2. INTRODUCTION
• OVERVIEW OF PERSONALITY DISORDERS
• THE 3 CLUSTERS
• 10 SPECIFIC PERSONALITY DISORDERS
• OVERVIEW OF THE DISORDER
• CAUSES AND TREATMENT
• PREVALENCE
• DSM-5 CRITERIA
• THE FUTURE FOR PERSONALITY DISORDERS

3. OVERVIEW OF PERSONALITY DISORDERS
• A PERSONALITY DISORDER IS A PERSISTENT PATTERN OF EMOTIONS,
COGNITIONS, AND BEHAVIOR THAT RESULTS IN ENDURING EMOTIONAL
DISTRESS FOR THE PERSON AFFECTED AND/OR FOR OTHERS AND MAY CAUSE
DIFFICULTIES WITH WORK AND RELATIONSHIPS.
• ROUGHLY 6% OF THE WORLDS POPULATION MAY HAVE AT LEAST ONE
PERSONALITY DISORDER
• PEOPLE TEND TO BE DIAGNOSED WITH MORE THAN ONE PERSONALITY
DISORDER.

4. PERSONALITY DISORDER CLUSTERS
CLUSTER A
• PARANOID PERSONALITY
DISORDER
• SCHIZOID PERSONALITY
DISORDER
• SCHIZOTYPAL
PERSONALITY DISORDER
CLUSTER B
• ANITSOCIAL
PERSONALITY DISORDER
• BORDERLINE
PERSONALITY DISORDER
• HISTRONIC PERSONALITY
DISORDER
• NARCISSISTIC
PERSONALITY DISORDER
CLUSTER C
• AVOIDANT PERSONALITY
DISORDER
• DEPENDENT PERSONALITY
DISORDER
• OBSESSIVE-COMPULSIVE
PERSONALITY DISORDER

5. CLUSTER A PERSONALITY DISORDERS
ODD OR ECCENTRIC DISORDERS
PEOPLE WHO ARE DIAGNOSED WITH THE NEXT THREE
PERSONALITY DISORDERS-PARANOID, SCHIZOID, AND
SCHIZOTYPAL SHARE COMMON FEATURES THAT
RESEMBLE SOME OF THE PSYCHOTIC SYMPTOMS SEEN IN
SCHIZOPHRENIA.

6. PARANOID PERSONALITY
DISORDER 301.0 (F60.0)
• INDIVIDUALS WITH PARANOID
PERSONALITY DISORDER ARE
EXCESSIVELY MISTRUSTFUL
AND SUSPICIOUS OF OTHERS,
WITHOUT ANY JUSTIFICATION
• THEY ASSUME OTHERS ARE OUT
TO HARM OR TRICK THEM

7. CLINICAL DESCRIPTION
• THE DEFINING CHARACTERISTIC OF PEOPLE WITH PARANOID PERSONALITY DISORDER IS A
PERVASIVE UNJUSTIFIED DISTRUST.
• THEY ARE OVERLY SUSPICIOUS
• MAY BE ARGUMENTATIVE, COMPLAIN OR MAY BE QUIET
• SENSITIVE TO CRITICISM AND HAVE AN EXCESSIVE NEED FOR AUTONOMY
• CAN HAVE PSYCHOTIC-LIKE SYMPTOMS SUCH AS: MAGICAL THINKING, PERCEPTUAL
DISTORTIONS, SOCIAL ISOLATION, POOR RAPPORT, AND CONSTRICTED AFFECT.
• INCREASED RISK FOR SUICIDE ATTEMPTS AND VIOLENT BEHAVIOR
• TEND TO HAVE A POOR QUALITY OF LIFE

8. CAUSES AND TREATMENT
CAUSES
• RELATIVES OF INDIVIDUALS WITH SCHIZOPHRENIA
MAY BE MORE LIKELY TO HAVE PARANOID PERSONALITY
DISORDER
• EARLY MISTREATMENT OR TRAUMATIC CHILDHOOD
EXPERIENCES MAY PLAY A ROLE IN THE DEVELOPMENT
OF PARANOID PERSONALITY DISORDER
• PERCEPTIONS OF OTHERS’ INTENT OR BEHAVIOR
COULD BE A RESULT OF THE WAY THEIR PARENTS
TAUGHT THEM TO BE CAREFUL ABOUT MAKING
MISTAKES AND MAY HAVE INSINUATED THAT THEY
WERE DIFFERENT FROM OTHERS
TREATMENT
• TYPICALLY DO NOT SEEK TREATMENT UNLESS THEY
ARE IN CRISIS OR SUFFERING FROM OTHER
PROBLEMS RELATED TO ANXIETY OR DEPRESSION
• THE THERAPEUTIC ALLIANCE IS CRITICAL
• OFTEN USE CBT
• HOWEVER, THERE ARE NO CONFIRMED THERAPIES
THAT SIGNIFICANTLY IMPROVE THE LIVES OF
PEOPLE SUFFERING FROM PARANOID PERSONALITY
DISORDER

9. PREVALENCE
• EARLY ADULTHOOD ONSET
• 6.3%-9.6% OF THE CLINICAL POPULATION
• 1.5%-1.8% OF THE GENERAL POPULATION
• EQUAL AMONG BOTH MEN AND WOMEN
• MAY ALSO HAVE SCHIZOTYPAL, BORDERLINE, NARCISSISTIC, AVOIDANT OR
OBSESSIVE-COMPULSIVE PERSONALITY DISORDERS

10. DSM V CRITERIA
A. A PERVASIVE DISTRUST AND SUSPICIOUSNESS OF OTHERS SUCH THAT THEIR MOTIVES ARE INTERPRETED AS
MALEVOLENT, BEGINNING BY EARLY ADULTHOOD AND PRESENT IN A VARIETY OF CONTEXTS, AS INDICATED BY
FOUR (OR MORE) OF THE FOLLOWING:
1. SUSPECTS, WITHOUT SUFFICIENT BASIS, THAT OTHERS ARE EXPLOITING, HARMING, OR DECEIVING HIM
OR HER.
2. IS PREOCCUPIED WITH UNJUSTIFIED DOUBTS ABOUT THE LOYALTY OR TRUSTWORTHINESS OF FRIEND OR
ASSOCIATES.
3. IS RELUCTANT TO CONFIDE IN OTHERS BECAUSE OF UNWARRANTED FEAR THAT THE INFORMATION
WILL BE USED MALICIOUSLY AGAINST HIM OR HER.
4. READS HIDDEN DEMEANING OR THREATENING MEANINGS INTO BENIGN REMARKS OR EVENTS.
5. PERSISTENTLY BEAR GRUDGES, I.E., IS UNFORGIVING OF INSULTS, INJURIES, OR SLIGHTS.
6. PERCEIVES ATTACKS ON HIS OR HER CHARACTER OR REPUTATION THAT ARE NOT APPARENT TO
OTHERS AND IS QUICK TO REACT ANGRILY OR TO COUNTERATTACK.
7. HAS RECURRENT SUSPICIONS, WITHOUT JUSTIFICATION, REGARDING FIDELITY OF SPOUSE OR SEXUAL
PARTNER.
B. DOES NOT OCCUR EXCLUSIVELY DURING THE COURSE OF SCHIZOPHRENIA, A BIPOLAR DISORDER OR DEPRESSIVE
DISORDER WITH PSYCHOTIC FEATURES, OR ANOTHER PSYCHOTIC DISORDER AND IS NOT ATTRIBUTABLE TO THE
PHYSIOLOGICAL EFFECTS OF ANOTHER MEDICAL CONDITION

