Lecture 1:
– Personality Disorders –
Definition:
A personality disorder is 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 in functioning.
To meet the criteria for a personality disorder, the pattern must be:
a. Enduring – long-term and stable across time and situations.
b. Deviant – differs significantly from cultural norms.
c. Inflexible and pervasive – consistent across a broad range of personal and social contexts.
d. Causing distress or impairment – leads to clinically significant distress or problems in functioning.
e. Stable and of long duration – usually starting in adolescence or early adulthood.
f. Not better explained by another mental disorder, substance use, or medical condition.
3 P’s:
DSM Versions:
DSM-IV (1994):
Personality disorders were grouped into three clusters (A, B, C).
Ten PDs were recognized (e.g., borderline, antisocial, avoidant, etc.).
Diagnosis was categorical: a person either had or didn’t have a PD based on specific criteria.
PDs were on Axis II (separate from Axis I clinical disorders like depression).
DSM-5 (2013):
Removed the old multiaxial system (no more Axis I vs. Axis II).
Kept the same 10 PDs and the cluster system (A, B, C).
Introduced a new dimensional model in Section III called the:
→ Alternative Model for Personality Disorders (AMPD).
Focuses on personality functioning (self + interpersonal) and pathological traits.
Recognizes that PD traits exist on a continuum, not just “present/absent.”
But this model was optional — not the main diagnostic system.
DSM-5-TR (2022):
Text revision, not a major overhaul.
, No new PDs or changes to criteria.
Continued to include the AMPD in Section III, with no structural change.
Added minor clarifications and updated examples to improve clinical utility and cultural
sensitivity.
Personality Clusters:
Personality disorders are grouped into three clusters (A, B, and C) based on descriptive similarities. Each
cluster reflects a distinct pattern of behavior and emotional experience.
Cluster A: “Weird” – odd, eccentric, socially distant.
Cluster B: “Wild” – emotional, dramatic, impulsive.
Cluster C: “Worried” – anxious, dependent, perfectionistic.
Prevalence:
Cluster A: 3.6% Cluster B: 4.5% Cluster C: 2.8%
Why the percentages don’t add up:
a. Overlap between clusters:
Many individuals meet criteria for more than one PD, and sometimes even for PDs across different
clusters.
Example: someone might meet criteria for Borderline PD (Cluster B) and Avoidant PD (Cluster
C).
b. Comorbidity is common:
PDs often co-occur with other mental disorders (e.g., depression, anxiety, substance use).
This makes it hard to calculate independent prevalence rates.
c. Different studies use different methods:
Some use self-report, others structured interviews, leading to small variations in rates.
Etiology:
Definition:
The diathesis–stress model explains how personality disorders (PDs) — and many other psychological
conditions — develop through an interaction between vulnerability (diathesis) and environmental
stressors (stress).
It suggests that having a predisposition alone is not enough to cause a disorder; symptoms emerge
when stressors activate or exacerbate those vulnerabilities.
,1. Diathesis (Predisposition):
Refers to an underlying vulnerability, which may be biological, genetic, or psychological.
Includes traits such as temperament, emotion regulation difficulties, cognitive distortions, or early
attachment problems.
For example:
A person with high impulsivity or low emotional control (biological diathesis) may be more prone
to Borderline PD.
A person with a naturally suspicious temperament may be predisposed to Paranoid PD.
2. Stress (Environmental Triggers):
Refers to external life events or environmental pressures that challenge a person’s coping abilities.
Common stressors include:
Childhood trauma (neglect, abuse, inconsistent caregiving)
Family conflict or loss
Social rejection or chronic stress
These stressors can activate or worsen the underlying predisposition, leading to maladaptive personality
patterns.
3. Interaction:
The disorder develops when both vulnerability and stress are present.
Example:
A person with a genetic tendency toward emotional instability (diathesis) who experiences
childhood neglect (stress) may develop Borderline PD.
If the same vulnerability occurs in a supportive environment, the disorder may not develop.
Cluster A:
Cluster A is known as the “odd or eccentric” cluster of personality disorders.
It includes Paranoid, Schizoid, and Schizotypal Personality Disorders, which are characterized by
social withdrawal, suspiciousness, emotional detachment, and unusual or distorted thinking.
, People with Cluster A PDs often appear isolated, guarded, or unconventional, and their behavior may
seem strange or eccentric...
Though they do not experience full-blown psychotic symptoms like those seen in schizophrenia.
(1A) Paranoid Personality Disorder (PPD)
Definition:
A pervasive distrust and suspiciousness of others, such that their motives are interpreted as malevolent.
