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PERSONALITYDISORDERS

Personality disorders, formerly known as character

disorders, make up a class of heterogeneous mental

disorders characterized by chronic, maladaptive, and

rigid patterns of cognition, affect, and behavior. They

are coded on Axis II of the American Psychiatric

Association’s Diagnostic and Statistical Manual of

Mental Disorders, fourth edition (DSM-IV) and reflect

patterns of thought, affect, and behavior that deviate

from the expectations of a person’s culture and impair

social and occupational functioning. Some, but not

all, cause emotional distress. Personality disorders do

not stem from inadequate reactions to acute stress,

but rather, they develop gradually and are expressed

in adolescence or early adulthood. Many traits associ-

ated with personality disorders may be shared by

nondisordered individuals. Although the signs and

symptoms of personality disorders may describe char-

acteristics that all people exhibit from time to time to

a certain extent, a personality disorder is defined by

the maladaptive pervasiveness and inflexibility of cer-

tain character traits.

Specific Personality Disorders

The DSM-IVarranges personality disorders into three

clusters on the basis of similarities among the disorders.

Cluster A:Individuals with these disorders often seem odd

or eccentric. The symptoms of these disorders are some-

what similar to the less severe symptoms of schizophrenia,

especially in its prodromal or residual phases. This cluster

includes paranoid, schizoid, and schizotypal personality

disorders.

Cluster B:Individuals with these disorders are com-

monly described as dramatic, impulsive, and erratic.

This cluster includes histrionic, narcissistic, antisocial,

and borderline personality disorders.

Cluster C:Individuals with these disorders often present

as anxious and fearful. It can be difficult to distinguish

these personality disorders from the anxiety-based Axis

I disorders in some individuals. This cluster includes

avoidant, dependent, and obsessive-compulsive person-

ality disorders.

PPaarraannooiidd PPeerrssoonnaalliittyy DDiissoorrddeerr

Individuals with paranoid personality disorder

(PPD) are suspicious of others, expecting to be mis-

treated by others. They expect harm to come to them-

selves and are sensitive to any evidence of impending

attacks, without sufficient basis or without consider-

ing alternative explanations. They tend to see them-

selves as blameless, instead finding fault for their

misfortunes in others, and they are likely to look for

clues that validate their expectations. They are preoc-

cupied with doubts about the loyalty or trustworthi-

ness of others and are, therefore, unlikely to confide

in others. They are hypersensitive in interactions with

others, often ascribing pejorative intent to even benign

remarks or events. Behaviorally, they are often

described as “vigilant,” and their interpersonal rela-

tionships are marked by hostility. Their internal anxi-

ety is related to their almost constant fear of being

harmed by others. They commonly bear grudges and

are unlikely to forgive perceived slights, often react-

ing with anger. Although some individuals diagnosed

with PPD exhibit transient psychotic symptoms (e.g.,

persecutory delusions), they are typically in contact

with reality and do not exhibit the perceptual distur-

bances and cognitive and behavioral disorganization

often found in psychoses. Some research has sug-

gested that PPD may be more closely related to delu-

sional disorder than schizophrenia. PPD occurs more

frequently in men and is most likely comorbid with

schizotypal, avoidant, and borderline personality dis-

orders. Its prevalence rate in the general population is

between 2% and 4%, and its prevalence in outpatient

psychiatric settings is about 4%.

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