11. SCHIZOID PERSONALITY
DISORDER 301.20 (F60.1)
• INDIVIDUALS WITH SCHIZOID PERSONALITY
DISORDER SHOW A PATTERN OF
DETACHMENT FROM SOCIAL RELATIONSHIPS
AND A LIMITED RANGE OF EMOTIONS IN
INTERPERSONAL SITUATIONS.
• MAY SEEM ALOOF, COLD, AND INDIFFERENT
TO OTHERS
• SCHIZOID MEANS TO TURN INWARD AND
AWAY FROM THE OUTSIDE WORLD
• FEEL RELATIONSHIPS ARE MESSY AND
UNDESIRABLE

12. CLINICAL DESCRIPTION
• DO NOT DESIRE OR ENJOY CLOSENESS WITH OTHERS, INCLUDING ROMANTIC
OR SEXUAL RELATIONSHIPS
• MAY APPEAR COLD AND DETACHED
• DO NOT SEEM AFFECTED BY PRAISE OR CRITICISM
• CAN HAVE PSYCHOTIC-LIKE SYMPTOMS RELATED TO SOCIAL ISOLATION,
POOR RAPPORT AND CONSTRICTED AFFECT.

13. CAUSES AND TREATMENT
CAUSES
• SHYNESS AS A CHILD HAS BEEN
REPORTED
• ABUSE AND NEGLECT IN
CHILDHOOD HAS BEEN REPORTED
• PARENTS OF CHILDREN WITH
AUTISM ARE MORE LIKELY TO HAVE
SCHIZOID PERSONALITY DISORDER
TREATMENT
• RARELY SEEK TREATMENT UNLESS THEY ARE
IN CRISIS DUE TO DEPRESSION OR LOSS OF
JOB
• THERAPY USUALLY CONSISTS OF SOCIAL-
SKILLS TRAINING AND MAY EVEN NEED TO BE
TAUGHT THE EMOTIONS FELT BY OTHERS TO
LEARN EMPATHY
• LITTLE OUTCOME RESEARCH HAS BEEN DONE
OF THE EFFECTIVENESS OF THIS APPROACH

14. PREVALENCE
• EARLY ADULTHOOD ONSET
• 1.4%-1.9% OF THE CLINICAL POPULATION
• 0.9%-1.2% OF THE GENERAL POPULATION
• SLIGHTLY MORE COMMON IN MEN
• MAY ALSO HAVE AVOIDANT OR OBSESSIVE-COMPULSIVE PERSONALITY
DISORDERS

15. DSM V CRITERIA
A. A PERVASIVE PATTERN OF DETACHMENT FROM SOCIAL RELATIONSHIPS AND A RESTRICTED RANGE OF
EXPRESSION OF EMOTIONS IN INTERPERSONAL SETTINGS, BEGINNING BY EARLY ADULTHOOD AND PRESENT IN A
VARIETY OF CONTEXTS, AS INDICATED BY FOUR (OR MORE) OF THE FOLLOWING:
1. NEITHER DESIRES NOR ENJOYS CLOSE RELATIONSHIPS, INCLUDING BEING PART OF A FAMILY.
2. ALMOST ALWAYS CHOOSES SOLITARY ACTIVITIES.
3. HAS LITTLE, IF ANY, INTEREST IN HAVING SEXUAL EXPERIENCES WITH ANOTHER PERSON.
4. TAKES PLEASURE IN FEW, IN ANY, ACTIVITIES.
5. LACKS CLOSE FRIENDS OR CONFIDANTS OTHER THAN FIRST-DEGREE RELATIVES.
6. APPEARS INDIFFERENT TO THE PRAISE OF CRITICISM OF OTHERS.
7. SHOW EMOTIONAL COLDNESS, DETACHMENT, OR FLATTENED AFFECTIVITY.
B. DOES NOT OCCUR EXCLUSIVELY DURING THE COURSE OF SCHIZOPHRENIA, A BIPOLAR DISORDER OR
DEPRESSIVE DISORDER WITH PSYCHOTIC FEATURES, ANOTHER PSYCHOTIC DISORDER, OR AUTISM SPECTRUM
DISORDER AND IS NOT ATTRIBUTABLE TO THE PHYSIOLOGICAL EFFECTS OF ANOTHER MEDICAL CONDITION.

16. SCHIZOTYPAL PERSONALITY
DISORDER 301.22 (F60.1)
• INDIVIDUALS WITH SCHIZOTYPAL
PERSONALITY DISORDER ARE TYPICALLY
SOCIALLY ISOLATED, TEND TO BE
SUSPICIOUS AND TO HAVE ODD BELIEFS
• CONSIDERED BY SOME TO BE ON THE SAME
SPECTRUM AS SCHIZOPHRENIA BUT
WITHOUT SOME OF THE MORE DEBILITATING
SYMPTOMS SUCH AS HALLUCINATIONS AND
DELUSIONS.
• LISTED IN THE DSM-5 UNDER BOTH
PERSONALITY DISORDERS AND
SCHIZOPHRENIA SPECTRUM DISORDER

17. CLINICAL DESCRIPTION
• HAVE PSYCHOTIC-LIKE (BUT NOT PSYCHOTIC) SYMPTOMS, SOCIAL DEFICITS,
AND SOMETIMES COGNITIVE IMPAIRMENTS OR PARANOIA
• OFTEN CONSIDERED ODD OR BIZARRE WITH ODD BELIEFS AND MAY ENGAGE IN
“MAGICAL THINKING”
• MAY BE SUSPICIOUS AND HAVE PARANOID THOUGHTS
• EXPRESS LITTLE EMOTION
• MAY DRESS IN UNUSUAL WAYS
• FEEL IT IS BETTER TO BE ISOLATED FROM OTHERS

18. CAUSES AND TREATMENT
CAUSES
• SOME BELIEVE THIS DISORDER IS ONE PHENOTYPE OF A
SCHIZOPHRENIA GENOTYPE
• ENVIRONMENT STRONGLY INFLUENCES THIS DISORDER
• SYMPTOMS STRONGLY ASSOCIATED WITH CHILDHOOD
MALTREATMENT AMONG MEN, THIS CHILDHOOD
MALTREATMENT SEEMS TO RESULT IN PTSD
SYMPTOMS IN WOMEN.
• MILD TO MODERATE DECREMENTS IN THEIR ABILITY TO
PERFORM ON TESTS INVOLVING MEMORY AND
LEARNING, SUGGESTING SOME DAMAGE IN THE LEFT
HEMISPHERE
• OTHER RESEARCH POINTS TO GENERALIZED BRAIN
ABNORMALITIES
TREATMENT
• 30%-50% OF INDIVIDUALS WITH THIS DISORDER
ALSO MEET THE CRITERIA FOR MAJOR DEPRESSIVE
DISORDER, THEREFORE TREATMENT MAY INCLUDE
SOME OF THE MEDICAL AND PSYCHOLOGICAL
TREATMENTS ASSOCIATED WITH TREATING MAJOR
DEPRESSIVE DISORDER.
• A COMBINATION OF ANTIPSYCHOTIC MEDICATION,
COMMUNITY TREATMENT, AND SOCIAL SKILLS
TRAINING HAVE EITHER SHOWN A REDUCTION IN
SYMPTOMS OR POSTPONED THE ONSET OF LATER
SCHIZOPHRENIA
• THE MOST PROMISING TREATMENT IS PREVENTION,
TREATING YOUNGER INDIVIDUALS WITH
ANTIPSYCHOTIC MEDICATIONS AND CBT TO HELP
AVOID THE ONSET OF SCHIZOPHRENIA.

