Personality disorder

Maladaptive patterns of behavior, cognition, and inner experience

This article has multiple issues. Please help improve it or discuss these issues on the talk page. (Learn how and when to remove these messages)

This article's tone or style may not reflect the encyclopedic tone used on Wikipedia. See Wikipedia's guide to writing better articles for suggestions. (May 2025) (Learn how and when to remove this message)

|

This article needs additional citations for verification. Please help improve this article by adding citations to reliable sources. Unsourced material may be challenged and removed.
Find sources: "Personality disorder" – news · newspapers · books · scholar · JSTOR (June 2025) (Learn how and when to remove this message)

|

(Learn how and when to remove this message)

Personality disorders

Cluster A (odd)

* Paranoid
* Schizoid
* Schizotypal

Cluster B (dramatic)

* Antisocial
* Borderline
* Histrionic
* Narcissistic

Cluster C (anxious)

* Avoidant
* Dependent
* Obsessive–compulsive

ICD-11 classification

* Mild
* Moderate
* Severe
* Severity unspecified

* Negative affectivity
* Detachment
* Dissociality
* Disinhibition
* Anankastia
* Borderline pattern

Other and unspecified

* Other specified
* Unspecified
* Trait specified

Depressive

* Depressive
* Cyclothymic

Others

* Passive–aggressive
* Masochistic
* Sadistic
* Psychopathy
* Haltlose
* Immature
* Post-traumatic organic

* v
* t
* e

Personality disorders (PD) are a class of mental health conditions characterized by enduring maladaptive patterns of behavior, cognition, and inner experience, exhibited across many contexts and deviating from those accepted by the culture.[1] These patterns develop early, are inflexible, and are associated with significant distress or disability.[2] The definitions vary by source and remain a matter of controversy.[3][4][5] Official criteria for diagnosing personality disorders are listed in the sixth chapter of the International Classification of Diseases (ICD) and in the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM).[6]

Personality, defined psychologically, is the set of enduring behavioral and mental traits that distinguish individual humans. Hence, personality disorders are characterized by experiences and behaviors that deviate from social norms and expectations. Those diagnosed with a personality disorder may experience difficulties in cognition, emotiveness, interpersonal functioning, or impulse control. For psychiatric patients, the prevalence of personality disorders is estimated between 40 and 60%.[7][8][9] The behavior patterns of personality disorders are typically recognized by adolescence, the beginning of adulthood or sometimes even childhood and often have a pervasive negative impact on the quality of life.[1][10][11]

Treatment for personality disorders is primarily psychotherapeutic. Evidence-based psychotherapies for personality disorders include cognitive behavioral therapy and dialectical behavior therapy, especially for borderline personality disorder.[12][13] A variety of psychoanalytic approaches are also used.[14] Personality disorders are associated with considerable stigma in popular and clinical discourse alike.[15] Despite various methodological schemas designed to categorize personality disorders, many issues occur with classifying a personality disorder because the theory and diagnosis of such disorders occur within prevailing cultural expectations; thus, their validity is contested by some experts on the basis of inevitable subjectivity. They argue that the theory and diagnosis of personality disorders are based strictly on social, or even sociopolitical and economic considerations.[16]

## Classification and symptoms

[edit]

As of 2025[update] the two latest editions of the major systems of classification are:

* the International Classification of Diseases (11th revision, ICD-11) published by the World Health Organization
* the Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition, Text Revision, DSM-5-TR) by the American Psychiatric Association.

The ICD is a collection of alpha-numerical codes which have been assigned to all known clinical states, and provides uniform terminology for medical records, billing, statistics and research. The DSM defines psychiatric diagnoses based on research and expert consensus. While the DSM-5-TR standard model diagnoses personality disorders as distinct categories, the ICD-11 diagnoses a single personality disorder dimensionally according to severity, with the possibility to additionally diagnose trait domains.[17] In the case of the Alternative DSM-5 Model for Personality disorders, the approach chosen is a hybrid dimensional–categorical model,[18] in which diagnosis can consist of either predefined categories based on specific combinations of traits and functioning levels,[19] or of a general diagnosis called personality disorder – trait specified.[19] The ICD-11 classifies schizotypal disorder among primary psychotic disorders rather than as a personality disorder as in the DSM-5.[20] There are accepted diagnostic issues and controversies with regard to distinguishing particular personality disorder categories from each other.[21]

### DSM-5

[edit]

See also: DSM-5 § Personality disorders

The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders stresses that a personality disorder is an enduring and inflexible pattern of long duration leading to significant distress or impairment and is not due to use of substances or another medical condition. The DSM-5 lists personality disorders in the same way as other mental disorders, rather than on a separate 'axis', as previously.[22] DSM-5 lists ten specific personality disorders: paranoid, schizoid, schizotypal, antisocial, borderline, histrionic, narcissistic, avoidant, dependent and obsessive–compulsive personality disorder.[23]

The DSM-5 and the more recent DSM-5-TR provide a definition and six criteria for General Personality Disorder. Any of its ten personality disorder diagnoses[24] is subject to this definition, which requires that a differential diagnosis is performed in order to verify that the disturbance is not the result of other mental disorders, medical conditions or substances, and that the disturbance is stable over time and "inflexible and pervasive across a broad range of personal and social situations", having evident continuity since "at least to adolescence or early adulthood". Additionally, disturbance must be evident in regards to at least two of four specified aspects of functioning, namely: cognition, affectivity, interpersonal functioning and impulse control.[24][25]

The specific personality disorders are grouped into the following three clusters based on descriptive similarities:

#### Cluster A (odd or eccentric disorders)

[edit]

People with these disorders can be paranoid and have difficulty being understood by others, as they often have odd or eccentric modes of speaking and an unwillingness and inability to form and maintain close relationships.[26]

* Paranoid personality disorder – pattern of irrational suspicion and mistrust of others, interpreting motivations as malevolent
* Schizoid personality disorder – cold affect and detachment from social relationships, apathy, and restricted emotional expression
* Schizotypal personality disorder – pattern of extreme discomfort interacting socially, and distorted cognition and perceptions

Significant evidence suggests a small proportion of people with Cluster A personality disorders, especially schizotypal personality disorder, have the potential to develop schizophrenia and other psychotic disorders. These disorders also have a higher probability of occurring among individuals whose first-degree relatives have either schizophrenia or a Cluster A personality disorder.[27]

#### Cluster B (dramatic, emotional, or erratic disorders)

[edit]

Cluster B personality disorders are characterized by dramatic, impulsive, self-destructive, emotional behavior and sometimes incomprehensible interactions with others.[26]

* Antisocial personality disorder – pervasive pattern of disregard for and violation of the rights of others, lack of empathy, lack of remorse, callousness, bloated self-image, and manipulative and impulsive behavior
* Borderline personality disorder – pervasive pattern of emotional dysregulation, inappropriate anger, fear of abandonment, dependent attachment styles, altered empathy,[28] mistrustfulness, and instability in relationships, self-image, identity, behavior and affect, often leading to self-harm (i.e., real or fictitious suicidal attempts) and impulsivity (i.e., reckless spending, substance misuse, poor nutrition, binge eating)
* Histrionic personality disorder – pervasive pattern of attention-seeking behavior, including excessive emotions, an impressionistic style of speech, inappropriate seduction, exhibitionism, and egocentrism
* Narcissistic personality disorder – pervasive pattern of grandiosity, haughtiness, intense anger towards criticism, overwhelming envy, need for admiration, deceptive and vindictive tendencies, and lack of empathy (and, in more severe expressions, criminal behavior with remorse).[29]

