Positi0e emotionalit" ;0s. nNa Gow anhedonia< *"enness , s) closednessFantas" ;0s. nNa nNa concrete< Aesthetics ;0s. nNa nNa disinterest< Feelings ;0s. nNa Gow ale5ith"mia< Actions ;0s. Gow Gow predicta2le< 9deas ;0s. closed4 Gow nNa minded< Jalues ;0s. Gow nNa dogmatic< #greeableness , s) antagonismTrust ;0s. Gow nNa mistrust< ,traightforwardne Gow nNa ss ;0s. deception< Altruism ;0s. Gow nNa e5ploitati0e< ?ompliance ;0s. Gow nNa aggression< 8odest" ;0s. nNa nNa arrogance< Tender4 mindedness ;0s. Gow nNa tough4minded< Conscientiousness

Gow nNa Gow nNa nNa nNa nNa

nNa nNa Gow nNa

High nNa

Gow Gow nNa Gow

nNa High nNa Gow nNa nNa

High nNa nNa High Gow Gow nNa High nNa High nNa nNa nNa nNa

Gow nNa Gow nNa nNa nNa Gow nNa

High nNa High High Gow nNa Gow nNa High nNa Gow nNa nNa

Gow nNa

High nNa nNa nNa nNa nNa nNa

nNa High nNa nNa nNa nNa nNa nNa

nNa nNa nNa nNa

nNa nNa nNa

nNa nNa nNa

Hig High Gow nNa nNa Gow h Hig High High High Gow nNa Gow h nNa nNa nNa nNa nNa nNa nNa nNa nNa Gow nNa Gow

Gow nNa Gow Gow nNa nNa

High nNa nNa nNa

nNa nNa nNa nNa nNa nNa

Gow nNa High Gow nNa Gow nNa nNa Gow nNa Gow nNa nNa Gow nNa Gow nNa nNa Gow nNa

High nNa nNa nNa High nNa High nNa

nNa

Gow

Gow nNa nNa nNa

Gow nNa nNa nNa High nNa

Gow nNa nNa Gow High High nNa Gow nNa nNa Gow nNa High nNa

, s) disinhibition?ompetence ;0s. la5ness< 1rder ;0s. disorderl"< )utifulness ;0s. irresponsi2ilit"< Achie0ement stri0ing ;0s. lac adaisical< ,elf4discipline ;0s. negligence< )eli2eration ;0s. rashness<

nNa nNa nNa nNa nNa nNa nNa nNa nNa nNa nNa nNa

nNa

nNa

nNa nNa nNa nNa nNa nNa nNa nNa

nNa High Gow nNa nNa nNa High Gow

Gow nNa nNa nNa nNa nNa

Gow nNa nNa nNa nNa nNa nNa nNa nNa nNa

nNa High Gow High nNa High nNa nNa

Gow nNa Gow nNa nNa Gow Gow Gow nNa nNa

nNa High Gow nNa nNa High nNa High

A++re*iations used( PPD % Paranoid Personality Disorder/ S(PD % Schi(oid Personality Disorder/ StPD % Schi(oty"al Personality Disorder/ #SPD % #ntisocial Personality Disorder/ 0PD % 0orderline Personality Disorder/ HPD % Histrionic Personality Disorder/ &PD % &arcissistic Personality Disorder/ # PD % # oidant Personality Disorder/ DPD % De"endent Personality Disorder/ *CPD % *bsessi e! Com"ulsi e Personality Disorder/ P#PD % Passi e!#ggressi e Personality Disorder/ D"PD % De"ressi e Personality Disorder/ n1a % not a ailable)

Causes
There are numerous possi2le causes of mental disorders! and the" ma" 0ar" depending on the disorder! the indi0idual! and the circumstances. There ma" 2e genetic dispositions as well as particular life e5periences! which ma" or ma" not include particular incidents of trauma or a2use. A stud" of almost #$$ male college students! a0eraging almost %$ "ears of age and who were not drawn from a clinical sample! e5amined the relationship 2etween childhood e5periences of se5ual and ph"sical a2use and currentl" reported personalit" disorder s"mptoms. ?hildhood a2use histories were found to 2e definiti0el" associated with greater le0els of s"mptomatolog". ,e0erit" of a2use was found to 2e statisticall" significant! 2ut clinicall" negligi2le! in s"mptomatolog" 0ariance spread o0er ?luster A! . and ? scales.[%'] ?hild a2use and neglect consistentl" e0idence themsel0es as antecedent ris s to the de0elopment of personalit" disorders in adulthood.[+$] 9n the following stud"! efforts were ta en to match retrospecti0e reports of a2use with a clinical population that had demonstrated ps"chopatholog" from childhood to adulthood who were later found to ha0e e5perienced a2use and neglect. 9n a stud" of ='% mothers and children! researchers as ed mothers if the" had screamed at their children! and told them that the" didnIt lo0e them or threatened to send them awa". ?hildren who had e5perienced such 0er2al a2use

were three times as li el" as other children ;who didn6t e5perience such 0er2al a2use< to ha0e 2orderline! narcissistic! o2sessi0e4compulsi0e or paranoid personalit" disorders in adulthood.[+&] The se5uall" a2used group demonstrated the most consistentl" ele0ated patterns of ps"chopatholog". 1fficiall" 0erified ph"sical a2use showed an e5tremel" strong correlation with the de0elopment of antisocial and impulsi0e 2eha0ior. 1n the other hand! cases of a2use of the neglectful t"pe that created childhood patholog" were found to 2e su2>ect to partial remission in adulthood.[+$]

