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EspañolPERSONALITY DISORDER
'Personality disorder', formerly referred to as a ''Characterological disorder'' is a class of mental disorder characterized by rigid and on-going patterns of thought and action. The underlying belief systems informing these patterns are referred to as fixed fantasies. The inflexibility and pervasiveness of these behavioral patterns often cause serious personal and social difficulties, as well as a general impairment of functioning.
Personality disorders are defined by the American Psychiatric Association as "''an enduring pattern of inner experience and behavior that deviates markedly from the expectations of the culture of the individual who exhibits it''". [1] These patterns, as noted, are inflexible and pervasive across many situations, due in large part to the fact that such behavior is ego-syntonic (i.e., the patterns are consistent with the ego integrity of the individual), and therefore, perceived to be appropriate by that individual. The onset of these patterns of behavior can typically be traced back to the beginning of adulthood, and, in rare instances, early adolescence. [1]
Personality disorders are noted on Axis II of the Diagnostic and Statistical Manual of Mental Disorders, or DSM-IV-TR (fourth edition, text revision), of the American Psychiatric Association.
Diagnosis of a personality disorder must satisfy the following general criteria in addition to the specific criteria listed under the specific personality disorder under consideration.
A. Experience and behavior that deviates markedly from the expectations of the individual's culture. This pattern is manifested in two (or more) of the following areas:
:# cognition (perception and interpretation of self, others and events)
:# affect (the range, intensity, lability, and appropriateness of emotional response)
:# interpersonal functioning
:# impulse control
B. The enduring pattern is inflexible and pervasive across a broad range of personal and social situations.
C. The enduring pattern leads to clinically significant distress or impairment in social, occupational, or other important areas of functioning.
D. The pattern is stable and of long duration and its onset can be traced back at least to adolescence or early adulthood.
E. The enduring pattern is not better accounted for as a manifestation or consequence of another mental disorder.
F. The enduring pattern is not due to the direct physiological effects of a substance or a general medical condition such as head injury.
People under 18 years old who fit the criteria of a personality disorder are usually not diagnosed with such a disorder, although they may be diagnosed with a related disorder. In order to diagnose an individual under the age of 18 with a personality disorder, symptoms must be present for at least one year. Antisocial personality disorder, by definition, cannot be diagnosed at all in persons under 18.
The DSM-IV lists ten personality disorders, grouped into three clusters. The DSM also contains a category for behavioral patterns that do not match these ten disorders, but nevertheless exhibit characteristics of a personality disorder. This category is labeled ''Personality Disorder NOS'' (Not Otherwise Specified).
''Cluster A'' (odd or eccentric disorders)
:
★ Paranoid personality disorder
:
★ Schizoid personality disorder
:
★ Schizotypal personality disorder
''Cluster B'' (dramatic, emotional, or erratic disorders)
:
★ Antisocial personality disorder
:
★ Borderline personality disorder
:
★ Histrionic personality disorder
:
★ Narcissistic personality disorder
''Cluster C'' (anxious or fearful disorders)
:
★ Avoidant personality disorder
:
★ Dependent personality disorder (''not'' the same as Dysthymia)
:
★ Obsessive-compulsive personality disorder (''not'' the same as Obsessive-compulsive disorder)
The revision of the previous edition of the DSM, DSM-III-R, also contained the ''Passive-Aggressive Personality Disorder'', the ''Self-Defeating Personality Disorder'', and the ''Sadistic Personality Disorder''. Passive-Aggressive Personality Disorder is a pattern of negative attitudes and passive resistance in interpersonal situations. Self-defeating personality disorder is characterised by behaviour that consequently undermines the person's pleasure and goals. Sadistic Personality Disorder is a pervasive pattern of cruel, demeaning, and aggressive behavior. These categories were removed in the current version of the DSM, because it is questionable whether these are separate disorders. Passive-Aggressive Personality Disorder and Depressive personality disorder were placed in an appendix of DSM-IV for research purposes.