#### Cluster C (anxious or fearful disorders)

[edit]

Cluster C personality disorders are characterised by a consistent pattern of anxious thinking or behavior.[26]

* Avoidant personality disorder – pervasive feelings of social inhibition and inadequacy, and extreme sensitivity to negative evaluation
* Dependent personality disorder – pervasive psychological need to be cared for by other people
* Obsessive–compulsive personality disorder – rigid conformity to rules, perfectionism, and control to the point of exclusion of leisurely activities and friendships (distinct from obsessive–compulsive disorder)

##### Other personality disorders

[edit]

The DSM-5 chapter on personality disorders also contains three diagnoses for conditions not matching these ten disorders,[30] which nevertheless exhibit characteristics of a personality disorder:

* Personality change due to another medical condition – personality disturbance due to the direct effects of a medical condition[31]
* Other specified personality disorder – used when recording the presence of personality disorder along with the reasons for the condition not being classified as one of the specific personality disorders.[30]
* Unspecified personality disorder – used when a patient presents with personality disorder symptoms that cause distress or impairment, but the clinician either chooses not to indicate the specific reason these criteria are not met for any one disorder, or there isn’t enough information available to make a more precise diagnosis.[30]

### DSM-5 Alternative model

[edit]

Main article: Alternative DSM-5 model for personality disorders

The Alternative DSM-5 Model for Personality Disorders (AMPD) presents a dimensional–categorical approach to diagnosis,[18] contrasting with existing categorical systems such as those in DSM-5 section II and ICD-10.[32] It aims to address several limitations of categorical systems, particularly the issues imprecision of excessive comorbidity.[33] This model evaluates personality pathology through two fundamental components: impaired personality functioning (criterion A) and pathological personality traits (criterion B).[32]

Personality functioning (criterion A) is assessed across self and interpersonal domains. The self domain encompasses identity and self-direction, while the interpersonal domain consists of empathy and intimacy.[34] Clinicians rate the degree of impairment using the Level of Personality Functioning Scale (LPFS), which ranges from 0 (little or no impairment) to 4 (extreme impairment).[35] Criterion B is based on five pathological trait domains, that characterize pathological personality expression: Negative Affectivity, Detachment, Antagonism, Disinhibition, and Psychoticism.[36] These domains are further divided into 25 specific trait facets,[36] such as irresponsibility and risk taking within the domain of disinhibition.[32]

The AMPD includes six specific personality disorders, which are defined by specific combinations of criteria A and B;[32] these are: antisocial, avoidant, borderline, narcissistic, obsessive-compulsive, and schizotypal.[19] It excludes four personality disorder categories (dependent, histrionic, paranoid, and schizoid) that are present in the standard model.[37] For cases that don't meet criteria for specific disorders but still show significant impairment, the model provides the Personality Disorder-Trait Specified (PD-TS) category, which documents the particular pattern of functional impairment and pathological traits.[38]

For diagnosis, the AMPD requires that the disturbance must be pervasive across situations and stable over time, typically emerging in adolescence or early adulthood. The disturbances cannot be better explained by other mental disorders, substance use, medical conditions, or attributed to developmental stages or sociocultural contexts.[35]

### ICD-11

[edit]

Main article: ICD-11 classification of personality disorders

The ICD-11 classification of personality disorders[17][39][40] is an implementation of a dimensional model of personality disorders,[17] meaning that individuals are assessed along continuous trait dimensions,[41] with personality disorders reflecting extreme or maladaptive variants of traits that are continuous with normal personality functioning,[42] and classified according to both severity of dysfunction and prominent trait domain specifiers.[41] The ICD-11 classification of personality disorders differs substantially from the one in the previous edition, ICD-10;[41] all distinct PDs have been merged into one: personality disorder (6D10), which can be coded as mild, moderate, severe, or severity unspecified.[17]

Severity is determined by the level of distress experienced and degree of impairment in day to day activities as a result of difficulties in aspects of self-functioning, (e.g., identity, self-worth and agency) and interpersonal relationships (e.g., desire and ability for close relationships and ability to handle conflicts), as well as behavioral, cognitive, and emotional dysfunctions.[17][40] There is also an additional category called personality difficulty (QE50.7), which can be used to describe personality traits that are problematic, but do not meet the diagnostic criteria for a PD.[43] A personality disorder or difficulty can be specified by one or more of the following prominent personality traits or patterns (6D11): Negative affectivity, Detachment, Dissociality, Disinhibition, and Anankastia.[41] In addition to the traits, a Borderline pattern (6D11.5) – similar in nature to borderline personality disorder – may be specified.[17]

In the ICD-11, any personality disorder must meet all of the following criteria:[44]

* There is an enduring disturbance characterized by problems in functioning of aspects of the self (e.g., identity, self-worth, accuracy of self-view, self-direction), and/or interpersonal dysfunction (e.g., ability to develop and maintain close and mutually satisfying relationships, ability to understand others' perspectives and to manage conflict in relationships).
* The disturbance has persisted over an extended period of time (e.g., lasting 2 years or more).
* The disturbance is manifest in patterns of cognition, emotional experience, emotional expression, and behaviour that are maladaptive (e.g., inflexible or poorly regulated).
* The disturbance is manifest across a range of personal and social situations (i.e., is not limited to specific relationships or social roles), though it may be consistently evoked by particular types of circumstances and not others.
* The symptoms are not due to the direct effects of a medication or substance, including withdrawal effects, and are not better accounted for by another mental disorder, a disease of the nervous system, or another medical condition.
* The disturbance is associated with substantial distress or significant impairment in personal, family, social, educational, occupational or other important areas of functioning.
* Personality disorder should not be diagnosed if the patterns of behaviour characterizing the personality disturbance are developmentally appropriate (e.g., problems related to establishing an independent self-identity during adolescence) or can be explained primarily by social or cultural factors, including socio-political conflict.

### ICD-10

[edit]

The ICD-10 lists these general guideline criteria:[45]

* Markedly disharmonious attitudes and behavior, generally involving several areas of functioning, e.g. affectivity, arousal, impulse control, ways of perceiving and thinking, and style of relating to others;
* The abnormal behavior pattern is enduring, of long standing, and not limited to episodes of mental illness;
* The abnormal behavior pattern is pervasive and clearly maladaptive to a broad range of personal and social situations;
* The above manifestations always appear during childhood or adolescence and continue into adulthood;
* The disorder leads to considerable personal distress but this may only become apparent late in its course;
* The disorder is usually, but not invariably, associated with significant problems in occupational and social performance.

