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Reservations Contents  

  1. Paranoid personality disorder.
  2. Schizoid personality disorder.
  3. Schizotypal however, this diagnostic rubric is not recommended for general use because it does not stand out clearly from simple schizophrenia or from schizoid or paranoid personality disorders.
  4. Dissocial (antisocial) personality disorder.
  5. Emotionally unstable (borderline) personality disorder.
  6. Histrionic personality disorder.
  7. Anankastic (obsessive-compulsive) personality disorder.
  8. Anxious (avoidant) personality disorder.
  9. Dependent personality disorder.
  10. Narcissistic Personality Disorder.
  11. Posttraumatic Stress Disorder (PTSD) EXTRA

Diagnosing Personality Disorders

Instead of the milk of human kindness: troubles.

To sort out symptoms of mental disorders and diseases we need diagnostic criteria and other information to guide the good work.

The information provided on this page should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions. The data compiled are for educational uses.

The main sources are (1) ICD-10 Classification of Mental and Behavioural Disorders by the World Health Organisation (WHO), Geneva, 1992, and (2) the Diagnostic and Statistical Manual of Mental Disorders, fourth Edition (DSM-IV) of 1994, by the American Psychiatric Association (APA), Arlington, VA. DSM-IV-TR is a text revision of it from 2000 and replacing DSM-IV. In 2013 came DSM-5. It is much like its predecessor, DSM-4-TR.

To ease understanding, some ways of wording are simplified with no losses of meaning and only scantily, in step with principles of plain English as formulated by Martin Cutts. For example, "for a minimum of" is replaced by "at least", which means just the same and without loss of information. Overseriousness and loosely founded, but studied meticulousness are out of the place, and sacrificing plain English totally is not. [Peg]

The material here was compiled by me some years ago. Note the reservation set annexed to the survey. - TK, 2011

Personality Disorders

A personality disorder is a severe disturbance in the character constitution and behaviour tendencies of the individual. Usually several areas of the personality are involved. Such a disturbance is nearly always associated with considerable personal and social disruption.

Below are the main personality disorders (general diagnostic guidelines). Each has its own pattern of symptoms (shown further down). Moreover, a personality disorder tends to appear in late childhood or adolescence and continues to be manifest into adulthood. Hence, diagnoses are not to be held of value for those younger than sixteen or seventeen years.

Odd, Dramatic, Anxious

To repeat, personality disorders are marked by long-lasting rigid patterns of thought and actions. They are inflexible, pervasive patterns or sets of inner experience and behaviour. They can cause serious problems and impairment of functioning and lessen thriving. To be diagnosed as part of a personality disorder, a conduct pattern must cause significant distress or impairment in personal, social, and/or occupational situations, but that is not all of the criteria that are to be met. Ten personality disorders can be grouped into three clusters:

A: ODD: Odd or eccentric disorders

• Paranoid personality disorder
• Schizoid personality disorder
• Schizotypal personality disorder (see reservatons above)

B: DRAMATIC: Dramatic, emotional, or erratic disorders

• Antisocial personality disorder
• Borderline personality disorder
• Histrionic personality disorder
• Narcissistic personality disorder

C: ANXIOUS: Anxious or fearful disorders

• Avoidant personality disorder
• Dependent personality disorder
• Obsessive-compulsive personality disorder (is not Obsessive-compulsive disorder)

"Personality Disorder NOS"

The DSM-IV contains a category for behavioural patterns that do not match the ten disorders on the list, but nevertheless have the characteristics of some personality disorder; this category is labeled Personality Disorder NOS (Not Otherwise Specified). The previous version of the DSM also contained the Passive-Aggressive Personality Disorder and the Self-Defeating 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.
      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.

There is room for more probing in this terrain:

Luxury Loving

"Luxury loving personality disorder" is not on the list and it is an imperfect world we live in as well.

Many are luxury-loving, and it is theoretically possible to suggest it as a specific mental disorder too maybe related to narcissism, or some obsessive traits - and why not mall sale frenzy as well. However, from tentatively surmising that widespread love of luxury may slowly glide into a marked, subtle inner disease, and to having verified diagnostic criteria to substantiate claims by, the way is long and not easy. Perhaps just such work should be undertaken, for something needs to be done where all is not well.

What we hold on to is the stance that widespread abuse of oneself and others, widespread unequal distribution of goods and good condition on the planet, and not enough caring for about two thirds of humankind, do not need to be overlooked as possible symptoms of things worse than callousness. In the rich countries and in other countries as well, those with power and money seldom share their wealth substantially with the poor. There are exceptions.
      As for rich countries themselves, they spend more on making destructive weapons and warfares than what would it would take to eradicate poverty. That is another part of the tragedy of being human on a polluted, seriously endangered planet. The swinish, overgreedy search for profit by exploitation equals sawing off the branch (soil, earth) to sit on. Stupidity alone may not account for these alarming trends that most citizens adapt to to survive. So maybe still unrecognised illnesses are involved. Are you luxury-loving marked by lack of caring?

