A personality disorder is a disorder in which someone's behavior or "inner experience" is not considered normal for their culture. These symptoms are often apparent from childhood, but are not diagnosable until adulthood.
General Personality Disorder
Duration – long term/lifelong
Onset – around age 15, diagnosis can only happen after age 18
Symptoms:
Patterns of inner experience and behavior not normal for culture in two or more:
Cognitive
Affective
Interpersonal functioning
Impulse control
Significant distress of inflexible and pervasive behaviors over long duration
Cluster A
Paranoid Personality Disorder F60.0
Onset – begins by early adulthood
Symptoms: Enduring pattern of behavior demonstrating suspicion and distrust of others beginning early in adulthood. At least four of these are present:
Believes others are out to harm or take advantage of him without basis
Preoccupation with doubts of other's loyalty or ability to trust friends and those around him
Reticent to trust others, believing information will be used against him
Reads threatening or humiliating messages into statements or events
Holds grudges
Believes character or reputation is under attack when no evidence is apparent to those around him
Ongoing suspicions spouse/significant other is engaging in sexual impropriety with another
Differential:
Other Mental Disorders with Psychotic Symptoms – (personality sx present before psychosis)
Paranoid Traits Associated with Physical Handicaps – (physical cause)
Other Personality Disorders and Personality Traits – (specific criteria)
Schizoid Personality Disorder F60.1
Onset – by adulthood
Symptoms: Enduring pattern of behavior demonstrating detachment from others and limited or restricted affect in social settings beginning early in adulthood. At least four of these are present:
Does not want or prefer close interpersonal relationships, inclusive of familial ones
Selects solitary activities almost exclusively
Has minimal or no interest in sexual activity with another
Has pleasure from few or no activities
Outside of immediate family members, has no close friends or individuals in whom he will confide
Is indifferent when either criticized or praised by another
Demonstrates emotional detachment or flattened affect
Differential:
Autism Spectrum Disorder – (impaired social interaction-specific interests)
Schizotypal Personality Disorder – (cognitive and perceptual distortions)
Avoidant Personality Disorder – (emotional instability/discomfort)
Obsessive-Compulsive Personality Disorder (obsession/devotion)
Schizotypal Personality Disorder F21
Symptoms: Enduring pattern of behavior demonstrating interpersonal deficits and social awkwardness associated with extreme discomfort, limited capacity for close relationships, eccentric behavior or distorted thoughts beginning early in adulthood. At least four of these are present:
Ideas of reference (not delusions of reference)
Odd beliefs that has influence over behavior, inconsistent with cultural norms; magical thinking
Unusual perceptual experiences, which may include bodily illusions
Odd cognitions and speech
Suspicions or paranoid ideations
Constricted or affect not appropriate to context
Eccentric, odd. or peculiar appearance or behavior
Outside of first-degree relatives there are no close friends or confidants
Paranoid fears fuel social anxiety, not diminishing over time or with familiarity
Differential:
Neurodevelopmental Disorders – (neurological in nature)
Paranoid Personality Disorder – (lack of magical thinking)
Schizoid Personality Disorder - (lack of magical thinking)
Avoidant Personality Disorder - (lack of magical thinking)
Narcissistic Personality Disorder - (social anxiety not feeling better than others)
Borderline Personality Disorder – (flat affect and odd beliefs not emotional)
Cluster B Personality Disorders
Antisocial Personality Disorder F60.2
Onset – criteria met since age 15 (only diagnosable at 18)
Symptoms: Enduring pattern of behavior demonstrating lack of regard for and violations of the rights of others beginning early in adulthood. At least three of these are present:
Repeated violations of the law, involving significant violations of social norms
Lying or deceiving for the purpose of exploiting others
Excessive risk-taking or not considering outcomes, taking precautions, or making necessary preparations
Anger and aggression demonstrated by violence or physical acting out
Irresponsibility and carelessness for the safety of human life
Poor work performance, lack of consistency, or not meeting financial commitments
Lacking empathy or remorse for others harmed by the individual-s behavior, or justifying the impact of their behavior on another despite having committed a clear violation
Differential:
Schizophrenia – (psychosis)
Bipolar Disorders – (episodes)
Narcissistic Personality Disorder – (impulsivity/lack of remorse)
Histrionic Personality Disorder – (sexual tendency not there)
Borderline Personality Disorder – (not as emotional/tearful)
Criminal Behavior not Associated with a Personality Disorder – (criteria)
Borderline Personality Disorder F60.3
Onset – average early adulthood
Symptoms:
Avoidance of real or imagined abandonment
Unstable/intense interpersonal relationships
Marked and persistent unstable self-image
Impulsivity through two: spending, sex, substance, reckless driving, binging)
Recurrent suicidal behavior/gestures/threats/self harm
Instability due to reactivity of mood lasting few hours and RARELY few days
Chronic feelings of emptiness
Uncontrollable anger
Paranoid ideation related to stress (or severe dissociative symptoms)
Differential:
Histrionic Personality Disorder – (sexual aspect)
Narcissistic Personality Disorder – (grandiosity)
Antisocial Personality Disorder – (lack of remorse)
Depressive Disorders – (depression with lack of others)
Bipolar Disorders (episodes/not life long)
Schizotypal Personality Disorder – (paranoid/fearful)
Paranoid Personality Disorder – (paranoid/fearful)
Dependent Personality Disorder – (marked dependence)
Histrionic Personality Disorder F60.4
Symptoms: Enduring pattern of behavior demonstrating highly emotional or excessive attention seeking beginning in early adulthood as evidenced by at least five of these:
Need to be at the center of attention
Engagement with others is often provocative, seductive, or sexual, even when to conducting one's self in such a manner is not appropriate to the setting or the relationship, even exhibitionistic
Emotional expression is often shallow, vacillating quickly
Attention seeking is often through dress, style, grooming, or other aspects of appearance
