Abnormal Psychology

Personality Disorders 581

Odd/Eccentric Personality Disorders

Cluster A personality disorders involve odd or eccentric behaviors and ways of

thinking. Patients who have a Cluster A personality disorder are likely to develop

an Axis I disorder that involves psychosis, such as schizophrenia or delusional disor-

der (Oldham et al., 1995; see Chapter 12). The three

personality disorders in this cluster—paranoid, schiz-

oid, and schizotypal personality disorders—are con-

sidered to be on the less severe end of the spectrum of

schizophrenia-related disorders. We’ll examine each

of the three Cluster A personality disorders in turn

and then consider what is known about the factors

that give rise to them and about how to treat them.

Rachel Reiland did not exhibit symptoms character-

istic of this group of personality disorders, and so we

will not discuss her again until we discuss Cluster B

personality disorders.

Paranoid Personality Disorder

The essential feature of paranoid personality disorder

is persistent and pervasive mistrust and suspiciousness,

accompanied by a bias to interpret other people’s mo-

tives as hostile (see Table 13.4, Criterion A). Someone

with this personality disorder may distrust co-workers

and family members, and even (falsely) believe that his

or her partner is having an affair, despite the partner’s

denials. The patient’s accusations create a diffi cult sit-

uation for the partner who is not having an affair but

can’t “prove” it to the patient’s satisfaction.

• In DSM-IV-TR, personality disorders are grouped into three clus-
  ters: Cluster A, characterized by odd or eccentric behaviors re-
  lated to features of schizophrenia; Cluster B, characterized by
  dramatic and erratic behaviors and problems with emotional
  regulation; and Cluster C, characterized by anxious or fearful
  behaviors.


• The category of personality disorders in DSM-IV-TR has been
  criticized on numerous grounds: The disorders are categorical
  and not continuous; the clusters are based on common super-
  ficialities not necessarily supported by research; the criteria
  for the disorders within a cluster overlap substantially; some of
  the disorders are not distinguished suffi ciently from Axis I dis-
  orders; the criteria for specific disorders aren’t supported by
  research; and the disorders and the criteria do not correspond
  to the types of personality problems observed by mental health
  clinicians, as is evident in the high prevalence of personality dis-
  order not otherwise specifi ed.


• The neuropsychosocial approach explains how personality dis-
  orders develop by highlighting the interactions among three
  sorts of factors:
  
  
  • Neurological factors involve the effects of genes on tem-
    perament.
  
  
  • Psychological factors include temperament, operant condition-
    ing, and dysfunctional beliefs.
  
  
  • Social factors include insecure attachment that can result from
    childhood abuse or neglect.
  
  
  
  


• Treatments for personality disorders include medications for
  comorbid symptoms, CBT or psychodynamic therapy, and family
  education and therapy, as well as couples, interpersonal, and
  group therapy.

Making a Diagnosis

• Reread Case 13.1 about Sarah, and determine whether or not her
  symptoms meet the general diagnostic criteria for a personality
  disorder, as noted in Table 13.1. Specifi cally, list which criteria
  apply and which do not. If you would like more information to
  determine whether she had a personality disorder, what infor-
  mation—specifi cally—would you want, and in what ways would
  the information infl uence your decision?

Table 13.4 • DSM-IV-TR Diagnostic Criteria for

Paranoid Personality Disorder

A. A pervasive distrust and suspiciousness of others such that their motives are

interpreted as malevolent, beginning by early adulthood and present in a variety of

contexts, as indicated by four (or more) of the following:

(1) suspects, without suffi cient basis, that others are exploiting, harming, or deceiv-

ing him or her

(2) is preoccupied with unjustifi ed doubts about the loyalty or trustworthiness of

friends or associates

(3) is reluctant to confi de in others because of unwarranted fear that the information

will be used maliciously against him or her

(4) reads hidden demeaning or threatening meanings into benign remarks or events

(5) persistently bears grudges (i.e., is unforgiving of insults, injuries, or slights)

(6) perceives attacks on his or her character or reputation that are not apparent to

others and is quick to react angrily or to counterattack

(7) has recurrent suspicions, without justifi cation, regarding fi delity of spouse or

sexual partner

B. Does not occur exclusively during the course of schizophrenia [Chapter 12], a mood

disorder with psychotic features [Chapter 6], or another psychotic disorder [Chapter

12] and is not due to the direct physiological effects of a general medical condition.

Source: Reprinted with permission from the Diagnostic and Statistical Manual of Mental Disorders,

Text Revision, Fourth Edition, (Copyright 2000) American Psychiatric Association.

Paranoid personality disorder

A personality disorder characterized by

persistent and pervasive mistrust and

suspiciousness, accompanied by a bias to

interpret other people’s motives as hostile.