Much that is common on this planet is neither beneficial nor healthy. You may suspect character disorders among the "new nobility" that wants to swim in luxury all life long, and among a lot of celebrity admirers too. Regrettably, those with money and power also have influence to bulwark against degraded esteem, so research "upward" can be difficult. A mere suspicion will not do. What is halfway suggested is that it might pay to investigate carefully how far and how widespread love of luxury is, and what criteria may be used to suggest a disease marked by such an overt, common symptom around. In other words, what could be involved is being adapted to a money-and-glamour focused culture, all in all.

To the degree the luxury lover needs to frolic by haughtiness through wealth, a certain lack of healthy play and merry behaviour early in life might be suspected, maybe substantial isolation too. Frolicing in unhealthy and basically unworthy and undignified ways should be investigated as a symptom of something deeper, and not regularly worshipped in common TV entertainment either.

Decay in basic relationships might serve decay of a sort, one that seeks substitutions in riches out of deep disappointments with one's relations.

Also, an urge for goodies as part of the lifestyle might serve as a weak indicator, and so on.

It could also be that developing love of luxury makes one oversentimental, and uncomfortable with less than the strikingly gorgeous allied with fooling innocents.

Check old, deep wounds of the mind (traumas) to see the issue more cogently.

And mind that a suggestive list of items has not been verified, that much work needs to go into verifications that are made use of in common practice. Till then, refrain from using "love of luxury" as a characteriological disorder. If not, you may be called on to prove or document your labelling, and it may not be so pleasant for you.

Diagnostic Advice

  • Most people with severe mental illness are not treated.
  • Therapists often disagree about diagnosis.
  • Patients often deny that they have mental illness.
  • Poor record-keeping obscures treatment response.

GENERAL diagnostic criteria for personality disorders that are not attributable to gross brain damage or disease or to another psychiatric disorder, must meet the following criteria in addition to the specific criteria for any personality disorders:

  1. Markedly dysharmonious attitudes and behaviour, involving usually several areas of functioning, e.g. affectivity, arousal, impulse control, ways of perceiving and thinking, and style of relating to others;
  2. The abnormal behaviour pattern is enduring, of long standing, and not limited to episodes of mental illness;
  3. The abnormal behaviour pattern is pervasive and clearly maladaptive to a broad range of personal and social situations;
  4. The above manifestations always appear during childhood or adolescence and continue into adulthood;
  5. The disorder leads to considerable personal distress but this may only become apparent late in its course;
  6. The disorder is usually, but not invariably, associated with significant problems in occupational and social performance.

A deep problem pattern can be manifested in two or more of these areas:

  • Cognition: perception and interpretation of self, others and events.
  • Affect: the range, intensity, labilit, and appropriateness of emotional response.
  • Interpersonal functioning.
  • Impulse control.

For different cultures and subcultures it may be necessary to develop specific sets of criteria with regard to social norms, rules and obligations. For diagnosing most of the subtypes listed below, clear evidence is usually required for at least three of the specific items in a clinical description list.

To recap: to qualify as a sign of a personality disorder a long-lasting pattern must be rigid and detected across a broad range of personal and social situations. It must lead to obvious and marked distress or impairment in social, occupational, or other important areas of functioning.

Its start can be traced back at least to adolescence or early adulthood. It is not better accounted for as a manifestation or consequence of another mind-disorder, and is not due to the direct physiological effects of a substance e.g. drug or a general medical condition such as head injury.

A blend of legal issues and psychiatric ones also result in this: 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. Antisocial personality disorder cannot be diagnosed in persons under eighteen.

Some Current Problems

Many of the deeply ingrained, maladaptive, lifelong behaviour patterns of personality disorders have been reckoned with for over half a century. Many causes have been speculated on, and there are a few outcomes of rearch too: Child abuse and neglect are risks for personality disorders in adulthood. The sexually abused may develop antisocial and impulsive conduct as grown-ups.

The DSM seeks to represent what the members of the American Psychiatric Association agree on. However, the diagnostic labels require personal interpretation from the users, and idea associations to key terms may be individualised with time, say the brothers Buzan. [Mmb 64-66], and given the blunderbuss nature of entry words that are assembled in groups or "category bags" or are called "pervasive patterns".

"Call a dog a bad name and hang him" has obvious parallells in modern psychiatry. The need for protection of victims of mislabelling stands out. Statistics brings evidence. There is no reason to think that all criminals are in jail or that all mentally disordered ones are taken care of. In fact, two thirds of the seriously mentally disordered ones are not treated. And there is no reason to ignore the facts that many sound persons are wrongly diagnosed and dishonoured thereby, to add to their previous burdens, if any.