8!idemiolo&y
The pre0alence of personalit" disorder in the general communit" was largel" un nown until sur0e"s starting from the &''$s. 9n 7$$( the median rate of diagnosa2le P) was estimated at &$.#O! 2ased on si5 ma>or studies across three nations. This rate of around one in ten! especiall" as associated with high use of ser0ices! is descri2ed as a ma>or pu2lic health concern re:uiring attention 2" researchers and clinicians.[+7] The pre0alence of indi0idual personalit" disorders ranges from a2out 7O to %O for the more common 0arieties! such as schi-ot"pal! antisocial! 2orderline! and histrionic! to $.*3 &O for the least common! such as narcissistic and a0oidant.[%7] A screening sur0e" across &% countries 2" the World Health 1rgani-ation using ),849J criteria! reported in 7$$' a pre0alence estimate of around #O for personalit" disorders. The rate sometimes 0aried with demographic and socioeconomic factors! and functional impairment was partl" e5plained 2" co4occurring mental disorders.[+%] 9n the U,! screening data from the /ational ?omor2idit" ,ur0e" @eplication 2etween 7$$& and 7$$%! com2ined with inter0iews of a su2set of respondents! indicated a population pre0alence of around 'O for personalit" disorders in total. Functional disa2ilit" associated with the diagnoses appeared to 2e largel" due to co4occurring mental disorders ;A5is 9 in the ),8<.[++] A UM national epidemiological stud" ;2ased on ),849J screening criteria<! reclassified into le0els of se0erit" rather than >ust diagnosis! reported in 7$&$ that the ma>orit" of people show some personalit" difficulties in one wa" or another ;short of threshold for diagnosis<! while the pre0alence of the most comple5 and se0ere cases ;including meeting criteria for multiple diagnoses in different clusters< was estimated at &.%O. A0en low le0els of personalit" s"mptoms were associated with functional pro2lems! 2ut the most se0erel" in need of ser0ices was a much smaller group.[+*] There are also some se5 differences in the fre:uenc" of personalit" disorders. The" are shown in the ta2le 2elow. Sex di""erences in t$e "re;uency o" !ersonality disorders.7/0 3y!e o" !ersonality disorder Sex Paranoid personalit" disorder Male ,chi-oid personalit" disorder Male

,chi-ot"pal personalit" disorder Antisocial personalit" disorder .orderline personalit" disorder Histrionic personalit" disorder /arcissistic personalit" disorder A0oidant personalit" disorder )ependent personalit" disorder 12sessi0e3compulsi0e personalit" disorder

Male Male 9emale 9emale Male 8;ual 9emale Male

Comor+idity
There is a considera2le personalit" disorder diagnostic co4occurrence. Patients who meet the ),849J4T@ diagnostic criteria for one personalit" disorder are li el" to meet the diagnostic criteria for another.[%7] )iagnostic categories pro0ide clear! 0i0id descriptions of discrete personalit" t"pes 2ut the personalit" structure of actual patients might 2e more accuratel" descri2ed 2" a constellation of maladapti0e personalit" traits. DSM-III-1 !ersonality disorder dia&nostic co-occurrence a&&re&ated across six researc$ sites.7/0 3y!e o" Personality PPD S'PD StPD ASPD BPD HPD PD A*PD DPD %CPD PAPD Disorder Paranoid ;PP)< ( &' &* +& 7( 7# ++ 7% 7& %$ ,chi-oid ;,-P)< %( %' ( 77 ( 77 ** && 7$ ' ,chi-ot"pal ;,tP)< +% %7 &' + &= 7# #( %+ &' &( Antisocial ;A,P)< %$ ( &* *' %' +$ 7* &' ' 7' .orderline ;.P)< %& # &# 7% %$ &' %' %# &7 7& Histrionic ;HP)< 7' 7 = &= +& +$ 7& 7( &% 7* /arcissistic ;/P)< +& &7 &( 7* %( #$ %7 7+ 7& %( A0oidant ;A0P)< %% &* 77 && %' &# &* +% &# &' )ependent ;)P)< 7# % &# &# +( 7+ &+ *= &* 77 12sessi0e4 ?ompulsi0e %& &$ && + 7* 7& &' %= 7= 7% ;1?P)< Passi0e4Aggressi0e %' # &7 7* ++ %# %' +& %+ 7% ;PAP)< Sites used DSM!III!R criterion sets) Data obtained for "ur"oses of informing the de elo"ment of the DSM!I2!TR "ersonality disorder diagnostic criteria) A++re*iations used( PPD % Paranoid Personality Disorder/ S(PD % Schi(oid Personality Disorder/ StPD % Schi(oty"al Personality Disorder/ #SPD % #ntisocial Personality Disorder/ 0PD % 0orderline Personality Disorder/ HPD % Histrionic Personality Disorder/ &PD % &arcissistic Personality Disorder/ # PD % # oidant

Personality Disorder/ DPD % De"endent Personality Disorder/ *CPD % *bsessi e! Com"ulsi e Personality Disorder/ P#PD % Passi e!#ggressi e Personality Disorder)

Mana&ement
S!eci"ic a!!roac$es
There are man" different forms ;modalities< of treatment used for personalit" disorders:
[+#]

9ndi0idual ps"chotherap" has 2een a mainsta" of treatment. There are long4term and short4term ;2rief< forms. Famil" therap"! including couples therap". Croup therap" for personalit" d"sfunction is pro2a2l" the second most used. Ps"chological4education ma" 2e used as an addition. ,elf4help groups ma" pro0ide resources for personalit" disorders. Ps"chiatric medications for treating s"mptoms of personalit" d"sfunction or co4 occurring conditions. 8ilieu therap"! a ind of group42ased residential approach! has a histor" of use in treating personalit" disorders! including therapeutic communities.

