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DSM-IV Diagnostic Criteria for a Personality Disorder:
A. An enduring pattern of inner experience and behavior that
deviates markedly from the expectations of the individual's
culture. This pattern is manifested in two (or more) of the
following areas:
1. cognition (ie, ways of perceiving and interpreting self,
other people, and events)
2. affectivity (ie, the range,
intensity, lability, and appropriateness of emotional response)
3. interpersonal functioning
4. impulse control
B. The enduring pattern is inflexible and pervasive across a
broad range of personal and social situations.
C. The enduring pattern leads to clinically significant
distress or impairment in social, occupational, or other
important areas of functioning.
D. The pattern is stable and of long duration and its onset
can be traced back at least to adolescence or early adulthood.
E. The enduring pattern is not better accounted for as a
manifestation of another mental disorder.
F. The enduring pattern is not due to the direct
physiological effects of a substance (eg, a drug of abuse, a
medication) or a general medical condition (eg, head trauma).
Classification: INDIVIDUAL PERSONALITY DISORDERS
A. CLUSTER A PERSONALITY DISORDERS:
1. PARANOID PERSONALITY DISORDER
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
friends 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 bears grudges, ie, 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 mood disorder with psychotic features, or
another psychotic disorder and is not due to the direct
physiological effects of a general medical condition.
2. SCHIZOID PERSONALITY DISORDER
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, if
any, activities
(5) lacks close friends or confidants other than
first-degree relatives
(6) appears indifferent to the praise or
criticism of others
(7) shows emotional coldness, detachment, or
flattened affectivity
B. Does not occur exclusively during the course of
schizophrenia, a mood disorder with psychotic features, another
psychotic disorder, or a pervasive developmental disorder and is
not due to the direct physiological effects of a general medical
condition.
3. SCHIZOTYPAL PERSONALITY DISORDER
A. 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 or is
inconsistent with subcultural norms (eg, 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 (eg, 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 friends or confidants
other than first-degree relatives
B. Does not occur exclusively during the course of
schizophrenia, a mood disorder with psychotic features, another
psychotic disorder, or a pervasive developmental disorder.
B. CLUSTER B PERSONALITY DISORDERS:
1. ANTISOCIAL PERSONALITY DISORDER
A. There is 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
physical 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 age 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 a manic episode.
2. BORDERLINE PERSONALITY DISORDER
A. 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 (eg, spending, sex, substance abuse,
reckless driving, binge eating) Note: Do not 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 (eg, 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 and
intense anger or difficulty controlling anger (eg, frequent
displays of temper, constant anger, recurrent physical fights)
(9) transient, stress-related paranoid ideation or severe
dissociative symptoms
3. HISTRIONIC PERSONALITY
DISORDER
A. 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:
(1) is uncomfortable in situations in which he or she is not
the center of attention
(2) interaction with others is often
characterized by inappropriate sexually seductive or provocative
behavior
(3) displays rapidly shifting and shallow expression of
emotions
(4) consistently uses physical appearance to draw
attention to self
(5) has a style of speech that is excessively
impressionistic and lacking in detail
(6) shows
self-dramatization, theatricality, and exaggerated expression of
emotion
(7) is suggestible, ie, easily influenced by others or
circumstances
(8) considers relationships to be more intimate
than they actually are
4. NARCISSISTIC PERSONALITY DISORDER
A. 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:
(1) has a grandiose sense of self-importance (eg, exaggerates
achievements and talents, expects to be recognized as superior
without commensurate achievements
(2) is preoccupied with
fantasies of unlimited success, power, brilliance, beauty or
ideal love
(3) 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)
(4)
requires excessive admiration
(5) has a sense of entitlement,
ie, unreasonable expectations of especially favorable treatment
or automatic compliance with his or her expectations
(6) is
interpersonally exploitative, ie, takes advantage of others to