Example: Dramatic

Let us venture on an example. if you doubt that someone labelled as theatrically self-dramatising over and over is ill or just an actor (in suspense), check the words. The "bag" called "histrionic" relates to actors, acting, or the theatre, the dramatic and affected performance with artificial emotions, extravagant display of costumes and decor, or some exhibitionist flair. There is a grave risk that immature personality styles may be misunderstood as personality disorders in some conclaves. The thin blue line between who is a good, dramatic actor and a mental "fool of acting", a histrionically disordered fellow, may not be found.

Subjectivity in diagnoses (labelling) work is to be expected and not feared, then. Different people of different cultures, education, and experience draw the lines differently, understand diagnostic keywords idiosyncratically, and live well on top of that, even. Evidence that there there are clear "diagnostic thresholds" between normal and abnormal are either absent or only weakly supported. Much seems to be relative to the diagnosticians too. That is a reason why they often conclude differently in single cases. The chance is that some make a living of acting, others of branding undeveloped actors as mad. And the point is that different experts in diagnosis reach different conclusions. Be that as it may.

Crude Items

"Where you are not known, nobody speaks ill of you." This should bring comfort to the paranoid ones, just as "Most people don't know who you are anyway, so how can everybody hate you?"

Insight is of many kinds and degrees. The often overlooked point is how low the reliability may be in modern diagnoses. But there is room for improvement: evidence suggests that both structured interviews and broader information can improve reliability of diagnosis.

There is some overlapping of criteria among different disorders in the list. A way of dealing with the problem has been to group common personality disorders into three clusters, each group with a set of similar disorders. There is also a "not otherwise specified" basket category. Suffice to say that the evidence is that current diagnostic categories may not reveal all people with personality disorders and who need treatment, or better treatment. The methods have some built-in flaws of inaccuracy and labelling defects, but still are of much use.

Personality disorder symptoms, as with all mental disorders, can vary over time and become much more acute during times of stress in a person's life. One should try to reflect on various interactions between physical health and disease and personality disorders.

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Mainly Personality Disorders

THERE are differences between personality disorders and other mental disorders. For example, the obsessive-compulsive personality disorder (OCPD) is defined differently than the obsessive-compulsive disorder (OCD). In the following you can find personality disorders defined by the concepts that professionals use, with nothing omitted from the central definitions.

Antisocial Personality Disorder

Antisocial (Dissocial) Personality Disorder WHO F60.2

This disorder usually comes to attention because of a gross disparity between behaviour and the prevailing social norms, and chalked out by at least three of the following:

  1. Callous unconcern for the feelings of others;
  2. Gross and persistent attitude of irresponsibility and disregard for social norms, rules and obligations;
  3. Incapacity to maintain enduring relationships, though having no difficulty in establishing them;
  4. Very low tolerance to frustration and a low threshold for discharge of aggression, including violence;
  5. Incapacity to experience guilt and to profit from experience, particularly punishment;
  6. Marked proneness to blame others, or to offer plausible rationalizations, for the behaviour that has brought the patient into conflict with society.

There may also be persistent irritability as an associated feature. Conduct disorder during childhood and adolescence, though not invariably present, may further support the diagnosis.

INCLUDING: amoral, antisocial, asocial, psychopathic, and sociopathic personality (disorder)

EXCLUDING: conduct disorders - emotionally unstable personality disorder

Diagnostic criteria for 301.7 Antisocial Personality Disorder: DSM-IV & DSM-IV-TR

Individuals with this Cluster B Personality Disorder in their actions regularly disregard and violate the rights of others. These conducts may be aggressive or destructive and may involve breaking laws or rules, deceit or theft.

There is a pervasive pattern of disregard for and violation of the rights of others occurring since age 15 years, as indicated by three (or more) of the following:

  1. Failure to conform to social norms with respect to lawful conducts as indicated by repeatedly performing acts that are grounds for arrest.
  2. Deceitfulness, as indicated by repeated lying, use of aliases, or conning others for personal profit or pleasure.
  3. Impulsivity or failure to plan ahead.
  4. Irritability and aggressiveness, as indicated by repeated physical fights or assaults.
  5. Reckless disregard for safety of self or others.
  6. Consistent irresponsibility, as indicated by repeated failure to sustain consistent work conduct or honor financial obligations.
  7. Lack of remorse, as indicated by being indifferent to or rationalizing having hurt, mistreated, or stolen from another.
  8. The individual is at least age 18 years.
  9. There is evidence of Conduct Disorder with onset before age 15 years.
  10. The occurrence of antisocial conduct is not exclusively during the course of Schizophrenia or a Manic Episode.
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Anxious (Avoidant) Personality Disorder

Anxious (Avoidant) Personality Disorder WHO F60.6

PERSONALITY disorder chalked out by at least three of the following:

  1. Persistent and pervasive feelings of tension and apprehension;
  2. Belief that one is socially inept, personally unappealing, or inferior to others;
  3. Excessive preoccupation with being criticized or rejected in social situations;
  4. Unwillingness to become involved with people unless certain of being liked;
  5. Restrictions in lifestyle because of need to have physical security;
  6. Avoidance of social or occupational activities that involve significant interpersonal contact because of fear of criticism, disapproval, or rejection.
Associated features may include hypersensitivity to rejection and criticism.