There are different specific theories or schools of therap" within man" of these modalities. The" ma"! for e5ample! emphasi-e ps"chod"namic techni:ues! or cogniti0e or 2eha0ioral techni:ues. 9n clinical practice! man" therapists use an 6eclectic6 approach! ta ing elements of different schools as and when the" seem to fit to an indi0idual client. There is also often a focus on common themes that seem to 2e 2eneficial regardless of techni:ues! including attri2utes of the therapist ;e.g. trustworthiness! competence! caring<! processes afforded to the client ;e.g. a2ilit" to e5press and confide difficulties and emotions<! and the match 2etween the two ;e.g. aiming for mutual respect! trust and 2oundaries<. 1es!onse o" Patients ,it$ Personality Disorders to Biolo&ical and Psyc$osocial 3reatments.7/0 1es!onse to 8*idence "or Brain 1es!onse to Biolo&ical Cluster Psyc$osocial Dys"unction 3reatments 3reatments A0idence for relationship ,chi-ot"pal patients ma" of schi-ot"pal impro0e on antips"chotic Poor. ,upporti0e A personalit" to medicationB otherwise not ps"chotherap" ma" help schi-ophreniaB otherwise indicated none nown A0idence suggesti0e for Antidepressants! Poor in antisocial antisocial and 2orderline antips"chotics! or mood personalit". Jaria2le in B personalitiesB otherwise sta2ili-ers ma" help for 2orderline! narcissistic! none nown 2orderline personalit"B and histrionic

/one nown

otherwise not indicated /o direct response. 8edications ma" help with comor2id an5iet" and depression

personalities 8ost common treatment for these disorders. @esponse 0aria2le

C$allen&es
The management and treatment of personalit" disorders can 2e a challenging and contro0ersial area! for 2" definition the difficulties ha0e 2een enduring and affect multiple areas of functioning. This often in0ol0es interpersonal issues! and there can 2e difficulties in see ing and o2taining help from organi-ations in the first place! as well as with esta2lishing and maintaining a specific therapeutic relationship. 1n the one hand! an indi0idual ma" not consider themsel0es to ha0e a mental health pro2lem! while on the other! communit" mental health ser0ices ma" 0iew indi0iduals with personalit" disorders as too comple5 or difficult! and ma" directl" or indirectl" e5clude indi0iduals with such diagnoses or associated 2eha0iors.[+=] The disrupti0eness people with personalit" disorders can create in an organisation ma es these! argua2l"! the most challenging conditions to manage. Apart from all these issues! an indi0idual ma" not consider their personalit" to 2e disordered or the cause of pro2lems. This perspecti0e ma" 2e caused 2" the patient6s ignorance or lac of insight into their own condition! an ego4s"ntonic perception of the pro2lems with their personalit" that pre0ents them from e5periencing it as 2eing in conflict with their goals and self4image! or 2" the simple fact that there is no distinct or o2>ecti0e 2oundar" 2etween 6normal6 and 6a2normal6 personalities. Unfortunatel"! there is su2stantial social stigma and discrimination related to the diagnosis. The term 6personalit" disorder6 encompasses a wide range of issues! each with different a le0el of se0erit" or disa2ilit"B thus! personalit" disorders can re:uire fundamentall" different approaches and understandings. To illustrate the scope of the matter! consider that while some disorders or indi0iduals are characteri-ed 2" continual social withdrawal and the shunning of relationships! others ma" cause fluctuations in forwardness. The e5tremes are worse still: at one e5treme lie self4harm and self4neglect! while at another e5treme some indi0iduals ma" commit 0iolence and crime. There can 2e other factors such as pro2lematic su2stance use or dependenc" or 2eha0ioral addictions. A person ma" meet criteria for multiple personalit" disorder diagnoses andNor other mental disorders! either at particular times or continuall"! thus ma ing coordinated input from multiple ser0ices a potential re:uirement. Therapists in this area can 2ecome disheartened 2" lac of initial progress! or 2" apparent progress that then leads to set2ac s. ?lients ma" 2e e5perienced as negati0e! re>ecting! demanding! aggressi0e or manipulati0e. This has 2een loo ed at in terms of 2oth therapist and clientB in terms of social s ills! coping efforts! defence mechanisms! or deli2erate strategiesB and in terms of moral >udgements or the need to consider underl"ing moti0ations for specific 2eha0iors or conflicts. The 0ulnera2ilities of a client! and indeed

therapist! ma" 2ecome lost 2ehind actual or apparent strength and resilience. 9t is commonl" stated that there is alwa"s a need to maintain appropriate professional personal 2oundaries! while allowing for emotional e5pression and therapeutic relationships. Howe0er! there can 2e difficult" ac nowledging the different worlds and understandings that client and therapist ma" li0e with. A therapist ma" assume that the inds of relationships and wa"s of interacting that ma e them feel safe and comforta2le! ha0e the same effect on clients. As an e5ample at one e5treme! people who ma" in their li0es ha0e 2een used to hostilit"! decepti0eness! re>ection! aggression or a2use! ma" in some cases 2e made confused! intimidated or suspicious 2" presentations of warmth! intimac" or positi0it". 1n the other hand! reassurance! openness and clear communication are usuall" helpful and needed. 9t can ta e se0eral months of sessions! and perhaps se0eral stops and starts! to 2egin to de0elop a trusting relationship that can meaningfull" address issues.[+(]

