Personality Disorders

by

Edelyn Verona, Sean McKinley, M. Sima Finy

• LAST REVIEWED: 25 October 2017
• LAST MODIFIED: 25 October 2017
• DOI: 10.1093/obo/9780199828340-0082

Introduction

Personality disorders (PDs) are defined in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5; published by the American Psychiatric Association in 2013) as “an enduring pattern of inner experience and behavior that deviates markedly from the expectations of the individual’s culture, is pervasive and inflexible, has an onset in adolescence or early adulthood, and leads to distress or impairment” (p. 645). Although broad in scope, this definition is meant to distinguish PDs from other psychological disorders that are less clearly related to enduring personality. Indeed, as of 1980, in DSM-III, PDs were introduced in a different “axis” from other disorders, such as mood or anxiety disorders, ensuring that clinicians pay attention to acute disorders as well as personality-based problems in living. The former were classified under Axis I, or “Clinical Disorders,” representing acute manifestations of illness (e.g., schizophrenia, panic disorder), whereas PDs were classified under Axis II (along with mental retardation) in order to capture inflexible personality traits that have become problematic and that require psychological attention. However, with the publication of DSM-5, the multi-axial system has been eliminated in favor of a general scheme that places all disorders (clinical and personality) on the same diagnostic plane. In DSM-5, ten distinct PDs are listed, organized into three clusters: odd or eccentric (paranoid, schizoid, schizotypal); dramatic, emotional, or erratic (antisocial, borderline, narcissistic, histrionic); and anxious or fearful (avoidant, obsessive-compulsive, dependent) disorders. Individuals who show broad dysfunctions in personality that warrant treatment but who do not meet criteria for any specific PD are often classified as “Unspecified Disorder,” which is not in itself a personality disorder, but instead used to enhance specificity of an existing disorder or as a means of attaching a diagnosis to an individual for treatment purposes. Furthermore, a dimensional model of personality disorder, in which symptoms would be identified on a gradient scale of severity rather than a diagnostic checklist, was proposed during the DSM-5 revision process; however, this model was not approved to replace the categorical schema and was instead placed in section III of the manual (entitled “Emerging measures and models”). As of the early 21st century the etiology for PDs is unclear and multidetermined, but specific temperamental (e.g., neuroticism, disinhibition), environmental (e.g., childhood abuse), and biological (e.g., prefrontal cognitive control systems) factors have been most implicated. Specific etiological factors studied in regard to the three PD clusters as well as treatment approaches are reviewed in subsequent sections, with a focus on empirical and scientifically grounded publications.

Overviews, Textbooks, and Historical Perspectives

Several references and textbooks provide comprehensive descriptions of personality disorders (PDs) and can be used as resources for understanding, and guides for treating, these psychiatric conditions. For example, Livesley 2001; Oldham, et al. 2005; Sperry 2016; and Widiger 2012 discuss the etiology, classification, and treatment of PDs. Lenzenweger and Clarkin 2005 describes some of the major theoretical perspectives of personality pathology, and Millon, et al. 2004 applies many of these theoretical perspectives to explain the development of each of the ten DSM-5 PDs. Finally, Alarcón, et al. 1998 considers the role of culture in the development of personality and PDs. These texts are intended for practitioners/clinicians, researchers, and students.

• Alarcón, Renato D., Edward F. Foulks, and Mark Vakkur. 1998. Personality disorders and culture: Clinical and conceptual interactions. New York: Wiley.

  One of the first texts to describe the role of social and cultural practices that contribute to personality development and PDs. Explains how cultural concepts and practices can be used to create effective therapeutic interventions, while highlighting the importance of cultural awareness for clinicians/practitioners.

• Lenzenweger, Mark F., and John F. Clarkin, eds. 2005. Major theories of personality disorder. 2d ed. New York: Guilford.

  Provides a historical overview and empirical developments of PD theories of the 20th and early 21st centuries; highlights the importance of viewing these theories as research heuristics. After an initial introduction on the history, classification, and research issues of PDs, each chapter covers one of the major theoretical perspectives (e.g., interpersonal, attachment) of personality pathology.

• Livesley, W. John, ed. 2001. Handbook of personality disorders: Theory, research, and treatment. New York: Guilford.

  Considered by many to be the definitive guide, this text provides a thorough review of PDs. Text is organized into the following sections: “Theoretical Perspectives and Nosological Issues” (classification), “Etiology and Development,” “Diagnosis and Assessment,” “Treatment,” and “Treatment Modalities and Special Issues” (e.g., forensic issues).

• Millon, Theodore, Seth Grossman, Carrie Millon, Sarah Meagher, and Rowena Ramnath. 2004. Personality disorders in modern life. 2d ed. Hoboken, NJ: Wiley.

  Describes the history and theoretical perspectives of personality pathology for the ten DSM-IV PDs and many of their subtypes. The development of each PD is explained in terms of a personality continuum ranging from normal to abnormal. In addition, the assessment and treatment of each PD are discussed.

• Oldham, John M., Andrew E. Skodol, and Donna S. Bender, eds. 2005. The American Psychiatric Publishing textbook of personality disorders. Washington, DC: American Psychiatric.

  One of the most exhaustive reference guides in the field, this text explains what makes personality “disordered.” Organized into the following sections: “Basic Concepts” (e.g., PD classification), “Clinical Evaluation” (e.g., differential diagnosis), “Etiology” (e.g., epidemiology), “Treatment” (e.g., pharmacotherapy), “Special Problems and Populations” (e.g., suicide), and “New Developments and Future Directions” (e.g., translational research).

• Sperry, Len. 2016. Handbook of diagnosis and treatment of DSM-5 personality disorders. 3d ed. New York: Routledge.

  Provides a theoretical overview and discusses intervention strategies, treatment approaches, and empirical findings for the ten DSM-5 PDs. After an introduction to the diagnosis and treatment of PDs, the text is organized by a discussion of each PD.

• Widiger, T. 2012. The Oxford handbook of personality disorders. New York: Oxford Univ. Press.

  DOI: 10.1093/oxfordhb/9780199735013.001.0001

  Published shortly before the publication of DSM-5, this book provides a summary of the latest information concerning the diagnosis, assessment, construct validity, etiology, pathology, and treatment of personality disorders. This volume includes chapters related to: continuity and eliminations from DSM-IV-TR to DSM-5, chapters authored by the DSM-5 Personality Disorders Working Group, and controversial areas for the DSM across its many versions (e.g., schizotypal personality disorder, narcissism, depressive personality disorder, dependent personality disorder, and dimensional classification).