Diagnostic criteria for 301.82 Avoidant (Anxious) Personality Disorder - DSM-IV

Individuals with this Cluster C Personality Disorder are socially inhibited, usually feel inadequate and are overly sensitive to criticism.

A pervasive pattern of social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation, beginning by early adulthood and present in a variety of contexts, as indicated by four (or more) of the following:

  1. Avoids occupational activities that involve significant interpersonal contact, because of fears of criticism, disapproval, or rejection.
  2. Is unwilling to get involved with people unless certain of being liked.
  3. Shows restraint within intimate relationships because of the fear of being shamed or ridiculed.
  4. Is preoccupied with being criticized or rejected in social situations.
  5. Is inhibited in new interpersonal situations because of feelings of inadequacy
  6. Views self as socially inept, personally unappealing, or inferior to others.
  7. Is unusually reluctant to take personal risks or to engage in any new activities because they may prove embarrassing.

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Borderline Personality Disorder

Emotionally Unstable (Borderline) Personality Disorder - WHO F60.3

There is a marked tendency to act impulsively without considering the consequences, together with affective instability. The ability to plan ahead may be minimal, and outbursts of intense anger may often lead to violence or "behavioural explosions"; these are easily precipitated when impulsive acts are criticized or thwarted by others.

Two variants of this personality disorder are specified, and both share this general theme of impulsiveness and lack of self-control.

Impulsive type:

The predominant traits are emotional instability and lack of impulse control. Outbursts of violence or threatening behaviour are common, particularly in response to criticism by others.

INCLUDING: explosive and aggressive personality (disorder).

EXCLUDING: dissocial personality disorder.

Borderline type:

Several of the marks of emotional instability are present; in addition, the patient's own self-image, aims, and internal preferences (including sexual) are often unclear or disturbed. There are usually chronic feelings of emptiness. A liability to become involved in intense and unstable relationships may cause repeated emotional crises and may be associated with excessive efforts to avoid abandonment and a series of suicidal threats or acts of self-harm (although these may occur without obvious precipitants).

INCLUDING: - borderline personality (disorder)

Diagnostic criteria for 301.83 Borderline Personality Disorder - DSM-IV

Individuals with this Cluster B Personality Disorder behave impulsively and their relationships, self-image, and emotions are unstable.

A pervasive pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsivity beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following:

  1. Frantic efforts to avoid real or imagined abandonment. Note: Do not include suicidal or self-mutilating conduct covered in Criterion 5.
  2. A pattern of unstable and intense interpersonal relationships chalked out by alternating between extremes of idealization and devaluation.
  3. Identity disturbance: markedly and persistently unstable self-image or sense of self.
  4. Impulsivity in at least two areas that are potentially self-damaging (e.g., spending, sex, Substance Abuse, reckless driving, binge eating). Note: Do not include suicidal or self-mutilating conduct covered in Criterion 5.
  5. Recurrent suicidal conduct, gestures, or threats, or self-mutilating conduct.
  6. Affective instability due to a marked reactivity of mood (e.g., intense episodic dysphoria, irritability, or anxiety usually lasting a few hours and only rarely more than a few days).
  7. Chronic feelings of emptiness.
  8. Inappropriate, intense anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights).
  9. Transient, stress-related paranoid ideation or severe dissociative symptoms.

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Dependent Personality Disorder

Dependent Personality Disorder WHO F60.7

Personality disorder marked by at least three of the following:

  1. Encouraging or allowing others to make most of one's important life decisions;
  2. Subordination of one's own needs to those of others on whom one is dependent, and undue compliance with their wishes;
  3. Unwillingness to make even reasonable demands on the people one depends on;
  4. Feeling uncomfortable or helpless when alone, because of exaggerated fears of inability to care for oneself;
  5. Preoccupation with fears of being abandoned by a person with whom one has a close relationship, and of being left to care for oneself;
  6. Limited capacity to make everyday decisions without an excessive amount of advice and reassurance from others.
Associated features may include perceiving oneself as helpless, incompetent, and lacking stamina.

INCLUDING: - asthenic, inadequate, passive, and self-defeating personality (disorder)

Diagnostic criteria for 301.6 Dependent Personality Disorder

Individuals with this Cluster C Personality Disorder use their submissive and clinging conduct toward others to elicit care, depending on them for initiative, reassurance, decision making, and advice.

A pervasive and excessive need to be taken care of that leads to submissive and clinging conduct and fears of separation, beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following:

  1. Has difficulty making everyday decisions without an excessive amount of advice and reassurance from others.
  2. Needs others to assume responsibility for most major areas of his or her life.
  3. Has difficulty expressing disagreement with others because of fear of loss of support or approval. Note: Do not include realistic fears of retribution.
  4. Has difficulty initiating projects or doing things on his or her own (because of a lack of self-confidence in judgment or abilities rather than a lack of motivation or energy).
  5. Goes to excessive lengths to obtain nurturance and support from others, to the point of volunteering to do things that are unpleasant.
  6. Feels uncomfortable or helpless when alone because of exaggerated fears of being unable to care for himself or herself.
  7. Urgently seeks another relationship as a source of care and support when a close relationship ends.
  8. Is unrealistically preoccupied with fears of being left to take care of himself or herself.