A study of almost 600 male college students, averaging almost 30 years of age and who were not drawn from a clinical sample, examined the relationship between childhood experiences of sexual and physical abuse and presently reported personality disorder symptoms. Childhood abuse histories were found to be definitively associated with greater levels of symptomatology. Severity of abuse was found to be statistically significant, but clinically negligible, in symptomatology variance spread over Cluster A, B and C scales. Miller and Lisak. Journal of Interpersonal Violence. June 1999
Child abuse and neglect consistently evidence themselves as antecedent risks to the development of personality disorders in adulthood. In this particular study, efforts were taken to match retrospective reports of abuse with a clinical population that had demonstrated psychopathology from childhood to adulthood who were later found to have experienced abuse and neglect. The sexually abused group demonstrated the most consistently elevated patterns of psychopathology. Officially verified physical abuse showed an extremely strong role in the development of antisocial and impulsive behavior. On the other hand, cases of abuse of the neglectful type that created childhood pathology were found to be subject to partial remission in adulthood. Cohen, Patricia, Brown, Jocelyn, Smailes, Elizabeth. "Child Abuse and Neglect and the Development of Mental Disorders in the General Population" Development and Psychopathology. 2001. Vol 13, No 4, pp981-999. ISSN 0954-5794
1. Diagnostic and Statistical Manual of Mental Disorders
2. Diagnostic and Statistical Manual of Mental Disorders
★ American Psychiatric Association. (2000). Diagnostic and Statistical Manual of Mental Disorders. 4th ed. (text revision). (DSM-IV-TR). Arlington, VA.
★ Marshall, W. & Serin, R. (1997) Personality Disorders. In Sm.M. Turner & R. Hersen (Eds.) Adult Psychopathology and Diagnosis. New York: Wiley. 508-541
★ Millon, Theodore (and Roger D. Davis, contributor) - ''Disorders of Personality: DSM IV and Beyond'' - 2nd ed. - New York, John Wiley and Sons, 1995 ISBN 0-471-01186-X
★ Fatal Flaws: Navigating Destructive Relationships With People With Disorders of Personality and Character, by Stuart C. Yudofsky, M.D. ISBN 1-58562-214-1
★ Anxiety disorder
★ Mood disorder
★ God complex
★ International Center for the Study of Psychiatry and Psychology
★ Personality psychology
★ Psychopathy
★ Eccentricity
★ Depression
★ List of Personality disorders
★ The Institute for Advanced Studies in Personology and Psychopathology the official website for Theodore Millon, Ph.D., D.Sc.
★ Personality Disorders Foundation
★ National Personality Disorder website for England
★ Overview of personality disorders
★ An exercise for students which illustrates behaviour that is typical of people with various personality disorders
★ National Mental Health Association Personality Disorder Fact Sheet
★ Personality Disorder test
★ Personality Disorders Motivation and Weapons
★ Personality Diagnostic Questionnaire (PDQ) web site
★ On-line test based on the PDQ-4
Personality disorders are defined by the American Psychiatric Association as "''an enduring pattern of inner experience and behavior that deviates markedly from the expectations of the culture of the individual who exhibits it''". [1] These patterns, as noted, are inflexible and pervasive across many situations, due in large part to the fact that such behavior is ego-syntonic (i.e., the patterns are consistent with the ego integrity of the individual), and therefore, perceived to be appropriate by that individual. The onset of these patterns of behavior can typically be traced back to the beginning of adulthood, and, in rare instances, early adolescence. [1]
DSM-IV-TR criteria
Personality disorders are noted on Axis II of the Diagnostic and Statistical Manual of Mental Disorders, or DSM-IV-TR (fourth edition, text revision), of the American Psychiatric Association.
General diagnostic criteria
Diagnosis of a personality disorder must satisfy the following general criteria in addition to the specific criteria listed under the specific personality disorder under consideration.
A. Experience and behavior that deviates markedly from the expectations of the individual's culture. This pattern is manifested in two (or more) of the following areas:
:# cognition (perception and interpretation of self, others and events)
:# affect (the range, intensity, lability, and appropriateness of emotional response)
:# interpersonal functioning
:# impulse control
B. The enduring pattern is inflexible and pervasive across a broad range of personal and social situations.
C. The enduring pattern leads to clinically significant distress or impairment in social, occupational, or other important areas of functioning.
D. The pattern is stable and of long duration and its onset can be traced back at least to adolescence or early adulthood.
E. The enduring pattern is not better accounted for as a manifestation or consequence of another mental disorder.
F. The enduring pattern is not due to the direct physiological effects of a substance or a general medical condition such as head injury.
People under 18 years old who fit the criteria of a personality disorder are usually not diagnosed with such a disorder, although they may be diagnosed with a related disorder. In order to diagnose an individual under the age of 18 with a personality disorder, symptoms must be present for at least one year. Antisocial personality disorder, by definition, cannot be diagnosed at all in persons under 18.
List of personality disorders defined in the DSM
The DSM-IV lists ten personality disorders, grouped into three clusters. The DSM also contains a category for behavioral patterns that do not match these ten disorders, but nevertheless exhibit characteristics of a personality disorder. This category is labeled ''Personality Disorder NOS'' (Not Otherwise Specified).