19. PREVALENCE
• 6.4%-5.7% OF THE CLINICAL POPULATION
• 0.9%-1.2% OF THE GENERAL POPULATION
• SLIGHTLY MORE COMMON AMONG MEN
• EARLY ADULTHOOD ONSET
• SOME GO ON TO DEVELOP SCHIZOPHRENIA
• INCREASED CHANCE IF THERE IS A RELATIVE WITH SCHIZOPHRENIA
• MAY ALSO HAVE PARANOID, BORDERLINE OR AVOIDANT PERSONALITY DISORDERS

20. DSM V CRITERIAA. A PERVASIVE PATTERN OF SOCIAL AND INTERPERSONAL DEFICITS MARKED BY ACUTE DISCOMFORT WITH,
AND REDUCED CAPACITY FOR, CLOSE RELATIONSHIPS, AS WELL AS BY COGNITIVE OR PERCEPTUAL
DISTORTIONS AND ECCENTRICITIES OF BEHAVIOR, BEGINNING BY EARLY ADULTHOOD AND PRESENT IN A
VARIETY OF CONTEXTS, AS INDICATED BY FIVE (OR MORE) OF THE FOLLOWING:
1. IDEAS OF REFERENCE (EXCLUDING DELUSIONS OF REFERENCE).
2. ODD BELIEFS OR MAGICAL THINKING THAT INFLUENCES BEHAVIOR AND IS INCONSISTENT WITH
SUBCULTURAL NORMS (E.G., SUPERSTITIOUSNESS, BELIEF IN CLAIRVOYANCE, TELEPATHY, OR “SIXTH
SENSE”; IN CHILDREN AND ADOLESCENTS, BIZARRE FANTASIES OR PREOCCUPATIONS).
3. UNUSUAL PERCEPTUAL EXPERIENCES, INCLUDING BODILY ILLUSIONS.
4. ODD THINKING AND SPEECH (E.G., VAGUE, CIRCUMSTANTIAL, METAPHORICAL, OVERELABORATE, OR
STEREOTYPED).
5. SUSPICIOUSNESS OR PARANOID IDEATION.
6. INAPPROPRIATE OR CONSTRICTED AFFECT.
7. BEHAVIOR OR APPEARANCE THAT IS ODD, ECCENTRIC, OR PECULIAR.
8. LACK OF CLOSE FRIEND OR CONFIDANTS OTHER THAN FIRS-DEGREE RELATIVES.
9. EXCESSIVE SOCIAL ANXIETY THAT DOES NOT DIMINISH WITH FAMILIARITY AND TENDS TO BE ASSOCIATED
WITH PARANOID FEARS RATHER THAN NEGATIVE JUDGMENTS ABOUT SELF.
B. DOES NOT OCCUR EXCLUSIVELY DURING THE COURSE OF SCHIZOPHRENIA, A BIPOLAR DISORDER OR
DEPRESSIVE DISORDER WITH PSYCHOTIC FEATURES, ANOTHER PSYCHOTIC DISORDER, OR AUTISM SPECTRUM
DISORDER.

21. CLUSTER B PERSONALITY DISORDERS
DRAMATIC, EMOTIONAL, OR ERRATIC
PEOPLE DIAGNOSED WITH CLUSTER B PERSONALITY
DISORDERS—ANTISOCIAL, BORDERLINE, HISTRIONIC, AND
NARCISSISTIC—ALL HAVE BEHAVIORS THAT HAVE BEEN
DESCRIBED AS DRAMATIC, EMOTIONAL, OR ERRATIC.

22. ANTISOCIAL PERSONALITY
DISORDER 301.7 (F60.2)
• COMPLETELY LACK CONSCIENCE AND
EMPATHY
• VIOLATE SOCIAL NORMS AND
EXPECTATIONS WITHOUT ANY SORT OF
GUILT OR REGRET.
• IRRESPONSIBLE, IMPULSIVE, AGGRESSIVE
AND DECEITFUL,
• CAN BE CHARMING AND MANIPULATIVE
TO GET WHAT THEY WANT
• FEEL THEY ARE ENTITLED TO BREAK RULES

23. CLINICAL DESCRIPTION
• THE TERM PSYCHOPATH IS OFTEN SYNONYMOUS WITH ANTISOCIAL PERSONALITY
DISORDER, THE DEBATE CONTINUES IF THESE REALLY ARE TWO DISTINCT DISORDERS.
• TEND TO HAVE LONG HISTORIES OF VIOLATING OTHERS
• CAN HAVE AGGRESSIVE BEHAVIORS WITH A LACK OF CONCERN FOR OTHER PEOPLE, NO
REMORSE
• LYING AND CHEATING ARE ALMOST ALWAYS PREVALENT, OFTEN UNABLE TO TELL THE
DIFFERENCE BETWEEN THE LIES AND TRUTHS THEY HAVE TOLD
• CONDUCT DISORDER MAY BE A PRECURSOR TO ANTISOCIAL PERSONALITY DISORDER
• A HIGHER IQ MAY HELP SOME FROM DEVELOPING MORE SERIOUS PROBLEMS, OR MAY AT
LEAST PREVENT THEM FROM GETTING CAUGHT.
• NOT ALL ARE CRIMINALS OR HAVE OUTWARD AGGRESSIVE BEHAVIORS
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24. CAUSES AND TREATMENT
CAUSES
• GENETIC—ENVIRONMENT INTERACTION
• ABNORMALLY LOW LEVELS OF CORTICAL
AROUSAL
• HIGHER THRESHOLD FOR EXPERIENCING FEAR
• MAY HAVE A DEFICIT IN AMYGDALA FUNCTIONING
• COERCIVE PARENTING—ALONG WITH GENETICS—
APPEARS TO BE INVOLVED WITH THE CALLOUS-
UNEMOTIONAL TRAITS RELATED TO LATER
PSYCHOPATHY.
• ONE POTENTIAL GENE-ENVIRONMENT INTERACTION
MAY BE SEEN IN THE ROLE OF FEAR CONDITIONING
IN CHILDREN.
• IMPORTANT THING TO KNOW IS THE INTEGRATIVE
MODEL OF ANTISOCIAL BEHAVIOR: BIOLOGICAL,
PSYCHOLOGICAL, AND CULTURAL FACTORS
COMBINE IN INTRICATE WAYS TO CREATE A
PERSON WITH THIS DISORDER
TREATMENT
• RARELY SEEK TREATMENT
• MOST ARE PESSIMISTIC ABOUT THE
OUTCOME OF TREATMENT, THERE ARE
FEW DOCUMENTED SUCCESS STORIES
• PREVENTION MAY BE THE BEST
APPROACH AND IS THE MOST
COMMONLY USED TREATMENT
STRATEGY

