The document provides an extensive overview of personality disorders, detailing their definition, diagnostic criteria according to DSM-IV-TR, and the various classifications into three clusters: A, B, and C, based on traits such as odd behavior, emotional instability, and anxiety. It discusses specific personality disorders within these clusters, highlighting common characteristics, prevalence rates, and relevant examples. Additionally, the text addresses the distinction between personality disorders and traits, emphasizing the impact on functioning and the associated risk factors for co-morbid mental health conditions.

1. PERSONALITY
DISORDERS
By Riya Jain

3. What is Personality?
A person’s broadly characteristic
traits, coping styles, and ways of
interacting in the social
environment emerge during
childhood and normally
crystallize into established
patterns by the end of
adolescence or early adulthood.
Personality Disorders must be
distinguished from personality traits
that do not reach the threshold for a
personality disorder. Personality traits
are diagnosed as a personality
disorder only when they are inflexible,
maladaptive, and persisting and cause
significant functional impairment or
subjective distress.

4. DIMENSIONAL MODELS
The Five-Factor Model (Goldberg,
1990; John & Naumann, 2008; McCrae &
Costa, 2008)
This model consists of the following five dimensions:
• Neuroticism
• Extroversion versus Introversion
• Openness versus Experience
• Agreeableness versus Antagonism
• Conscientiousness
 Other dimensions that have been studied include
novelty seeking, reward dependence, harm
avoidance, dominance, affiliation, constraint,
persistence, positive emotionality versus negative
emotionality, pleasure seeking versus pain
avoidance, passive accommodation versus active
modification, and self-propagation versus other
nurturance.

5. DSM-IV-TR’s DIAGNOSTIC CRITERIA
The essential feature of a personality disorder is is an enduring pattern of inner experience and
behavior that deviates markedly from the expectations of the individual’s culture. The definition
of personality disorders in the DSM-IV-TR is based on criteria:
Criteria A
This pattern must be
manifested in at least
two of the following
areas: cognition,
affectivity, interpersonal
functioning, or impulse
control.
Criteria D
The pattern is stable and
of long duration, and its
onset can be traced back
at least to adolescence or
early adulthood.
Criteria E
The pattern is not
better accounted for
as a manifestation or
consequence of
another mental
disorder.
Criteria B
The enduring pattern is
inflexible and pervasive
across a broad range of
personal and social
situations,
Criteria C
The enduring pattern leads to
clinically significant distress or
impairment in social,
occupational, or other
important areas of functioning.
Criteria F
The enduring pattern is
not due to the direct
physiological effects of
a substance or a
general medical
condition.

6. Overview of Personality Disorders
•Aaron Beck and his colleagues have proposed a useful integrative scheme
that may highlight some of the commonalities and differences among the
personality disorders. (Beck and Freeman,1990; Pretzer & Beck, 1996) .
•In their view people with personality disorders can be characterized on several
different dimensions, including the kinds of interpersonal strategies they use.
•Each personality disorder is also characterized by a different set of behavior
patterns that are overdeveloped, and another set of behavior patterns that are
underdeveloped. In many cases the deficient behaviors are somehow
counterparts to the overdeveloped features. (Beck & Freeman, 1990; Pretzer &
Beck, 1996).
•Finally, Beck and colleagues also propose that each personality disorder is
characterized by different core dysfunctional beliefs that people with
personality disorders have about themselves and the world around them..

9. Classification of Personality Disorders
Cluster A
Paranoid, Schizoid,
Schizotypical
Behavior: Unusual; Odd
or eccentric
Distrust and
Suspiciousness; Social
detachment
Cluster B
Histrionic, Narcissistic,
Antisocial , Borderline
Behavior: Impulsive;
Dramatic, Emotional,
Erratic
Antisocial activities; more
colorful, forceful, more
contact with authorities.
Cluster C
Avoidant, Dependent,
Obsessive-Compulsive
Behavior: Anxiety and
Fearfulness; more likely to
seek help
Difficult to distinguish
from Anxiety-based
Disorders
The DSM-IV personality disorders are grouped into 3 clusters based on similarities among
the disorders:

