Personality Disorders 623
Summary of
Dramatic/Erratic
Personality Disorders
The hallmark of antisocial personality disorder
is a persistent disregard for the rights of others,
which may lead these people to violate rules or
laws or to act aggressively. To be diagnosed
with this personality disorder, an individual
must have exhibited symptoms of conduct
disorder before the age of 15. The diagnostic
criteria for antisocial personality disorder over-
lap with aspects of psychopathy. However, psy-
chopathy is defi ned by a more restrictive set of
criteria, which focus on emotional and interper-
sonal characteristics, such as a lack of empa-
thy, as well as antisocial behaviors. In contrast,
for antisocial personality disorder, the focus is
on behaviors, particularly criminal behaviors.
More criminals are diagnosed with antisocial
personality disorder than with psychopathy.
Psychopathy and antisocial personality
disorder are thought to arise from feedback
loops among various factors, including genes
and temperament, lack of empathy, classical and
operant conditioning, abuse or neglect or in-
consistent discipline in childhood, parents’
criminal behavior, and attachment style. Treat-
ment for psychopathy has generally not been
successful; treatment for antisocial person-
ality disorder focuses on modifying specific
behaviors and has some degree of success, at
least temporarily, in motivated individuals.
Borderline personality disorder is character-
ized by volatile emotions, an unstable self-image,
and impulsive behavior in relationships. People
with this disorder have problems with emotional
regulation—which is probably related to their
temperament—and may engage in self-harming
behaviors or try to commit suicide. Factors that
contribute to borderline personality disorder
include the genetic and neurological underpin-
nings of emotional dysregulation, a relatively
low threshold for emotional responsiveness, an
easily changeable sense of self, cognitive distor-
tions, and a history of abuse, neglect, or feeling
invalidated by others. Treatment for borderline
personality may include medication, CBT, DBT,
intensive psychodynamic therapy, and IPT.
The hallmark of histrionic personality dis-
order is attention seeking, usually through ex-
aggerated emotional displays. Symptoms may
also include a sense of boredom or emptiness
and a low tolerance for frustration.
Narcissistic personality disorder is charac-
terized by a grandiose sense of self-importance
and a constant desire for praise and admira-
tion. People with this disorder may also feel a
sense of entitlement, behave arrogantly, and
have difficulty understanding other people’s
points of view.
Thinking like a clinician
In high school and college, Will acted in
school plays. Now in his 30s, he travels a lot,
making presentations for his job, and so has a
lot of independence. He likes the freedom of
not having a boss looking over his shoulder
all the time, and he enjoys making presenta-
tions. Because no one really knows how many
hours he works, he sometimes starts late in
the morning or quits early; then, he heads for
a bar to down a few beers. Occasionally, he
takes whole days off—after he’s had too much
to drink the night before. He’s been through a
series of girlfriends, never staying with one for
more than 6 months. Lately, though, his single
status has been bothering him, and he’s been
wondering why there don’t seem to be any de-
cent women out there.
In what ways does Will seem typical of
someone with a Cluster B (dramatic/erratic)
personality disorder? In what ways is he un-
usual? What would you need to know before
you could decide whether he had a dramatic/
erratic personality disorder? Which specific
personality disorder seems most likely from
the description of him, and why? Why is—
or isn’t—this information enough to make a
diagnosis?Summary of
Fearful/Anxious
Personality Disorders
The hallmark of avoidant personality disorder
is social inhibition, which usually stems from
feeling inadequate or being overly sensitive
to negative evaluation. Although similar to so-
cial phobia, avoidant personality disorder has
criteria that are more pervasive and involves
a more general reluctance to take risks. CBT
methods that are used to treat social phobia
can also be effective with avoidant personal-
ity disorder.
Dependent personality disorder is char-
acterized by submissive and clingy behaviors,
based on fear of separation; these behaviors
are intended to elicit attention, reassurance,
and decision making from other people.
People with dependent personality disorder
are chronically plagued by self-doubt and
consistently underestimate their abilities;
in fact, they may not know how to function
independently.
Obsessive-compulsive personality disor-
der is characterized by preoccupations with
perfectionism, orderliness, and self-control
and by low levels of fl exibility and effi ciency.
These rigid personality traits may lead these
people to have diffi culty prioritizing and mak-
ing decisions, and they are often intolerant of
emotional or “illogical” behavior in others.Thinking like a clinician
Juan and his wife, Beatriz, are from Argentina.
They have been referred to mental health ser-
vices by their family doctor. Beatriz always
brings her husband with her to her doctor’s
appointments, and she wants her husband
in the room during the examination, although
her English is more than suffi cient to express
herself and understand the doctor.
Beatriz and Juan happened to mention at
her last medical visit that she never leaves the
house if Juan isn’t with her. She didn’t see why
she should, because Juan is happy to go with
her wherever she needs to go. She said that
she likes it this way—that she doesn’t feel
“stuck” at home and that Juan pretty much
takes care of whatever she doesn’t feel able
to do.
Before thinking about a possible diagno-
sis, what specifi c areas of Beatriz’s function-
ing would you want to know more about, and
why? What other types of information would
you want to have (for example, about cultural
issues), and why? Might Beatriz be suffering
from an Axis I disorder? If so, which one, and
what would you need to know to be relatively
certain of that? If not, why not? What person-
ality disorder or disorders might she have (or
does she have none)? On what information do
you base your judgment?Key Terms
Personality disorders (p. 567)
Personality (p. 568)
Cluster A personality disorders (p. 572)
Cluster B personality disorders (p. 572)
Cluster C personality disorders (p. 572)
Paranoid personality disorder (p. 581)
Schizoid personality disorder (p. 583)
Schizotypal personality disorder (p. 585)
Antisocial personality disorder (p. 593)
Conduct disorder (p. 593)
Psychopathy (p. 595)
Borderline personality disorder (p. 599)
Histrionic personality disorder (p. 608)
Narcissistic personality disorder (p. 610)
Avoidant personality disorder (p. 613)
Dependent personality disorder (p. 614)
Obsessive-compulsive personality
disorder (p. 617)More Study Aids
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