These notes are a summary of the DSM-IV criteria for Personality disorders, which should be coded for on axis 2 in a muti-axial formulation.

PERSONALITY : can be defined as enduring patterns of perceiving, relating to, and thinking about the environment and oneself.

(Kaplan) = the totality of emotional and behavioural traits that characterise the person in day to day living under ordinary conditions; it is relatively stable and predictable.

PERSONALITY DISORDER : an enduring pattern of inner experience and behaviour 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.

DSM-IV groups personality disorders into 3 clusters.

Cluster A : Odd / Eccentric

= Paranoid, Schizoid, Schizotypal

Cluster B : Dramatic / Emotional / Erratic

= Antisocial, Borderline, Histrionic, Narcissistic

Cluster C : Anxious / Fearful

= Avoidant, Dependant, Obsessive-compulsive

Note that more than one personality disorder, from more than one cluster may be present in a patient concurrently.

PARANOID PERSONALITY DISORDER

a pervasive pattern of distrust and suspiciousness of others such that their motives are interpreted as malevolent, beginning by early adulthood and characterized by four (or more) of the following :

1 - suspects that others are exploiting, harming or

deceiving him

2 - pre-occupied with unjustified doubts about the

loyalty or trustworthiness of friends

3 - reluctant to confide in others

4 - reads hidden demeaning or threatening meanings

into benign remarks or events

5 - persistently bears grudges / unforgiving

6 - perceives attacks on his character or reputation

that are not apparent to others and is quick to

react angrily or counterattack

7 - has recurrent suspicions, without justification,

regarding the fidelity of spouse

SCHIZOID PERSONALITY DISORDER

a pervasive pattern of detachment from social relationships and a restricted range of emotional expression in interpersonal settings, beginning by early adulthood and indicated by four (or more) of the following :

1 - neither desires nor enjoys close relationships

2 - almost always chooses solitary activities

3 - little, if any, interest in sexual experiences

with another person

4 - takes pleasure in few, if any, activities

(anhedonia)

5 - lacks close friends or confidants other than

first degree relatives

6 - appears indifferent to praise or criticism

7 - shows emotional coldness, detachment, or

flattened affect

SCHIZOTYPAL PERSONALITY DISORDER

a pervasive pattern of acute discomfort with, and reduced capacity for, close relationships as well as by cognitive or perceptual distortions and eccentricities of behaviour, beginning by early adulthood and indicated by five (or more) of the following :

1 - ideas of reference (not delusions of reference)

2 - odd beliefs or magical thinking that influence

behaviour and are inconsistent with subcultural

norms (eg superstitiousness etc)

3 - unusual perceptual experiences

4 - odd thinking and speech (vague, metaphorical,

overelaborate, circumstantial, stereotyped)

5 - suspiciousness or paranoid ideation

6 - inappropriate or constricted affect

7 - behaviour or appearance that is odd, eccentric

or peculiar

8 - lack of close friends or confidants other than

first degree relatives

9 - excessive social anxiety that does not diminish

with familiarity and tends to be associated

with paranoid fears rather than negative

judgements about self

ANTISOCIAL PERSONALITY DISORDER

a pervasive pattern of disregard for, and violation of the rights of others occurring since age 15 years, as indicated by 3 (or more) of the following :

1 - failure to conform to social norms with respect

to lawful behaviours as indicated by repeatedly

performing acts that are grounds for arrest

2 - deceitfulness, 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, indicated by

repeated physical fights or assaults

5 - reckless disregard for safety of self or others

6 - consistent irresponsibility, indicated by

repeated failure to sustain consistent work

behaviour or honor financial obligations

7 - lack of remorse, indicated by being indifferent

to or rationalising having hurt, mistreated, or

stolen from others

The individual must be at least 18 years, and there must be evidence of conduct disorder with onset before 15 years.

BORDERLINE PERSONALITY DISORDER

a pervasive pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsivity by early adulthood, indicated by 5 (or more) of the following.