10. “CLUSTER A”
PARANOID PERSONALITY DISORDER
Suspiciousness and
Mistrust of others;
Doubts about
loyalty;
Hypersensitive;
problems in
interpersonal
relationships
Tend to see self as
blameless; ascribes
evil motives to
others; Hold
grudges(Bernstein,
Useda, &
Siever,1995)
On guard for
perceived attacks by
others; in clear
contact with reality;
experience transient
psychotic symptoms
(Thompson-Pope &
Turkat,1993)
Shares symptoms
with Paranoid
Schizophrenia; more
related to Axis 1
Delusional disorder
than to
Schizophrenia
(Bernstein et
al.,1995)
Examples include Richard Nixon, Adolf Hitler, Joseph Stalin &
Saddam Hussein.

12. Prevalence and Gender Ratio Estimate
0.5-2%
Males > Females

13. Schizoid Personality Disorder
Impaired social
relationships; Lack
social skills; Not
emotionally reactive
Inability and lack of
desire to form
attachments to
others; Negative
symptoms of
schizophrenia:
Anhedonia and
Social withdrawal.
Classified as loners
and introverts, with
solitary interests
and occupations
(Widiger &
Frances,1994);
appears cold and
aloof
Neither desire nor
enjoy close
relationships; Need
for love, belonging
and approval fails to
develop.
Examples include Squidward from Sponge Bob Squire Pants and Dexter Morgan
from Dexter (just his personality not the serial killing).

14. Add a Slide Title - 3
John Nash(A Beautiful Mind)
Peter Green
Mary Todd Lincoln
Charles Darwin
Bill Gates
Isaac Asimov
Bobby Fisher
Karl Marx
Belle for the Beauty and the beast
Sigmund Freud

15. Prevalence and Gender Ratio Estimate
<1%
Males > Females

16. Schizotypal Personality Disorder
Peculiar thought
patterns; Excessively
introverted;
Pervasive social and
interpersonal
deficits
Cognitive and
perceptual
distortions and
eccentricities in
their
communication and
behavior(Widiger &
Frances,1994)
Involves oddities of
thought, perception,
or speech; Highly
personalized and
superstitious
thinking; Under
extreme stress:
transient psychotic
symptoms
Attentional Deficits
and Working
memory deficits;
“Schizophrenic
genotype”;Increased
risk for developing
schizophrenia
Magical thinking,
ideas of reference ,
odd speech and
suspicious beliefs;
Shares genetic link
with schizophrenia
(Kendler &
Gardner,1997)
Examples include Kramer from Seinfeld, Doc Brown from Back to the Future and the
characters on the Big Bang Theory, Vincent Van Gogh.

18. Prevalence and Gender Ratio Estimate
3%
Males > Females

19. Histrionic Personality Disorder
Excessive
attention-seeking
behavior and
emotionality; self
dramatization;
Seen as overly
reactive, shallow
and insincere.
Tend to feel
unappreciated,
irritated and
tempered if not
the center of
attraction; stormy
interpersonal
relationships
Appearance and
behavior:
Theatrical,
Emotional,
Provocative and
seductive; More in
Women than men
Highly Suggestible
and perceives
relationships to
be closer than
they are; Poor
sexual
adjustment(Apt&
Hurlbert,1994)
“CLUSTER B”
Examples include Madonna, Scarlett O’Hara, Paris Hilton & most reality
TV stars.

21. Prevalence and Gender Ratio Estimate
2-3%
Males = Females

22. Narcissistic Personality Disorder
Exaggerated sense of self-
importance, preoccupation
with receiving attention;
lack of empathy(Blais,
Hilsenroth&
Castlebury,1997); fantasies
of outstanding
achievement; sensitive to
criticism
Grandiosity(Ronningstam
& Gunderson); Strong
tendency to overestimate
their abilities and
accomplishments while
underestimating others;
fragile sense of self esteem
underneath; more observed
in men
Behave in stereotypical
ways to gain acclaim and
recognition; Likes to
associate with high-status
people only; envious of
other people and believes
people are envious
too(Gunderson
&Smith,1995)
Unwilling to take the
perspectives of others, to
see things other than
“through their own eyes”,
takes advantage of others
for their own; arrogant,
snobbish, haughty
behaviors and attitudes
Examples include Gregory House MD, Walter White from Breaking Bad & Stephen
Colbert (the character, not the actual actor), Donald Trump.

