Home / Courses / Abnormal Psychology / Unit 7

Abnormal Psychology Unit 7: Personality Disorders

Personality disorders are enduring, inflexible patterns of thinking, feeling and relating that begin by early adulthood and cause distress or impairment. The DSM-5-TR lists ten, grouped into three clusters, and also offers a dimensional alternative model.

Covers: General definition of a personality disorder, Cluster A: paranoid, schizoid and schizotypal, Cluster B: antisocial, borderline, histrionic and narcissistic, Cluster C: avoidant, dependent and obsessive-compulsive, Antisocial personality disorder and psychopathy, Borderline personality disorder and dialectical behavior therapy, Categorical versus dimensional models of personality pathology

Study guide

A personality disorder is an enduring pattern of inner experience and behavior that deviates markedly from the expectations of a person's culture, shows up in at least two areas (thinking, emotions, relationships or impulse control), is pervasive and inflexible across situations, begins by adolescence or early adulthood, is stable over time and causes distress or impairment. Many personality traits are ego-syntonic, meaning they feel natural and acceptable to the person, so people often seek help for other problems, such as depression, or because others pressure them. Comorbidity is high, both with other personality disorders and with mood, anxiety and substance use disorders. Diagnosis is less reliable than for many other conditions, partly because the categories overlap. The DSM-5-TR groups the ten disorders into three clusters based on descriptive similarity.

Cluster A disorders share odd or eccentric behavior. Paranoid personality disorder involves pervasive distrust and suspicion, reading hidden threats into innocent remarks and holding grudges. Schizoid personality disorder involves detachment from relationships and a restricted range of emotional expression; the person prefers solitude and seems indifferent to praise or criticism. Schizotypal personality disorder involves acute discomfort in close relationships plus cognitive or perceptual distortions and eccentric behavior, such as ideas of reference, magical thinking, odd speech and unusual perceptions. Schizotypal personality disorder is also listed in the schizophrenia spectrum chapter, and relatives of people with schizophrenia show higher rates of it. Unlike schizophrenia, these patterns do not involve sustained psychosis.

Cluster B disorders share dramatic, emotional or erratic behavior. Antisocial personality disorder is a pattern of disregard for and violation of others' rights since age 15, including deceit, impulsivity, aggression, irresponsibility and lack of remorse; it requires the person to be at least 18 with evidence of conduct disorder before 15. Psychopathy, measured by Robert Hare's PCL-R, overlaps but adds core emotional traits such as callousness, shallow affect and superficial charm. Borderline personality disorder involves instability in relationships, self-image and emotions, marked impulsivity, frantic efforts to avoid abandonment, chronic emptiness, intense anger, and recurrent suicidal behavior or self-injury. Histrionic personality disorder involves excessive emotionality and attention seeking. Narcissistic personality disorder involves grandiosity, a need for admiration and a lack of empathy, often masking fragile self-esteem.

Cluster C disorders share anxious or fearful behavior. Avoidant personality disorder involves social inhibition, feelings of inadequacy and hypersensitivity to negative evaluation; the person wants relationships but avoids them out of fear of rejection, which distinguishes it from schizoid detachment. It overlaps heavily with social anxiety disorder. Dependent personality disorder involves an excessive need to be taken care of, leading to submissive, clinging behavior, difficulty making everyday decisions without reassurance and fear of separation. Obsessive-compulsive personality disorder (OCPD) involves preoccupation with orderliness, perfectionism and control at the expense of flexibility and efficiency, such as being unable to finish a project because standards are too strict. Unlike OCD, OCPD does not involve true obsessions and compulsions, and its traits are usually ego-syntonic.

Causes combine temperament and experience. Antisocial personality disorder is linked to genetic influences, low physiological arousal and weak fear conditioning (the fearlessness hypothesis), and harsh or inconsistent parenting. Marsha Linehan's biosocial theory explains borderline personality disorder as emotional vulnerability interacting with an invalidating environment that dismisses or punishes emotional expression. Linehan's dialectical behavior therapy (DBT), which balances acceptance and change, teaches mindfulness, distress tolerance, emotion regulation and interpersonal effectiveness and reduces self-harm and hospitalization. Many people with borderline personality disorder improve substantially over time. Critics argue that ten overlapping categories fit poorly, so the DSM-5-TR's Alternative Model for Personality Disorders in Section III rates impairment in self and interpersonal functioning plus five pathological trait domains: negative affectivity, detachment, antagonism, disinhibition and psychoticism.