History
Personalit" disorder is a term with a distinctl" modern meaning! owing in part to its clinical usage and the institutional character of modern ps"chiatr". The currentl" accepted meaning must 2e understood in the conte5t of historical changing classification s"stems such as ),849J and its predecessors. Although highl" anachronistic! and ignoring radical differences in the character of su2>ecti0it" and social relations! some ha0e suggested similarities to other concepts going 2ac to at least the ancient Cree s.[%] For e5ample! the Cree philosopher Theophrastus descri2ed 7' 6character6 t"pes that he saw as de0iations from the norm! and similar 0iews ha0e 2een found in Asian! Ara2ic and ?eltic cultures. A long4standing influence in the Western world was Calen6s concept of personalit" t"pes which he lin ed to the four humours proposed 2" Hippocrates. ,uch 0iews lasted into the &(th centur"! when e5periments 2egan to :uestion the supposed 2iologicall" 2ased humours and 6temperaments6. Ps"chological concepts of character and 6self6 2ecame widespread. 9n the &'th centur"! 6personalit"6 referred to a person6s conscious awareness of their 2eha0ior! a disorder of which could 2e lin ed to altered states such as dissociation. This sense of the term has 2een compared to the use of the term 6multiple personalit" disorder6 in the first 0ersions of the ),8.[+'] Ph"sicians in the earl" &'th centur" started to diagnose forms of insanit" that in0ol0ed distur2ed emotions and 2eha0iors 2ut seemingl" without significant intellectual impairment or delusions or hallucinations. Philippe Pinel referred to this as 6manie sans dPlire6 3 insanit" without delusion 3 and descri2ed a num2er of cases mainl" in0ol0ing e5cessi0e or ine5plica2le anger or rage. Hames ?owles Prichard ad0anced a similar concept he called moral insanit"! which would 2e used to diagnose patients for some decades. 68oral6 in this sense referred to affect ;emotion or mood< rather than necessaril" ethics! 2ut it was argua2l" 2ased in part on religious! social and moral 2eliefs! with a pessimism a2out medical inter0ention so that social control should ta e precedence.[*$] These categories were much different and 2roader than later definitions of personalit" disorder! while also 2eing de0eloped 2" some into a more specific meaning of moral degenerac" a in to later ideas a2out 6ps"chopaths6. ,eparatel"! @ichard 0on Mrafft4A2ing

populari-ed the terms sadism and masochism! as well as homose5ualit"! as ps"chiatric issues. The Cerman ps"chiatrist Moch sought to ma e the moral insanit" concept more scientific! suggesting in &('& the phrase 6ps"chopathic inferiorit"6! theori-ed to 2e a congenital disorder. This referred to continual and rigid patterns of misconduct or d"sfunction in the a2sence of apparent mental retardation or illness! supposedl" without a moral >udgement. )escri2ed as deepl" rooted in his ?hristian faith! his wor has 2een descri2ed as a fundamental te5t on personalit" disorders that is still of use toda".[*&]

/0t$ century
9n the earl" 7$th centur"! another Cerman ps"chiatrist! Amil Mraepelin! included a chapter on ps"chopathic inferiorit" in his influential wor on clinical ps"chiatr" for students and ph"sicians. He suggested si5 t"pes 3 e5cita2le! unsta2le! eccentric! liar! swindler and :uarrelsome. The categories were essentiall" defined 2" the most disordered criminal offenders o2ser0ed! distinguished 2etween criminals 2" impulse! professional criminals! and mor2id 0aga2onds who wandered through life. Mraepelin also descri2ed three paranoid ;meaning then delusional< disorders! resem2ling later concepts of schi-ophrenia! delusional disorder and paranoid personalit" disorder. A diagnostic term for the latter concept would 2e included in the ),8 from &'*7! and from &'($ the ),8 would also include schi-oid and schi-ot"pal personalit" disordersB interpretations of earlier ;&'7&< theories of Arnst Mretschmer led to a distinction 2etween these and another t"pe later included in the ),8! a0oidant personalit" disorder. 9n &'%% @ussian ps"chiatrist P"otr .oriso0ich Cannush in pu2lished his 2oo Manifestations of "sycho"athies: statics/ dynamics/ systematic as"ects! which was one of the first attempts to de0elop a detailed t"polog" of ps"chopathies. @egarding maladaptation! u2i:uit"! and sta2ilit" as the three main s"mptoms of 2eha0ioral patholog"! he distinguished ' clusters of ps"chopaths: c"cloids ;including constitutionall" depressi0e! constitutionall" e5cita2le! c"cloth"mics! and emotionall" la2ile<! asthenics ;including ps"chasthenics<! schi-oids ;including dreamers<! paranoiacs ;including fanatics<! epileptoids! h"sterical personalities ;including pathological liars<! unsta2le ps"chopaths! antisocial ps"chopaths! and constitutionall" stupid.[*7] ,ome elements of Cannush in6s t"polog" were later incorporated into the theor" de0eloped 2" a @ussian adolescent ps"chiatrist! Andre" Qe0gen"e0ich Gich o! who was also interested in ps"chopathies along with their milder forms! the so4called accentuations of character.
[*%]

Ps"chiatrist )a0id Henderson pu2lished in &'%' a theor" of 6ps"chopathic states6 which ended up contri2uting to the term 2ecoming popularl" lin ed to anti4social 2eha0ior. Her0e" 8. ?lec le"Is &'+& te5t! The 8as of ,anit"! 2ased on his personal categori-ation of similarities he noted in some prisoners! mar ed the start of the modern clinical conception of ps"chopath" and its popularist usage.[*+]