The ICD adds: "For different cultures it may be necessary to develop specific sets of criteria with regard to social norms, rules and obligations."[45] Chapter V in the ICD-10 contains the mental and behavioral disorders and includes categories of personality disorder and enduring personality changes. They are defined as ingrained patterns indicated by inflexible and disabling responses that significantly differ from how the average person in the culture perceives, thinks, and feels, particularly in relating to others.[46]

The specific personality disorders (F60) are: paranoid, schizoid, dissocial, emotionally unstable (borderline type and impulsive type), histrionic, anankastic, anxious (avoidant) and dependent.[47] This category also includes Other specific personality disorders (includes PDs characterized as eccentric, haltlose, immature, narcissistic, passive–aggressive, or psychoneurotic), as well as Personality disorder, unspecified (includes "character neurosis" and "pathological personality"). In addition to specific PDs, there are also the following categories:

* Mixed and other personality disorders (F61; defined as conditions that are often troublesome but do not demonstrate the specific pattern of symptoms in the named disorders).
* Enduring personality changes, not attributable to brain damage and disease (F62; for conditions that seem to arise in adults without a diagnosis of personality disorder, following catastrophic or prolonged stress or other psychiatric illness).

### Other personality types and Millon's description

[edit]

Further information: Millon's personality disorder subtypes and Millon's personality disorder descriptions

Some types of personality disorder were in previous versions of the diagnostic manuals but have been deleted. Examples include sadistic personality disorder (pervasive pattern of cruel, demeaning, and aggressive behavior) and self-defeating personality disorder or masochistic personality disorder (characterized by behavior consequently undermining the person's pleasure and goals). They were listed in the DSM-III-R appendix as "Proposed diagnostic categories needing further study" without specific criteria.[48]

Psychologist Theodore Millon, a researcher on personality disorders, and other researchers consider some relegated diagnoses to be equally valid disorders, and may also propose other personality disorders or subtypes, including mixtures of aspects of different categories of the officially accepted diagnoses.[49]

### Categorical vs Dimensional approach

[edit]

Further information: Dimensional models of personality disorders

This section needs to be updated. The reason given is: This section bases a lot of claims on information from the 2000's.. Please help update this article to reflect recent events or newly available information. (June 2025)

|

Personality disorder classification can generally be broken down into a categorical approach and a dimensional approach. The categorical approach views personality disorders as discrete entities that are distinct from each other as well as from normal personality. In contrast, the dimensional approach suggests that personality disorders exist on a continuum, with traits varying in degree rather than kind.[50] This dimensional perspective may allow for more nuanced understanding and flexible diagnostic practices.

There has been a sustained movement toward replacing categorical models of personality disorder classification with dimensional approaches.[51][52] The categorical model has been criticized for not being sufficiently evidence-based;[32] for issues such as undue prevalence of comorbidity,[51][52] with the majority of people with a PD being eligible for another PD diagnosis;[53] as well as for heterogeneity within categories,[52] and stigmatization.[51] In regards to the AMPD, it has been found that "[a]s a result of these shortcomings, many patients in clinical practice misleadingly receive multiple PD diagnoses, a “not otherwise specified” PD diagnosis, or no PD diagnosis at all, even if a PD diagnosis is relevant to the presentation".[32] In response, dimensional models have been developed that assess personality disorders in terms of severity of impairment and maladaptive personality traits.[51] Emerging research indicates that dimensional models may also facilitate the personalization of psychotherapy by aligning treatment strategies with underlying trait dimensions rather than diagnostic categories.[54]

This shift is reflected in the inclusion of the AMPD in Section III of the DSM-5, and in the ICD-11’s adoption of a dimensional system. While the DSM-5-TR standard model diagnoses personality disorders as distinct categories, the ICD-11 diagnoses a single personality disorder according to severity, with the possibility to additionally diagnose trait domains.[17] In the case of the DSM-5 AMPD, the approach chosen is a dimensional–categorical model,[18] which takes into account both pathological traits and level of impairment,[55] and also contains predefined categories based on specific combinations.[19] The AMPD also contains a general diagnosis called personality disorder – trait specified.[19] These newer approaches are believed to ameliorate several shortcomings of the categorical model,[52] as well as improve clinical utility[50] and potentially reduce stigma,[51][50] although no research has so far specifically examined the effect on stigma.[50]

Thomas Widiger, a psychologist, and his collaborators have contributed to this debate significantly.[56] He discussed the constraints of the categorical approach and argued for the dimensional approach to personality disorders. Specifically, he proposed the Five Factor Model of personality as an alternative to the classification of personality disorders. For example, this view specifies that Borderline Personality Disorder can be understood as a combination of emotional lability (i.e., high neuroticism), impulsivity (i.e., low conscientiousness), and hostility (i.e., low agreeableness). Many studies across cultures have explored the relationship between personality disorders and the Five Factor Model.[57] This research has demonstrated that personality disorders largely correlate in expected ways with measures of the Five Factor Model[58] and has set the stage for including the Five Factor Model within DSM-5.[58]

As of 2002, there were over fifty published studies relating the five factor model (FFM) to personality disorders.[59] Since that time, a number of additional studies have expanded on this research base and provided further empirical support for understanding the DSM personality disorders in terms of the FFM domains.[60] In her seminal review of the personality disorder literature published in 2007, Lee Anna Clark asserted that "the five-factor model of personality is widely accepted as representing the higher-order structure of both normal and abnormal personality traits".[61] The five factor model has been shown to significantly predict all 10 personality disorder symptoms and outperform the Minnesota Multiphasic Personality Inventory (MMPI) in the prediction of borderline, avoidant, and dependent personality disorder symptoms.[62]

Research results examining the relationships between the FFM and each of the ten DSM personality disorder diagnostic categories are widely available. For example, in a study published in 2003 titled "The five-factor model and personality disorder empirical literature: A meta-analytic review",[63] the authors analyzed data from 15 other studies to determine how personality disorders are different and similar, respectively, with regard to underlying personality traits. In terms of how personality disorders differ, the results showed that each disorder displays a FFM profile that is meaningful and predictable given its unique diagnostic criteria. With regard to their similarities, the findings revealed that the most prominent and consistent personality dimensions underlying a large number of the personality disorders are positive associations with neuroticism and negative associations with agreeableness.

### Additional factors

[edit]

In addition to classifying by category and cluster, it is possible to classify personality disorders using additional factors such as severity, impact on social functioning, and attribution.[64]

## Presentation

[edit]

### Comorbidity

[edit]

It is common for patients with a personality disorder to develop symptoms of another kind, co-occurring. Patients who meet the DSM-IV-TR diagnostic criteria for one personality disorder are likely to meet the diagnostic criteria for another.[65] Psychotic, affective, and anxiety disorders are usually the most common among personality disorders. This can lead to not diagnosing personality disorders. While diagnostic categories provide clear, vivid descriptions of discrete personality types, personality structure of actual patients might be more accurately described by a constellation of maladaptive personality traits.

