PERSONALITY DISORDERS:
An enduring (long-standing) pattern in
two or more of the following areas:
1) Cognition (thoughts) - ways of
interpreting and perceiving events
2) Affectivity (emotions) - range, intensity,
lability, & appropriateness
3) Interpersonal functioning (behavior)
4) Impulse control (behavior)
Personality Traits vs. Disorders
Deviation from social & cultural norms – consider
contribution of situational & cultural context
Inflexibility – rigid patterns of behaviors &
responses
Pervasive – present in a variety of contexts
Clinically significant distress – for self or others
Impairment in functioning – highly maladaptive
Stable & long-lasting - onset by early adulthood,
long-term pattern vs. occasional
CLUSTER A PERSONALITY
DISORDERS
Characterized by:
Odd behavior,
reactions, emotions
Eccentric thoughts &
behaviors – e.g.
illusory or magical
thinking, inappropriate
social interactions
Isolative behavior –
social withdrawal
Suspiciousness –
paranoia
Includes:
Paranoid Personality
Disorder
Schizoid Personality
Disorder
Schizotypal
Personality Disorder
May represent mild
variations of
Schizophrenia, but
reality testing is intact
PARANOID PERSONALITY DISORDER
A. A pervasive pattern of distrusting, being
suspicious of, and attributing
malevolent intention to others
B. Pattern of behavior is not due to
Schizophrenia, a Mood Disorder with
Psychotic Features, another Psychotic
Disorder, the effects of a substance, or
a general medical condition
PARANOID PERSONALITY DISORDER
Indicated by 4 or more of the following 7:
1. Assuming others will exploit, harm, or deceive them
2. Continually doubting the loyalty or trustworthiness of
friends or associates
3. Reluctance to confide in others because fear info will
be used against them
4. Reading hidden demeaning or threatening meanings
into benign remarks or events
5. Persistently bearing grudges
6. Often believing they have been attacked or slighted
and are quick to react angrily or with counterattack
7. Continually suspecting spouse or sexual partner of
being unfaithful
PARANOID PERSONALITY DISORDER
What it looks like:
Chronically suspicious of others
Distrusting of others
Assuming the worst intention
Not open
Continually doubting loyalty of others
Unforgiving
Hold grudges
PARANOID PERSONALITY DISORDER
Facts & Figures:
 Prevalence – 0.5-2.5% in general population
 Gender – more common in males
 Onset – often first apparent in childhood and
adolescence
 Cultural Factors – need for caution in diagnosing
members of minority, ethnic, immigrant, refugee groups
Treatment Considerations:
 Importance of developing trust & a solid therapeutic
alliance
 Cognitive therapy to counter mistaken assumptions and
negative beliefs about others
 No evidence that therapy is very successful
SCHIZOID PERSONALITY DISORDER
A.Characterized by a pervasive pattern of:
-detachment from social relationships
-restricted range of emotional expression
in interpersonal settings
B. Pattern of behavior is not due to
schizophrenia, a Mood Disorder with
Psychotic Features, another Psychotic
Disorder, or a Pervasive Developmental
Disorder.