Towards the mid 7$th centur"! ps"choanal"tic theories were coming to the fore 2ased on wor from the turn of the centur" 2eing populari-ed 2" ,igmund Freud and others. This included the concept of 6character disorders6! which were seen as enduring pro2lems lin ed not to specific s"mptoms 2ut to per0asi0e internal conflicts or derailments of normal childhood de0elopment. These were t"picall" understood as wea nesses of character or willful de0iance! and were distinguished from neurosis or ps"chosis. The term 62orderline6 stems from a 2elief that some indi0iduals were functioning on the edge of those two categories! and a num2er of the other personalit" disorder categories were also hea0il" influenced 2" this approach! including dependent! o2sessi0e4compulsi0e and histrionic![**] the latter starting off as a con0ersion s"mptom of h"steria particularl" associated with women! then a h"sterical personalit"! then renamed histrionic personalit" disorder in later 0ersions of the ),8. A passi0e aggressi0e st"le was defined clinicall" 2" ?olonel William 8enninger during World War 99 in the conte5t of men6s reactions to militar" compliance! which would later 2e referenced as a personalit" disorder in the ),8.[*#] 1tto Mern2erg was influential with regard to the concepts of the 2orderline and narcissistic personalities which were later incorporated as disorders into the ),8 in &'($. 8eanwhile! a more general personalit" ps"cholog" had 2een de0eloping in academia and to some e5tent clinicall". Cordon Allport was pu2lishing theories of personalit" traits from the &'7$s! and Henr" 8urra" ad0anced a theor" called 6personolog"6 which influenced a later e" ad0ocate of personalit" disorders! Theodore 8illon. Tests were de0eloping or 2eing applied for personalit" e0aluation! including pro>ecti0e tests such as the @orshach! as well as :uestionnaires such as the 8innesota 8ultiphasic Personalit" 9n0entor". Around mid4centur"! Hans A"senc was anal"sing traits and personalit" t"pes! and ps"chiatrist Murt ,chneider was popularising a clinical use in place of the pre0iousl" more usual terms 6character6! 6temperament6 or 6constitution6. American ps"chiatrists officiall" recognised concepts of enduring personalit" distur2ances in the first )iagnostic and ,tatistical 8anual of 8ental )isorders in the &'*$s! which relied hea0il" on ps"choanal"tic concepts. ,omewhat more neutral language was emplo"ed in the ),8499 in &'#(! though the terms and descriptions had onl" a slight resem2lance to current definitions. The ),84999 pu2lished in &'($ made some ma>or changes! nota2l" putting all personalit" disorders onto a second separate 6a5is6 along with mental retardation! intended to signif" more enduring patterns! distinct from what were considered a5is one mental disorders. 69nade:uate6 and 6asthenic6 personalit" disorder6 categories were deleted! and others were unpac ed into more t"pes! or changed from 2eing personalit" disorders to regular disorders. ,ociopathic personalit" disorder! which had 2een the term for ps"chopath"! was renamed Antisocial Personalit" )isorder. 8ost categories were gi0en more specific 6operationali-ed6 definitions! with standard criteria that ps"chiatrists could agree on in order to conduct research and diagnose patients.[*=] 9n the ),84999 re0ision! self4defeating personalit" disorder and sadistic personalit" disorder were included as pro0isional diagnoses re:uiring further stud". The" were dropped in the ),849J! though a proposed 6depressi0e personalit" disorder6 was addedB in addition! the official diagnosis of passi0e4aggressi0e personalit" disorder was dropped! tentati0el" renamed 6negati0istic personalit" disorder.6[*(]

9nternational differences ha0e 2een noted in how attitudes ha0e de0eloped towards the diagnosis of personalit" disorder. Murt ,chneider had argued that the" were simpl" 6a2normal 0arieties of ps"chic life6 and therefore not necessaril" the domain of ps"chiatr"! a 0iew said to still ha0e influence in Cerman" toda". .ritish ps"chiatrists ha0e also 2een reluctant to address such disorders or consider them on a par with other mental disorders! which has 2een attri2uted partl" to resource pressures within the /ational Health ,er0ice! as well as to negati0e medical attitudes towards 2eha0iors associated with personalit" disorders. 9n the U,! the pre0ailing healthcare s"stem and ps"chanal"tic tradition has 2een said to pro0ide a rationale for pri0ate therapists to diagnose some personalit" disorders more 2roadl" and pro0ide ongoing treatment for them.[*']

C$ildren
8ain article: Personalit" de0elopment disorder Aarl" stages and preliminar" forms of personalit" disorders need a multi4dimensional and earl" treatment approach. Personalit" de0elopment disorder is considered to 2e a childhood ris factor or earl" stage of a later personalit" disorder in adulthood.[#$] 9n addition! in @o2ert F. Mrueger6s re0iew of their research indicates that some children and adolescents do suffer from clinicall" significant s"ndromes that resem2le adult personal disorders! and that these s"ndromes ha0e meaningful correlates and are conse:uential. 8uch of this research has 2een framed 2" the adult personalit" disorder constructs from A5is 99 of the )iagnostic and ,tatistical 8anual. Hence! the" are less li el" to encounter the first ris the" descri2ed at the outset of their re0iew: clinicians and researchers are not simpl" a0oiding use of the P) construct in "outh. Howe0er! the" ma" encounter the second ris the" descri2ed: under4appreciation of the de0elopmental conte5t in which these s"ndromes occur. That is! although P) constructs show continuit" o0er time! the" are pro2a2ilistic predictorsB not all "ouths who e5hi2it P) s"mptomatolog" 2ecome adult P) cases.[#$]

1e"erences
R Hump up to: a b American Ps"chiatric Association ;7$&%<. Diagnostic and Statistical Manual of Mental Disorders ;Fifth ed.<. Arlington! JA: American Ps"chiatric Pu2lishing. pp. #+#3#+'. 9,./ '=(4$4('$+74***4(. 7. <um! u! = .errios! C A ;&''%<. DAuropean 0iews on personalit" disorders: a conceptual histor"D. Com"rehensi e Psychiatry 75 ;&<: &+3%$. doi:&$.&$&#N$$&$4++$S;'%<'$$%&4S. P89) (+7*%(=. %. R Hump up to: a b 8illon! TheodoreB @oger ). )a0is ;&''#<. Disorders of Personality: DSM!I2 and 0eyond. /ew Qor : Hohn Wile" T ,ons! 9nc. p. 77#. 9,./ $4+=&4$&&(#4S. +. <um! u! = A Cuide to ),84*: Personalit" )isorders 8edscape Ps"chiatr"! .ret ,. ,tet a! 8)! ?hristoph U. ?orrell! 8a" 7&! 7$&% &.

