Personality Disorders

• The DSM-5 includes 10 personality disorders that fall into clusters A, B, or C.
• Personality disorders are long-standing patterns of behavior that begin early in development and run a chronic course.
• The causes of personality disorders start in childhood, but are difficult to specify.
• Treatment for personality disorders is difficult and prognosis is poor.
• Disagreement exists over how to categorize personality disorders, including categorical versus dimensional, or some combination of both.
• Personality disorders are enduring, inflexible predispositions that are maladaptive, causing distress and/or impairment, have high comorbidity, and poorer prognosis.
• Personality disorders are ego-syntonic, meaning they often feel consistent with one's identity, and patients don't feel that treatment is necessary.
• Personality disorders are categorized into 10 specific disorders organized into 3 clusters: Cluster A (Paranoid, Schizoid, and Schizotypal), Cluster B (Antisocial, Borderline, Histrionic, and Narcissistic), and Cluster C (Avoidant, Dependent, Obsessive-Compulsive).
• Developmental influences suggest that a high-conflict childhood increases the likelihood of Antisocial Personality Disorder (APD) in at-risk children.
• Treatment for Conduct Disorder is often incarceration as it is the only viable alternative.
• Development of Antisocial Personality is influenced by genetic, developmental, and neurobiological factors.
• Conduct Disorder features include bullying, physical fights, using weapons, physical cruelty to people and animals, destruction of property, theft, violation of rules, and more.
• Gray’s model suggests that inhibition signals are outweighed by reward signals in individuals with Conduct Disorder.
• The Cortical immaturity hypothesis suggests that the cerebral cortex is not fully developed in individuals with Conduct Disorder.
• The Fearlessness hypothesis suggests that individuals with Conduct Disorder fail to respond to danger cues.
• Genetic influences suggest that individuals are more likely to develop antisocial behavior if their parents have a history of antisocial behavior or criminality.
• Conduct Disorder is most often diagnosed in boys and these individuals often become juvenile offenders and tend to become involved with drugs.
• Conduct Disorder falls within the Disruptive, Impulse-Control and Conduct Disorders category in DSM-5 and is a separate diagnosis for children who engage in behaviors that violate society’s norms.
• Arousal theory suggests that people with Antisocial Personality Disorder (APD) are chronically under-aroused and seek stimulation from the types of activities that would be too fearful or aversive for most.
• Psychological and social influences suggest that psychopaths are less likely to give up when the goal becomes unattainable, which may explain why they persist with behavior.
• Prevailing neurobiological theories include the Underarousal hypothesis, which suggests that cortical arousal is too low in individuals with Conduct Disorder.
• Neurobiological influences suggest that antisocial traits are not well explained by neuropsychological research.
• Cluster A of personality disorders includes Paranoid, Schizoid, and Schizotypal Personality Disorders.
• The dimensional model of personality disorders rates individuals on the degree to which they exhibit various personality traits.
• Schizoid Personality Disorder is characterized by a pervasive pattern of detachment from social relationships, very limited range of emotions in interpersonal situations, and childhood shyness, abuse, and neglect contributing to the disorder.
• Personality disorders may transition into a different personality disorder.
• The causes of Paranoid Personality Disorder are unclear, with biological and psychological contributions being unclear, and early learning that people and the world are dangerous contributing to the disorder.
• Treatment options for Paranoid Personality Disorder are limited, with few individuals seeking professional help on their own, and treatment focusing on the development of trust and cognitive therapy to counter negativistic thinking.
• Paranoid Personality Disorder is characterized by pervasive and unjustified mistrust and suspicion.
• Schizotypal Personality Disorder is characterized by behavior and dress that is odd and unusual, socially isolated and highly suspicious, magical thinking, ideas of reference, and illusions, and many meeting criteria for major depression.
• Families with inconsistent parental discipline and support, and histories of crime are often associated with Antisocial Personality Disorder.
• Personality disorders have traditionally been assigned as all-or-nothing categories, but DSM-5 introduced a dimensional model of personality disorders.
• The causes of Schizotypal Personality Disorder are unclear, with a phenotype of a schizophrenia genotype being a possibility, and more generalized brain deficits contributing to the disorder.
• Treatment options for Schizotypal Personality Disorder are limited, with 30% to 50% meeting criteria for major depressive disorder, and the main focus of treatment being on developing social skills and addressing comorbid depression.
• Personality disorders affect about 1% of the general population and tend to run a chronic course if untreated.
• Antisocial Personality Disorder is often associated with early behavior problems and conduct disorder, with a “callous-unemotional” type of conduct disorder more likely to evolve into antisocial PD.
• Antisocial Personality Disorder is characterized by failure to comply with social norms, violation of the rights of others, irresponsible, impulsive, and deceitful behavior, lack of a conscience, empathy, and remorse, and “sociopathy” or “psychopathy” typically referring to this disorder or very similar traits.
• Treatment options for Cluster B: Borderline Personality Disorder include few good outcome studies, antidepressant medications provide some short-term relief, and dialectical behavior therapy is the most promising treatment.
• Cluster B: Histrionic Personality Disorder is characterized by overly dramatic, sensational, and sexually provocative behavior, often impulsive and need to be the center of attention, thinking and emotions are perceived as shallow, and is more commonly diagnosed in females.
• Cluster B: Narcissistic Personality Disorder is characterized by an exaggerated and unreasonable sense of self-importance, preoccupation with receiving attention, lack sensitivity and compassion for other people, and is highly sensitive to criticism, envious, and arrogant.