Cluster A

Patients seem eccentric, peculiar, or withdrawn.

Familial association with psychotic disorders.

schizotypal personality
disorder
paranoid personality
disorder (PPD) 1. Ideas of reference (excluding delusions
of reference).
At least four of the following must also 2. Odd beliefs or magical thinking,
be present: inconsistent with cultural norms.
1. Suspicion (without evidence) that others 3. Unusual perceptual experiences (such as
are exploiting or deceiving
him or her.
schizoid personality bodily illusions).
4. Suspiciousness.
2. Preoccupation with doubts of loyalty or 5. Inappropriate or restricted affect.
trustworthiness of friends or A pattern of voluntary social withdrawal and 6. Odd or eccentric appearance or behavior.
acquaintances. restricted range of emotional expression, 7. Few close friends or confidants.
3. Reluctance to confide in others. beginning by early adulthood and present in 8. Odd thinking or speech (vague,
4. Interpretation of benign remarks as a variety of contexts. stereotyped, etc.).
threatening or demeaning. Four or more of the following must also 9. Excessive social anxiety.
5. Persistence of grudges. be present: Magical thinking may include:
6. Perception of attacks on his or her 1. Neither enjoying nor desiring close Belief in clairvoyance or telepathy.
character that is not apparent to relationships (including family). Bizarre fantasies or preoccupations.
others; quick to counterattack. 2. Generally choosing solitary activities. Belief in superstitions.
7. Suspicions regarding fidelity of spouse 3. Little (if any) interest in sexual activity Odd behaviors may include involvement in
or partner. with another person. cults or strange religious practices.
4. Taking pleasure in few activities (if any).

being pathologically jealous,

5. Few close friends or confidants (if any).
6. Indifference to praise or criticism. Treatment
7. Emotional coldness, detachment, or
More commonly diagnosed in men than flattened affect.
in women. Psychotherapy
Diagnosed more often in men than women.
low-dose antipsychotics if necessary
Treatment Unlike with avoidant personality disorder,
patients with schizoid personality disorder
prefer to be alone.
Psychotherapy

Group psychotherapy should be avoided Treatment

due to mistrust and misinterpre- tation of
others’ statements. Lack insight for individual psychotherapy,
and may find group therapy threatening;
may benefit from day programs or drop-in
Patients may also benefit from a short centers.
course of antipsychotics for tran- sient Antidepressants if comorbid major
psychosis. depression is diagnosed.
Personality
disorder criteria—
CAPRI
Cognition
Affect
Personal Relations
Impulse control
Biological, genetic, and
psychosocial factors
during childhood and
adoles- cence contribute
to the development of
personality disorders.
Personality disorders are
generally very difficult to
treat, especially since few
patients are aware that they
need help. The disorders tend
to be chronic and lifelong.
In general, pharmacologic
treatment has limited
usefulness (see individ- ual
exceptions below) except in
treating comorbid mental
conditions (e.g., major
depressive disorder).
Psychotherapy is usually the
most helpful.
 borderline personality
antisocial personality Differential Diagnosis
disorder (BPD)
Pervasive pattern of impulsivity and
disorder Bipolar I/II: Mood swings unstable relationships, affects, self- image,
Pattern of disregard for and violation of experienced in BPD are and behaviors, present by early adulthood
the rights of others since age 15. rapid, brief, moment-to- and in a variety of contexts.
Patients must be at least 18 years old for moment reactions to At least five of the following must
this diagnosis; history of behavior as a perceived environmental or be present:
child/adolescent must be consistent with psychological triggers. 1. Frantic efforts to avoid real or imagined
conduct disorder abandonment.

Three or more of the following should Treatment 2. Unstable, intense interpersonal

relationships (e.g., extreme love–hate
relationships).
be present: Dialectical behavior therapy 3. Unstable self-image.
1. Failure to conform to social norms by (DBT) 4. Impulsivity in at least two potentially
committing unlawful acts. Pharmacotherapy has been harmful ways (spending, sexual
2. Deceitfulness/repeated lying/ shown to be more useful in BPD activity, substance use, binge eating, etc.).
manipulating others for personal gain. than in any other personality 5. Recurrent suicidal threats or attempts or
3. Impulsivity/failure to plan ahead. disorder. self-mutilation.
4. Irritability and aggressiveness/repeated 6. Unstable mood/affect.
fights or assaults. 7. Chronic feelings of emptiness.
5. Recklessness and disregard for safety of 8. Difficulty controlling anger.
self or others. 9. Transient, stress-related paranoid ideation
6. Irresponsibility/failure to sustain work or or dissociative symptoms.
honor financial obligations. Diagnosed three times more often in women
7. Lack of remorse for actions. than men.
Males with alcoholic parents are at Suicide rate: 10%.
increased risk. Borderline patients commonly use
There is a higher incidence in poor urban the defense mechanism of splitting
areas and in prisoners but no —they view others and themselves
racial difference. as all good or all bad. (
Genetic component: Increased risk among
first-degree relatives

Treatment
Psychotherapy is generally ineffective.
Pharmacotherapy may be used to treat
symptoms of anxiety or depres-
cluster B
sion, but use caution due to high addictive These patients are often
potential of these patients.
emotional, impulsive, and dramatic

histrionic personality
disorder (HPD)
Pattern of excessive emotionality and attention
narcissistic personality disorder seeking, present by early adulthood and in a
variety of contexts.
(NPD) At least five of the following must be present:
1. Uncomfortable when not the center
Pattern of grandiosity, need for admiration, of attention.