*.

<um! u! = ,aU! H. ;7$$&<. DPersonalit" )isorders!D pp. &&%$&4&&%$( in ,melser! /. H. T .altes! P. .. ;eds.< International encyclo"edia of the social 3 beha ioral sciences! Amsterdam: Alse0ier doi:&$.&$&#N.$4$(4$+%$=#4=N$%=#%4% 9,./ '=(4$4$(4$+%$=#4( #. <um! u! = Mern2erg! 1. ;&'(+<. ,e0ere Personalit" )isorders. /ew Ha0en! ?T: Qale Uni0ersit" Press! 9,./ $%$$$*%+'*. =. R Hump up to: a b ,chacter! ). G.B Cil2ert! ). T. and Wegner! ). 8. ;7$&&< Psychology! 7nd Adition. p. %%$! 9,./ &+7'7%=&'(. (. <um! u! = 8cWilliams! /anc" ;7' Hul" 7$&&<. Psychoanalytic Diagnosis/ Second .dition: 4nderstanding Personality Structure in the Clinical Process. Cuilford Press. pp. &'#3. 9,./ '=(4&4#$'&(4+'+4$. @etrie0ed 7 )ecem2er 7$&&. '. <um! u! = Hic e"! Philip. ;7$&$4$*4$*< Personalit" )isorders Are /ot 9llnesses. .eha0iorismandmentalhealth.com. @etrie0ed on 7$&%4$+4&#. &$. <um! u! = Ancowit-! /anc". ;7$&$4$(4$#< A Ciant ,tep .ac ward for 9ntro0erts ;/anc" Ancowit-<. Ps"cholog"toda".com. @etrie0ed on 7$&%4$+4&#. &&. <um! u! = .radshaw! Hames. ;7$$#4&&4$&< Classer headlines ps"chotherap" conference. The /ational Ps"chologist. @etrie0ed on 7$&%4$+4&#. &7. <um! u! = Widiger TA ;1cto2er 7$$%<. DPersonalit" disorder diagnosisD. 5orld Psychiatry / ;%<: &%&3*. P8? &*7*&$#. P89) &#'+#'&(. &%. <um! u! = WH1 ;7$&$< 9?)4&$: )isorders of adult personalit" and 2eha0iour &+. <um! u! = American Ps"chiatric Association ;7$&%<. Diagnostic and Statistical Manual of Mental Disorders ;Fifth ed.<. Arlington! JA: American Ps"chiatric Pu2lishing. pp. +*&3+*'. 9,./ '=(4$4('$+74***4(. &*. <um! u! = WH1 ;7$&$< 9?)4&$: ,pecific Personalit" )isorders &#. <um! u! = D9nternational ,tatistical ?lassification of )iseases and @elated Health Pro2lems &$th @e0ision ;9?)4&$< Jersion for 7$&$ ;1nline Jersion<D. Apps.who.int. @etrie0ed on 7$&%4$+4&#. &=. <um! u! = Gangmaac ! ?. ;7$$$<. D6Haltlose6 t"pe personalit" disorder ;9?)4&$ F#$.(<D. The Psychiatrist /5 ;#<: 7%*37%#. doi:&$.&&'7Np2.7+.#.7%*42. &(. <um! u! = American Ps"chiatric Association ;7$&%<. Diagnostic and Statistical Manual of Mental Disorders ;Fifth ed.<. Arlington! JA: American Ps"chiatric Pu2lishing. pp. #+*3#(+! =#&3=(&. 9,./ '=(4$4('$+74***4(. &'. <um! u! = Fuller! AM! .lashfield! @M! 8iller! 8! Hester! T ;&''7<. D,adistic and self4defeating personalit" disorder criteria in a rural clinic sampleD. 6ournal of Clinical Psychology 5> ;#<: (7=3%&. doi:&$.&$$7N&$'=4 +#=';&''7&&<+(:#V(7=::A9)4H?GP77=$+($#&(W%.$.?1B74&. P89) &+*7==7. 7$. <um! u! = 8illon! Theodore ;7$$+< Personality Disorders in Modern 7ife! Hohn Wile" T ,ons! 9,./ $+=&##(*$(. 7&. <um! u! = Widiger! Thomas ;7$&7<. The *xford Handboo8 of Personality Disorders) 15ford Uni0ersit" Press. 9,./ '=(4$&''=%*$&%. 77. <um! u! = 8illon! Theodore ;7$$+<. Personality Disorders in Modern 7ife! p. +. Hohn Wile" T ,ons! 9nc.! Ho2o en! /ew Herse". 9,./ $4+=&47%=%+4*. 7%. R Hump up to: a b c 8urra"! @o2in 8. et al ;7$$(<. Psychiatry) 9ourth .dition. ?am2ridge Uni0ersit" Press. 9,./ '=(4$4*7&4#$+$(4#.

7+.