25. PREVALENCE
• 3.9%-5.9% IN THE CLINICAL POPULATION
• 1.0%-1.8% IN THE GENERAL POPULATION
• MUCH MORE COMMON AMONG MEN
• DISSIPATES AFTER AGE 40
• USUALLY SHOWS UP DURING ADOLESCENTS, HOWEVER, THE INDIVIDUAL MUST BE
AT LEAST 18 YEARS OLD TO RECEIVE THIS DIAGNOSIS
• SUBSTANCE ABUSE OCCURS IN 60% OF PEOPLE WITH ANTISOCIAL PERSONALITY
DISORDER

26. DSM V CRITERIA
A. A PERVASIVE PATTERN OF DISREGARD FOR AND VIOLATION OF THE RIGHTS OF OTHERS,
OCCURRING SINCE AGE 15 YEARS, AS INDICATED BY THREE (OR MORE) OF THE
FOLLOWING:
1. FAILURE TO CONFORM TO SOCIAL NORMS WITH RESPECT TO LAWFUL BEHAVIORS, AS INDICATED BY
REPEATEDLY PERFORMING ACTS THAT ARE GROUNDS FOR ARREST.
2. DECEITFULNESS, AS INDICATED BY REPEATED LYING, USE OF ALIASES, OR CONNING OTHERS FOR
PERSONAL PROFIT OR PLEASURE.
3. IMPULSIVITY OR FAILURE TO PLAN AHEAD.
4. IRRITABILITY AND AGGRESSIVENESS, AS INDICATED BY REPEATED PSYCHISAL FIGHTS OR ASSAULTS.
5. RECKLESS DISREGARD FOR SAFETY OF SELF OR OTHERS.
6. CONSISTENT IRRESPONSIBILITY, AS INDICATED BY REPEATED FAILURE TO SUSTAIN CONSISTENT WORK
BEHAVIOR OR HONOR FINANCIAL OBLIGATIONS.
7. LACK OF REMORSE, AS INDICATED BY BEING INDIFFERENT TO OR RATIONALIZING HAVING HURT,
MISTREATED, OR STOLEN FROM ANOTHER.
B. THE INDIVIDUAL IS AT LEAST 18 YEARS.
C. THERE IS EVIDENCE OF CONDUCT DISORDER WITH ONSET BEFORE AGE 15 YEARS.
D. THE OCCURRENCE OF ANTISOCIAL BEHAVIOR IS NOT EXCLUSIVELY DURING THE COURSE
OF SCHIZOPHRENIA OR BIPOLAR DISORDER.

27. BORDERLINE PERSONALITY
DISORDER 301.83 (F60.3)
• THEIR MOODS AND RELATIONSHIPS
ARE UNSTABLE, AND USUALLY HAVE
A POOR SELF-IMAGE
• THEY OFTEN FEEL EMPTY AND ARE
AT GREAT RISK OF DYING BY THEIR
OWN HANDS.
• FEEL THEY DESERVE TO BE
PUNISHED

28. CLINICAL DESCRIPTION
• TEND TO HAVE TURBULENT RELATIONSHIPS, FEARING ABANDONMENT BUT LACKING
CONTROL OVER THEIR EMOTIONS
• MAY ENGAGE IN BEHAVIORS THAT ARE SUICIDAL, SELF-MUTILATIVE, OR BOTH
• CAN GO FROM ANGER TO DEEP DEPRESSION QUICKLY
• “STABLY UNSTABLE” MEANING THE INSTABILITY OF THEIR EMOTIONS, INTERPERSONAL
RELATIONSHIPS, THEIR SELF-CONCEPT, AND BEHAVIORS
• IMPULSIVE
• FEELINGS OF EMPTINESS
• DIFFICULTIES WITH THEIR OWN IDENTITIES

29. CAUSES AND TREATMENT
CAUSES
• MORE PREVALENT IN FAMILIES WITH THE
DISORDER
• LINKED TO MOOD DISORDERS
• GENE-ENVIRONMENT INTERACTION IN REGARDS TO
EARLY TRAUMA, NEGLECT, SEXUAL ABUSE,
PHYSICAL ABUSE OR A COMBINATION
• TEMPERAMENT OR NEUROLOGICAL IMPAIRMENTS
AND THEY INTERACT WITH PARENTAL STYLES MAY
ACCOUNT FOR SOME CASES
TREATMENT
• LIKELY TO SEEK TREATMENT BECAUSE THEY ARE SO DISTRESSED
• MOOD STABILIZERS
• DIALECTICAL BEHAVIOR THERAPY (DBT) TO COPE WITH
STRESSORS-TAUGHT HOW TO IDENTIFY AND REGULATE
EMOTIONS, PROBLEM SOLVING TECHNIQUES, LEARN TO TRUEST
THEIR OWN RESPONSES RATHER THAN DEPEND ON VALIDATION
FROM OTHERS
• CBT
• SCHEMA FOCUSED THERAPY
• MENTALIZATION-BASED THERAPY (MBT)
• TEND TO IMPROVE DURING THEIR 30’S AND 40’S

30. PREVALENCE
• 28.5% IN THE CLINICAL POPULATION
• 1.4%-1.6% IN THE GENERAL POPULATION
• APPROXIMATELY EQUAL AMONG MEN AND
WOMEN
• ADOLESCENT OR EARLY ADULTHOOD ONSET
• SYMPTOMS GRADUALLY IMPROVE IF THEY
SURVIVE INTO THEIR 30’S
• ALMOST 10% ATTEMPT SUICIDE, 6%
SUCCEED
• 20% HAVE MAJOR DEPRESSION
• 40% HAVE BIPOLAR DISORDER
• UP TO 67% HAVE AT LEAST ONE
SUBSTANCE ABUSE DISORDER
• EATING DISORDERS ARE COMMON,
ESPECIALLY BULIMIA
• ALMOST 25% OF PEOPLE WITH
BULIMIA ALSO HAVE BORDERLINE
PERSONALITY DISORDER

31. DSM V CRITERIA
A PERVASIVE PATTERN OF INSTABILITY OF INTERPERSONAL RELATIONSHIPS, SELF-IMAGE, AND
AFFECTS, AND MARKED IMPULSIVITY, BEGINNING BY EARLY ADULTHOOD AND PRESENT IN A VARIETY
OF CONTEXTS, AS INDICATED BY FIVE (OR MORE) OF THE FOLLOWING:
1. FRANTIC EFFORTS TO AVOID REAL OR IMAGINED ABANDONMENT. (NOTE: DO NOT INCLUDE SUICIDAL
OR SELF-MUTILATING BEHAVIOR COVERED IN CRITERION 5.)
2. A PATTERN OF UNSTABLE AND INTENSE INTERPERSONAL RELATIONSHIPS CHARACTERIZED BY
ALTERNATING BETWEEN EXTREMES OF IDEALIZATION AND DEVALUATION.
3. IDENTITY DISTURBANCE: MARKEDLY AND PERSISTENTLY UNSTABLE SELF-IMAGE OR SENSE OF SELF.
4. IMPULSIVITY IN AT LEAST TWO AREAS THAT ARE POTENTIALLY SELF-DAMAGING (E.G., SPENDING, SEX,
SUBSTANCE ABUSE, RECKLESS DRIVING, BINGE EATING). (NOTE: DO NO INCLUDE SUICIDAL OR SELF-
MUTILATING BEHAVIOR COVERED IN CRITERION 5.)
5. RECURRENT SUICIDAL BEHAVIOR, GESTURES, OR THREATS, OR SELF-MUTILATING BEHAVIOR.
6. AFFECTIVE INSTABILITY DUE TO A MARKED REACTIVITY OF MOOD (E.G., INTENSE EPISODIC DYSPHORIA,
IRRITABILITY, OR ANXIETY USUALLY LASTING A FEW HOURS AND ONLY RARELY MORE THAN A FEW DAYS).
7. CHRONIC FEELINGS OF EMPTINESS.
8. INAPPROPRIATE INTENSE ANGER OR DIFFICULTY CONTROLLING ANGER (E.G., FREQUENT DISPLAYS OF
TEMPER, CONSTANT ANGER, RECURRENT PHYSICAL FIGHTS).
9. TRANSIENT, STRESS-RELATED PARANOID IDEATION OR SEVERE DISSOCIATIVE SYMPTOMS.