''Cluster A'' (odd or eccentric disorders)
:
★ Paranoid personality disorder
:
★ Schizoid personality disorder
:
★ Schizotypal personality disorder
''Cluster B'' (dramatic, emotional, or erratic disorders)
:
★ Antisocial personality disorder
:
★ Borderline personality disorder
:
★ Histrionic personality disorder
:
★ Narcissistic personality disorder
''Cluster C'' (anxious or fearful disorders)
:
★ Avoidant personality disorder
:
★ Dependent personality disorder (''not'' the same as Dysthymia)
:
★ Obsessive-compulsive personality disorder (''not'' the same as Obsessive-compulsive disorder)
Revisions and exclusions from past DSM editions
The revision of the previous edition of the DSM, DSM-III-R, also contained the ''Passive-Aggressive Personality Disorder'', the ''Self-Defeating Personality Disorder'', and the ''Sadistic Personality Disorder''. Passive-Aggressive Personality Disorder is a pattern of negative attitudes and passive resistance in interpersonal situations. Self-defeating personality disorder is characterised by behaviour that consequently undermines the person's pleasure and goals. Sadistic Personality Disorder is a pervasive pattern of cruel, demeaning, and aggressive behavior. These categories were removed in the current version of the DSM, because it is questionable whether these are separate disorders. Passive-Aggressive Personality Disorder and Depressive personality disorder were placed in an appendix of DSM-IV for research purposes.
Etiological Studies
A study of almost 600 male college students, averaging almost 30 years of age and who were not drawn from a clinical sample, examined the relationship between childhood experiences of sexual and physical abuse and presently reported personality disorder symptoms. Childhood abuse histories were found to be definitively associated with greater levels of symptomatology. Severity of abuse was found to be statistically significant, but clinically negligible, in symptomatology variance spread over Cluster A, B and C scales. Miller and Lisak. Journal of Interpersonal Violence. June 1999
Child abuse and neglect consistently evidence themselves as antecedent risks to the development of personality disorders in adulthood. In this particular study, efforts were taken to match retrospective reports of abuse with a clinical population that had demonstrated psychopathology from childhood to adulthood who were later found to have experienced abuse and neglect. The sexually abused group demonstrated the most consistently elevated patterns of psychopathology. Officially verified physical abuse showed an extremely strong role in the development of antisocial and impulsive behavior. On the other hand, cases of abuse of the neglectful type that created childhood pathology were found to be subject to partial remission in adulthood. Cohen, Patricia, Brown, Jocelyn, Smailes, Elizabeth. "Child Abuse and Neglect and the Development of Mental Disorders in the General Population" Development and Psychopathology. 2001. Vol 13, No 4, pp981-999. ISSN 0954-5794
References
1. Diagnostic and Statistical Manual of Mental Disorders
2. Diagnostic and Statistical Manual of Mental Disorders
Further reading
★ American Psychiatric Association. (2000). Diagnostic and Statistical Manual of Mental Disorders. 4th ed. (text revision). (DSM-IV-TR). Arlington, VA.
★ Marshall, W. & Serin, R. (1997) Personality Disorders. In Sm.M. Turner & R. Hersen (Eds.) Adult Psychopathology and Diagnosis. New York: Wiley. 508-541
★ Millon, Theodore (and Roger D. Davis, contributor) - ''Disorders of Personality: DSM IV and Beyond'' - 2nd ed. - New York, John Wiley and Sons, 1995 ISBN 0-471-01186-X
★ Fatal Flaws: Navigating Destructive Relationships With People With Disorders of Personality and Character, by Stuart C. Yudofsky, M.D. ISBN 1-58562-214-1
See also
★ Anxiety disorder
★ Mood disorder
★ God complex
★ International Center for the Study of Psychiatry and Psychology
★ Personality psychology
★ Psychopathy
★ Eccentricity
★ Depression
★ List of Personality disorders
External links
★ The Institute for Advanced Studies in Personology and Psychopathology the official website for Theodore Millon, Ph.D., D.Sc.
★ Personality Disorders Foundation
★ National Personality Disorder website for England
★ Overview of personality disorders
★ An exercise for students which illustrates behaviour that is typical of people with various personality disorders
★ National Mental Health Association Personality Disorder Fact Sheet
★ Personality Disorder test
★ Personality Disorders Motivation and Weapons
★ Personality Diagnostic Questionnaire (PDQ) web site
★ On-line test based on the PDQ-4
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