1 - frantic efforts to avoid real or imagined

abandonment

2 - unstable and intense interpersonal relationships

alternating between extremes of idealization

and devaluation

3 - identity disturbance; marked and persistently

unstable self-image or sense of self

4 - impulsivity in at least 2 areas that are

potentially self-damaging (eg sepnding, sex,

substance abuse, driving, eating)

5 - recurrent suicidal behaviour, gestures, threats,

or self-mutilating behaviour

6 - affective instability due to a marked reactivity

of mood

7 - chronic feelings of emptiness

8 - inappropriate, intense anger or difficulty

controlling anger

9 - transient, stress related paranoid ideation or

severe dissociative symptoms

HISTRIONIC PERSONALITY DISORDER

a pervasive pattern of excessive emotionality and attention seeking, beginning by early adulthood, indicated by 5 (or more) of the following :

1 - is unconfortable in situations in which he or

she is not the center of attention

2 - inappropriate sexually seductive or provocative

behaviour

3 - rapidly shifting and shallow expression of

emotions

4 - consistently uses physical appearance to draw

attention to self

5 - style of speech which is excessively

impressionistic and lacking in detail

6 - shows self-dramatisation, theatricality, and

exaggerated expression of emotion

7 - is suggestible ie. easily influenced by others

8 - considers relationships to be more intimate than

they actually are

NARCISSISTIC PERSONALITY DISORDER

a pervasive pattern of grandiosity (in fantasy or behaviour), need for admiration, and lack of empathy, beginning by early adulthood and indicated by 5 (or more) of the following :

1 - has a grandiose sense of self-importance (eg

exaggerates achievements and talents

2 - is per-occupied with fantasies of unlimited

succes, power, beauty, brilliance, or love

3 - believes that he or she is "special" and unique

and can only be understood by, or associate

with, other special or high-status people

4 - requires excessive admiration

5 - has a sense of entitlement. ie. unreasonable

expectations of especially favourable treatment

or automatic compliance withe his or her

expectations

6 - is interpersonally exploitative, takes advantage

of others to achieve his or her own ends

7 - lacks empathy

8 - is often envious of others or believes that

others are envious of him or her

9 - shows arrogant, haughty behaviours or attitudes

AVOIDANT PERSONALITY DISORDER

a pervasive pattern of social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation, beginning by early adulthood and indicated by 4 (or more) of the following :

1 - avoids occupational activities that involve

significant interpersonal contact, because of

fears of criticism, disapproval, or rejection

2 - unwilling to get involved with people unless

certain of being liked

3 - shows restraint within intimate relationships

4 - is peroccupied 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

ie. inferiority complex, timidity

DEPENDANT PERSONALITY DISORDER

a pervasive and excessive need to be taken care of, leading to submissive and clinging behaviour and fears of separation, beginning by earlt adulthood, and indicated by 5 (or more) of the following :

1 - difficulty making everyday decisions without an

excessive amount of advice and reassurance

2 - needs others to assume responsibility for most

major areas of his or her life

3 - has difficulty expressing disagreemnet with

others because of fears of loss of support or

approval

4 - difficulty initiating projects or doing things

on his or her own becuaes of a lack of self-

confidence in judgement

5 - goes to excessive lengths to obtain nurturance

and support from others

6 - feels uncomfortable or helpless when alone

because of fears of being unable to care for

his or herself

7 - urgently seeks another relationship as a source

of care and support when a close relationship

ends

8 - unrealistically preoccupied with fears of being

left to take care of himself or herself

OBSESSIVE-COMPULSIVE PERSONALITY DISORDER

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 indicated by 4 (or more) of the following :

1 - 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

3 - excessively devoted to work and productivity to

the exclusion of leisure activities and

friendships

4 - 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 - reluctant to delegate tasks or to work with

others unles they submit to exactly his or her

way of doing things

7 - adopts a miserly spending style towards both

self and others; money is hoarded for future

catastrophes

8 - shows rigidity and stubbornness

they may have a stiff, formal, and rigid demeanour. Affect may be constricted. They lack spontaneity or a sense of humour. Lack flexibility and are intolerant.