DSM-III-R personality disorder diagnostic co-occurrence aggregated across six research sites[65]: 1721  Type of Personality Disorder  | PPD  | SzPD  | StPD  | ASPD  | BPD  | HPD  | NPD  | AvPD  | DPD  | OCPD  | PAPD

|
|
|
|
|
|
|
|
|
|
|

Paranoid (PPD)  | —  | 8  | 19  | 15  | 41  | 28  | 26  | 44  | 23  | 21  | 30
Schizoid (SzPD)  | 38  | —  | 39  | 8  | 22  | 8  | 22  | 55  | 11  | 20  | 9
Schizotypal (StPD)  | 43  | 32  | —  | 19  | 4  | 17  | 26  | 68  | 34  | 19  | 18
Antisocial (ASPD)  | 30  | 8  | 15  | —  | 59  | 39  | 40  | 25  | 19  | 9  | 29
Borderline (BPD)  | 31  | 6  | 16  | 23  | —  | 30  | 19  | 39  | 36  | 12  | 21
Histrionic (HPD)  | 29  | 2  | 7  | 17  | 41  | —  | 40  | 21  | 28  | 13  | 25
Narcissistic (NPD)  | 41  | 12  | 18  | 25  | 38  | 60  | —  | 32  | 24  | 21  | 38
Avoidant (AvPD)  | 33  | 15  | 22  | 11  | 39  | 16  | 15  | —  | 43  | 16  | 19
Dependent (DPD)  | 26  | 3  | 16  | 16  | 48  | 24  | 14  | 57  | —  | 15  | 22
Obsessive–Compulsive (OCPD)  | 31  | 10  | 11  | 4  | 25  | 21  | 19  | 37  | 27  | —  | 23
Passive–Aggressive (PAPD)  | 39  | 6  | 12  | 25  | 44  | 36  | 39  | 41  | 34  | 23  | —

Sites used DSM-III-R criterion sets. Data obtained for purposes of informing the development of the DSM-IV-TR personality disorder diagnostic criteria.

Abbreviations used: PPD – Paranoid Personality Disorder, SzPD – Schizoid Personality Disorder, StPD – Schizotypal Personality Disorder, ASPD – Antisocial Personality Disorder, BPD – Borderline Personality Disorder, HPD – Histrionic Personality Disorder, NPD – Narcissistic Personality Disorder, AvPD – Avoidant Personality Disorder, DPD – Dependent Personality Disorder, OCPD – Obsessive–Compulsive Personality Disorder, PAPD – Passive–Aggressive Personality Disorder.

The disorders in each of the three clusters may share with each other underlying common vulnerability factors involving cognition, affect and impulse control, and behavioral maintenance or inhibition, respectively. They may also have a spectrum relationship to certain syndromal mental disorders:[65]

* Paranoid, schizoid or schizotypal personality disorders may be observed to be premorbid antecedents of delusional disorders or schizophrenia.
* Borderline personality disorder is seen in association with mood and anxiety disorders, with impulse-control disorders, eating disorders, ADHD, ASD, or a substance use disorder.
* Avoidant personality disorder is seen with social anxiety disorder.

### Impact on functioning

[edit]

It is generally assumed that all personality disorders are linked to impaired functioning and a reduced quality of life (QoL) because that is a basic diagnostic requirement. But research shows that this may be true only for some types of personality disorder. In several studies, higher levels of disability and lower QoL were predicted by avoidant, dependent, schizoid, paranoid, schizotypal and antisocial personality disorders. This link is particularly strong for avoidant, schizotypal and borderline PD. Not being able to fit in society for borderline personality disorder leads to a high risk of suicide, but with treatment, that risk can be reduced.[citation needed] However, obsessive–compulsive PD was not related to a reduced QoL or increased impairment. A prospective study reported that all PD were associated with significant impairment 15 years later, except for obsessive compulsive and narcissistic personality disorder.[66]

One study investigated some aspects of "life success" (status, wealth and successful intimate relationships). It showed somewhat poor functioning for schizotypal, antisocial, borderline, and dependent PD; schizoid PD had the lowest scores regarding these variables. Paranoid, histrionic and avoidant PD were average. Narcissistic and obsessive–compulsive PD, however, had high functioning and appeared to contribute rather positively to these aspects of life success.[11] There is also a direct relationship between the number of diagnostic criteria and quality of life. For each additional personality disorder criterion that a person meets there is an even reduction in quality of life.[67] Another[which?] study indicated that negative affectivity predicts suicidal attempts.[citation needed] Personality disorders – especially dependent, narcissistic, and sadistic personality disorders – also facilitate various forms of counterproductive work behavior, including knowledge hiding and knowledge sabotage.[68]

#### In the workplace

[edit]

Personality disorders can impact workplace experiences in various ways, depending on the diagnosis, severity, individual, and job context. Some individuals may experience difficulties with interpersonal relationships, communication, or stress management, which can affect workplace dynamics.[69][70] In addition to the direct effects of personality-related traits, indirect factors such as comorbid mental health conditions, educational challenges, or external life stressors may also influence job performance.[71][72]

While challenges may exist, individuals with personality disorders can also be in high level positions in the corporate world. In 2005 and again in 2009,[citation needed] psychologists Belinda Board and Katarina Fritzon at the University of Surrey, UK, interviewed and gave personality tests to high-level British executives and compared their profiles with those of criminal psychiatric patients at Broadmoor Hospital in the UK. They found that three – namely: histrionic, narcissistic and obsessive–compulsive – out of eleven personality disorders were actually more common in executives than in the disturbed criminals.[73] According to leadership academic Manfred F.R. Kets de Vries, it seems almost inevitable that some personality disorders will be present in a senior management team.[74]

#### Social functioning

[edit]

Social function is affected by many other aspects of mental functioning apart from that of personality. However, whenever there is persistently impaired social functioning in conditions in which it would normally not be expected, the evidence suggests that this is more likely to be created by personality abnormality than by other clinical variables.[75] The Personality Assessment Schedule[76] gives social function priority in creating a hierarchy in which the personality disorder creating the greater social dysfunction is given primacy over others in a subsequent description of personality disorder.

## Issues

[edit]

### In children and adolescents

[edit]

Main article: Personality development disorder

Diagnosing personality disorders in children is approached with caution. During childhood and adolescence, personality traits are still forming as well as ongoing cognitive and emotional development. Additionally, diagnosing a child with a personality disorder is followed with a big stigma that can be difficult for a child to face.[77] Rather than focusing on formal diagnoses, clinicians and researchers often emphasize identifying early signs of maladaptive behavior patterns that may become more stable over time. Early stages and preliminary forms of personality disorders need a multi-dimensional and early treatment approach.[citation needed] Personality development disorder is considered to be a childhood risk factor or early stage of a later personality disorder in adulthood.