Treatment
and lack of empathy begin- ning by early 2. Inappropriately seductive or
adulthood and present in a variety of provocative behavior.
contexts. 3. Rapidly shifting but shallow expression
Five or more of the following must of emotion.
Psychotherapy is the treatment 4. Uses physical appearance to draw attention
be present:
of choice. to self.
1. Exaggerated sense of self-importance.
Psychotropics may be used if a 5. Speech that is impressionistic and lacking
2. Preoccupation with fantasies of unlimited
comorbid psychiatric disorder is in detail.
money, success, brilliance,
also 6. Theatrical and exaggerated expression
etc.
diagnosed. of emotion.
3. Believes that he or she is “special” or
unique and can associate only 7. Easily influenced by others or situation.
with other high-status individuals. 8. Perceives relationships as more intimate than
4. Requires excessive admiration. they actually are.
5. Has sense of entitlement. Women are more likely to have HPD
6. Takes advantage of others for self-gain. than men.
7. Lacks empathy.
8. Envious of others or believes others are histrionic patients often use the defense
envious of him or her. mechanism of regression—they revert to childlike
9. Arrogant or haughty. behaviors.

Treatment
Antisocial personality disorder: Both
types of patients exploit others, but NPD
patients want status and recognition,
while antisocial patients want material
gain or simply the subjugation of others. Psychotherapy
Narcissistic patients become depressed
Pharmacotherapy to treat associated
when they don’t get the recognition they
think they deserve. depressive or anxious symptoms as
necessary.
NARCISS
avoidant personality dependent personality
disorder disorder (DPD)
At least five of the following must
Avoids occupation that involves be present:
interpersonal contact due to a fear 1. Difficulty making everyday decisions
of criticism and rejection. without reassurance from others.
Unwilling to interact unless certain 2. Needs others to assume responsibilities
of being liked. for most areas of his or her
Cautious of interpersonal life.
relationships. 3. Difficulty expressing disagreement
Preoccupied with being criticized or because of fear of loss of approval.
rejected in social situations. 4. Difficulty initiating projects because of
Inhibited in new social situations lack of self-confidence.
because he or she feels inadequate. 5. Goes to excessive lengths to obtain
Believes he or she is socially inept support from others.
and inferior. 6. Feels helpless when alone.
Reluctant to engage in new
activities for fear of embarrassment 7. Urgently seeks another relationship when
one ends.
Schizoid patients prefer to be alone. 8. Preoccupied with fears of being left to
Avoidant patients want to be with others take care of self.
but are too scared of rejection regression is often seen in people with DPD.
This is defined as going back to a younger
age of maturity.

Treatment Women are more likely to be diagnosed with

DPD than men
Difficulties with employment since they
Psychotherapy
cannot act independently or
Selective serotonin reuptake inhibitors without close supervision.
(SSRIs) may be prescribed for
comorbid social anxiety disorder or major
depression.
Treatment
Psychotherapy
Pharmacotherapy may be used to treat
associated symptoms of anxiety or
depression

cluster c
These patients appear anxious
and fearful

obssesive-compulsive personality
disorder (OCPD)
Preoccupation with details,
Treatment
Men are two times more likely to have OCPD
rules, lists, and organization than women.
such that the Obsessive-compulsive disorder
major point of the activity (OCD): Patients with OCPD do not
have the recurrent obsessions or
is lost.
compulsions that are present in Psychotherapy is the treatment of
2. Perfectionism that is OCD. In addition, the symptoms of
detrimental to completion of choice. Cognitive-behavior
OCPD are ego-syntonic rather
task. than ego-dystonic (as in OCD);
therapy may be particularly useful.
3. Excessive devotion to work. OCD patients are aware that they Pharmacotherapy may be used to
4. Excessive have a problem and wish that their treat associated symptoms as
conscientiousness and thoughts and behaviors would go necessary.
scrupulousness about morals away.
and Narcissistic personality disorder:
ethics. Both personalities involve
5. Will not delegate tasks. assertiveness and achievement,
6. Unable to discard but NPD patients are motivated by
worthless objects. status, whereas OCPD patients
are motivated by the work itself.
7. Miserly spending style.
8. Rigid and stubborn.