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Personality Disorders
Marc A. Schuckit, M.D.University of California, San
DiegoVA San Diego Healthcare
System
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GREEK TEMPERAMENTS
Sanguine
Melancholic
Choleric
Phlegmatic
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FREUD
Oral
Anal
Phallic
Genital
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DEFINITIONS Personality - Usual Emotional +
Behavioral Characteristics Personality Traits - Components of
Personality Temperament - Affective Tone,
Intensity, Reactivity Character - Moral + Personality Traits
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PERSONALITY DISORDERS Totality of Emotional +
Behavioral Traits Onset Teens Enduring, Inflexible, Consistent,
Maladaptive Causes Significant Impairment
and/or Distress
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DSM IV PDAxis II10 Diagnoses + NOS +
AppendixPolytheticClusters
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DSM IV PERSONALITY DISORDERS
ParanoidSchizoidSchizotypalAntisocialBorderline
HistrionicNarcissisticAvoidantDependentObsessive-
Compulsive
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CLUSTERSA. Odd or Eccentric
Paranoid Schizotypal
Schizoid
B. Dramatic or ErraticAntisocial Histrionic
Borderline Narcissistic
C. AnxiousAvoidant Obsessive - Compulsive
Dependent
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CHARACTERISTICS OF PD Relation to Axis I 10% - 20% of General Population Gender : ASPD, Schizoid
Avoidant, Dependent Etiological Theories
DynamicBiological / Genetic
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PERSONALITY DISORDERS
Totality of emotional + behavioral traits
Onset teens Enduring, inflexible, consistent,
maladaptive Causes significant impairment
and/or distress
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PARANOID PDPervasive Distrust + Suspiciousness,
Interpret Motives as Evil
4 + of :
Suspicious Feels Attacked
Preoccupation with Distrust Jealous
Won’t Confide Grudges
Misinterprets Motives
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SCHIZOID PDDetached + Few Emotions
4 + of :
Eschew Closeness No Close Friends
Solitary Indifferent
No Sex Interest Cold
Not Enjoy Activities
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SCHIZOTYPAL PDDiscomfort with Relationships, Cognitive
Distortions + Eccentric
5 + of :Ideas of Reference Odd Magical Beliefs
Perceptual Disturbances Odd Thoughts/Speech
Paranoia Inappropriate Affect
Odd Behavior/Appearance Loner
Anxious Socially
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ANTISOCIAL PD (ASPD)
Disregard Rights of Others (and meet Conduct Disorder)
3 + of :
Unlawful Reckless
Deceitful Irresponsible
Impulsive Lack Remorse
Aggressive
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BORDERLINE PDUnstable Relationships, Affect, Self-Image
Plus Impulsiveness
5 + of :Fears Abandonment Mood Shifts
Unstable Relationships Feels Empty
Changing Self-Image Anger
Impulsive Sex, Spending, Temporary Etc Paranoia
Suicidal Behavior
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HISTRIONIC PDExcessive Emotionality, Attention
Seeking
5 + of :
Needs Attention Preens
Seductive Dramatic
Mood Shifts Suggestible
Impressionistic, Exaggerates Vague Speech Relationships
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NARCISSISTIC PDGrandiose, Needs Admiration, Without
Empathy
5 + of :
Self Important Exploitative
Fantasies of Success Lacks Empathy
Feels Special Envious
Needs Admiration Arrogant
Entitled
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AVOIDANT PDInhibited, Inadequate, Sensitive
4 + of : Avoids Social Activity
Reluctant Relationships
Fears Intimacy
Fears Criticism
Avoids New Activities
Sees Self Inferior
Fears Embarrassment
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DEPENDENT PDNeeds to be Taken Care of, Fears Separation
5 + of :
Indecisive Seeks Nurturance
Avoids Responsibility Fears Solitude
Avoids Frantic for Disagreements Relationships
Lacks Initiative Fears Abandonment
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OBSESSIVE-COMPULSIVE PD
Orderliness, Perfectionist, Inflexible
4 + of :
Detail Oriented Unable to Discard
Perfectionism Can’t Delegate
Work Oriented Miserly
Over Conscientious Rigid
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PASSIVE-AGGRESSIVE PD
Negative Attitudes with Passive Resistance to Demands
4 + of :Passive Envious, Resentful
Misunderstood, Exaggerated Unappreciated Complaints
Sullen, Argumentative Defiant then Contrite
Scorns Authority
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PERSONALITY DISORDERS Totality of Emotional +
Behavioral Traits Onset Teens Enduring, Inflexible,
Consistent, Maladaptive Causes Significant
Impairment and/or Distress
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SUMMARY PART IParanoid Suspicious, Jealous, But Not
Psychotic or Unlawful
Schizoid Unemotional, Cold, Indifferent
Schizotypal Odd + Magical Beliefs, Behaviors, Not Paranoid
ASPD Aggressive, Unlawful, Impulsive
Borderline Unstable, Chaotic, Impulsive Not Aggressive or Unlawful
Histrionic Dramatic, Seductive But Not Chaotic
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SUMMARY PART IINarcissistic Self-Centered, Entitled, Lacks
Empathy But Not Unlawful or Chaotic
Avoidant Needs People But Fears Relationships
Dependent Needs Relationships, Indecisive, Fears Abandonment
Obsessive- Rigid, Perfectionist + Inefficient
Compulsive
Passive- Negative Attitudes with Passive Aggressive Resistance to Demands
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INSTRUMENTS FOR PD
Mostly Current StatusSome Focus on
Temperament or Personality Components
Few Consider Full Diagnostic Syndrome