32. HISTRIONIC PERSONALITY
DISORDER 301.50 (F60.4)
• INDIVIDUALS WITH HISTRIONIC
PERSONALITY DISORDER TEND TO
BE OVERLY DRAMATIC AND OFTEN
SEEM ALMOST TO BE ACTING
• WHICH IS WHY THE TERM
HISTRIONIC WHICH MEANS
THEATRICAL IN MANNER, IS USED.

33. CLINICAL DESCRIPTION
• PEOPLE WITH HISTRIONIC PERSONALITY DISORDER ARE INCLINED TO EXPRESS EMOTIONS IN AN EXAGGERATED
FASHION. EX. HUGGING SOMEONE THEY HAVE JUST MET OR CRYING UNCONTROLLABLY DURING A SAD MOVIE.
• ALSO TEND TO BE VAIN SELF-CENTERED AND UNCOMFORTABLE WHEN THEY ARE NOT IN THE LIMELIGHT
• OFTEN SEDUCTIVE IN APPEARANCE AND BEHAVIOR AND THEY ARE TYPICALLY CONCERNED ABOUT THEIR LOOKS
• SEEKS REASSURANCE AND APPROVAL CONSTANTLY
• IMPULSIVE AND HAVE GREAT DIFFICULTY DELAYING GRATIFICATION
• THE COGNITIVE STYLE ASSOCIATED WITH HISTRIONIC PERSONALITY IS IMPRESSIONISTIC, CHARACTERIZED
BY A TENDENCY TO VIEW SITUATIONS IN GLOBAL, BLACK AND WHITE TERMS.
• SPEECH IS OFTEN VAGUE, LACKING IN DETAIL, AND CHARACTERIZED EXAGGERATION.

34. CAUSES & TREATMENT
CAUSES
• ONE HYPOTHESIS INVOLVES A POSSIBLE
RELATIONSHIP WITH ANTISOCIAL DISORDER
• EVIDENCE SUGGESTS THAT HISTRIONIC
PERSONALITY AND ANTISOCIAL DISORDER
CO-OCCUR MORE OFTEN THAT CHANCE
WOULD ACCOUNT FOR.
• ROUGHLY 2/3 OF PEOPLE WITH A
HISTRIONIC PERSONALITY ALSO MET
CRITERIA FOR ANTISOCIAL PERSONALITY
DISORDER.
TREATMENT
• ALTHOUGH A GREAT DEAL HAS BEEN WRITTEN
ABOUT WAYS OF HELPING PEOPLE WITH
HISTRIONIC PERSONALITY DISORDER, LITTLE OF
THE RESEARCH DEMONSTRATES SUCCESS.
• SOME THERAPISTS HAVE TRIED TO MODIFY THE
ATTENTION GETTING BEHAVIOR.
• A LARGE PART OF THERAPY FOR THESE
INDIVIDUALS USUALLY FOCUSES ON THE
PROBLEMATIC INTERPERSONAL RELATIONSHIPS

35. PREVALENCE
• HAVE HIGHER RATES AMONG
WOMEN THAN MEN
• THE HIGH RATE OF WOMEN OVER
MEN RAISES QUESTIONS ABOUT
THE NATURE OF DISORDER AND ITS
DIAGNOSTIC CRITERIA
• DATA FROM THE 2001-2002NATIONAL
EPIDEMIOLOGICSURVEY ON ALCOHOL AND
RELATED CONDITIONS SUGGEST A PREVALENCE OF
HISTRIONIC PERSONALITY OF 1.84%
• HISTRIONIC PERSONALITY DISORDER HAS BEEN
ASSOCIATED WITH HIGHER RATES OF SOMATIC
SYMPTOM DISORDER, CONVERSION DISORDER
(FUNCTIONAL NEUROLOGICAL SYMPTOM
DISORDER) AND MAJOR DEPRESSIVE DISORDER.
BORDERLINE, NARCISSISTIC, ANTISOCIAL, AND
DEPENDENT PERSONALITY DISORDERS OFTEN CO-
OCCUR.

36. DSM V CRITERIA
• A PERVASIVE PATTERN OF EXCESSIVE EMOTIONALITY AND ATTENTION
SEEKING, BEGINNING BY EARLY ADULTHOOD AND PRESENT IN A VARIETY OF
CONTEXTS, AS INDICATED BY FIVE (OR MORE) OF THE FOLLOWING:
• BE UNCOMFORTABLE IN SITUATIONS IN WHICH HE OR SHE IS NOT THE CENTER OF
ATTENTION
• INTERACTION WITH OTHERS IS OFTEN CHARACTERIZED BY INAPPROPRIATE
SEXUALLY SEDUCTIVE OR PROVOCATIVE BEHAVIOR.
• DISPLAYS RAPIDLY SHIFTING AND SHALLOW EXPRESSION OF EMOTIONS.
• CONSISTENTLY USES PHYSICAL APPEARANCE TO DRAW ATTENTION TO SELF.
• HAS A STYLE OF SPEECH THAT IS EXCESSIVELY IMPRESSIONISTIC AND LACKING
DETAIL.
• SHOWS SELF-DRAMATIZATION, THEATRICALITY, AND EXAGGERATED EXPRESSION
OF EMOTION.
• IS SUGGESTIBLE (I.E. EASILY INFLUENCED BY OTHERS OR CIRCUMSTANCES).
• CONSIDERS RELATIONSHIPS TO BE MORE INTIMATE THAN THEY ACTUALLY ARE.

