More about Personality Disorder


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Dr John Stevens MB BS MRCPsych

Medico-Legal and Expert Witness Practice






There are several diagnosable personality disorders, each with its constellation of behaviours and symptoms. These can be grouped into three different clusters:


Cluster A: Odd or eccentric behaviour


Cluster B: Dramatic or emotional


Cluster C: Anxious or fearful



Individuals may show traits of several personality disorders without fulfilling the full related diagnostic criteria for any single personality disorder.


Certain people with personality disorders may experience associated psychiatric conditions, such as Eating Disorders or Bipolar Affective Disorder (previously known as Manic-Depressive Illness). Other related serious psychological difficulties can include Alcohol Dependence and/or the misuse of psychoactive drugs, prescribed or illicit.


The assessment of Personality Disorder relies not only on current behaviour or relationship difficulties, but also on an overview of the individual's long-term emotional development. Rating Scales may be employed as part of the assessment process. These are often favoured by lawyers and psychologists because they confer the appearance of certainty in an uncertain diagnostic environment..


Cluster A



Schizoid Personality Disorder:


People with a schizoid personality are introverted, withdrawn, solitary, emotionally cold, and distant. They are often absorbed with their own thoughts and feelings and are fearful of closeness and intimacy with others. Such persons may also harbour private beliefs which are at odds with cultural norms.



Paranoid Personality Disorder:


The essential feature tor this type of personality disorder is interpreting the actions of others as deliberately threatening or demeaning.


People with paranoid personality disorder are untrusting, unforgiving. and prone to angry or aggressive outbursts without justification because they perceive others as unfaithful, disloyal, condescending or deceitful.


This kind of person may also be jealous, guarded, secretive, and scheming, and may appear to be emotionally "cold" or excessively serious.



Schizotypal Personality Disorder:


A pattern of peculiarities best describes those with schizotypal personality disorder. People may have odd or eccentric manners of speaking or dressing. Strange, outlandish or paranoid beliefs and thoughts are common.


People with schizotypal personality disorder have difficulties forming relationships and experience extreme anxiety in social situations. They may react inappropriately or not react at all during a conversation or they may talk to themselves. Some also display signs of "magical thinking" by maintaining that they can see into the future or read other people's.



Cluster B



Antisocial Personality Disorder:


People with an antisocial personality disorder characteristically act out their conflicts and ignore normal rules of social behaviour. These individuals are impulsive or irresponsible, and may be callous. Older equivalent terms are Psychopathy and Moral Insanity, or possibly Dangerous & Severe Personality Disorder (DSPD).


Typically, the antisocial personality has a history of legal difficulties, belligerent and irresponsible behaviour, aggressive and even violent relationships. They show scant respect for other people and feel little or no remorse about the effects of their behaviour on others. Such persons are at high risk for substance abuse, especially alcoholism, since it helps them to relieve tension, irritability and boredom.



Borderline Personality Disorder:


People with a borderline personality disorder are unstable in several areas, including interpersonal relationships, behaviour, mood, and self-image. Abrupt and extreme mood changes, stormy interpersonal relationships, an unstable and fluctuating self-image, unpredictable and self-destructive actions characterise the person with borderline personality disorder.


These individuals generally have great difficulty with their own sense of identity. They often experience the world in extremes. viewing others as either "all good" or "all bad." A person with borderline personality may form an intense personal attachment with someone, and fears of abandonment may lead to an excessive dependency on others.


Self-mutilation or recurrent suicidal gestures may be used to get attention or manipulate others. Impulsive actions, chronic feelings of emptiness, and episodes of intense inappropriate anger are also associated with this disorder, which is more common among females.



Narcissistic Personality Disorder:


Everyone requires a balanced degree of narcissism as part of a well functioning personality. This is called normal self-esteem.


People with a narcissistic personality have an exaggerated sense of self-importance and entitlement, beinq absorbed by fantasies of unlimited success, and seeking constant validation and admiration. The narcissistic personality is insecure and oversensitive to failure. Furthermore, such persons may tend to exploit interpersonal relationships.


Cluster C



Anxious-Avoidant Personality Disorder:


Avoidant personalities are often hypersensitive to rejection and are unwilling to become involved with others unless they are sure of being liked. Excessive social discomfort, timidity, fear of criticism, avoidance of social or work activities that involve interpersonal contact are characteristic of the avoidant personality. They are feartul of saying something considered foolish in company, and are hurt by perceived disapproval.


Although some may hunger for friendship, people with avoidant or anxious-avoidant personality disorder may have no close relationships beyond their immediate family. Many feel disabled by their inability to relate well to others.



Dependent Personality Disorder:


People with dependent personality disorder may exhibit a pattern of dependent and submissive behaviour, relying on others to make decisions for them. They require excessive reassurance and advice, and may be easily hurt by criticism. Some feel uncomfortable and helpless if they are alone, and can be devastated when a close relationship ends.


Typically lacking in self-confidence, the dependent personality rarely initiates projects and rarely acts independently. This disorder usually begins by early adulthood and is diagnosed more frequently in females than males.



Obsessive-Compulsive Personality Disorder:


People with compulsive personalities (or Anankastic Personalities) are conscientious with high levels of aspiration and who also strive for perfection.


Never satisfied with their achievements, people with a compulsive personality disorder may take on excessive responsibilities which threaten to overwhelm them.



Such people are highly cautious or overcautious, they weigh all aspects of a problem and pay attention to every detail, making it difficult for them to reach decisions and complete tasks.


Although people with obsessive-compulsive personality disorder are reliable, dependable, orderly, methodical and honest, their inflexibility or inability to adapt to changing circumstances can greatly irritate those who have to live or work with them.