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Histrionic Personality Disorder

Histrionic Personality Disorder - WHO F60.4

Personality disorder chalked out by at least three of the following:

  1. Self-dramatization, theatricality, exaggerated expression of emotions;
  2. Suggestibility, easily influenced by others or by circumstances;
  3. Shallow and labile affectivity;
  4. Continual seeking for excitement, appreciation by others, and activities in which the patient is the centre of attention;
  5. Inappropriate seductiveness in appearance or behaviour;
  6. Over-concern with physical attractiveness.
Associated features may include egocentricity, self-indulgence, continuous longing for appreciation, feelings that are easily hurt, and persistent manipulative behaviour to achieve own needs.

INCLUDING: - hysterical and psychoinfantile personality (disorder)

Diagnostic criteria for 301.50 Histrionic Personality Disorder - DSM-IV

Individuals with this Cluster B Personality Disorder exaggerate their emotions and go to excessive lengths to seek attention.

A pervasive pattern of excessive emotionality and attention seeking, beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following:

  1. Is uncomfortable in situations in which he or she is not the center of attention.
  2. Interaction with others is often chalked out by inappropriate sexually seductive or provocative conduct.
  3. Displays rapidly shifting and shallow expression of emotions.
  4. Consistently uses physical appearance to draw attention to self.
  5. Has a style of speech that is excessively impressionistic and lacking in detail.
  6. Shows self-dramatization, theatricality, and exaggerated expression of emotion.
  7. Is suggestible, i.e., easily influenced by others or circumstances.
  8. Considers relationships to be more intimate than they actually are.

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Narcissistic Personality Disorder

Narcissistic Personality Disorder - WHO F60.8

THe ICD-10 does not specifically define the characteristics of this personality disorder. Instead, this disorder is classified in the category "Other Specific Personality Disorders". ICD-10 states that Narcissistic Personality Disorder is "a personality disorder that fits none of the specific rubrics F60.0-F60.7". That is, this personality disorder does not meet the diagnostic criteria for:

  1. F60.0 Paranoid personality disorder
  2. F60.1 Schizoid personality disorder
  3. F60.2 Dissocial (antisocial) personality disorder
  4. F60.3 Emotionally unstable (borderline) personality disorder
  5. F60.4 Histrionic personality disorder
  6. F60.5 Anankastic (obsessive-compulsive) personality disorder
  7. F60.6 Anxious (avoidant) personality disorder
  8. F60.7 Dependent personality disorder
      INCLUDING: - eccentric, "haltlose" type, immature, narcisstic, passive-aggressive, and psychoneurotic personality disorder.

Diagnostic criteria for 301.81 Narcissistic Personality Disorder - DSM-IV & DSM-IV-TR

Individuals with this type of personality disorder have an excessive sense of how important they are. They demand and expect to be admired and praised by others and have limited capacity to appreciate others' perspectives.

A pervasive pattern of grandiosity (in fantasy or conduct), need for admiration, and lack of empathy, beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following:

  1. Has a grandiose sense of self-importance (e.g., exaggerates achievements and talents, expects to be recognized as superior without commensurate achievements).
  2. Is preoccupied with fantasies of unlimited success, power, brilliance, beauty, or ideal love.
  3. Believes that he or she is "special" and unique and can only be understood by, or should associate with, other special or high-status people (or institutions).
  4. Requires excessive admiration.
  5. Has a sense of entitlement, i.e., unreasonable expectations of especially favorable treatment or automatic compliance with his or her expectations.
  6. Is interpersonally exploitative, i.e., takes advantage of others to achieve his or her own ends.
  7. Lacks empathy: is unwilling to recognize or identify with the feelings and needs of others.
  8. Is often envious of others or believes that others are envious of him or her.
  9. Shows arrogant, haughty conducts or attitudes.

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Obsessive-Compulsive Personality Disorder (OCPD)

Anankastic (Obsessive-Compulsive) Personality Disorder - WHO F60.5

Personality disorder chalked out by at least three of the following:

  1. Feelings of excessive doubt and caution;
  2. Preoccupation with details, rules, lists, order, organization or schedule;
  3. Perfectionism that interferes with task completion;
  4. Excessive conscientiousness, scrupulousness, and undue preoccupation with productivity to the exclusion of pleasure and interpersonal relationships;
  5. Excessive pedantry and adherence to social conventions;
  6. Rigidity and stubbornness;
  7. Unreasonable insistence by the patient that others submit to exactly his or her way of doing things, or unreasonable reluctance to allow others to do things;
  8. Intrusion of insistent and unwelcome thoughts or impulses.
      INCLUDING: - compulsive and obsessional personality (disorder) - obsessive-compulsive personality disorder.