SCHIZOID PERSONALITY DISORDER
Indicated by 4 or more of the following 7:
1. Neither desiring nor enjoying close relationships,
including being part of a family
2. Almost always choosing solitary activities
3. Having little, if any, interest in sexual
experiences/relationships
4. Taking pleasure in few, if any, activities
5. Lacking close friends or confidants
6. Indifference to praise or criticism
7. Emotional coldness, detachment, or flatness
SCHIZOID PERSONALITY DISORDER
What it looks like:
Emotionally cold & distant
Great difficulty forming relationships
Social isolation – loner
Restricted affect – lack of emotional
expressiveness
Lack of interest in people,
relationships, & most activities
SCHIZOID PERSONALITY DISORDER
Facts & Figures:
 Prevalence – uncommon; <1%
 Gender – slightly more common and
impairing in males
 Onset – often first apparent in childhood and
adolescence
 Cultural – need for caution in diagnosing
people from different cultural backgrounds,
environments, or immigrants
SCHIZOID PERSONALITY DISORDER
Contributing factors:
 Childhood shyness
 Genetics
 Parenting: neglectful & cold parenting; intrusive
mother; absent father
 Lower density of dopamine receptors
 Traumatic experiences
Treatment:
 Modeling healthy relationship skills & emotional
expression
 Empathy training – teaching the person how to identify,
express, & respond to emotion
 Social skills training, including role playing
 Building a support network
SCHIZOTYPAL PERSONALITY DISORDER
A. A pervasive pattern of social and
interpersonal deficits marked by:
-acute discomfort with close relationships
-a reduced capacity for close relationships
-cognitive or perceptual distortions
-eccentric behaviors
B. Pattern is not due to schizophrenia, a
Mood Disorder with Psychotic Features,
another Psychotic Disorder, or a
Pervasive Developmental Disorder
SCHIZOTYPAL PERSONALITY DISORDER
Indicated by 5 or more of the following 9:
1. Ideas of reference
2. Odd beliefs or magical thinking
3. Unusual perceptual experiences
4. Odd thinking & speech
5. Suspiciousness or paranoid ideation
6. Inappropriate or constricted affect
7. Odd, eccentric or peculiar behavior or
appearance
8. Lack of close friends or confidants
9. Excessive social anxiety that does not diminish
with familiarity and tends to be associated with
paranoid fears
SCHIZOTYPAL PERSONALITY DISORDER
What it looks like:
Social impairment & isolation
Social discomfort & anxiety
Variety of odd beliefs & cognitions
Unusual perceptions & perceptual
experiences
Odd speech & presentation
Eccentric & peculiar behavior
Inappropriate or blunted affect
SCHIZOTYPAL PERSONALITY DISORDER
Facts & Figures:
 Prevalence – 3-5% of general population
 Gender – slightly more common in males
 Onset – often first apparent in childhood and
adolescence
 Course – chronic; some go on to develop
Schizophrenia
 Cultural – need to consider cultural context
when evaluating symptoms
SCHIZOTYPAL PERSONALITY DISORDER
Contributing Factors:
 Biological and genetic factors have been
emphasized – Schizotypal PD as a milder
variant of schizophrenia
Treatment Considerations:
 Psychotropic medication –
antidepressants, antipsychotics
 Cognitive-behavioral therapy
 Social skills training
Cluster A Scenario
An individual receives an invitation to
attend the birthday party of a supervisor
at work. This supervisor is not well
known to the individual, in fact, they
have only spoken on a couple of
occasions.
Paranoid Personality Disorder
Cognitions include:
This person reached their
position through
dishonesty or fraud – they
are not to be trusted.
My colleagues are out to
get me – it will not be safe
to be in an unfamiliar
setting with them.
My job security is being
threatened.
Behaviors include:
Approaching the supervisor
to research these
suspicions in a hostile and
accusatory manner
Finding an excuse to not
attend the birthday party
Increased irritability in the
workplace
Hypervigilance for
“suspicious” behavior from
colleagues
Schizoid Personality Disorder
Cognitions Include:
Not wanting to go to
the party
I would rather be
alone.
This party won’t be
enjoyable.
Behaviors include:
Not attending the
party
Telling the
supervisor she won’t
attend in a cold,
detached way
Schizotypal Personality Disorder
Cognitions Include:
I was meant to go to
this birthday party
because something
supernatural will occur
I wonder why the
supervisor chose me?
Will I be prepared to
handle what is to
come?
Behaviors Include:
Wearing an unusual
ceremonial costume to
the party
Remaining detached
from others at the party
Speaking to others in
an elaborate way
CLUSTER B
PERSONALITY DISORDERS
Characteristics:
Includes:
Dramatic
Antisocial Personality
Disorder
Emotional
Borderline Personality
Erratic behavior
Disorder
Impulsiveness
Histrionic Personality
Reduced capacity
Disorder
for empathy
Narcissistic Personality
Unstable emotions
Disorder
& relationships
ANTISOCIAL PERSONALITY DISORDER
A.
B.
C.
D.