37. NARCISSISTIC
301.81 (F60.81)
• PEOPLE WITH NARCISSISTIC PERSONALITY
DISORDER HAVE AN UNREASONABLE SENSE
OF SELF IMPORTANCE AND ARE SO
PREOCCUPIED WITH THEMSELVES THAT
THEY LACK SENSITIVITY AND COMPASSION
FOR OTHER PEOPLE.
• THEY AREN’T COMFORTABLE UNLESS
SOMEONE IS ADMIRING THEM.
• THEIR EXAGGERATED FEELINGS AND THEIR
FANTASIES OF GREATNESS, CALLED
GRANDIOSITY, CREATE A NUMBER OF
NEGATIVE ATTRIBUTES.
• THEY REQUIRE A AND EXPECT A
GREAT DEAL OF SPECIAL ATTENTION
• THEY ALSO TEND TO USE OR EXPLOIT
OTHERS FOR THEIR OWN INTERESTS
AND SHOW LITTLE EMPATHY.
• AND BECAUSE THEY OFTEN FAIL TO
LIVE UP TO THEIR OWN
EXPECTATIONS, THEY ARE OFTEN
DEPRESSED

38. CAUSES & TREATMENT
CAUSES
• SOME BELIEVE THAT NARCISSISTIC
PERSONALITY DISORDER ARISES
LARGELY FROM A PROFOUND FAILURE
BY THE PARENTS OF MODELING
EMPATHY EARLY IN CHILD’S
DEVELOPMENT. AS A CONSEQUENCE,
THE CHILD REMAINS FIXATED AT A
SELF-CENTERED, GRANDIOSE STAGE
OF DEVELOPMENT.
TREATMENT
• WHEN THERAPY IS ATTEMPTED WITH THESE INDIVIDUALS, IT
OFTEN FOCUSES ON THEIR GRANDIOSITY, THEIR
HYPERSENSITIVITY TO EVALUATION, AND THEIR LACK OF
EMPATHY TOWARDS OTHERS.
• COGNITIVE THERAPY STRIVES TO REPLACE THEIR FANTASIES
WITH A FOCUS ON THE DAY-TO-DAY PLEASURABLE EXPERIENCES
THAT ARE TRULY ATTAINABLE.
• RELAXATION THERAPY IS USED TO HELP THEM FACE AND ACCEPT
CRITICISM
• BECAUSE INDIVIDUALS WITH THIS DISORDER ARE VULNERABLE
TO SEVERE DEPRESSION EPISODES, PARTICULARLY IN MIDDLE
AGE, TREATMENT IS OFTEN INITIATED FOR THE DEPRESSION

39. PREVALENCE
• THIS DISORDER IS INCREASING IN PREVALENCE IN MOST
WESTERN SOCIETIES, PRIMARILY AS A CONSEQUENCE OF LARGE-
SCALE SOCIAL CHANGES, INCLUDING GREATER EMPHASIS ON
SHORT-TERM HEDONISM, INDIVIDUALISM,COMPETITIVENESS,
AND SUCCESS.
• THE INCREASE MAY ALSO BE A CONSEQUENCE OF INCREASED
INTEREST IN AND RESEARCH OF THE DISORDER.
• OF THOSE DIAGNOSED WITH NARCISSISTIC PERSONALITY
DISORDER, 50%-75% ARE MALE.
• ASSOCIATED WITH ANOREXIA NERVOSA AND SUBSTANCE USE
DISORDERS (ESPECIALLY RELATED TO COCAINE).
• BORDERLINE, HISTRIONIC, ANTISOCIAL, AND PARANOID
PERSONALITY DISORDERS OFTEN CO-OCCUR.
• PREVALENCE ESTIMATES FOR NARCISSISTIC
PERSONALITY DISORDER, BASED ON DSM-IV
DEFINITIONS, RANGE FROM 0% TO 6.2% IN
COMMUNITY SAMPLES.
• NARCISSISTIC TRAITS MAY BE PARTICULARLY
COMMON IN ADOLESCENTS AND DO NOT NECESSARILY
INDICATE THAT THE INDIVIDUAL WILL GO ON TO HAVE
NARCISSISTIC PERSONALITY DISORDER.
• INDIVIDUALS WITH NARCISSISTIC PERSONALITY
DISORDER MAY HAVE SPECIAL DIFFICULTIES
ADJUSTING TO THE ONSET OF PHYSICAL AND
OCCUPATIONAL LIMITATIONS THAT ARE INHERENT IN
THE AGING PROCESS

40. DSM V CRITERIA
• A PERVASIVE PATTERN OF GRANDIOSITY (IN FANTASY OR BEHAVIOR), NEED FOR ADMIRATION,
AND LACK OF EMPATHY, BEGINNING BY EARLY ADULTHOOD AND PRESENT IN A VARIETY OF
CONTEXTS, AS INDICATED BY FIVE (OR MORE) OF THE FOLLOWING:
• HAS A GRANDIOSE SENSE OF SELF IMPORTANCE (E.G. EXAGGERATES ACHIEVEMENTS AND TALENTS,
EXPECTS TO BE RECOGNIZED AS SUPERIOR WITHOUT COMMENSURATE ACHIEVEMENTS).
• IS PREOCCUPIED WITH FANTASIES OF UNLIMITED SUCCESS, POWER, BRILLIANCE, BEAUTY, OR IDEAL LOVE.
• BELIEVES THAT HE OR SHE IS “SPECIAL” AND UNIQUE AND CAN ONLY BE UNDERSTOOD BY, OR SHOULD
ASSOCIATE WITH, OTHER SPECIAL OR HIGH-STATUS PEOPLE (OR INSTITUTIONS).
• REQUIRES EXCESSIVE ADMIRATION
• HAS A SENSE OF ENTITLEMENT (I.E., UNREASONABLE EXPECTATIONS OF ESPECIALLY FAVORABLE
TREATMENT OR AUTOMATIC COMPLIANCE WITH HIS OR HER EXPECTATIONS).
• IS INTERPERSONALLY EXPLOITATIVE (I.E., TAKES ADVANTAGE OF OTHERS TO ACHIEVE HIS OR HER OWN
ENDS).
• LACKS EMPATHY: IS UNWILLING TO RECOGNIZE OR IDENTIFY WITH THE FEELINGS AND NEEDS OF OTHERS
• IS OFTEN ENVIOUS OF OTHERS OR BELIEVES THAT OTHERS ARE ENVIOUS OF HIM OR HER
• SHOWS ARROGANT, HAUGHTY BEHAVIORS OR ATTITUDES

41. CLUSTER C PERSONALITY DISORDERS
ANXIOUS OR FEARFUL
PEOPLE DIAGNOSED WITH THE NEXT THREE PERSONALITY
DISORDERS WE HIGHLIGHT- AVOIDANT, DEPENDENT, AND
OBSESSIVE COMPULSIVE SHARE COMMON FEATURES WITH
PEOPLE WHO HAVE ANXIETY DISORDERS.

42. AVOIDANT PERSONALITY DISORDER
301.82 (F60.6)
• EXTREMELY SENSITIVE TO THE OPINIONS OF OTHER AND ALTHOUGH THEY DESIRE SOCIAL RELATIONSHIPS, THEIR ANXIETY LEADS THEM TO
AVOID SUCH ASSOCIATIONS THEIR EXTREMELY LOW SELF ESTEEM COUPLED WITH A FEAR OF REJECTION CAUSES THEM TO BE LIMITED IN
THEIR FRIENDSHIPSAND DEPENDENT ON THOSE THEY FEEL COMFORTABLE WITH.
• ASOCIAL BECAUSE THEY ARE INTERPERSONALLY ANXIOUS AND FEARFUL OF REJECTION.
• THESE INDIVIDUALS FEEL CHRONICALLY REJECTED BY OTHERS AND ARE PESSIMISTIC ABOUT THEIR FUTURE.
• AVOIDANT PERSONALITY DISORDER APPEARS TO BE EQUALLY FREQUENT IN MALES AND FEMALES.
• OTHER DISORDERS THAT ARE COMMONLY DIAGNOSED WITH AVOIDANT PERSONALITY DISORDER INCLUDE DEPRESSIVE, BIPOLAR,AND
ANXIETY DISORDERS, ESPECIALLY SOCIAL ANXIETY DISORDER (SOCIAL PHOBIA)
• OFTEN DIAGNOSED WITH DEPENDENT PERSONALITY DISORDER,ALSO TENDS TO BE DIAGNOSED WITH BORDERLINE PERSONALITY DISORDER
AND WITH CLUSTER A PERSONALITY (I.E. PARANOID, SCHIZOID, OR SCHIZOTYPAL PERSONALITY DISORDER)
• OFTEN STARTS IN INFANCY OR CHILDHOOD WITH SHYNESS, ISOLATION, AND FEAR OF STRANGERS AND NEW SITUATIONS.
• PREVALENCE OF ABOUT 2.4% FOR AVOIDANT PERSONALITY DISORDER

