0.19 Personality disorders

Many students begin a personality course hoping to learn about personality disorders. As fascinating and disturbing as personality disorders can be, this topic is best covered in an abnormal psychology course. However, many instructors also like to discuss personality disorders, in part to address the importance of developing a healthy personality. Thus, this appendix has been included to briefly present this topic, for those students and instructors who want to include it within their overall examination of personality development.

A Complex Problem

When I first wrote this appendix I approached the complexity of personality disorders by including two sections: the DSM criteria for diagnosing personality disorders and an alternative way of categorizing these disorders proposed by Theodore Millon. With the advent of the DSM-V (American Psychiatric Association, 2013) things have gotten even more complex. The DSM-V continues with the same categories as were used in the DSM-IV (American Psychiatric Association, 2000), but then it offers a completely different set of criteria for diagnosing personality disorders. No other DSM edition has done this, suggesting that personality disorders are proving to be the most complex group of psychological disorders.

So, I have now kept the same two first sections, since the official diagnostic criteria are essentially the same (only some changes in the wording of the text) and Theodore Millon's alternative theory is particularly interesting. Then, I briefly describe the new alterntive being offered in the DSM-V (leaving it up to you to explore them in more detail).

DSM-V Categories of Personality Disorder

The Diagnostic and Statistical Manual of Mental Disorders, 5 th Ed. (DSM-V; American Psychiatric Association, 2013) defines personality disorders 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, is stable over time, and leads to distress or impairment.” The consideration of cultural context is perhaps the most significant change in this definition from the earlier DSM-III. The DSM-V suggests that the personality disorders can be grouped into three clusters, plus a “not otherwise specified” category, for a total of 11 specific diagnoses, the authors caution that the identified clusters have not been consistently validated and that individuals may present combinations of personality disorders from different clusters. Nonetheless, the DSM-V still presents the three clusters of personality disorders (plus the “not otherwise specified” classification). Cluster A, the odd or eccentric types , are paranoid, schizoid, and schizotypal personality disorders. Cluster B, the dramatic, emotional, or erratic types , are antisocial, borderline, histrionic, and narcissistic personality disorders. And finally, Cluster C, the anxious or fearful types , are the avoidant, dependent, and obsessive-compulsive personality disorders.