EXCLUDING: - obsessive-compulsive disorder.

Diagnostic criteria for 301.4 Obsessive-Compulsive Personality Disorder (OCPD)

Individuals with this sort of personality disorder sacrifice openness, spontaneity, and flexibility to pursue orderliness, control, and perfectionism.

A pervasive pattern of preoccupation with orderliness, perfectionism, and mental and interpersonal control, at the expense of flexibility, openness, and efficiency, beginning by early adulthood and present in a variety of contexts, as indicated by four (or more) of the following:

  1. Is preoccupied with details, rules, lists, order, organization, or schedules to the extent that the major point of the activity is lost.
  2. Shows perfectionism that interferes with task completion (e.g., is unable to complete a project because his or her own overly strict standards are not met).
  3. Is excessively devoted to work and productivity to the exclusion of leisure activities and friendships (not accounted for by obvious economic necessity).
  4. Is overconscientious, scrupulous, and inflexible about matters of morality, ethics, or values (not accounted for by cultural or religious identification).
  5. Is unable to discard worn-out or worthless objects even when they have no sentimental value.
  6. Is reluctant to delegate tasks or to work with others unless they submit to exactly his or her way of doing things.
  7. Adopts a miserly spending style toward both self and others; money is viewed as something to be hoarded for future catastrophes.
  8. Shows rigidity and stubbornness.
Also: anancastia, anancastic, anankastic.

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Paranoid Personality Disorder

Paranoid Personality Disorder - WHO F60.0

Personality disorder chalked out by at least three of the following:

  1. Excessive sensitiveness to setbacks and rebuffs;
  2. Tendency to bear grudges persistently, i.e. refusal to forgive insults and injuries or slights;
  3. Suspiciousness and a pervasive tendency to distort experience by misconstruing the neutral or friendly actions of others as hostile or contemptuous;
  4. A combative and tenacious sense of personal rights out of keeping with the actual situation;
  5. Recurrent suspicions, without justification, regarding sexual fidelity of spouse or sexual partner;
  6. Tendency to experience excessive self-importance, manifest in a persistent self-referential attitude;
  7. Preoccupation with unsubstantiated "conspiratorial" explanations of events both immediate to the patient and in the world at large.
      INCLUDING: - expansive paranoid, fanatic, querulant and sensitive paranoid personality (disorder)

EXCLUDING: - delusional disorder - schizophrenia

Diagnostic criteria for 301.0 Paranoid Personality Disorder - DSM-IV

Individuals with this Cluster A Personality Disorder distrust others and are suspicious of their motives.

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 sufficient basis, that others are exploiting, harming, or deceiving him or her.
  2. Is preoccupied with unjustified doubts about the loyalty or trustworthiness of friends or associates.
  3. Is reluctant to confide 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 justification, regarding fidelity of spouse or sexual partner.
  8. Does not occur exclusively during the course of Schizophrenia, a Mood Disorder With Psychotic Features, or another Psychotic Disorder and is not due to the direct physiological effects of a general medical condition.
Note: If criteria are met prior to the onset of Schizophrenia, add "Premorbid," e.g., "Paranoid Personality Disorder (Premorbid)."

Also: paranoia.

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Schizoid Personality Disorder

Schizoid Personality Disorder - WHO F60.1

Personality disorder chalked out by at least three of the following:

  1. Few, if any, activities, provide pleasure.
  2. Emotional coldness, detachment or flattened affectivity.
  3. Limited capacity to express either warm, tender feelings or anger towards others.
  4. Apparent indifference to either praise or criticism.
  5. Little interest in having sexual experiences with another person (taking into account age).
  6. Almost invariable preference for solitary activities.
  7. Excessive preoccupation with fantasy and introspection.
  8. Lack of close friends or confiding relationships (or having only one) and of desire for such relationships.
  9. Marked insensitivity to prevailing social norms and conventions.
      EXCLUDING: - Asperger's syndrome - delusional disorder - schizoid disorder of childhood - schizophrenia - schizotypal disorder

Diagnostic criteria for 301.20 Schizoid Personality Disorder - DSM-IV

Individuals with this Cluster A Personality Disorder express only a limited range of emotion in social interactions and form few if any close relationships with others.

A pervasive pattern of detachment from social relationships and a restricted range of expression of emotions in interpersonal settings, beginning by early adulthood and present in a variety of contexts, as indicated by four (or more) of the following:

  1. Neither desires nor enjoys close relationships, including being part of a family.
  2. Almost always chooses solitary activities.
  3. Has little, if any, interest in having sexual experiences with another person.
  4. Takes pleasure in few, if any, activities.
  5. Lacks close friends or confidants other than first-degree relatives.
  6. Appears indifferent to the praise or criticism of others.
  7. Shows emotional coldness, detachment, or flattened affectivity.
  8. Does not occur exclusively during the course of Schizophrenia, a Mood Disorder With Psychotic Features, another Psychotic Disorder, or a Pervasive Developmental Disorder and is not due to the direct physiological effects of a general medical condition.
Note: If criteria are met before the onset of Schizophrenia, add "Premorbid," e.g., "Schizoid Personality Disorder (Premorbid)."