43. CAUSES & TREATMENT
CAUSES
• SOME EVIDENCE HAS FOUND THAT AVOIDANT PERSONALITY IS
RELATED TO OTHER SUBSCHIZOPHRENIA-RELATED DISORDERS,
OCCURRING MORE OFTEN IN RELATIVES OF PEOPLE WHO HAVE
SCHIZOPHRENIA.
• PYSCHOSOCIAL AND BIOLOGICAL INFLUENCES
• MAY BE BORN WITH DIFFICULTTEMPERAMENT OR
PERSONALITY CHARACTERISTICS.
• MORE LIKELY TO REPORT CHILDHOOD EXPERIENCES OF
ISOLATION, REJECTION, AND CONFLICT WITH OTHERS.
• PARENTS ARE MORE REJECTING, MORE GUILT
ENGENDERING AND LESS AFFECTIONATE WHICH
SUGGEST THAT PARENTING MAY CONTRIBUTE TO THE
DEVELOPMENT OF THIS DISORDER.
TREATMENT
• BEHAVIORAL INTERVENTION TECHNIQUES
FOR ANXIETY AND SOCIAL SKILLS
PROBLEMS HAVE HAD SOME SUCCESS.
• THERAPEUTIC ALLIANCE- THE
COLLABORATIVE CONNECTION BETWEEN
THERAPIST AND CLIENT APPEARS TO BE
AN IMPORTANT PREDICTOR FOR SUCCESS
IN THIS GROUP

44. DSM V CRITERIA
• A PERVASIVE PATTERN OF SOCIAL INHIBITION, FEELINGS OF INADEQUACY, AND
HYPERSENSITIVITY TO NEGATIVE EVALUATION, BEGINNING BY EARLY ADULTHOOD AND
PRESENT IN A VARIETY OF CONTEXTS, AS INDICATED BY FOUR (OR MORE) OF THE
FOLLOWING:
• AVOIDS OCCUPATIONAL ACTIVITIES THAT INVOLVE SIGNIFICANT INTERPERSONAL
CONTACT BECAUSE OF FEARS OF CRITICISM, DISAPPROVAL, OR REJECTION.
• IS UNWILLING TO GET INVOLVED WITH PEOPLE UNLESS CERTAIN OF BEING LIKED.
• SHOWS RESTRAINT WITHIN INTIMATE RELATIONSHIPS BECAUSE OF THE FEAR OF BEING
SHAMED OR RIDICULED.
• IS PREOCCUPIED WITH BEING CRITICIZED OR REJECTED IN SOCIAL SITUATIONS.
• IS INHIBITED IN NEW INTERPERSONAL SITUATIONS BECAUSE OF FEELINGS OF
INADEQUACY.
• VIEWS SELF AS SOCIALLY INEPT, PERSONALLY UNAPPEALING, OR INFERIOR TO OTHERS.
• IS UNUSUALLY RELUCTANT TO TAKE PERSONAL RISKS OR TO ENGAGE IN ANY NEW
ACTIVITIES BECAUSE THEY MAY PROVE EMBARRASSING.

45. DEPENDENT PERSONALITY
DISORDER 301.6 (F60.7)
• RELY ON OTHERS TO MAKE
ORDINARY DECISIONS AS WELL AS
IMPORTANT ONES, WHICH RESULTS
IN AN UNREASONABLE FEAR OF
ABANDONMENT.
• SOMETIMES AGREE WITH OTHER
PEOPLE WHEN THEIR OWN OPINION
DIFFERS SO AS NOT TO BE
REJECTED.
• THERE MAY BE AN INCREASED RISK OF
DEPRESSIVE DISORDERS, ANXIETY DISORDERS,
AND ADJUSTMENT DISORDERS.
• OFTEN CO-OCCURSWITH OTHER PERSONALITY
DISORDERS, ESPECIALLY BORDERLINE, AVOIDANT,
AND HISTRIONIC PERSONALITY DISORDERS.
• CHRONIC PHYSICAL ILLNESS OR SEPARATION
ANXIETY DISORDER IN CHILDHOODOR
ADOLESCENCE MAY PREDISPOSE THE INDIVIDUAL
TO THE DEVELOPMENT OF THIS DISORDER
• PREVALENCE: 0.49%
• DIAGNOSED MORE FREQUENTLY IN FEMALES

46. CAUSES & TREATMENT
CAUSES
• IT WAS THOUGHT THAT SUCH DISRUPTIONS AS
THE EARLY DEATH OF A PARENT OR NEGLECT OR
REJECTION BY CAREGIVER COULD CAUSE PEOPLE
TO GROW UP FEARING ABANDONMENT
• GENETIC INFLUENCES ARE IMPORTANT IN THE
DEVELOPMENT IN THIS ORDER
• WHAT IS NOT YET UNDERSTOOD ARE THE
PHYSIOLOGICAL FACTORS UNDERLYING THE
GENETIC INFLUENCES AND HOW THEY INTERACT
WITH ENVIRONMENTAL INFLUENCES
TREATMENTS
• THE TREATMENT LITERATURE FOR THIS
DISORDER IS MOSTLY DESCRIPTIVE LITTLE
RESEARCH EXISTS TO SHOW WHETHER A
PARTICULAR TREATMENT IS EFFECTIVE
• CAN APPEAR AS IDEAL CLIENTS BECAUSE OF
THEIR EAGERNESS TO GIVE RESPONSIBILITY
FOR THEIR PROBLEM TO THERAPIST
• THERAPY PROGRESSES GRADUALLY

47. DSM V CRITERIA
• A PERVASIVE AND EXCESSIVE NEED TO BE TAKEN CARE OF THAT LEADS TO SUBMISSIVE AND
CLINGING BEHAVIOR AND FEARS OF SEPARATION, BEGINNING BY EARLY ADULTHOOD AND
PRESENT IN A VARIETY OF CONTEXTS, AS INDICATED BY FIVE (OR MORE) OF THE FOLLOWING:
• HAS DIFFICULTY MAKING EVERYDAY DECISIONS WITHOUT AN EXCESSIVE AMOUNT OF ADVICE AND
REASSURANCE FROM OTHERS.
• NEEDS OTHERS TO ASSUME RESPONSIBILITY FOR MOST MAJOR AREAS OF HIS OR HER LIFE
• HAS DIFFICULTY EXPRESSING DISAGREEMENT WITH OTHER BECAUSE OF FEAR OF LOSS OF SUPPORT OR
APPROVAL (NOTE: DO NOT INCLUDE REALISTIC FEARS OF RETRIBUTION.)
• HAS DIFFICULTY INITIATING PROJECTS OR DOING THINGS ON HIS OR HER OWN (BECAUSE OF A LACK OF
SELF-CONFIDENCE IN JUDGEMENT OR ABILITIES RATHER THAN A LACK OR MOTIVATION OR ENERGY).
• GOES TO EXCESSIVE LENGTHS TO OBTAIN NURTURANCE AND SUPPORT FROM OTHERS, TO THE POINT OF
VOLUNTEERING TO DO THINGS THAT ARE UNPLEASANT.
• FEELS UNCOMFORTABLE OR HELPLESS WHEN ALONE BECAUSE OF EXAGGERATED FEARS OF BEING
UNABLE TO CARE FOR HIMSELF OR HERSELF.
• URGENTLY SEEKS ANOTHER RELATIONSHIP AS A SOURCE OF CARE AND SUPPORT WHEN A CLOSE
RELATIONSHIP ENDS.
• IS UNREALISTICALLY PREOCCUPIED WITH FEARS OF BEING LEFT TO TAKE CARE OF HIMSELF OR HERSELF.