DSM-5-TR Core Features:
For a diagnosis, 4 or more of the following must be present:
Suspects, without sufficient basis, that others are exploiting or deceiving them
Preoccupied with unjustified doubts about others’ loyalty
Reluctant to confide in others due to fear that information will be used against them
Reads hidden, demeaning meanings into benign remarks
Persistently bears grudges
Perceives attacks on their character and reacts with anger
Recurrent suspicions of infidelity in partner
Typical Presentation:
Guarded, defensive, and hypersensitive to criticism
Sees neutral actions as intentional harm
Difficult to trust even close friends or family
Epidemiology & Course:
Prevalence: ~2–4%
More common in men; may precede delusional disorder or schizophrenia
Comorbidities:
Depression, agoraphobia, OCPD, psychotic disorders (risk factor)
,Case Cue:
(Sarah) → distrustful, interprets neutral remarks as criticism, isolates herself; “suspicious.”
(2A) Schizoid Personality Disorder (ScPD)
Definition:
A pervasive pattern of detachment from social relationships and restricted range of emotional expression
in interpersonal settings.
DSM-5-TR Core Features
Four (or more) of the following:
Neither desires nor enjoys close relationships
Almost always chooses solitary activities
Little interest in sexual experiences
Takes pleasure in few, if any, activities
Lacks close friends or confidants
Appears indifferent to praise or criticism
Shows emotional coldness, detachment, or flat affect
Typical Presentation
Prefers being alone, emotionally distant
Limited expression of feelings; seems indifferent or aloof
Appears self-sufficient, but may feel lonely internally
Epidemiology & Course
Prevalence: ~3–5%, slightly more in men.
May precede schizotypal or schizophrenia spectrum conditions
Comorbidities
Depression, avoidant PD, schizotypal PD
, Case Cue
(Mei) → quiet librarian, enjoys solitude, indifferent to praise or criticism; “loner.”
(3A) Schizotypal Personality Disorder (StPD)
Definition:
A pervasive pattern of social and interpersonal deficits, with acute discomfort in close relationships,
cognitive or perceptual distortions, and eccentric behavior.
DSM-5-TR Core Features:
Five (or more) of the following:
Ideas of reference (excluding delusions)
Odd beliefs or magical thinking (e.g., telepathy, superstition)
Unusual perceptual experiences (e.g., sensing a presence)
Odd thinking and speech (vague, metaphorical)
Suspiciousness or paranoid ideation
Inappropriate or constricted affect
Behavior or appearance that is odd or eccentric
Lack of close friends or confidants
Excessive social anxiety that does not diminish with familiarity
Typical Presentation:
Eccentric clothing, speech, or beliefs
May believe in supernatural powers or “special” connections
Desires social contact but struggles due to oddness and anxiety
Epidemiology & Course:
Prevalence: ~3%, slightly more in men
Related to schizophrenia spectrum; some later develop schizophrenia
Comorbidities:
Depression, anxiety disorders, schizophrenia-spectrum disorders
– Personality Disorders –
Definition:
A personality disorder is 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 in functioning.
To meet the criteria for a personality disorder, the pattern must be:
a. Enduring – long-term and stable across time and situations.
b. Deviant – differs significantly from cultural norms.
c. Inflexible and pervasive – consistent across a broad range of personal and social contexts.
d. Causing distress or impairment – leads to clinically significant distress or problems in functioning.
e. Stable and of long duration – usually starting in adolescence or early adulthood.
f. Not better explained by another mental disorder, substance use, or medical condition.
3 P’s:
DSM Versions:
DSM-IV (1994):
Personality disorders were grouped into three clusters (A, B, C).
Ten PDs were recognized (e.g., borderline, antisocial, avoidant, etc.).
Diagnosis was categorical: a person either had or didn’t have a PD based on specific criteria.
PDs were on Axis II (separate from Axis I clinical disorders like depression).
DSM-5 (2013):
Removed the old multiaxial system (no more Axis I vs. Axis II).
Kept the same 10 PDs and the cluster system (A, B, C).
Introduced a new dimensional model in Section III called the:
→ Alternative Model for Personality Disorders (AMPD).
Focuses on personality functioning (self + interpersonal) and pathological traits.
Recognizes that PD traits exist on a continuum, not just “present/absent.”
But this model was optional — not the main diagnostic system.
DSM-5-TR (2022):
Text revision, not a major overhaul.
, No new PDs or changes to criteria.
Continued to include the AMPD in Section III, with no structural change.
Added minor clarifications and updated examples to improve clinical utility and cultural
sensitivity.
Personality Clusters:
Personality disorders are grouped into three clusters (A, B, and C) based on descriptive similarities. Each
cluster reflects a distinct pattern of behavior and emotional experience.
Cluster A: “Weird” – odd, eccentric, socially distant.
Cluster B: “Wild” – emotional, dramatic, impulsive.
Cluster C: “Worried” – anxious, dependent, perfectionistic.
Prevalence:
Cluster A: 3.6% Cluster B: 4.5% Cluster C: 2.8%
Why the percentages don’t add up:
a. Overlap between clusters:
Many individuals meet criteria for more than one PD, and sometimes even for PDs across different
clusters.
Example: someone might meet criteria for Borderline PD (Cluster B) and Avoidant PD (Cluster
C).
b. Comorbidity is common:
PDs often co-occur with other mental disorders (e.g., depression, anxiety, substance use).