Key ideas

• Personality disorders are pervasive, inflexible and stable patterns that begin by early adulthood.
• Cluster A is odd or eccentric, Cluster B is dramatic or erratic, and Cluster C is anxious or fearful.
• Avoidant individuals want closeness but fear rejection, while schizoid individuals are indifferent to closeness.
• Antisocial personality disorder requires age 18 and conduct disorder before 15; psychopathy adds callous emotional traits.
• Borderline personality disorder centers on instability in emotions, relationships and self-image, with fear of abandonment.
• DBT, based on the biosocial theory, is the best-supported treatment for borderline personality disorder.
• The Alternative Model rates personality functioning and five trait domains instead of only fixed categories.

Formulas and rules

Common mistakes

• Confusing schizoid (indifferent to relationships) with avoidant (wants relationships but fears rejection).
• Treating OCPD and OCD as the same; OCPD involves rigid perfectionism without true obsessions and compulsions.
• Diagnosing antisocial personality disorder in a 16-year-old; the person must be at least 18.
• Equating psychopathy with antisocial personality disorder; psychopathy emphasizes callous, shallow emotional traits.
• Assuming personality disorders never improve; borderline symptoms often decline substantially over time.

Before the test, make sure you can

• State the general criteria for a personality disorder.
• Name the three clusters and assign each of the ten personality disorders to the correct cluster.
• Distinguish similar disorders: schizoid versus avoidant, schizotypal versus schizophrenia, OCPD versus OCD.
• Apply the age and conduct disorder rules for antisocial personality disorder and contrast it with psychopathy.
• Describe the core features of borderline personality disorder and Linehan's biosocial theory.
• Explain the four DBT skill modules.
• Describe the dimensional Alternative Model and why researchers favor it.

Words to know

Personality disorder

An enduring, pervasive and inflexible pattern of inner experience and behavior that deviates from cultural expectations and causes distress or impairment.

Ego-syntonic

Experienced by the person as consistent with their self-image and acceptable, as many personality traits are.

Paranoid personality disorder

Pervasive distrust and suspicion of others, who are assumed to have harmful motives.

Schizoid personality disorder

Detachment from social relationships and a restricted range of emotional expression.

Schizotypal personality disorder

Discomfort with close relationships plus odd beliefs, perceptual distortions and eccentric behavior.

Antisocial personality disorder

Pervasive disregard for and violation of others' rights since age 15, diagnosed at 18 or older.

Psychopathy

A personality pattern of callousness, shallow emotions, lack of remorse and manipulation, often measured with the PCL-R.

Borderline personality disorder

Pervasive instability of relationships, self-image and emotions, with marked impulsivity and fear of abandonment.

Histrionic personality disorder

Excessive emotionality and attention seeking, often through dramatic or seductive behavior.

Narcissistic personality disorder

Grandiosity, a need for admiration and a lack of empathy.

Avoidant personality disorder

Social inhibition, feelings of inadequacy and hypersensitivity to negative evaluation.

Dependent personality disorder

An excessive need to be taken care of, leading to submissive, clinging behavior and fear of separation.

Obsessive-compulsive personality disorder

Preoccupation with order, perfectionism and control at the expense of flexibility and efficiency.

Invalidating environment

In Linehan's theory, a setting in which a child's emotional expressions are dismissed, ignored or punished.

Dialectical behavior therapy

Linehan's treatment combining acceptance and change, with skills training in mindfulness, distress tolerance, emotion regulation and interpersonal effectiveness.

Fearlessness hypothesis

The idea that people with antisocial traits have unusually low fear and arousal, so punishment deters them less.

Alternative Model for Personality Disorders

A DSM-5-TR Section III model that rates personality functioning and five pathological trait domains.

Sample practice questions

30 more questions like these, from level 1 to 5, are in the practice set.