Pervasive pattern of disregard for and
violation of the basic rights of others
Beginning in childhood or early
adolescence (must have evidence of
Conduct Disorder prior to 15 years)
Continuing into adulthood (must be at
least 18 years)
Occurrence of antisocial behavior is not
exclusively during a course or
Schizophrenia or Mania
ANTISOCIAL PERSONALITY DISORDER
Indicated by 3 or more of the following 7:
1. Failure to conform to social norms and laws, e.g.
repeatedly performing acts that are grounds for arrest
2. Deceitfulness & manipulation, e.g. repeated lying, using
aliases, or conning others for personal profit or pleasure
3. Impulsivity or failure to plan ahead
4. Irritability and aggressiveness, e.g. repeated physical
fights or assaults
5. Reckless disregard for safety of self or others
6. Consistently & extremely irresponsible, e.g. repeated
failure to sustain consistent work or honor financial
obligations
7. Lack of remorse, e.g. being indifferent to or rationalizing
having hurt, mistreated, or stolen from another
ANTISOCIAL PERSONALITY DISORDER
What you see:
Aggressiveness
Superficial charm
Self-centered
Bore easily, high need for stimulation, sensation-seeking,
thrill-seeking
Lie easily
Conning, manipulative
Relationships of “utility”
Lack of remorse – little or no guilt about the harm they
cause others
Lack of empathy – may seem cold & insensitive
Enjoy testing, provoking, pushing, “playing with” others
Criminal behavior – feel rules don’t apply to them
ANTISOCIAL PERSONALITY DISORDER
Facts & Figures:
 Prevalence: 3% males; <1% females
 Gender: more common in males
 SES: associated with low SES & urban
settings; important to consider the social
and economic context for behaviors
 Course: chronic, but symptoms tend to
lessen or remit by 4th decade of life
Antisocial Personality Disorder
Contributing Factors:
Strong biological roots:






Genetic influence
Low levels of 5HT
Low arousability
Excessive theta waves
Poor impulse control
Fearlessness
Environmental factors:


Parenting: harsh, inconsistent, neglectful, uninvolved, abusive
Chronic stress, trauma
Treatment:
Psychotherapy is not very effective; often court-mandated
Lithium & SSRI’s may help control impulsive, aggressive
behaviors
BORDERLINE PERSONALITY DISORDER
A pervasive pattern of marked impulsivity and
unstable relationships, self image, and
emotions
Indicated by 5 or more of the following 9:
1. Frantic efforts to avoid real or imagined
abandonment
2. A pattern of unstable and intense interpersonal
relationships – shifts from extreme idealization
to devaluation
3. Identity disturbance – sudden & dramatic shifts
in self image, e.g. goals, values, career plans &
aspirations, sexual identity, types of friends
BORDERLINE PERSONALITY DISORDER
4. Impulsive behavior that is potentially self-damaging,
e.g. spending, sex, substance abuse, reckless
driving, binge eating
5. Recurrent suicidal behavior, gestures, or threats, or
self-mutilating behavior
6. Affective instability due to highly reactive mood, e.g.
episodes of dysphoria, anxiety, panic, irritability,
anger, despair
7. Chronic feelings of emptiness
8. Inappropriate, intense anger or difficulty controlling
anger; e.g. frequent temper, biting sarcasm, enduring
bitterness, verbal outbursts, recurrent fights
9. Transient, stress-related paranoia or dissociative
symptoms, such as depersonalization
BORDERLINE PERSONALITY DISORDER
What it looks like:
Unstable mood & emotions – lack control
over emotions
Unstable self-concept
Unstable interpersonal relationships
Poor impulse control
Self-destructive
Good at splitting
Vacillating between extremely positive &
negative evaluations of self & others
BORDERLINE PERSONALITY DISORDER
Facts & Figures:
 Prevalence: 1-3% of general population
 Gender: 75% female
 Completed suicide rate: 6-10%
 Course:



greater instability, impairment, and suicide risk
in adolescence & young adulthood
symptoms gradually wane with advancing age
by 30’s & 40’s, most attain greater stability in
relationships and vocational functioning
BORDERLINE PERSONALITY DISORDER
Contributing Factors:
 Biological factors – low levels of serotonin
 Family history of mood disorders
 Environmental factors – invalidating &
neglectful parenting; history of abuse; trauma
Treatment:
 Drug therapies – SSRI’s for dysphoria; mood
stabilizers for mood instability
 Long-term therapy
 Dialectical Behavior Therapy
 Trauma work
HISTRIONIC PERSONALITY DISORDER