In addition, in Robert F. Krueger's review of their[whose?] research indicates that some children and adolescents do experience clinically significant syndromes that resemble adult personality disorders, and that these syndromes have meaningful correlates and are consequential. Much of this research has been framed by the adult personality disorder constructs from Axis II of the Diagnostic and Statistical Manual[edition needed]. Hence, they[who?] are less likely to encounter the first risk they described at the outset of their review: clinicians and researchers are not simply avoiding use of the PD construct in youth. However, they may encounter the second risk they described: under-appreciation of the developmental context in which these syndromes occur. That is, although PD constructs show continuity over time, they are probabilistic predictors; not all youths who exhibit PD symptomatology become adult PD cases.[78]

### Openness to experience

[edit]

Main article: Openness to experience

At least three aspects of openness to experience are relevant to understanding personality disorders: cognitive distortions, lack of insight (means the ability to recognize one's own mental illness) and impulsivity. Problems related to high openness that can cause problems with social or professional functioning are excessive fantasising, peculiar thinking, diffuse identity, unstable goals and nonconformity with the demands of the society.[79]

High openness is characteristic to schizotypal personality disorder (odd and fragmented thinking), narcissistic personality disorder (excessive self-valuation) and paranoid personality disorder (sensitivity to external hostility). Lack of insight (shows low openness) is characteristic to all personality disorders and could help explain the persistence of maladaptive behavioral patterns.[80]

The problems associated with low openness are difficulties adapting to change, low tolerance for different worldviews or lifestyles, emotional flattening, alexithymia and a narrow range of interests.[79] Rigidity is the most obvious aspect of (low) openness among personality disorders and that shows lack of knowledge of one's emotional experiences. It is most characteristic of obsessive–compulsive personality disorder; the opposite of it known as impulsivity (here: an aspect of openness that shows a tendency to behave unusually or autistically) is characteristic of schizotypal and borderline personality disorders.[80]

## Causes

[edit]

This section needs additional citations for verification. Please help improve this article by adding citations to reliable sources in this section. Unsourced material may be challenged and removed. (May 2025) (Learn how and when to remove this message)

|

Personality disorders are complex conditions influenced by a combination of genetic, environmental, and experiential factors. These disorders emerge from the interaction of multiple determinants, making the precise causes difficult to identify. Environmental factors play a significant role in the development of personality disorders. These include prenatal conditions, childhood trauma, abuse, neglect, and other adverse childhood experiences. Possible genetic and neurobiological causes have also been identified.

The causality can be categorized as follows: necessary causes, which are factors that must precede another event for it to occur but are not sufficient by themselves to cause the disorder; sufficient causes, which are capable of causing pathology on their own without requiring the presence of other factors to result in the development of a disorder; and contributory causes, which increase the likelihood of developing a disorder but are neither necessary nor sufficient on their own. Socioeconomic factors, childhood trauma, or other adverse life events may contribute to the emergence of a personality disorder but are not definitive causes.

The problem of genetic confounding is explained by psychologist Svenn Torgersen in a 2009 review:[81]

> If parents treat their children badly, and the children develop personality disorders, it does not necessarily mean that the treatment of the children is the cause of the development. An alternative explanation may be that the parents themselves have some personality disorder traits, partly due to genes. These genetically influenced traits correlate with poor parenting, explaining the genetic influence on parenting. The children inherit the genes and subsequently develop personality disorders. The personality disorders might thus have developed in any case, independent of the childhood conditions.[82]

Twin studies allow scientists to assess the influence of genes and environment, in particular, how much of the variation in a trait is attributed to the "shared environment" (influences shared by twins, such as parents and upbringing) or the "unshared environment" (measurement error, noise, differing illnesses between twins, randomness in brain growth, and social or non-social experiences that only one twin experienced).[83][84][81]

### Childhood and parenting

[edit]

Early childhood experiences, especially those involving primary caregivers, play a significant role in shaping personality traits. Psychoanalytic theories suggest that childhood trauma and early relationships are critical to personality development. However, there is ongoing debate about which specific childhood experiences are most influential.

#### Abuse and neglect

[edit]

Further information: Child abuse, Child neglect, and Child sexual abuse

Child abuse and neglect consistently show up as risk factors to the development of personality disorders in adulthood.[85] A study looked at retrospective reports of abuse of participants that had demonstrated psychopathology throughout their life and were later found to have past experience with abuse. In a study of 793 mothers and children, researchers asked mothers if they had screamed at their children, and told them that they did not love them or threatened to send them away. Children who had experienced such verbal abuse were three times as likely as other children (who did not experience such verbal abuse) to have borderline, narcissistic, obsessive–compulsive or paranoid personality disorders in adulthood.[86] The sexually abused group demonstrated the most consistently elevated patterns of psychopathology. Officially verified physical abuse showed an extremely strong correlation with the development of antisocial and impulsive behavior. On the other hand, cases of abuse of the neglectful type that created childhood pathology were found to be subject to partial remission in adulthood.[85]

#### Parenting and attachment

[edit]

Further information: Attachment theory

See also: Parenting styles § Dysfunctional styles, and Attachment disorder

Evidence shows personality disorders may begin with parental personality issues. These cause the child to have their own difficulties in adulthood, such as difficulties reaching higher education, obtaining jobs, and securing dependable relationships. By either genetic or modeling mechanisms, children can pick up these traits.[87] Additionally, poor parenting appears to have symptom elevating effects on personality disorders.[87] More specifically, lack of maternal bonding has also been correlated with personality disorders. In a study comparing 100 healthy individuals to 100 borderline personality disorder patients, analysis showed that BPD patients were significantly more likely not to have been breastfed as a baby (42.4% in BPD vs. 9.2% in healthy controls).[88] These researchers suggested "Breastfeeding may act as an early indicator of the mother-infant relationship that seems to be relevant for bonding and attachment later in life". Additionally, findings suggest personality disorders show a negative correlation with two attachment variables: maternal availability and dependability. When left unfostered, other attachment and interpersonal problems occur later in life ultimately leading to development of personality disorders.[89]

Repeated negative or dysfunctional patterns of parent-child interactions can reinforce the development of maladaptive personality traits. For instance, inconsistent or punitive parenting may contribute to the development of anxious or avoidant behaviors in children, which could later manifest as personality disorders.[citation needed]

### Genetic

[edit]

Currently, genetic research for the understanding of the development of personality disorders is[according to whom?] severely lacking. However, there are a few possible risk factors currently in discovery. Researchers are currently looking into genetic mechanisms for traits such as aggression, fear and anxiety, which are associated with diagnosed individuals. More research is being conducted into disorder specific mechanisms.[90]

### Socioeconomic status

[edit]

Socioeconomic status has also been looked at as a potential cause for personality disorders. There is a strong association with low parental/neighborhood socioeconomic status and personality disorder symptoms.[87] In a 2015 publication from Bonn, Germany, which compared parental socioeconomic status and a child's personality, it was seen that children who were from higher socioeconomic backgrounds were more altruistic, less risk seeking, and had overall higher IQs.[91] These traits correlate with a low risk of developing personality disorders later on in life. In a study looking at female children who were detained for disciplinary actions found that psychological problems were most negatively associated with socioeconomic problems.[92] Furthermore, social disorganization was found to be positively correlated with personality disorder symptoms.[93]

### Neurobiological

[edit]

Research shows that several brain regions are altered in personality disorders, particularly: hippocampus up to 18% smaller, a smaller amygdala, malfunctions in the striatum-nucleus accumbens and the cingulum neural pathways connecting them and taking care of the feedback loops on what to do with all the incoming information from the multiple senses; so what comes out is anti-social – not according to what is the social norm, socially acceptable and appropriate.[94][95]

## Management

[edit]

See also: Management of antisocial, avoidant, borderline, dependent, histrionic, and narcissistic personality disorder

See also: Management of obsessive–compulsive, paranoid, schizoid, and schizotypal personality disorder

This section needs additional citations for verification. Please help improve this article by adding citations to reliable sources in this section. Unsourced material may be challenged and removed. (May 2025) (Learn how and when to remove this message)

|

The management of personality disorders involves a combination of psychotherapeutic, behavioral, and occasionally pharmacological interventions aimed at reducing symptoms, improving interpersonal functioning, and enhancing quality of life. Given the heterogeneous nature of personality disorders, treatment approaches are often tailored to the individual's specific diagnosis, severity, and co-occurring conditions.