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Schizotypal Personality Disorder

Schizotypal Personality Disorder WHO F21

A disorder chalked out by eccentric behaviour and anomalies of thinking and affect which resemble those seen in schizophrenia, although no definite and characteristic schizophrenic anomalies have occurred at any stage. There is no dominant or typical disturbance, but any of the following may be present:

  1. Inappropriate or constricted affect (the individual appears cold and aloof);
  2. Behaviour or appearance that is odd, eccentric, or peculiar;
  3. Poor rapport with others and a tendency to social withdrawal;
  4. Odd beliefs or magical thinking, influencing behaviour and inconsistent with subcultural norms;
  5. Suspiciousness or paranoid ideas;
  6. Obsessive ruminations without inner resistance, often with dysmorphophobic, sexual or aggressive contents;
  7. Unusual perceptual experiences including somatosensory (bodily) or other illusions, depersonalization or derealization;
  8. Vague, circumstantial, metaphorical, overelaborate, or stereotyped thinking, manifested by odd speech or in other ways, without gross incoherence;
  9. Occasional transient quasi-psychotic episodes with intense illusions, auditory or other hallucinations, and delusion-like ideas, usually occurring without external provocation.
The disorder runs a chronic course with fluctuations of intensity. Occasionally it evolves into overt schizophrenia. There is no definite onset and its evolution and course are usually those of a personality disorder. It is more common in individuals related to schizophrenics and is believed to be part of the genetic "spectrum" of schizophrenia.

Diagnostic Guidelines

This diagnostic rubric is not recommended for general use because it is not clearly demarcated either from simple schizophrenia or from schizoid or paranoid personality disorders. If the term is used, three or four of the typical features listed above should have been present, continuously or episodically, for at least two years. The individual must never have met criteria for schizophrenia itself. A history of schizophrenia in a first-degree relative gives additional weight to the diagnosis but is not a prerequisite.

INCLUDING: - borderline schizophrenia - latent schizophrenia - latent schizophrenic reaction - prepsychotic schizophrenia - prodromal schizophrenia - pseudoneurotic schizophrenia - pseudopsychopathic schizophrenia - schizotypal personality disorder.

EXCLUDING: - Asperger's syndrome - schizoid personality disorder

Diagnostic criteria for 301.22 Schizotypal Personality Disorder - DSM-IV & DSM-IV-TR

Individuals with this Cluster A Personality Disorder, like individuals with schizoid personalities, have little capacity for close relationships but they are also eccentric in their conducts, perceptions, and thinking.

A pervasive pattern of social and interpersonal deficits marked by acute discomfort with, and reduced capacity for, close relationships as well as by cognitive or perceptual distortions and eccentricities of conduct, beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following:

  1. Ideas of reference (excluding delusions of reference).
  2. Odd beliefs or magical thinking that influences conduct and is inconsistent with subcultural norms (e.g., superstitiousness, belief in clairvoyance, telepathy, or "sixth sense"; in children and adolescents, bizarre fantasies or preoccupations).
  3. Unusual perceptual experiences, including bodily illusions.
  4. Odd thinking and speech (e.g., vague, circumstantial, metaphorical, overelaborate, or stereotyped).
  5. Suspiciousness or paranoid ideation.
  6. Inappropriate or constricted affect.
  7. Conduct or appearance that is odd, eccentric, or peculiar.
  8. Lack of close friends or confidants other than first-degree relatives.
  9. Excessive social anxiety that does not diminish with familiarity and tends to be associated with paranoid fears rather than negative judgments about self.
  10. Does not occur exclusively during the course of Schizophrenia, a Mood Disorder With Psychotic Features, another Psychotic Disorder, or a Pervasive Developmental Disorder.
Note: If criteria are met prior to the onset of Schizophrenia, add "Premorbid," e.g., "Schizotypal Personality Disorder (Premorbid)."

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Posttraumatic Stress Disorder (PTSD)

When an individual who has been exposed to a traumatic event develops anxiety symptoms, reexperiencing of the event, and avoidance of stimuli related to the event lasting more than four weeks, they may be suffering from this Anxiety Disorder.

