DSM-5 Detailed Summary: Personality Disorders
1. Definition:
Personality disorders are enduring patterns of inner experience and behavior that deviate markedly from the
expectations of the individuals culture, are pervasive and inflexible, begin in adolescence or early adulthood,
and lead to distress or impairment.
2. Diagnostic Criteria:
- The pattern is manifested in two (or more) of the following areas:
* Cognition (ways of perceiving and interpreting self, others, events)
* Affectivity (range, intensity, lability, and appropriateness of emotional response)
* Interpersonal functioning
* Impulse control
- The pattern is inflexible and pervasive across situations.
- Leads to clinically significant distress or impairment.
- Stable and of long duration (onset traced back to adolescence or early adulthood).
- Not better explained by another mental disorder or substance/medical condition.
3. Cluster System:
DSM-5 groups personality disorders into three clusters:
A. Cluster A Odd/Eccentric:
i. Paranoid Personality Disorder:
* Distrust and suspiciousness; others motives interpreted as malevolent.
* Believes others are exploiting or deceiving them.
* Reluctant to confide; reads hidden meanings; bears grudges.
* Differentiation: no delusions (unlike paranoid schizophrenia).
ii. Schizoid Personality Disorder:
* Detachment from social relationships; restricted emotional expression.
* Prefers solitude; indifferent to praise/criticism.
* No desire for close relationships.
* Differentiation: lacks psychotic features (vs. schizophrenia).
iii. Schizotypal Personality Disorder:
* Acute discomfort in close relationships; cognitive/perceptual distortions; eccentric behavior.
* Odd beliefs/magical thinking, unusual perceptual experiences, suspiciousness.
* May appear on schizophrenia spectrum; higher risk of later psychosis.
B. Cluster B Dramatic/Emotional/Erratic:
i. Antisocial Personality Disorder:
* Disregard for/violation of others rights since age 15.
* Must be 18 years old; evidence of Conduct Disorder before age 15.
* Deceitful, impulsive, aggressive, irresponsible, lack of remorse.
* Strongly associated with criminal behavior.
ii. Borderline Personality Disorder:
* Instability in relationships, self-image, and affects; marked impulsivity.
* Frantic efforts to avoid abandonment.
* Identity disturbance, self-harm, mood swings, intense anger.
* Common comorbidities: depression, substance use, PTSD.
* Often requires DBT (Dialectical Behavior Therapy).
iii. Histrionic Personality Disorder:
* Excessive emotionality and attention-seeking.
* Inappropriate sexually seductive behavior, shallow emotions.
* Uses physical appearance to draw attention.
* Highly suggestible, perceives relationships as more intimate than they are.
iv. Narcissistic Personality Disorder:
* Grandiosity, need for admiration, lack of empathy.
* Fantasies of success/power/beauty; believes they are special.
* Exploitative; envious; arrogant.
* Differentiate from BPD: less emotional lability, more stable self-image.
C. Cluster C Anxious/Fearful:
i. Avoidant Personality Disorder:
* Social inhibition, feelings of inadequacy, hypersensitivity to negative evaluation.
* Avoids activities involving interpersonal contact.
* Restraint in relationships due to fear of shame.
* Differentiate from social anxiety: more pervasive pattern.
ii. Dependent Personality Disorder:
* Excessive need to be taken care of submissive/clingy behavior.
* Difficulty making decisions; needs reassurance.
* Fear of separation; urgently seeks new relationships when one ends.
iii. Obsessive-Compulsive Personality Disorder:
* Preoccupation with orderliness, perfectionism, control.
* Inflexible, stubborn; overly devoted to work.
* Hoards, reluctant to delegate.
* Differentiate from OCD: no true obsessions/compulsions.
4. General Features and Differential Diagnosis:
- Must be distinguished from:
* Normal personality traits
* Other psychiatric conditions (e.g., schizophrenia, mood disorders)
* Substance use or medical conditions
- Many show comorbidity across disorders or with Axis I disorders.
5. Treatment:
- Psychotherapy: primary treatment (CBT, DBT, psychodynamic therapy)
- Medications: for comorbid conditions (e.g., depression, anxiety, mood stabilization)
- Cluster A: may need low-dose antipsychotics (esp. schizotypal)
- Cluster B: DBT effective for BPD
- Cluster C: SSRIs may help with anxiety symptoms
6. Prognosis:
- Varies by type; Cluster B tends to be more severe.
- BPD improves with age and treatment.
- OCPD may be stable and improve with insight.
- Antisocial often chronic, difficult to treat.
7. Key Exam Facts:
- Personality disorders must be pervasive, inflexible, early onset, and impairing.
- BPD = unstable relationships, impulsivity, self-harm.
- ASPD requires age 18 + history of conduct disorder.
- OCPD = OCD.
- Avoidant PD vs. social phobia = broader pattern of avoidance.