There are different specific theories or schools of therapy within many of these treatment modalities. They may, for example, emphasize psychodynamic techniques, or cognitive or behavioral techniques. In clinical practice, many therapists use an 'eclectic' approach, taking elements of different schools as and when they seem to fit to an individual client. There is also often a focus on common themes that seem to be beneficial regardless of techniques, including attributes of the therapist (e.g. trustworthiness, competence, caring), processes afforded to the client (e.g. ability to express and confide difficulties and emotions), and the match between the two (e.g. aiming for mutual respect, trust and boundaries).

Treatment guidelines focused on managing ASPD and BPD emphasize treating comorbid diagnoses.[96][97] There is a limited amount of evidence in regards to the treatment of AvPD,[98] DPD,[99][100] HPD,[101] NPD,[102][103] OCPD,[104][105] PPD,[106] SzPD,[107] and StPD.[108] The management of personality disorders such as the aforementioned includes medication and therapy.[109]

Response of patients with personality disorders to biological and psychosocial treatments[65]: 36  Cluster  | Evidence for brain dysfunction | Response to biological treatments  | Response to psychosocial treatments

|
|
|

A  | Evidence for relationship of schizotypal personality to schizophrenia; otherwise none known.  | Schizotypal patients may improve on antipsychotic medication; otherwise not indicated.  | Poor. Supportive psychotherapy may help.
B  | Evidence suggestive for antisocial and borderline personalities; otherwise none known.  | Antidepressants, antipsychotics, or mood stabilizers may help for borderline personality; otherwise not indicated.  | Poor in antisocial personality. Variable in borderline, narcissistic, and histrionic personalities.
C  | None known.  | No direct response. Medications may help with comorbid anxiety and depression.  | Most common treatment for these disorders. Response variable.

### Psychotherapy

[edit]

Individual psychotherapy has been a mainstay of treatment.[110] There are long-term and short-term (brief) forms. Within individual therapy, various theories and schools of therapy are used. The American Psychiatric Association and Cochrane both found that psychotherapy was effective in treating BPD.[111][112][113]

Proposed non-pharmacological treatments include behavioural therapy, cognitive therapy, brief psychodynamic treatments, schema therapy, graded exposure, social skills training, psychodynamic psychotherapy, and supportive–expressive psychotherapy for AvPD;[114][98] clarification-oriented psychotherapy and cognitive therapy for DPD;[99][115] lifestyle modifications, medication, and psychotherapy such as CBT or group therapy for HPD;[116][117] socialization groups, and psychodynamic psychotherapy for SzPD;[107] and social skills training for STPD;[118] and psychodynamic therapy, cognitive therapy, and radically open dialectical behaviour therapy for OCPD.[104][105]

#### Cognitive behavioral therapy

[edit]

Main article: Cognitive behavioral therapy

Cognitive behavioral therapy (CBT) is a form of psychotherapy that aims to reduce symptoms of various mental health conditions, primarily depression, PTSD, and anxiety disorders.[119][120][121]

Cognitive behavioral therapy focuses on challenging and changing cognitive distortions (thoughts, beliefs, and attitudes) and their associated behaviors in order to improve emotional regulation and help the individual develop coping strategies to address problems.[120][122] CBT is widely applied across personality disorders, focusing on managing negative thought patterns and maladaptive behaviors. It is evidence-based and commonly used for avoidant, obsessive-compulsive, and dependent personality disorders.[citation needed] It has also been proposed for paranoid PD.[106]

#### Dialectical behavior therapy

[edit]

Main article: Dialectical behavior therapy

Dialectical behavior therapy (DBT) is an evidence-based[123] psychotherapy that began with efforts to treat personality disorders and interpersonal conflicts.[123] Evidence suggests that DBT can be useful in treating mood disorders and suicidal ideation as well as for changing behavioral patterns such as self-harm and substance use.[124] DBT evolved into a process in which the therapist and client work with acceptance and change-oriented strategies and ultimately balance and synthesize them—comparable to the philosophical dialectical process of thesis and antithesis, followed by synthesis.[123] The NICE review for BPD recommended DBT in the treatment of BPD symptoms.[96]

#### Other psychotherapies

[edit]

Psychodynamic therapy aims to uncover unconscious conflicts and explore the influence of early experiences on current behavior, particularly helpful for disorders with deep-rooted interpersonal and identity issues.[citation needed] Mentalization-Based Therapy (MBT), initially developed for borderline personality disorder, helps individuals understand their own and others' mental states,[125] and has shown promise for treating antisocial traits, especially in individuals with moderate psychopathy.[citation needed]

### Psychosocial

[edit]

There are many different forms (modalities) of treatment used for personality disorders:[110]

* Family therapy, including couples therapy.
* Group therapy for personality dysfunction is probably[according to whom?] the second most used. For ASPD, NICE guidelines recommend group therapy focused on cognitive and behavioural techniques to manage symptoms.[97]
* Psychological-education may be used as an addition.
* Self-help groups may provide resources for personality disorders.
* Milieu therapy, a kind of group-based residential approach, has a history of use in treating personality disorders, including therapeutic communities.
* The practice of mindfulness that includes developing the ability to be nonjudgmentally aware of unpleasant emotions appears to be a promising clinical tool for managing different types of personality disorders.[126][127]

#### Behavioral management in childhood

[edit]

Early interventions focused on parenting strategies can reduce the risk of maladaptive personality development: Punitive methods often result in anxiety, social withdrawal, or aggression. Replacing punitive discipline with supportive and structured methods fosters healthy emotional development. Contingent reward methods may promote dependency on approval. Balancing reward with encouragement of autonomy and self-worth is recommended. Inconsistent parenting contributes to confusion and anxiety. Consistency and structure in discipline help develop adaptive behavior patterns.[citation needed]

### Pharmacological

[edit]

Psychiatric medications are not a primary treatment for personality disorders, and their use for this purpose lacks sufficient evidence.[128] They may however be prescribed to address co-occurring symptoms,[128] such as anxiety, depression, or impulsivity. Common medications include antidepressants (for mood-related symptoms), anxiolytics (used cautiously for short-term anxiety), and antipsychotics (for severe cognitive distortions or paranoid ideation).[citation needed] It has been suggested that future development of pharmacological treatments should focus on the treatment of traits, such as those in the AMPD and ICD-11 classifcation.[128]

NICE guidelines discourage the use of medication to treat ASPD and BPD, or their symptoms and related behaviors.[97][96] The Cochrane Review for ASPD found that there was no good quality evidence for the use of medication or therapy for the treatment of ASPD.[129][130] Both the American Psychiatric Association and Cochrane found that the evidence for medication being effective in treating BPD was weak.[111][112][113] Medication has been proposed for treatment of negative symtoms similar to those in schizophrenia in the case of SzPD.[107] Risperidone and olanzapine have been proposed for STPD.[118]

Despite the lack of evidence supporting the benefit of antipsychotics in people with personality disorders, 1 in 4 who do not have a serious mental illness are prescribed them in UK primary care. Many people receive these medication for over a year, contrary to NICE guidelines.[131][132] No medication has been approved by the U.S. Food and Drug Administration for the purpose of treating personality disorders.[128]

### Challenges

[edit]

The management and treatment of personality disorders can be a challenging and controversial area, for by definition the difficulties are enduring and affect multiple areas of functioning. This often involves interpersonal issues, and there can be difficulties in seeking and obtaining help from organizations in the first place, as well as with establishing and maintaining a specific therapeutic relationship. There is also substantial social stigma and discrimination related to the diagnosis.