A pervasive pattern of excessive emotionality
and attention-seeking behavior
Indicated by 5 or more of the following 8:
1. Feels uncomfortable or unappreciated
when not the center of attention
2. Inappropriately seductive or provocative
behavior
3. Displays rapidly shifting and shallow
emotions
HISTRIONIC PERSONALITY DISORDER
4. Consistently uses physical appearance to
draw attention to self
5. Have strong opinions & impressions, but
can’t back up with facts, details, examples,
evidence
6. Is overly dramatic, theatrical and
emotionally expressive
7. Is suggestible, i.e. easily influenced by
others, fads, or circumstances
8. Considers relationships to be more
intimate than they actually are
HISTRIONIC PERSONALITY DISORDER
What it looks like:
Flamboyant self expression & presentation
Over-blown, overly dramatic emotional rxns
Needy & solicitous of others
Require excessive approval & reassurance
Frequently dependent
Impressionistic & superficial
Overly concerned with appearance
Seductive & charming
HISTRIONIC PERSONALITY DISORDER
Facts & Figures:
 Prevalence: 2-3% in general population
 Gender: diagnosed more frequently in women;
prevalence may be equal for males & females
 Sex role stereotypes influence the behavioral
expression of the disorder
 Aging presents special difficulties
 Course: chronic, but sx may improve with age
Contributing Factors:
 Unmet needs for attention & success
NARCISSISTIC PERSONALITY DISORDER
Pervasive pattern of grandiosity in fantasy or
behavior, need for admiration, and lack of
empathy
Indicated by 5 or more of the following 9:
1. Grandiose sense of self importance, e.g.
overestimating one’s abilities, exaggerating
one’s accomplishments,
underestimating/devaluing others.
2. Fantasies about unlimited success, power,
brilliance, beauty, or love.
3. Belief that one is special, superior, or unique.
NARCISSISTIC PERSONALITY DISORDER
4. Need for excessive admiration and/or constant
attention
5. Sense of entitlement, i.e. expecting especially
favorable treatment or automatic compliance from
others
6. Conscious or unwitting exploitation of others
7. Lack of empathy for others; e.g. insensitivity,
emotional coldness, lack of interest in others
8. Envying others; believing others envy them
9. Arrogant, haughty, patronizing, snobby, or disdainful
behaviors or attitudes
NARCISSISTIC PERSONALITY DISORDER
What it looks like:
Self-enhancing, self-aggrandizing
Self-centered, self-absorbed
Readily dismiss opinions of others
Need to feel special
Love to receive special treatment
Can become rageful & attacking in
response to perceived threat
NARCISSISTIC PERSONALITY DISORDER
Facts & Figures:
 Prevalence: <1% in general
population
 Gender: up to 75% male
 Age: narcissistic traits are particularly
common in adolescents
 Course: the aging process presents
special difficulties; may improve over
time
NARCISSISTIC PERSONALITY DISORDER
Causes:
 Parental factors: failure in modeling empathy; rejecting,
abandoning, or cold; capricious, unreliable; treating the
child as an extension of themselves; overvaluation; lack
of genuine, sincere affection
Treatment:
 Usually seek treatment at insistence of family member or
as a result of a major life crisis
 Coping skills to improve ability to accept criticism &
rejection and to help person develop a more realistic
view of their abilities and talents
 Empathy building
 Addressing depression & other underlying problems that
may exist
Cluster B Scenario
An individual sees someone they
occasionally date out at the movies
with another date.
Antisocial Personality Disorder
Cognitions Include:
Behaviors Include:
Thoughts about
Socially unacceptable
what could be done
or unlawful behavior to
to ensure that they
interrupt the date
are the one selected
(calling in a bomb threat
for the date next
to the movie theatre)
time – it is, after all,
Starting rumors about
a dog eat dog world.
the person who their
romantic interest was
on a date with, or about
the romantic interest
themselves.
Borderline Personality Disorder
Cognitions Include:
She must hate me
now.
I am worthless.
I will never have a
relationship.
My life is over.
I was in love with
her.
Behaviors Include:
An emotional
outburst
Self injurious
behavior
Calling attention to
himself impulsively
in the moment
Histrionic Personality Disorder
Cognitions Include:
I can’t stand that
person (either the
romantic interest or
the date).
Didn’t someone tell
me he was
promiscuous?