<um! u! = T"rer! P. ;7$$$< Personality Disorders: Diagnosis/ Management and Course) Second .dition. Gondon: Arnold Pu2lishers Gtd.! pp. &7#3%7. 9,./ '=($=7%#$=%##. 7*. <um! u! = /ur! U.! T"rer! P.! 8erson! ,.! T Hohnson! T. ;7$$+<. D@elationship 2etween clinical s"mptoms! personalit" distur2ance! and social function: a statistical en:uir"D. Irish 6ournal of Psychological Medicine /1: &'3 77. 7#. <um! u! = T"rer! P.! T Ale5ander! H. ;&'='<. D?lassification of Personalit" )isorderD. 0ritish 6ournal of Psychiatry 17? ;7<: 7%(37+7. doi:&$.&&'7N2>p.&%*.7.&#%. P89) +(#(+'. 7=. <um! u! = T"rer! P.! 8itchard! ,.! 8ethuen! ?.! T @anger! 8. ;7$$%<. DTreatment4re>ecting and treatment4see ing personalit" disorders: T"pe @ and T"pe ,D. 6ournal of Personality Disorders 1@ ;%<: 7#%37#(. doi:&$.&*7&Npedi.&=.%.7#%.77&*7. P89) &7(%'&$+. 7(. <um! u! = Attner! ,usan G. 7$&&. DPersonalit" )isorders and Wor .D 9n Wor Accommodation and @etention in 8ental Health! ?hapter ' 7'. <um! u! = Attner! ,usan G.B 8aclean! Hohanna ?atherine! French! 8ichael T. ;& Hanuar" 7$&&<. D)oes Ha0ing a )"sfunctional Personalit" Hurt Qour ?areerX A5is 99 Personalit" )isorders and Ga2or 8ar et 1utcomesD. Industrial Relations: # 6ournal of .conomy and Society ?0 ;&<: &+'3&=%. doi:&$.&&&&N>.&+#(47%7S.7$&$.$$#7'.5. %$. <um! u! = .oard! .elinda HaneB Frit-on! Matarina ;7$$*<. D)isordered personalities at wor D. Psychology Crime and 7a: 11: &=. doi:&$.&$($N&$#(%&#$%&$$$&#%+%$+. %&. <um! u! = de Jries! 8anfred F. @. Mets ;7$$%<. DThe )ar ,ide of GeadershipD. 0usiness Strategy Re ie: 15 ;%<: 7#. %7. R Hump up to: a b c d e f g Tasman! Allan et al ;7$$(<. Psychiatry) Third .dition. Hohn Wile" T ,ons! Gtd. 9,./ '=(4$+=$4$#*=&4#. %%. <um! u! = )iagnostic and ,tatistical 8anual of 8ental )isorders ;),84 9J<! +th edition! Te5t @e0ision. Washington! )?: American Ps"chiatric AssociationB 7$$$. %+. <um! u! = WH1 ;7$&$< 9?)4&$: ?linical descriptions and diagnostic guidelines: )isorders of adult personalit" and 2eha0ior %*. <um! u! = Widiger! T. A.B ,hedler! H ;&''%<. DThe ),849994@ categorical personalit" disorder diagnoses: A criti:ue and an alternati0eD. Psychological In;uiry 5 ;7<: =*3'$. doi:&$.&7$=Ns&*%7='#*pli$+$7Y&. P89) ''('*#%. %#. <um! u! = ?osta! P.T.! T Widiger! T.A. ;7$$&<. Personalit" disorders and the fi0e4factor model of personalit" ;7nd ed.<. Washington! )?: American Ps"chological Association. %=. <um! u! = ,amuel! )... T Widiger! T.A. ;7$$(<. DA meta4anal"tic re0iew of the relationships 2etween the fi0e4factor model and ),8 personalit" disorders: A facet le0el anal"sisD. Clinical Psychology Re ie: /> ;(<: &%7#3&%+7. doi:&$.&$&#N>.cpr.7$$(.$=.$$7. P8? 7#&+++*. P89) &(=$(7=+. %(. <um! u! = Widiger! Thomas A.! ?osta! Paul T. ;7$&7<. Personality Disorders and the 9i e!9actor Model of Personality/ Third .dition. 9,./ '=(4&4 +%%(4&&##4&.

%'.