24. Prevalence and Gender Ratio Estimate
<1%
Males > Females

25. Antisocial Personality Disorder
Lack of ethical and moral
development; deceitful,
aggressive or antisocial
behavior; impulsive,
irritable, irresponsible
behavior
Acc to DSM, occurring
since age 15 and before 15,
person must have had
conduct disorder
symptoms: destruction of
property, deceitfulness,
serious violation of rules,
aggression towards people
or animals.
Some has enough
intelligence and social
charm; more common in
men; 3% in men and 1% in
women (Golomb et
al.,1995; Robins et al.,
1984)
Examples include Serial Killers, The Joker and The Grinch, Hitler
and Saddam Hussein.

27. Difference between Narcissistic and Histrionic
Personality Disorder
Widiger and Trull(1993) attempted to
summarize the major differences in this way,
“The histrionic tends to be more emotional and
dramatic than the narcissistic, and whereas
both may be promiscuous, the narcissistic is
more dispassionately exploitative, while the
histrionic is more overtly needy. Both will be
exhibitionistic, but the histrionic seeks
attention, whereas the narcissistic seeks
admiration.”

28. Difference between Narcissistic and Antisocial
Personality Disorder
Widiger and Trull(1993) noted that the most
basic distinction is that “The narcissist’s
exploitation would be more for the purpose
of demonstrating domination, prestige, and
superiority rather than for the personal,
material gain of the antisocial personality”

29. Prevalence and Gender Ratio Estimate
1% Females
3% Males

30. Borderline Personality Disorder
Impulsivity and
Instability in
interpersonal
relationships, self-
image and moods;
Highly unstable
mood; intense
outbursts; suicide
and self- mutilation
Feeling slighted;
might become
verbally abusive
toward loved ones
or might threaten
suicide over minor
setbacks; chronic
feelings of
emptiness; self-
destructive beh.,
Involves over
idealization of
friends or lovers;
end in bitter
disappointment or
disillusionment.
Associated with
relief from anxiety
or dysphoria and
analgesia ;
manipulative suicide
attempts
Examples include Princess Diana, Marilyn Monroe, Megan Fox and Adolf Hitler.

31. Borderline Personality Disorder
•People with BPD are usually aware of
their circumstances and surroundings,
they may have relatively short or transient
episodes in which they appear to be out
of contact with reality and experience
delusions and hallucinations.
•Among patients with dissociative
symptoms , the risk for self- mutilation
seems especially high. ( Brodsky, Cloitre,
& Dulit, 1995)
•Estimates are that about 2% of the
population may qualify for the diagnosis
of BPD.
 Approximately, 75% of individuals receiving
this diagnosis are women.

33. Prevalence and Gender Ratio Estimate
2%
Females > Males
(by 3:1)

34. Avoidant Personality Disorder
Extreme social inhibition
and introversion; limited
social relationships and
reluctance to enter into
social interactions.
Hypersensitivity to rejection
and social derogation; fear
of criticism and rebuff;
desire affection; do not
enjoy aloneness; cannot
face situations of
embarrassment or risk.
Inability to relate
comfortably causes acute
anxiety, low self-esteem,
excessive self-
consciousness; shyness
CLUSTER C
Examples include

35. Avoidant Personality Disorder
•It may be a biologically based disorder
often starting in infancy or childhood that
is reinforced by environmental factors to
become a highly stable and chronic
behavioral pattern. (Alden&Kapp, 1988;
Kagan, 1997;)
•Key difference between schizoid and
avoidant personalities:
Avoidant personality: hypersensitive to
criticism, shy, and insecure.
Schizoid personality: aloof, cold, and
indifferent to criticism. (Millon&Martinez,
1995)
 Key difference between dependent and
avoidant personalities:
Dependent personality: Great difficulty
separating in relationships because of
feelings of incompetence on their own.
Primary focus on being taken care of.
Avoidant personality: Problems initiating them
because of fearing criticism or rejection.
(Millon&Martinez, 1995). Primary focus on
avoidance of humiliation and rejection.

