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Personality Disorder

Personality disorders are a contentious diagnostic category that describe “an enduring pattern of inner experience and behavior that deviates markedly from the expectations of the individual’s culture, is pervasive and inflexible, has an onset in adolescence or early adulthood, is stable over time, and leads to distress or impairment” (APA, 2013). Personality traits are enduring patterns, exhibited in wide range of contexts, of perceiving, relating to, and thinking about the environment and oneself. If personality traits are inflexible, maladaptive, and cause clinically significant distress or functional impairment then they are said to constitute a personality disorder. The use of a ‘personality disorder’ diagnostic category is contentious because: many people feel judged or stigmatized by being given the label of ‘personality disorder’; many people fit diagnostic criteria for more than one personality disorder which makes some doubt the utility and reliability of diagnosis; historically, the label of personality disorder has been associated with the subtext ‘untreatable’ and ‘difficult.’ Read more
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Assertive Communication

Communicating assertively is an essential skill for maintaining healthy self-esteem and strong relationships. This information handout describes the k ... https://www.psychologytools.com/resource/assertive-communication/

Information Handout

Assertive Responses

Communicating assertively is an essential skill for maintaining healthy self-esteem and strong relationships. The Assertive Responses exercise helps c ... https://www.psychologytools.com/resource/assertive-responses/

Exercise

Autonomic Nervous System

The autonomic nervous system (ANS) automatically regulates the function of body systems outside of voluntary control. The Autonomic Nervous System han ... https://www.psychologytools.com/resource/autonomic-nervous-system/

Information Handout

Barriers Abusers Overcome In Order To Abuse

Individuals who have experienced abuse often focus on their own actions (or inactions) and blame themselves for their own abuse. This client informati ... https://www.psychologytools.com/resource/barriers-abusers-overcome-in-order-to-abuse/

Exercise

Behavioral Experiment

Behavioral experiments allow individuals to test the validity of their beliefs and assumptions. They are a core experiential technique for therapeutic ... https://www.psychologytools.com/resource/behavioral-experiment/

Worksheet

CBT Thought Record

The CBT Thought Record is an essential tool in cognitive behavioral therapy. Thought challenging records help people to evaluate their negative automa ... https://www.psychologytools.com/resource/cbt-thought-record/

Worksheet

Emotions Motivate Actions

Many clients find it helpful to recognize the range of actions that are motivated by different emotional states. This worksheet encourages clients to ... https://www.psychologytools.com/resource/emotions-motivate-actions/

Information Handout

Grounding Objects (Audio)

The Grounding Objects exercise is a simple technique which teaches people with PTSD or dissociative disorders how to use objects with particular senso ... https://www.psychologytools.com/resource/grounding-objects-audio/

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Grounding Statements (Audio)

Grounding techniques are used to help people to reorient themselves to the present moment and to safety. Grounding Statements are a form of cognitive ... https://www.psychologytools.com/resource/grounding-statements-audio/

Audio

Grounding Techniques

Individuals who have experienced trama often find it difficult to stay within the ‘window of tolerance’. Grounding techniques (which can b ... https://www.psychologytools.com/resource/grounding-techniques/

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Intrusive Memory Record

Intrusive (unwanted, involuntary) memories are a common feature of PTSD, but also depression and other conditions. This Intrusive Memory Record is des ... https://www.psychologytools.com/resource/intrusive-memory-record/

Worksheet

Mindful Attention (Audio)

Mindful Attention is a technique for becoming aware of one’s thoughts and experiences, and being able to observe these as transient mental events. ... https://www.psychologytools.com/resource/mindful-attention-audio/

Audio

Motivational Systems (Emotional Regulation Systems)

At the heart of Compassion Focused Therapy (CFT) is an evolutionary model of human motivational systems. Developed by Paul Gilbert it is a helpful len ... https://www.psychologytools.com/resource/motivational-systems-emotional-regulation-systems/