#### Egosyntonicity

[edit]

Further information: Egosyntonicity

An individual with personality disorder may not consider themselves to have a mental health problem, or their personality to be disordered or the cause of problems. This perspective may be caused by the patient's ignorance or lack of insight into their own condition. Psychoanalytic theory has been used to explain treatment-resistant tendencies as egosyntonic (i.e. consistent with the ego integrity of the individual), which means that patients don't experience the pathology as being in conflict with their goals and self-image, and is therefore perceived to be appropriate. In addition, this behavior can result in maladaptive coping skills and may lead to personal problems that induce extreme anxiety, distress, or depression and result in impaired psychosocial functioning.[133]

Of those who have a personality disorder, many lack recognition of any abnormality and defend valiantly their continued occupancy of their personality role; they have been termed the Type R, or treatment-resisting personality disorders. This is in opposition to the Type S or treatment-seeking ones, who are keen on altering their personality disorders and sometimes clamor for treatment.[64] The classification of 68 personality disordered patients on the caseload of an assertive community team using a simple scale showed a 3 to 1 ratio between Type R and Type S personality disorders with Cluster C personality disorders being significantly more likely to be Type S, and paranoid and schizoid (Cluster A) personality disorders significantly more likely to be Type R than others.[134]

#### Heterogeneity

[edit]

The term 'personality disorder' encompasses a wide, heterogeneous range of issues, each with a different level of severity or impairment; thus, personality disorders can require fundamentally different approaches and understandings. For example, while some manifestations are characterized by continual social withdrawal and the shunning of relationships, others may cause fluctuations in forwardness. The extremes are worse still: at one extreme lie self-harm and self-neglect, while at another extreme some individuals may commit violence and crime. There can be other factors such as problematic substance use or dependency or behavioral addictions.

#### Difficulties in therapy

[edit]

Therapists can become disheartened by lack of initial progress, or by apparent progress that then leads to setbacks. Clients may be perceived as negative, rejecting, demanding, aggressive or manipulative. This has been looked at in terms of both therapist and client; in terms of social skills, coping efforts, defense mechanisms, or deliberate strategies; and in terms of moral judgments or the need to consider underlying motivations for specific behaviors or conflicts. The vulnerabilities of a client, and of a therapist, may become lost behind actual or apparent strength and resilience. Community mental health services may view individuals with personality disorders as too complex or difficult, and may directly or indirectly exclude individuals with such diagnoses or associated behaviors.[135]

In treatment, it is important to maintain appropriate professional personal boundaries while allowing for emotional expression[136][137] and therapeutic relationships. However, there can be difficulty in acknowledgement of the differences in subjective perspectives between client and therapist. A therapist may assume that the kinds of relationships and ways of interacting that make them feel safe and comfortable have the same effect on clients. As an example of one extreme, people who may have been exposed to hostility, deceptiveness, rejection, aggression or abuse in their lives, may in some cases be made confused, intimidated or suspicious by presentations of warmth, intimacy or positivity. On the other hand, reassurance, openness and clear communication are usually helpful and needed. It can take several months of sessions, and perhaps several stops and starts, to begin to develop a trusting relationship that can meaningfully address a client's issues.[138]

## Epidemiology

[edit]

The prevalence of personality disorder in the general community was largely unknown until surveys starting from the 1990s. In 2008 the median rate of diagnosable PD was estimated at 10.6%, based on six major studies across three nations. This rate of around one in ten, especially as associated with high use of cocaine, is described as a major public health concern requiring attention by researchers and clinicians.[139] The prevalence of individual personality disorders ranges from about 2% to 8% for the more common varieties, such as obsessive-compulsive, schizotypal, antisocial, borderline, and histrionic, to 0.5–1% for the least common, such as narcissistic and avoidant.[140][65]

A screening survey across 13 countries by the World Health Organization using DSM-IV criteria, reported in 2009 a prevalence estimate of around 6% for personality disorders. The rate sometimes varied with demographic and socioeconomic factors, and functional impairment was partly explained by co-occurring mental disorders.[141] In the US, screening data from the National Comorbidity Survey Replication between 2001 and 2003, combined with interviews of a subset of respondents, indicated a population prevalence of around 9% for personality disorders in total. Functional disability associated with the diagnoses appeared to be largely due to co-occurring mental disorders (Axis I in the DSM).[142] This statistic has been supported by other studies in the US, with overall global prevalence statistics ranging from 9% to 11%.[143][144]

A UK national epidemiological study (based on DSM-IV screening criteria), reclassified into levels of severity rather than just diagnosis, reported in 2010 that the majority of people show some personality difficulties in one way or another (short of threshold for diagnosis), while the prevalence of the most complex and severe cases (including meeting criteria for multiple diagnoses in different clusters) was estimated at 1.3%. Even low levels of personality symptoms were associated with functional problems, but the most severely in need of services was a much smaller group.[145] Personality disorders (especially Cluster A) are found more commonly among homeless people.[146]

There are some sex differences in the frequency of personality disorders which are shown in the table below.[147]: 206  The known prevalence of some personality disorders, especially borderline PD and antisocial PD are affected by diagnostic bias. This is due to many factors including disproportionately high research towards borderline PD and antisocial PD, alongside social and gender stereotypes, and the relationship between diagnosis rates and prevalence rates.[140] Since the removal of depressive PD, self-defeating PD, sadistic PD and passive-aggressive PD from the DSM-5, studies analysing their prevalence and demographics have been limited.

