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Personality disorders (PDs) pose a major challenge to the modern profession of mental health care. Unlike depression, anxiety, and other disorders that are more commonly the focus of treatment, personality disorders are generally understood to be pervasive, inflexible, maladaptive, and enduring expressions of personality. People with PDs exact a heavy cost from themselves and society, as well as place considerable pressure on the mental health care system. The American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR) is currently the most widely used diagnostic system to diagnose personality disorders, particularly in the United States. The International Classification of Diseases (ICD-10), maintained by the World Health Organization, is another important diagnostic system.

The DSM-IV-TR distinguishes among 10 PDs that are conceptually organized into three clusters, designated Cluster A (odd-eccentric), Cluster B (dramatic-erratic), and Cluster C (anxious-fearful). Cluster A includes paranoid, schizoid, and schizotypal PDs. Cluster B includes antisocial, borderline, histrionic, and narcissistic PDs. Cluster C includes avoidant, dependent, and obsessive-compulsive PDs. In addition, the DSM allows for the diagnosis of personality disorder not otherwise specified (PD-NOS), which can be given when a person meets general criteria for a personality disorder and traits of several PDs, but does not meet the criteria for any one specific disorder. This entry reviews what is known about the personality disorders in the DSM-IV-TR. The review will focus on the features, etiology, prevalence, comorbidity, course, and treatment of the various PDs.

Features ofDSM-IV-TR Personality Disorders

Cluster A (Odd-Eccentric)

Paranoid Personality Disorder

According to DSM-IV-TR, Paranoid PD (PPD) is characterized by a consistent pattern of distrust of the motives of other people. People with this disorder assume that people will intentionally exploit, harm, or deceive them, and they often feel deeply injured by another person. They are frequently reluctant to become close to others out of fear that any personal information they reveal about themselves will later be used to hurt them. Individuals with this disorder can be severely sensitive to criticism and therefore are likely to feel attacked, threatened, or criticized by others. They might read hidden meanings or malevolent intentions into innocent remarks, mistakes, or compliments. It is also very difficult for a person with PPD to forgive others for perceived insults or injuries. Prolonged hostility, aggression, reactions of anger to perceived insults, and jealousy without adequate justification are also common.

Schizoid Personality Disorder

DSM-IV-TR notes that those with schizoid PD (SPD) are characteristically detached from and uninterested in social relationships. People with SPD may choose careers or hobbies that allow them to avoid contact with other people, and they typically are uninterested in developing intimate or sexual relationships. In addition, those with SPD have a flatness of affect that leads others to experience them as cold and aloof. Not only do they derive little pleasure from sensory or interpersonal experiences, they are also usually unmoved by the disapproval of others. They might claim that they do not experience strong emotions, whether positive or negative. Further, people with SPD may fail to respond to social cues, such as a smile, leading others to perceive them as self-absorbed, socially inept, or conceited.

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