48. OBSESSIVE COMPULSIVE
PERSONALITY DISORDER 301.4
(F60.05)
• PEOPLE WHO HAVE OBSESSIVE COMPULSIVE PERSONALITY DISORDER ARE CHARACTERIZED BY A FIXATION ON
THINGS BEING DONE “THE RIGHT WAY.”
• TEND TO HAVE POOR INTERPERSONAL RELATIONSHIPS.
• AN INTRIGUING THEORY SUGGESTS THAT THE PSYCHOLOGICAL PROFILES OF MANY SERIAL KILLERS POINT TO
THE ROLE OF OBSESSIVE COMPULSIVE PERSONALITY DISORDER.
• MASTERS OF CONTROL IN MANIPULATING THEIR VICTIMS
• NEED TO CONTROL ALL ASPECTS OF THE CRIME FITS THE PATTERN OF PEOPLE WITH OBSESSIVE COMPULSIVE
PERSONALITY DISORDERS, AND SOME COMBINATION OF THIS DISORDER AND UNFORTUNATE CHILDHOOD
EXPERIENCE MAY LEAD TO THIS DISTURBING DISORDER.
• COMMON TO FIND AMONG GIFTED CHILDREN WHOSE QUEST FOR PERFECTIONISM CAN BE QUITE DEBILITATING
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49. OCPD
• APPEARS TO BE DIAGNOSED ABOUT TWICE AS
OFTEN AMONG MALES
• OBSESSIVE-COMPULSIVE PERSONALITY DISORDER
IS ONE OF THE MOST PREVALENT PERSONALITY
DISORDERS IN THE GENERAL POPULATION, WITH
ESTIMATED PREVALENCE RANGING FROM 2.1% TO
7.9%
• INDIVIDUALS WITH ANXIETY DISORDERS,
INCLUDING GENERALIZED ANXIETY DISORDER,
SOCIAL ANXIETY DISORDER (SOCIAL PHOBIA),AND
SPECIFIC PHOBIAS, AND OCD
• MAY BE AN ASSOCIATIONS WITH DEPRESSIVE AND
BIPOLAR DISORDERS AND EATING DISORDERS.

50. CAUSES & TREATMENTS
CAUSES
• WEAK GENETICS CONTRIBUTIONS
• MAY BE PREDISPOSED TO FAVOR
STRUCTURE IN THEIR LIVES.
TREATMENT
• THERAPY
• OFTEN ATTACKS THE FEARS THAT
SEEM TO UNDERLIE NEED FOR
ORDERLINESS
• HELP CLIENT RELAX OR USE
DISTRACTIONS TECHNIQUES TO
REDIRECT COMPULSIVE THOUGHTS
• CBT

51. DSM V CRITERIA
• A PERVASIVE PATTERN OF PREOCCUPATION WITH ORDERLINESS, PERFECTIONISM, AND
MENTAL AND INTERPERSONAL CONTROL, AT THE EXPENSE OF FLEXIBILITY, OPENNESS, AND
EFFICIENCY, BEGINNING BY EARLY ADULTHOOD AND PRESENT IN A VARIETY OF CONTEXTS, AS
INDICATED BY FOUR (OR MORE) OF THE FOLLOWING:
• IS PREOCCUPIED WITH DETAILS, RULES, LISTS, ORDER, ORGANIZATION OR SCHEDULES TO THE EXTENT THAT
THE MAJOR POINT OF THE ACTIVITY IS LOST
• SHOWS PERFECTIONISM THAT INTERFERES WITH TASK COMPLETION (E.G. IS UNABLE TO COMPLETE A
PROJECT BECAUSE HIS OR HER OWN OVERLY STRICT STANDARDS ARE NOT MET).
• IS EXCESSIVELY DEVOTED TO WORK AND PRODUCTIVITY TO THE EXCLUSION OF LEISURE ACTIVITIES AND
FRIENDSHIPS (NOT ACCOUNTED FOR BY OBVIOUS NECESSITY).
• IS OVERCONSCIENTIOUS, SCRUPULOUS, AND INFLEXIBLE ABOUT MATTERS OF MORALITY, ETHICS, OR
VALUES (NOT ACCOUNTED FOR BY CULTURAL OR RELIGIOUS IDENTIFICATION).
• IS UNABLE TO DISCARD WORN-OUT OR WORTHLESS OBJECTS EVEN WHEN THEY HAVE NO SENTIMENTAL
VALUE.
• IS RELUCTANT TO DELEGATE TASKS OR TO WORK WITH OTHERS UNLESS THEY SUBMIT TO EXACTLY HIS OR
HER WAY OF DOING THINGS.
• ADOPTS A MISERLY SPENDING STYLE TOWARD BOTH SELF AND OTHERS: MONEY IS VIEWED AS
SOMETHING TO BE HOARDED FOR FUTURE CATASTROPHES.
• SHOWS RIGIDITY AND STUBBORNNESS.

52. REFERENCES
• AMERICAN PSYCHIATRIC ASSOCIATION (2013). DIAGNOSTIC AND STATISTICAL
MANUAL OF MENTAL DISORDERS, (5TH EDITION)/ARLINGTON, VA, AMERICAN
PSYCHIATRIC ASSOCIATION, 2013.
• BARLOW, D. AND DURAND, V. (2012). ABNORMAL PSYCHOLOGY, (7TH
EDITION)/STAMFORD, CT: CENGAGE LEARNING.
• BORDERLINE PERSONALITY DISORDER. NATIONAL ALLIANCE ON MENTAL ILLNESS.
HTTP://WWW.NAMI.ORG/LEARN-MORE/MENTAL-HEALTH-CONDITIONS/BORDERLINE-
PERSONALITY-DISORDER/OVERVIEW
• BORDERLINE PERSONALITY DISORDER. NATIONAL INSTITUTE OF MENTAL HEALTH.
HTTP://WWW.NIMH.NIH.GOV/HEALTH/PUBLICATIONS/BORDERLINE-PERSONALITY-
DISORDER/INDEX.SHTML
• HARE PSYCHOPATHY CHECKLIST. ENCYCLOPEDIA OF MENTAL HEALTH DISORDERS.
HTTP://WWW.MINDDISORDERS.COM/FLU-INV/HARE-PSYCHOPATHY-
CHECKLIST.HTML#IXZZ2VY2BRSPX