Speech may be impressionistic or vague
The individual may be especially good at storytelling, often spinning stories to create a better tale than truth, exaggerating what has occurred for dramatic flare
The individual is easily persuaded, susceptible to circumstances or desires of others
Relationships are often felt to be very intimate, close, or cherished, when in fact the other party may not consider the relationship to be more than an acquaintanceship because of the limited nature of the relationship
Differential:
Borderline Personality Disorder – (sexual/attention seeking)
Antisocial Personality Disorder – (lack of remorse/avoidance)
Narcissistic Personality Disorder – (higher self esteem)
Narcissistic Personality Disorder F60.81
Symptoms: Enduring pattern of behavior demonstrating preoccupation with power and prestige, the need to both have and maintain both,beginning early in adulthood as evidenced by at least five of these:
Belief that one is better than others, exaggerates accomplishments, and demands recognition
Fantasies of limitless power, attraction, intelligence, and perfect love
Belief that one is distinctive and one-of-a kind, unable to be understood by common people, requiring someone of equally high-minded status, or an institution of a commensurate level
Demands constant admiration and praise
Believes they are worthy of things or treatment that has not been earned, and that others should bend to their will
Works to achieve own ends, regardless of the cost or impact on others
Does not have empathy for others
Envies or is jealous of what others have, or believes others are jealous of what he or she has
Demonstrates tough-minded, egotistical, arrogant manner
Differential:
Borderline Personality Disorder – (grandiosity)
Antisocial Personality Disorder – (lack of aggression)
Histrionic Personality Disorder – (doesn’t seduce)
Mania or Hypomania – (duration)
Obsessive-Compulsive Personality Disorder – (lack of obsessive compulsions)
Schizotypal Personality Disorder – (lack of avoidance)
Paranoid Personality Disorder – (lack of avoidance)
Cluster C Personality Disorders
Avoidant Personality Disorder F60.6
Onset – usually childhood through adolescence and early adulthood
Symptoms: Enduring pattern of behavior demonstrating a longstanding pattern of social inhibition, going to great lengths to avoid social interactions, feeling somehow deficient or lacking in what it takes to be accepted beginning early in adulthood. At least four of these are present:
Holds jobs that minimize interpersonal engagement to avoid hurt and pain associated with being criticized, rejected, and
Feeling the weight of disapproval by others
Does not engage with others without certainty of acceptance
Holds back in interpersonal relationships fearing humiliation and shame
Is constantly concerned about being rejected or judged in social settings
When entering a new relationship, holds back out of fears of failure or not being good enough
Believes he or she is not as good as others, will fail in a social context, or that others view them as generally undesirable
Does not risk in new settings or try new things believing they will embarrass themselves
Differential:
Social Anxiety Disorder (Social Phobia) – (avoidance due to anxiety)
Agoraphobia – (avoidance only leaving home)
Dependent Personality Disorder – (reliance on a specific person)
Schizoid Personality Disorder – (psychosis)
Schizotypal Personality Disorder – (psychosis)
Paranoid Personality Disorder – (paranoid sx)
Dependent Personality Disorder F60.7
Onset – begins by early adulthood
Symptoms: Enduring pattern of behavior demonstrating an extreme need to have their psychological needs met by another, fearing separation and doing what is required to remain attached to another beginning early in adulthood. At least five of these are present:
Struggles to make daily decisions without input and encouragement
Requires others to take responsibility on issues impacting any significant life area
Divergence of opinion with another is not tolerable due to disapproval fears
Poor self-confidence causes sufficient self-doubt to hinder starting new projects or trying new things on his or her own
Seeks nurturance by any means necessary, even to the point of doing things one would not otherwise ever do to gain support or nurturing
Suffers intense fears of being defenseless when alone
Engages in serial relationships to avoid being alone and continue to get the needed relationship support and associated care
Fears being left to fend alone
Differential:
Depressive Disorders – (depression, but lack of intense fear of loneliness)
Panic Disorder – (panic attacks – can be comorbid)
Agoraphobia – (not fear of being alone fear of leaving home)
Borderline Personality Disorder - (fear of loneliness not abandonment)
Histrionic Personality Disorder – (seductive behavior)
Avoidant Personality Disorder – (overall avoidance, not just dependence)
Obsessive-Compulsive Personality Disorder F60.5
Onset – begins by early adulthood
Symptoms: Enduring pattern of behavior demonstrating feelings of doubt, extreme conscientiousness, preoccupation and fanatical attention to detail, rigidity, demandingness, and perfectionism, present across multiple life areas beginning early in adulthood. At least 4 of these are present:
Loses the point of why they are doing something because of their rigid focus on how to do it
Cannot complete an activity because of the perfectionism surrounding what they require of themselves
Works to the exclusion of social outlets (e.g. relationships, hobbies, family), unless demanded by ecologically sound reasons
Inconsistent with their own spiritual beliefs or cultural values, the individual hold to a strict, inflexible moral or ethical code
Keeps objects that have no monetary, sentimental, or other value or purpose because they cannot discard them
Struggles to delegate or to team work unless the other party agrees to uphold his or her standards and desired ways of doing something
Hoards finances in the event of a future disaster, refusing to spend a penny more than required on self or others
Is rigid and inflexible
Differential:
Obsessive-Compulsive Disorder – (lack of presence of true obsession and compulsions)
Hoarding Disorder – (major hoarding, main issue)
Narcissistic Personality Disorder – (perfectionism and self-criticism
Antisocial Personality Disorder – (self-criticism)
Schizoid Personality Disorder – (psychosis)
Other Specified Personality Disorder F60.89
Unspecified Personality Disorder F60.9
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