We were in love.
Behaviors Include:
A dramatic outburst
Sexually seductive
behavior
Excessive emotional
response that is
prolonged and
involves many
people
Narcissistic Personality Disorder
Cognitions Include:
Behaviors Include:
A brief thought of being
Loudly discussing
rejected
accomplishments in the movie
theatre so the romantic
Thoughts of being
interest and date are sure to
superior to the other
hear
date
Showing how well known they
Thoughts that the date
are by greeting every
would be envious if they
acquaintance in the movie
knew who she was
theater
Approaching the romantic
interest and asking them to
call or actually starting up a
conversation
Cluster C Personality Disorders
Characterized by: Includes:
Avoidant
Anxious behavior
Personality Disorder
Chronic fears
Dependent
Perfectionism
Personality Disorder
Constant selfObsessivedoubt
Compulsive
Personality Disorder
AVOIDANT PERSONALITY DISORDER

A pervasive pattern of social inhibition,
feeling inadequate, and hypersensitivity to
negative evaluation
Indicated by 4 or more of the following 7:
1. Avoid work or school activities involving significant
interpersonal contact because fear disapproval,
criticism, or rejection
2. Resist getting involved with people without
assurance that they will be liked and accepted
without criticism
3. Are restrained in intimate relationships because
fear being shamed or ridiculed
AVOIDANT PERSONALITY DISORDER
Continued:
4. Are preoccupied with being criticized or rejected in
social situations (confirmatory bias)
5. Inhibited in new interpersonal situations due to
feeling inadequate & having low self-esteem
6. See self as socially inept, unappealing, or inferior
to others
7. Unusual reluctance to take personal risks or
engage in any new activities because these may
prove embarrassing
AVOIDANT PERSONALITY DISORDER
What it looks like:
Feel inadequate
Low self-esteem
Socially incompetent
Worry about being criticized
Avoid situations, activities, relationships, and
people where there is any potential for them
to be criticized, rejected, ridiculed,
embarrassed, or disapproved of
AVOIDANT PERSONALITY DISORDER
Facts & Figures:
 Prevalence: 0.5%-1.0% in general population
 Gender: equally frequent for men & women
 Course: avoidant/shy behavior often starts in infancy or
childhood & increases during adolescence & early adulthood
 Prognosis: modest improvements with treatment
 Need for caution with: (1) different cultural/ethnic groups; (2)
immigrants; (3) children & adolescents
Causal Factors:
 Parental rejection
 Sensitive temperament
Treatment:
 Behavioral interventions – systematic desensitization,
behavioral rehearsal, social skills & assertiveness training
DEPENDENT PERSONALITY DISORDER
A pervasive and excessive need to be taken care of
that leads to submissive and clinging behavior and
fears of separation.
Indicated by 5 or more of the following 8:
1. Difficulty making everyday decisions without an
excessive amount of advice and reassurance from
others.
2. Allow others to assume responsibility for major
areas of his/her life.
3. Difficulty expressing disagreement with others
because they fear losing support or approval.
DEPENDENT PERSONALITY DISORDER
4. Difficulty initiating projects or doing things on own
because lack self confidence
5. Go to excessive lengths to obtain nurturance and
support from others, e.g. volunteering to do things
that are unpleasant
6. Feel uncomfortable or helpless when alone due to
exaggerated fears of being unable to take care of self
7. Urgently seek another relationship as a source of care
and support when a close relationship ends; become
quickly & indiscriminately attached to people
8. Preoccupied with fears of being left to take care of self
DEPENDENT PERSONALITY DISORDER
What it looks like:
Worry about being abandoned
Lack self-confidence
Submissive, clingy, needy
Urgency, desperation with relationship-seeking
Need for others to assume responsibility for them
Rely on others for almost everything:
 To take care of them
 To do things for them
 To make decisions for them
 To support and nurture them
DEPENDENT PERSONALITY DISORDER
Facts & Figures:
 Prevalence: 2%; one of the most frequently reported
personality disorders in mental health clinics
 Age & cultural factors need to be considered
 Gender: diagnosed more frequently in females; may be
equally prevalent for men & women
Causes:
 Disruption in early bonding/attachment due to early
death of a parent or neglect or rejection by caregivers
Treatment:
 Long-term psychotherapy
 Assertiveness training, self-esteem work, skills building
OBSESSIVE-COMPULSIVE
PERSONALITY DISORDER
A pervasive pattern of preoccupation with orderliness,
perfectionism, and control, at the expense of
flexibility, openness, and efficiency
Indicated by 4 or more of the following 8:
1. So preoccupied with procedures, details, lists,
order, and schedules that the major point of the
activity is lost.