37. Prevalence and Gender Ratio Estimate
0.5-1%
Males = Females

38. Dependent Personality Disorder
Extreme Dependence on
other people; clinging and
submissive behavior; co-
morbid diagnosis of anxiety
disorders; common with
eating disorders patients
Acute discomfort and panic
at the possibility of
separation or being alone;
excessive reliance on
EMS(Bornstein, 1992,1997)
Indiscriminate selection of
mates; remain in
psychologically or
physically abusive
relationships;
indecisiveness; lacks self
confidence

40. Differences in Personality Disorders
•Borderline and dependant personalities:
Borderline reacts with feelings of
emptiness or rage if abandonment
occurs.
Dependent personalities reacts initially
with submissiveness and appeasement.
Does not have pattern of intense and
stormy relationships.
•Histrionic and dependant personalities:
Histrionics are much more gregarious,
flamboyant, and actively demanding of
attention.
Dependent personalities is more docile
and self-effacing.
• Avoidant and Dependent Personalities:
Avoidant personality is more socially timid and
avoids relationships rather than be rejected.
Dependent personalities seeks out relationships
with others in spite of the fear of being rejected.

41. Prevalence and Gender Ratio Estimate
2%
Males = Females

42. Obsessive-Compulsive Personality
Disorder
Perfectionism and an
excessive concern with
maintaining order; difficulty
delegating tasks to others;
quite rigid and stubborn,
over conscientiousness
Maintains mental and
interpersonal control
through careful attention to
rules and schedules,
inflexible about moral and
ethical issues, excessively
devoted to work
Perfectionism is quite
dysfunctional: never
finishing projects; difficult in
relaxing and having
fun(Widiger&Frances,1994)

44. Differences in Personality Disorders:
•Narcissistic Personality disorder and
OCPD:
Narcissistic personalities are more
grandiose and likely to believe he or she
has achieved perfection.
OC Personality is often quite self-
critical.
•Schizoid Personality Disorder and OCPD:
Schizoids lacks the capacity for close
relationships.
OC Personality has difficulty in
interpersonal relationships because of
excessive devotion to work and because
of difficulty expressing emotions.

45. Prevalence and Gender Ratio Estimate
1%
Males > Females
(by 2:1)

46. Provisional Categories of Personality Disorder in DSM-
IV
PASSIVE-AGGRESSIVE
PERSONALITY DISORDER
•Pervasive pattern of passive
resistance to demands in social or
work situations; through
procrastination, forgetfulness, or
sulking,
•Strong pattern of negativistic
attitudes.
•Complain of being misunderstood
and unappreciated: highly critical or
scornful of authority; complain about
personal misfortunes and are envious
of others being fortunate.
DEPRESSIVE PERSONALITY DISORDER
• Pattern of depressive cognitions and
behaviors that begins by early adulthood and
is pervasive in nature.
• Unhappy mood or dejection; tend to feel
inadequate, worthless or guilty; highly self-
critical, judgmental towards others;
pessimistic, prone to worry.
• Emphasis on distorted cognitions and
interpersonal traits than is true for dysthymic
disorder.

47. Epidemiological study
•Prevalence estimates for one or more
personality disorders have ranged
from 4.4 percent to 14.8 percent.
(Grant et al., 2005; Lenzenweger,
2008; Paris, 2010)
•One review averaging across six
relatively small epidemiological
studies estimated that about 13
percent of the population meets
criteria for at least one personality
disorder at some point in their lives
(Mattia & Zimmerman, 2001).
•Several studies from Sweden have
yielded very similar estimates
(Eskelius et al., 2001; Torgersen et al.,
2001).
 One study estimated that about 10 percent
of the population exhibits at least one
personality disorder, with 5.7 percent in
Cluster A, 1.5 percent in Cluster B, and
6 percent in Cluster C.
 One summary of evidence estimated that
about three-quarters of people diagnosed
with a personality disorder also have an Axis
I disorder (Dolan- Sewell et al., 2001).
For example, personality disorders are often
associated with anxiety disorders, mood
disorders, substance-abuse and dependence,
and sexual deviations.(L.A. Clark, 2005, 2007;
Grant, Hasin at al., 2005; Grant, Stinson et al.,
2005; Mattia & Zimmerman, 2001).

48. Statistics for Personality disorders

49. END..