<um! u! = 8iller! P. 8. T Gisa ! ). ;&'''<. DAssociations .etween ?hildhood A2use and Personalit" )isorder ,"mptoms in ?ollege 8alesD. 6ournal of Inter"ersonal 2iolence 15 ;#<: #+7. doi:&$.&&==N$((#7#$''$&+$$#$$*. @etrie0ed 8a" 7*! 7$&$. +$. R Hump up to: a b ?ohen! PatriciaB .rown! Hocel"n and ,mailes! Ali-a2eth ;7$$&<. D?hild A2use and /eglect and the )e0elopment of 8ental )isorders in the Ceneral PopulationD. De elo"ment and Psycho"athology 17 ;+<: '(&3'''. P89) &&==&'&=. +&. <um! u! = DWhat ?auses Ps"chological )isordersXD. #merican Psychological #ssociation. 7$&$. Archi0ed from the original on 7$&$4&&47$. +7. <um! u! = Gen-enweger! 8ar F. ;7$$(<. DApidemiolog" of Personalit" )isordersD. Psychiatric Clinics of &orth #merica 71 ;%<: %'*3+$%. doi:&$.&$&#N>.psc.7$$(.$%.$$%. P89) &(#%(#+7. +%. <um! u! = Huang! Q.B Moto0! @.! de Cirolamo! C.! Preti! A.! Angerme"er! 8.! .en>et! ?.! )em"ttenaere! M.! de Craaf! @.! Cure>e! 1.! Maram! A. /.! Gee! ,.! Gepine! H. P.! 8atschinger! H.! Posada4Jilla! H.! ,uliman! ,.! Jilagut! C.! Messler! @. ?. ;%$ Hune 7$$'<. D),849J personalit" disorders in the WH1 World 8ental Health ,ur0e"sD. The 0ritish 6ournal of Psychiatry 19? ;&<: +#3*%. doi:&$.&&'7N2>p.2p.&$(.$*(**7. P8? 7=$*(=%. P89) &'*#=('#. ++. <um! u! = Gen-enweger! 8ar F.B Gane! 8ichael ?.! Goranger! Armand W.! Messler! @onald ?. ;7$$#<. D),849J Personalit" )isorders in the /ational ?omor2idit" ,ur0e" @eplicationD. 0iological Psychiatry A/ ;#<: **%3*#+. doi:&$.&$&#N>.2iops"ch.7$$#.$'.$&'. P8? 7$++*$$. P89) &=7&='7%. +*. <um! u! = Qang! 8.B ?oid! H.! T"rer! P. ;%& August 7$&$<. DPersonalit" patholog" recorded 2" se0erit": national sur0e"D. The 0ritish 6ournal of Psychiatry 19@ ;%<: &'%3&''. doi:&$.&&'7N2>p.2p.&&$.$=('*#. P89) 7$($='#%. +#. <um! u! = 8agna0ita! Heffre" H. ;7$$+< Hand2oo of personalit" disorders: theor" and practice! Hohn Wile" and ,ons! 9,./ '=(4$4+=&4+(7%+4*. +=. <um! u! = )a0ison! ,. A. ;7$$7<. DPrinciples of managing patients with personalit" disorderD. #d ances in Psychiatric Treatment > ;&<: &3'. doi:&$.&&'7Napt.(.&.&. +(. <um! u! = 8cJe"! ). T 8urph"! /. ;eds.< ;7$&$< Treating Personalit" )isorder: ?reating @o2ust ,er0ices for People with ?omple5 8ental Health /eeds! 9,./ $47$%4(+&&*4( +'. <um! u! = ,ur"anara"an! Ceetha ;7$$7< The Histor" of the ?oncept of Personalit" )isorder and its ?lassification! The 8edicine Pu2lishing ?ompan" Gtd. *$. <um! u! = Augstein! HF ;&''#<. DH ? Prichard6s concept of moral insanit"Za medical theor" of the corruption of human natureD. Medical history 50 ;%<: %&&3+%. doi:&$.&$&=N,$$7*=7=%$$$#&%7'. P8? &$%=&7(. P89) (=*==&=. *&. <um! u! = Cutmann! P ;7$$(<. DHulius Gudwig August Moch ;&(+&3 &'$(<: ?hristian! philosopher and ps"chiatristD. History of Psychiatry 19 ;=+ Pt 7<: 7$73&+. doi:&$.&&==N$'*=&*+S$=$($##&. P89) &'&7=(%'.

*7.

<um! u! = [\]]^_`a] b. c. ;7$$$<. <=>?>@A BC>DEBAF>G/ >D CFAF>@A/ H>?AI>@A/ C>CFJIAF>@A. def\ghijkglm naohpmqmfk`mr pmk^f\qkglh]]mr shfata]k`mr \`\fhsaa. 9,./ *4(#$'%4$&*4&. *%. <um! u! = uav`m w. x. ;7$&$< bkaymz\gaa a \`th]g^\taa y\q\`ghq\ ^ zmfqmkg`ml. {hvj! 9,./ '=(4*4'7#(4$(7(4#. *+. <um! u! = Arrigo! .. A. ;& Hune 7$$&<. DThe ?onfusion 10er Ps"chopath" ;9<: Historical ?onsiderationsD. International 6ournal of *ffender Thera"y and Com"arati e Criminology 5? ;%<: %7*3%++. doi:&$.&&==N$%$##7+S$&+*%$$*. **. <um! u! = Am" Heim T )rew Westen ;7$$+< Theories of personalit" and personalit" disorders *#. <um! u! = Gane! ?. ;& Fe2ruar" 7$$'<. DThe ,urprising Histor" of Passi0e4Aggressi0e Personalit" )isorderD. Theory 3 Psychology 19 ;&<: **3=$. doi:&$.&&==N$'*'%*+%$(&$&+&'. *=. <um! u! = Hoermann! ,imoneB |upanic ! ?orinne A. and )om2ec ! 8ar ;Hanuar" 7$&&< The Histor" of the Ps"chiatric )iagnostic ,"stem ?ontinued. mentalhelp.net. *(. <um! u! = 1ldham! Hohn 8. ;7$$*<. DPersonalit" )isordersD. 9*C4S 7: %=73%(7. *'. <um! u! = Mendell! @A ;7$$7<. DThe distinction 2etween personalit" disorder and mental illnessD. The 0ritish 6ournal of Psychiatry 1>0 ;7<: &&$. doi:&$.&&'7N2>p.&($.7.&&$. #$. R Hump up to: a b Mrueger! @.B ?arlson! ,cott @. ;7$$&<. DPersonalit" disorders in children and adolescentsD. Current Psychiatry Re"orts 7 ;&<: +#3*&. doi:&$.&$$=Ns&&'7$4$$&4$$=74+. P89) &&&===*'.

9urt$er readin&

8arshall! W. T ,erin! @. ;&''=< Personalit" )isorders. 9n ,m.8. Turner T @. Hersen ;Ads.< Adult Ps"chopatholog" and )iagnosis. /ew Qor : Wile". *$(3*+& 8urph"! /. T 8cJe"! ). ;7$&$< Treating ,e0ere Personalit" )isorder: ?reating @o2ust ,er0ices for ?lients with ?omple5 8ental Health /eeds. Gondon: @outledge 8illon! Theodore ;and @oger ). )a0is! contri2utor< 3 Disorders of Personality: DSM I2 and 0eyond 3 7nd ed. 3 /ew Qor ! Hohn Wile" and ,ons! &''* 9,./ $4 +=&4$&&(#4S Qudofs "! ,tuart ?. ;7$$*<. 9atal 9la:s: &a igating Destructi e Relationshi"s 5ith Peo"le 5ith Disorders of Personality and Character ;&st ed. ed.<. Washington: ).?. 9,./ &4*(*#747&+4&.

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