2. Perfectionism interferes with task completion and
causes significant dysfunction and distress.
3. Excessive devotion to work and productivity to the
exclusion of leisure activities and friendships (not
accounted for by obvious economic necessity).
OBSESSIVE-COMPULSIVE
PERSONALITY DISORDER
4. Excessively conscientious, scrupulous, and inflexible
about matters of morality, ethics or values (not
accounted for by cultural or religious identification)
5. Inability to discard worn-out or worthless objects,
even when they have no sentimental value
6. Reluctance to delegate tasks or work to others
unless they submit to exactly their way of doing
things
7. Overly miserly and stingy with money: hoard money
for future catastrophes
8. Rigidity and stubbornness
OBSESSIVE-COMPULSIVE
PERSONALITY DISORDER
What it looks like:
Controlling – have to have control over everything in their life
Believe they have to be perfect to be accepted by others
Follow rigid routines & become anxious when routines are
disrupted
Orderly
Lose the forest for the trees
Inefficient at completing tasks
Workaholics – unable to delegate
Rigid morals & values
Pack rats
Rigid and stubborn
Overly frugal and stingy with money
OBSESSIVE-COMPULSIVE
PERSONALITY DISORDER
Facts & Figures:
 Prevalence: 1-4% of community samples
 Gender: diagnosed twice as often among males
 Special considerations: individual’s reference group
Treatment Considerations:
 May seek Tx due to depression or slipping productivity
 Don’t like the loss of control inherent in therapy – tend to
counter by providing a detailed, orderly account of Sx &
issues
 Therapist needs to avoid competing with client to direct the
session
 Antidepressants may be helpful for underlying anxiety &
depression
Cluster C Scenario
This individual is going to meet her
boyfriend’s parents in another city
for the first time.
Avoidant Personality Disorder
Cognitions Include:
Is it possible to get
out of this?
They won’t approve
of me.
They might be
mean to me.
How could they
ever like me?
Behaviors Include:
Speaking very little
around the family
Avoiding the
situation altogether
Taking excessive
measures to ensure
that she is approved
of (bringing
luxurious gifts)
Dependent Personality Disorder
Cognitions Include:
What will I wear, do,
say? (Followed by
asking her boyfriend
for input about this.)
I have to make sure
they like me.
Behaviors Include:
Volunteering to babysit
all the children while the
adults go out to dinner
Sticking by her
boyfriend’s side the
entire time
Agreeing to everything
the family suggests and
with all the opinions
they offer
Obsessive-Compulsive
Personality Disorder
Cognitions Include:
Everyone here is doing
everything wrong.
Distress about having to
delegate work tasks
while away, and about
the dogsitter’s ability to
perform tasks (or the
babysitter’s…)
Behaviors Include:
Planning out activities to
fill the entire trip.
Making extensive lists of
things to bring but not
packing until the last
minute.
Exhibiting a great deal of
distress when conforming
to others’ ways of doing
things or being stubborn
and ensuring that things
are done her way.
Theories of Personality Disorders:
Family dynamics – growing up in a dysfunctional,
abusive, invalidating, overprotective, controlling,
or uncaring environment; poor parenting; parentchild relationship
Genetic Influences
Biological/biochemical Influences
Trauma & other significant experiences
Continuum model – personality disorders
represent extreme variations of normal
personality traits
Treatment for Personality Disorders
Long-term supportive, structured psychotherapy
Dialectical Behavior Therapy (DBT) – accepting &
validating client, setting limits, skills training
Cognitive Behavioral Therapy (CBT) – challenging
maladaptive thoughts, beliefs, schemas; skills
training; behavioral experimentation
Psychodynamic/Object Relations Therapy –
emphasis on transference, the effect of past
relationships on the present, raising insight
Relational/Interpersonal Therapy – using the
therapeutic relationship and other significant
relationships to foster growth, change, and healing