Personality Disorder

Types of Personality Disorder

Types of personality disorders include:

• paranoid personality disorder
• schizoid personality disorder
• schizotypal personality disorder
• antisocial personality disorder / dissocial personality disorder
• borderline personality disorder / emotionally unstable personality disorder
• histrionic personality disorder
• narcissistic personality disorder
• avoidant personality disorder / anxious personality disorder
• dependent personality disorder
• obsessive-compulsive personality disorder / anankastic personality disorder

Signs and Symptoms of Personality Disorders

Both the DSM-5 and ICD-10 offer criteria for a ‘general’ personality disorder. More specific diagnoses are made only if the general criteria are met.

DSM-5 Criteria for a General Personality Disorder

A general personality disorder is characterized in the DSM-5 as an enduring pattern of inner experience and behavior that deviates markedly from the expectations of an individual’s culture. This pattern is manifested in two or more of these domains:

• cognitions (including perceiving and interpreting: the self, other people, events);
• affectivity (range, intensity, lability, appropriateness);
• interpersonal functioning;
• impulse control.

The DSM-5 requires that this enduring pattern:

• be inflexible and pervasive across a broad range of personal and social situations;
• leads to clinically significant distress or impairment in functioning;
• is stable and of a long duration, with an onset in adolescence or early adulthood.

ICD-10 Criteria for a General Personality Disorder

General diagnostic guidelines for a personality disorder indicate that an individual’s presentation meet the following criteria.

• Markedly disharmonious attitudes and behavior, involving usually several areas of functioning, e.g., affectivity, arousal, impulse control, ways of perceiving and thinking, and style of relating to others.
• The abnormal behavior pattern is enduring, of long standing, and not limited to episodes of mental illness.
• The abnormal behavior pattern is pervasive and clearly maladaptive to a broad range of personal and social situations.
• The above manifestations always appear during childhood or adolescence and continue into adulthood.
• The disorder leads to considerable personal distress but this may only become apparent late in its course.
• The disorder is usually, but not invariably, associated with significant problems in occupational and social performance.

Prevalence of Personality Disorders

• Prevalence of paranoid personality disorder has been estimated at between 2.3% and 4.4%.
• Prevalence of schizoid personality disorder has been estimated at between 3.1% and 4.9%.
• Prevalence of schizotypal personality disorder has been estimated at between 0.6% to 4.6%.
• Prevalence of antisocial personality disorder has been estimated at between 0.2% and 3.3%. Prevalence of antisocial personality disorder is much higher in forensic populations.
• Prevalence of borderline personality disorder has been estimated to be 1.6% with a top range of 5.9%. The prevalence of borderline personality disorder is about 6% in primary care settings, 10% in outpatient mental health settings, and 20% among psychiatric inpatients.
• Prevalence of histrionic personality disorder has been estimated to be 1.84%.
• Prevalence of narcissistic personality disorder has been estimated at between 0% and 6.2%.
• Prevalence of avoidant personality disorder has been estimated to be 2.4%.
• Prevalence of dependent personality disorder has been estimated at between 0.49% and 0.6%.
• Prevalence of obsessive-compulsive personality disorder has been estimated at between 2.1% and 7.9%.

Psychological Models and Theory of Personality Disorders

Cognitive behavior therapy (CBT) is able to conceptualize and treat the problems of personality disorder (Beck, Davis, & Freeman, 2015). In a review of treatment for personality disorders Matusiewicz, Hopwood, Banducci and Lejuez (2010) argue:

“From a cognitive behavioral perspective, personality disorders are maintained by a combination of maladaptive beliefs about self and others, contextual/​environmental factors that reinforce problematic behavior and/​or undermine effective behavior, and skill deficits that preclude adaptive responding. CBT incorporates a wide range of techniques to modify these factors, including cognitive restructuring, behavior modification, exposure, psychoeducation, and skills training. In addition, CBT for personality disorder emphasizes the importance of a supportive, collaborative, and well-defined therapeutic relationship, which enhances the patient’s willingness to make changes and serves as a potent source of contingency.”

Dialectical behavior therapy (DBT) is a modified form of cognitive behavioral therapy that was developed as a treatment for borderline personality disorder / emotional unstable personality disorder (BPD/​EUPD: Linehan, 2014). DBT is a biopsychosocial theory that proposes that some individuals have a biological predisposition for emotional dysregulation. If they are raised in emotionally invalidating environments they fail to develop emotional regulation skills which manifest in the characteristics of BDP/​EUPD.

Schema-focused therapy proposes that personality disorders are the result of early maladaptive schemas (e.g., mistrust/​abuse, entitlement/​grandiosity, unrelenting standards / hypercriticalness) that interfere with the person’s ability to meet their core needs. Patterns of avoidance and compensation are developed in order to avoid triggering the core schema, but these strategies are rigid and become over-generalized. Schema-focused therapy employs cognitive, behavioral, imagery, experiential, and psychodynamic techniques (Young, Klosko & Weishaar, 2003).

Resources for Working with Personality Disorders

Psychology Tools resources available for working therapeutically with personality disorders may include:

• psychological models of personality disorders
• information handouts for personality disorders
• exercises for personality disorders
• CBT worksheets for personality disorders
• self-help programs for personality disorders

References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (DSM-5®). American Psychiatric Pub.

Beck, A. T., Davis, D. D., & Freeman, A. (Eds.). (2015). Cognitive therapy of personality disorders(3rd ed.). New York: Guilford Press.

Linehan, M. M. (2014). DBT skills training manual(2nd ed.). New York: Guilford Press.

Matusiewicz, A. K., Hopwood, C. J., Banducci, A. N., & Lejuez, C. W. (2010). The effectiveness of cognitive behavioral therapy for personality disorders. Psychiatric Clinics, 33(3), 657–685.

Young, J. E, Klosko, J. S., & Weishaar, M. E. (2003). Schema therapy: A practitioner’s guide. New York: Guilford Press.