This makes it hard to calculate independent prevalence rates.
c. Different studies use different methods:
Some use self-report, others structured interviews, leading to small variations in rates.
Etiology:
Definition:
The diathesis–stress model explains how personality disorders (PDs) — and many other psychological
conditions — develop through an interaction between vulnerability (diathesis) and environmental
stressors (stress).
It suggests that having a predisposition alone is not enough to cause a disorder; symptoms emerge
when stressors activate or exacerbate those vulnerabilities.
,1. Diathesis (Predisposition):
Refers to an underlying vulnerability, which may be biological, genetic, or psychological.
Includes traits such as temperament, emotion regulation difficulties, cognitive distortions, or early
attachment problems.
For example:
A person with high impulsivity or low emotional control (biological diathesis) may be more prone
to Borderline PD.
A person with a naturally suspicious temperament may be predisposed to Paranoid PD.
2. Stress (Environmental Triggers):
Refers to external life events or environmental pressures that challenge a person’s coping abilities.
Common stressors include:
Childhood trauma (neglect, abuse, inconsistent caregiving)
Family conflict or loss
Social rejection or chronic stress
These stressors can activate or worsen the underlying predisposition, leading to maladaptive personality
patterns.
3. Interaction:
The disorder develops when both vulnerability and stress are present.
Example:
A person with a genetic tendency toward emotional instability (diathesis) who experiences
childhood neglect (stress) may develop Borderline PD.
If the same vulnerability occurs in a supportive environment, the disorder may not develop.
Cluster A:
Cluster A is known as the “odd or eccentric” cluster of personality disorders.
It includes Paranoid, Schizoid, and Schizotypal Personality Disorders, which are characterized by
social withdrawal, suspiciousness, emotional detachment, and unusual or distorted thinking.
, People with Cluster A PDs often appear isolated, guarded, or unconventional, and their behavior may
seem strange or eccentric...
Though they do not experience full-blown psychotic symptoms like those seen in schizophrenia.
(1A) Paranoid Personality Disorder (PPD)
Definition:
A pervasive distrust and suspiciousness of others, such that their motives are interpreted as malevolent.
DSM-5-TR Core Features:
For a diagnosis, 4 or more of the following must be present:
Suspects, without sufficient basis, that others are exploiting or deceiving them
Preoccupied with unjustified doubts about others’ loyalty
Reluctant to confide in others due to fear that information will be used against them
Reads hidden, demeaning meanings into benign remarks
Persistently bears grudges
Perceives attacks on their character and reacts with anger
Recurrent suspicions of infidelity in partner
Typical Presentation:
Guarded, defensive, and hypersensitive to criticism
Sees neutral actions as intentional harm
Difficult to trust even close friends or family
Epidemiology & Course:
Prevalence: ~2–4%
More common in men; may precede delusional disorder or schizophrenia
Comorbidities:
Depression, agoraphobia, OCPD, psychotic disorders (risk factor)
,Case Cue:
(Sarah) → distrustful, interprets neutral remarks as criticism, isolates herself; “suspicious.”
(2A) Schizoid Personality Disorder (ScPD)
Definition:
A pervasive pattern of detachment from social relationships and restricted range of emotional expression
in interpersonal settings.
DSM-5-TR Core Features
Four (or more) of the following:
Neither desires nor enjoys close relationships
Almost always chooses solitary activities
Little interest in sexual experiences
Takes pleasure in few, if any, activities
Lacks close friends or confidants
Appears indifferent to praise or criticism
Shows emotional coldness, detachment, or flat affect
Typical Presentation
Prefers being alone, emotionally distant
Limited expression of feelings; seems indifferent or aloof
Appears self-sufficient, but may feel lonely internally
Epidemiology & Course
Prevalence: ~3–5%, slightly more in men.
May precede schizotypal or schizophrenia spectrum conditions
Comorbidities
Depression, avoidant PD, schizotypal PD
, Case Cue
(Mei) → quiet librarian, enjoys solitude, indifferent to praise or criticism; “loner.”
(3A) Schizotypal Personality Disorder (StPD)
Definition:
A pervasive pattern of social and interpersonal deficits, with acute discomfort in close relationships,
cognitive or perceptual distortions, and eccentric behavior.
DSM-5-TR Core Features:
Five (or more) of the following:
Ideas of reference (excluding delusions)
Odd beliefs or magical thinking (e.g., telepathy, superstition)
Unusual perceptual experiences (e.g., sensing a presence)
Odd thinking and speech (vague, metaphorical)
Suspiciousness or paranoid ideation
Inappropriate or constricted affect
Behavior or appearance that is odd or eccentric
Lack of close friends or confidants
Excessive social anxiety that does not diminish with familiarity
Typical Presentation:
Eccentric clothing, speech, or beliefs
May believe in supernatural powers or “special” connections
Desires social contact but struggles due to oddness and anxiety
Epidemiology & Course:
Prevalence: ~3%, slightly more in men
Related to schizophrenia spectrum; some later develop schizophrenia
Comorbidities:
Depression, anxiety disorders, schizophrenia-spectrum disorders