Diagnostic criteria for 309.81 Posttraumatic Stress Disorder - DSM-IV & DSM-IV-TR

  1. The person has been exposed to a traumatic event in which both of the following were present:
    1. The person experienced, witnessed, or was confronted with an event or events that involved actual or threatened death or serious injury, or a threat to the physical integrity of self or others.
    2. The person's response involved intense fear, helplessness, or horror. Note: In children, this may be expressed instead by disorganized or agitated conduct.
  2. The traumatic event is persistently reexperienced in one (or more) of the following ways:
    1. Recurrent and intrusive distressing recollections of the event, including images, thoughts, or perceptions. Note: In young children, repetitive play may occur in which themes or aspects of the trauma are expressed.
    2. Recurrent distressing dreams of the event. Note: In children, there may be frightening dreams without recognizable content.
    3. Acting or feeling as if the traumatic event were recurring (includes a sense of reliving the experience, illusions, hallucinations, and dissociative flashback episodes, including those that occur on awakening or when intoxicated). Note: In young children, trauma-specific reenactment may occur.
    4. Intense psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event.
    5. Physiological reactivity on exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event.
  3. Persistent avoidance of stimuli associated with the trauma and numbing of general responsiveness (not present before the trauma), as indicated by three (or more) of the following:
    1. Efforts to avoid thoughts, feelings, or conversations associated with the trauma.
    2. Efforts to avoid activities, places, or people that arouse recollections of the trauma.
    3. Inability to recall an important aspect of the trauma.
    4. Markedly diminished interest or participation in significant activities.
    5. Feeling of detachment or estrangement from others.
    6. Restricted range of affect (e.g., unable to have loving feelings).
    7. Sense of a foreshortened future (e.g., does not expect to have a career, marriage, children, or a normal life span).
  4. Persistent symptoms of increased arousal (not present before the trauma), as indicated by two (or more) of the following:
    1. Difficulty falling or staying asleep.
    2. Irritability or outbursts of anger.
    3. Difficulty concentrating.
    4. Hypervigilance.
    5. Exaggerated startle response.
  5. Duration of the disturbance (symptoms in Criteria B, C, and D) is more than one month.
  6. The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.
Specify if:
Acute: if duration of symptoms is less than three months
Chronic: if duration of symptoms is three months or more.

Specify if:
With Delayed Onset: if onset of symptoms is at least six months after the stressor.

Also: Acute Stress Disorder, battle fatigue, gross stress reaction, shell shock.

Contents


Diagnostic criteria of personality disorders, Literature  

Antony, Martin M., and David H. Barlow, eds. Handbook of Assessment and Treatment Planning for Psychological Disorders. New York: The Guilford Press, 2002.

APA (American Psychiatric Association). Diagnostic and Statistical Manual of Mental Disorders. 5th ed. (DSM-5). London: APA, 2013.

Babiak, Paul, and Robert D. Hare. Snakes in Suits: When Psychopaths Go to Work. E-book ed. New York: HarperCollins, 2007.

Ehrman, Bart D. How Jesus Became God: The Exaltation of a Jewish Preacher from Galilee. New York: HarperOne, 2014.

Gossop, Michael. Theories of Neurosis. With a Foreword by H. J. Eysenck. New York: Springer-Verlag, 1981.

Hamilton, William L. Saints and Psychopaths. San Jacinto, CA: Dharma Audio Network Associates, 1995.

Hare, Robert. Without Conscience: The Disturbing World of the Psychopaths among Us. New York: The Guilford Press, 1999.

Kantor, Martin. The Psychopathy of Everyday Life: How Antisocial Personality Disorder Affects All of Us. Westport, CT: Praeger, 2006.

Livesley, W. John. Practical Management of Personality Disorder. New York: The Guilford Press, 2003.

Morrison, James. DSM-5 Made Easy: The Clinician's Guide to Diagnosis.. New York: The Guilford Press, 2014.

Paris, Joel. Personality Disorders over Time: Precursors, Course, and Outcome. Arlington, VA: American Psychiatric Publishing, 2003.

Patrick, Christopher J. ed. Handbook of Psychopathy. New York: The Guilford Press, 2006.

Ratcliffe, Susan, ed. The Oxford Dictionary of Thematic Quotations. New York: Oxford University Press, 2000.

Ronningstam, Elsa. Identifying and Understanding the Narcissistic Personality. New York: Oxford University Press, 2005.

Sperry, Len, Jon Carlson, Jill Duba Sauerheber, and Jon Sperry, eds. Psychopathology and Psychotherapy: DSM-5 Diagnosis, Case Conceptualization, and Treatment. 3rd ed. Hove, East Sussex: Routledge, 2015.

Stone, Michael H. Personality Disordered Patients: Treatable and Untreatable. Arlington, VA: American Psychiatric Publishing, 2006.

Taylor, Michael Alan, and Nutan Atre Vaidya. Descriptive Psychopathology: The Signs and Symptoms of Behavioral Disorders. E-book ed. Cambridge: Cambridge University Press, 2009. Vaknin, Sam. Narcissistic and Psychopathic Leaders. Prague: Narcissus Publications, 2009. Mmb: Buzan, Tony, with Barry Buzan. The Mind Map Book. Rev. ed. London: BBC Books, 1995.

Peg: Cutts, Martin. The Plain English Guide. Oxford: Oxford University Press, 1996.

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