Personality Disorders

I. Background
 A. Definition
• Personality disorder = enduring patterns of
perceiving, relating to, and thinking about
the environment and oneself that are
exhibited in a wide range of important
social and personal contexts that cause
significant functional impairment or
subjective distress
 B. DSM-IV General criteria for
personality disorder
A. Enduring pattern of inner experience and
behavior that deviates markedly from
cultural expectations. Manifested in two
or more of the following areas:
1) Cognition
2) Affectivity
3) Interpersonal functioning
4) Impulse control
 B. General criteria (cont.)
B. Pattern is inflexible and pervasive across
a broad range of personal and social
situations
C. Pattern leads to clinically significant
impairment or distress
D. Pattern is stable and of long duration and
onset can be traced to adolescence or
early childhood
 B. General criteria (cont.)
E. Pattern not better accounted for as a
manifestation of another disorder
F. Not due to substance or GMC (e.g., head
trauma)
 B. General criteria (cont.)
• Person must meet the general criteria
before a specific PD is diagnosed
• Coded on Axis II
 C. Other Features
• Lack insight into PD (seek treatment for
Axis I problem or relationship problems)
• PD symptoms are ego syntonic = feels like
a normal part of oneself
• Most have interpersonal problems
• Can be difficult to diagnose in initial
session
• Intractable, difficult to treat; can affect
treatment of other disorders
 D. Cluster Organization in DSM-IV

• PDs classified within clusters defined by

common features
1) Cluster A
– main feature is odd or eccentric in nature
– 3 PDs in this cluster:
• Paranoid PD – distrust and suspiciousness
• Schizoid PD – detachment from social
relationships (does not want them)
• Schizotypal PD – social deficits and perceptual
distortions or eccentricities
 D. Clusters (cont.)
2) Cluster B
– Main feature is dramatic, emotional, or erratic
– 4 PDs in this cluster:
• Antisocial PD – disregard for social norms and
rights of others
• Borderline PD – instability in relationships, self-
image, and mood; impulsivity
• Histrionic PD – excessive emotionality and
attention seeking
• Narcissistic PD – grandiosity, need for admiration,
self-centered
 D. Clusters (cont.)
3) Cluster C
– Main feature involves anxiety or fearfulness
– 3 PDs in this cluster:
• Dependent PD – submissive, need to be taken
care of
• Avoidant PD – social inhibition and inadequacy
• Obssessive-compulsive PD – orderliness,
perfectionism, need to control things
 E. Categorical System
• DSM-IV is a categorical classification
system
• Personality traits viewed as dimensional
constructs
• Push toward dimensional approach to
classifying PDs
• PD research lags behind Axis I research
 PDs are least reliable diagnoses 
problems for their systematic study
 Personality Disorders

II. Antisocial Personality Disorder

(ASPD)
 A. Background
• ASPD diagnosis stems from Cleckley’s
description of psychopathy:
1. Superficial charm
2. Absence of delusions and irrational thinking
3. Absence of “nervousness”
4. Unreliability
5. Untruthfulness and insincerity
6. Lack of remorse or shame
7. Inadequately motivated antisocial behavior
8. Poor judgment and failure to learn by experience
 Psychopathy (cont.)
9. Pathological egocentricity and incapacity for
love
10. General poverty in major affective reactions
11. Specific loss of insight
12. Unresponsiveness in general interpersonal
relations
13. Fantastic and uninviting behavior with drink
14. Suicide rarely carried out
15. Sex life impersonal, trivial, and poorly
integrated
16. Failure to follow any life plan
 A. Background (cont.)
• ASPD definition based on Cleckley’s view
appeared in DSM-II
• Psychopathy is now a separate construct with an
antisocial (ASPD-like) component
• Lee Robins’ work in mid-1960’s formed basis of
current ASPD criteria
– Found that most antisocial adults were antisocial in
childhood
– Most antisocial children are not antisocial as adults
 A. Background (cont.)
• ASPD vs. criminality
– “criminal” is a legal term denoting conviction
for breaking a law:
• Not all people with ASPD are criminals (or in jails)
• Not all people in jail or considered criminal have
ASPD
• Not all people with ASPD are psychopaths
 B. Criteria and features of
ASPD
• Case of George
1. DSM-IV criteria (p. 433)
A. Pattern of disregard for and violation
of the rights of others occurring since
age 15 as indicated by 3 or more:
(1) failure to conform to social norms
(2) repeated lying/conning
(3) impulsivity or failure to plan ahead
 1. Criteria (cont.)
(4) irritability and aggressiveness
(5) reckless disregard for safety
(6) consistent irresponsibility
(7) lack of remorse
B. Individual is at least 18 years old
C. Evidence of Conduct Disorder before age 15
D. Occurrence of antisocial behavior not
exclusively during course of schizophrenia
or a manic episode
 B. Criteria and features of
ASPD (cont.)
2. Course and statistics
- prevalence is 3% in men; lower in
women
- sex difference is probably real, but
may be inflated by clinician bias
- onset in childhood (by definition)
- CD portion may start as early as age
3-5
 2. Statistics and course (cont.)
• Course of all PDs is chronic, but overt
antisocial behavior seems to age out after
40
- could still show ASPD features (e.g., lying;
poor work habits)
 B. Criteria and features of
ASPD (cont.)
3. Causal influences
- twin, family, and adoption data show
strong genetic influence
- CD also appears to have shared
environment influence
- poor socialization due to low fearfulness
may account for some cases
 C. Treatment
• Most don’t seek treatment for ASPD
(usually substance abuse)
• No treatment shown to be efficacious
• More likely to end up in jail than in
treatment
• Focus is on prevention – target antisocial
children
 Summary
• PDs are enduring, maladaptive patterns of
relating to the world and to others
• General criteria for PD, then specific PD
• DSM-IV arranges PDs in 3 clusters
according to shared characteristics
• Lack of insight – usually do not seek
treatment for the PD; PD can impact
treatment of other disorders
• ASPD