Information Handout

Relaxed Breathing Exercise 1 (Audio)

Breathing Exercise 1 guides the listener through simple instructions to make their breathing slower, deeper, and more regular. ... https://www.psychologytools.com/resource/relaxed-breathing-exercise-1-audio/

Audio

Relaxed Breathing Exercise 2 (Audio)

Breathing Exercise 2 uses the imagery of inflating a balloon to help the listener make their breathing slower, deeper, and more regular. ... https://www.psychologytools.com/resource/relaxed-breathing-exercise-2-audio/

Audio

Relaxed Breathing Exercise 3 (Audio)

Breathing Exercise 3 uses the imagery of breathing air of different colours to help the listener make their breathing slower, deeper, and more regular ... https://www.psychologytools.com/resource/relaxed-breathing-exercise-3-audio/

Audio

Relaxed Breathing Exercise 4 (Audio)

Breathing Exercise 4 guides the listener through simple instructions to breathe in a more relaxed fashion. ... https://www.psychologytools.com/resource/relaxed-breathing-exercise-4-audio/

Audio

Sensory Grounding Using Smells (Audio)

The Sensory Grounding Using Smells exercise is an audio track from the Psychology Tools For Overcoming PTSD Audio Collection. It is designed to teach ... https://www.psychologytools.com/resource/sensory-grounding-using-smells-audio/

Audio

Sensory Grounding Using Your Five Senses (Audio)

The Sensory Grounding Using Your Five Senses exercise is an audio track from the Psychology Tools For Overcoming PTSD Audio Collection. It is designed ... https://www.psychologytools.com/resource/sensory-grounding-using-your-five-senses-audio/

Audio

Therapy Blueprint

Since the publication of this version of the therapy blueprint we have also developed a more sophisticated version: Therapy Blueprint (Universal) A th ... https://www.psychologytools.com/resource/therapy-blueprint/

Exercise

Thought Challenging Record 7 Column

The thought record is an essential tool in cognitive behavioral therapy (CBT). Thought challenging records help people to evaluate their negative auto ... https://www.psychologytools.com/resource/thought-challenging-record-7-column/

Worksheet

Trauma, Dissociation, And Grounding

Trauma, Dissociation, and Grounding is a guide written for clients who have experienced trauma and who are troubled by dissociation. It provides clear ... https://www.psychologytools.com/resource/trauma-dissociation-and-grounding/

Guide

Types Of Dissociation

The Types Of Dissociation information handout is designed for clients who have experienced trauma and describes dissociation using accessible terminol ... https://www.psychologytools.com/resource/types-of-dissociation/

Information Handout

Unhelpful Thinking Styles

Human thinking is subject to a number of characteristic biases. Cognitive restructuring is the process of helping individuals to overcome their biases ... https://www.psychologytools.com/resource/unhelpful-thinking-styles/

Information Handout

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What Are Personality Disorders?

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
Personality disorder Defining characteristics
Paranoid Extreme suspiciousness and mistrust of others, and tendency to view themselves as superior and unique. Constantly on guard and reactive to real or perceived threats
Schizoid Restricted range of affect, interpersonal indifference, and isolation
Schizotypal Odd, eccentric behavior, distorted thoughts and perceptions, inappropriate affect, and discomfort with social relationships
Antisocial Aggressive interpersonal interactions, impulsivity, lack of remorse, and defiant disregard for safety of self and others
Borderline Volatile interpersonal relationships, fear of abandonment, self-mutilation/suicidality, impulsivity, and emotional instability
Histrionic Need to be center of attention, exaggerated/inappropriate emotionality, and seductiveness
Narcissistic Inflated self-importance, inability to empathize with others, and overemphasis on status
Avoidant Low tolerance for negative emotions, few close relationships, and fear of rejection or ridicule in interpersonal interactions
Dependent Persistent and pathological need to be with and gain approval of others
Obsessive-compulsive Preoccupation with adherence to rules, orderliness, and control

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.