achieve his or her own ends
(7) lacks empathy: is unwilling to
recognize or identify with the feelings and needs of others
(8)
is often envious of others or believes that others are envious
of him or her
(9) shows arrogant, haughty behaviors or attitudes
C. CLUSTER C PERSONALITY DISORDERS:
1. AVOIDANT PERSONALITY DISORDER
A. 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:
(1) avoids occupational activities that involve significant
interpersonal contact, because of fears of criticism,
disapproval, or rejection
(2) is unwilling to get involved with
people unless certain of being liked
(3) shows restraint within
intimate relationships because of a fear of being shamed or
ridiculed
(4) is preoccupied with being criticized or rejected
in social situations
(5) is inhibited in new interpersonal
situations because of feelings of inadequacy
(6) views self as
socially inept, personally unappealing, or inferior to others
(7) is unusually reluctant to take personal risks or to engage
in any new activities because they may prove embarrassing
2. DEPENDENT PERSONALITY DISORDER
A. 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:
(1) has difficulty making everyday decisions without an
excessive amount of advice and reassurance from others
(2) needs
others to assume responsibility for most major areas of his or
her life
(3) has difficulty expressing disagreement with others
because of fear of loss of support or approval. Note: Do not
include realistic fears of retribution.
(4) has difficulty
initiating projects or doing things on his or her own (because
of a lack of self-confidence in judgment or abilities rather
than a lack of motivation or energy)
(5) goes to excessive
lengths to obtain nurturance and support from others, to the
point of volunteering to do things that are unpleasant
(6) feels
uncomfortable or helpless when alone because of exaggerated
fears of being unable to care for himself or herself
(7)
urgently seeks another relationship as a source of care and
support when a close relationship ends
(8) is unrealistically
preoccupied with fears of being left to take care of himself or
herself
3. OBSESSIVE-COMPULSIVE PERSONALITY
DISORDER
A. 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:
(1) is preoccupied with details, rules, lists, order,
organization, or schedules to the extent that the major point of
the activity is lost
(2) shows perfectionism that interferes
with task completion (eg, is unable to complete a project
because his or her own overly strict standards are not met)
(3)
is excessively devoted to work and productivity to the exclusion
of leisure activities and friendships (not accounted for by
obvious economic necessity)
(4) is overconscientious,
scrupulous, and inflexible about matters of morality, ethics, or
values (not accounted for by cultural or religious
identification)
(5) is unable to discard worn-out or worthless
objects even when they have no sentimental value
(6)
is reluctant to delegate tasks or to work with others unless
they
submit to exactly his or her way of doing things
(7) adopts a
miserly spending style toward both self and others; money is
viewed as something to be hoarded for future catastrophes
(8)
shows rigidity and stubbornness
D. OTHER PERSONALITY DISORDERS:
Passive-Aggressive (Negativistic) Personality Disorder -
Although officially classified as personality disorders not
otherwise specified, passive-aggressive personality disorder has
been in the nomenclature for many years Depressive Personality
Disorder - depressive personality disorder has been the focus of
considerable research. In DSM-IV:
This disorder is characterized by passive resistance and
negativistic attitudes toward others who place demands on the
person with the disorder. These demands are resented and opposed
indirectly through procrastination, stubbornness, intentional
inefficiency and memory lapses. Such individuals tend to be
sullen, irritable, and cynical, and they chronically complain of
being underappreciated and cheated. Interest in attachment
relationships is typically low, as such people tend to be
unsuccessful in interpersonal relationships because of their
capacity to evoke hostility and negative responses from others.
Some researchers have proposed that this is essentially the
same concept as dysthymic disorder. These individuals are gloomy
and their self-esteem is habitually low. They are harsh on
themselves and tend to be judgmental of others. They are
pessimistic about the future and remorseful about the past. They
tend to be quiet, passive, and unassertive. The disorder can be
distinguished from major depression by its chronicity and by the
absence of somatic signs of depression such as sleep or appetite
disturbance.
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