Sex differences in the frequency of personality disorders  Type of personality disorder  | Predominant sex  | Notes

|
|

Paranoid personality disorder | Inconclusive  | In clinical samples men have higher rates, whereas epidemiologically there is a reported higher rate of women[82] although due the controversy of paranoid personality disorder the usefulness of these results is disputed[140][148]
Schizoid personality disorder | Male  | About 10% more common in males[149]
Schizotypal personality disorder | Inconclusive  | The DSM-5 reports it is slightly more common in males, although other results suggest a prevalence of 4.2% in women and 3.7% in men[1][150]
Antisocial personality disorder | Male  | About three times more common in men,[151] with rates substantially higher in prison populations, up to almost 50% in some prison populations[151]
Borderline personality disorder | Female  | Diagnosis rates vary from about three times more common in women, to only a minor predominance of women over men. This is partially attributable to increased rates of treatment-seeking in women, although disputed[140][82]
Histrionic personality disorder | Equal  | Prevalence rates are equal, although diagnostic rates can favour women[152][82][140]
Narcissistic personality disorder | Male  | 7.7% for men, 4.8% for women[153][154]
Avoidant personality disorder | Female  | 2.8% in women, 1.2% in men.[140]
Dependent personality disorder | Female  | 0.6% in women, 0.4% in men.[82][140]
Depressive personality disorder | Equal[155] | No longer present in the DSM-5 and no longer widely used[1]
Passive–aggressive personality disorder | N/A  | No longer present in the DSM-5 and no longer widely used[1][156]
Obsessive–compulsive personality disorder | Inconclusive  | The DSM-5 lists a male-to-female ratio of 2:1, however other studies have found equal rates[157]
Self-defeating personality disorder | Female[158] | Removed since the DSM-IV, not present in the DSM-5[1]
Sadistic personality disorder | Male[159] | Removed since the DSM-IV, not present in the DSM-5[1]

## History

[edit]

### Diagnostic and Statistical Manual history

[edit]

Personality disorder diagnoses in each edition of the Diagnostic and Statistical Manual[147]: 17  DSM-I  | DSM-II  | DSM-III  | DSM-III-R  | DSM-IV(-TR)  | DSM-5

|
|
|
|
|

Inadequate[a] | Inadequate  | Deleted[147]: 19  | —  | —  | —
Schizoid[a] | Schizoid  | Schizoid  | Schizoid  | Schizoid  | Schizoid
Cyclothymic[a] | Cyclothymic  | Reclassified[147]: 16, 19  | —  | —  | —
Paranoid[a] | Paranoid  | Paranoid  | Paranoid  | Paranoid  | Paranoid
—  | —  | Schizotypal  | Schizotypal  | Schizotypal  | Schizotypal[b]
Emotionally unstable[c] | Hysterical[147]: 18  | Histrionic  | Histrionic  | Histrionic  | Histrionic
—  | —  | Borderline[147]: 19  | Borderline  | Borderline  | Borderline
Compulsive[c] | Obsessive–compulsive  | Compulsive  | Obsessive–compulsive  | Obsessive–compulsive  | Obsessive–compulsive
Passive–aggressive,
Passive–dependent subtype[c] | Deleted[147]: 18  | Dependent[147]: 19  | Dependent  | Dependent  | Dependent
Passive–aggressive,
Passive–aggressive subtype[c] | Passive–aggressive  | Passive–aggressive  | Passive–aggressive  | Deleted[d][160]: 629  | —
Passive–aggressive,
Aggressive subtype[c] | —  | —  | —  | —  | —
—  | Explosive[147]: 18  | Deleted[147]: 19  | —  | —  | —
—  | Asthenic[147]: 18  | Deleted[147]: 19  | —  | —  | —
—  | —  | Avoidant[147]: 19  | Avoidant  | Avoidant  | Avoidant
—  | —  | Narcissistic[147]: 19  | Narcissistic  | Narcissistic  | Narcissistic
Antisocial reaction[e] | Antisocial  | Antisocial  | Antisocial  | Antisocial  | Antisocial
Dyssocial reaction[e] | —  | —  | —  | —  | —
Sexual deviation[e] | Reclassified[147]: 16, 18  | —  | —  | —  | —
Addiction[e] | Reclassified[147]: 16, 18  | —  | —  | —  | —
Appendix
|  |  | Self-defeating  | Passive-aggressive (Negativistic)[160]: 733  | Personality disorder - Trait specified[38]
|  |  | Sadistic  | Depressive  |

Introduced   Deleted

1. ^ a b c d DSM-I Personality Pattern disturbance subsection.[147]: 16
2. ^ Also classified as a schizophrenia-spectrum disorder in addition to personality disorder.
3. ^ a b c d e DSM-I Personality Trait disturbance subsection.[147]: 16
4. ^ Excluded from formal diagnoses and moved to Appendix.
5. ^ a b c d DSM-I Sociopathic personality disturbance subsection.[147]: 16

### Before the 20th century

[edit]

Personality disorder is a term with a distinctly modern meaning, owing in part to its clinical usage and the institutional character of modern psychiatry. The currently accepted meaning must be understood in the context of historical changing classification systems such as DSM-IV and its predecessors. Although highly anachronistic, and ignoring radical differences in the character of subjectivity and social relations, some have suggested similarities to other concepts going back to at least the ancient Greeks.[4]: 35  For example, the Greek philosopher Theophrastus described 29 'character' types that he saw as deviations from the norm, and similar views have been found in Asian, Arabic and Celtic cultures. A long-standing influence in the Western world was Galen's concept of personality types, which he linked to the four humours proposed by Hippocrates.

In ancient India, the concept of temperament was closely related to the ideas in Ayurvedic medicine, which categorized individuals according to three doshas—Vata, Pitta, and Kapha. These doshas, or bodily humors, were believed to influence not just physical health but also the mental and emotional state of a person. Imbalances in these doshas were thought to result in behavioral abnormalities, echoing the Western notion of temperament but grounded in a more holistic, mind-body connection.

Similarly, ancient Chinese philosophy emphasized the balance of the five elements (wood, fire, earth, metal, and water), with each element corresponding to certain personality traits and emotional responses. Traditional Chinese medicine linked these elements to specific organs in the body and believed that emotional imbalances could result in physical illness. The idea that a person's emotional and behavioral state could affect both their health and their social relationships is a concept that resonates with contemporary ideas about personality disorders.

In the Arabic world, thinkers like Avicenna (Ibn Sina) incorporated Galenic ideas into their medical writings, further developing the concept of temperament. Avicenna expanded on the four humors proposed by Hippocrates and Galen, suggesting that certain personality traits—such as choleric (angry), melancholic (sad), sanguine (optimistic), and phlegmatic (calm)—were reflective of imbalances in bodily fluids. These early understandings of personality types laid the groundwork for later, more refined concepts of character in Western psychiatry.

The Celtic tradition also featured an early form of personality categorization, though more aligned with social roles and behaviors within their tribes. The Celts saw human nature as a reflection of natural forces, and individuals who exhibited extreme or deviant behaviors were often seen as outside the norms of their community, potentially deserving of spiritual or ritual intervention. This is similar to how the concept of personality disorders began to be tied to moral and social deviations rather than purely medical ones.[citation needed]

Such views lasted into the eighteenth century, when experiments began to question the supposed biologically based humours and 'temperaments'. Psychological concepts of character and 'self' became widespread. In the nineteenth century, 'personality' referred to a person's conscious awareness of their behavior, a disorder of which could be linked to altered states such as dissociation. This sense of the term has been compared to the use of the term 'multiple personality disorder' in the first versions of the DSM.[161]

Physicians in the early nineteenth century started to diagnose forms of insanity involving disturbed emotions and behaviors but seemingly without significant intellectual impairment or delusions or hallucinations. Philippe Pinel referred to this as ' manie sans délire ' – mania without delusions – and described a number of cases mainly involving excessive or inexplicable anger or rage. James Cowles Prichard advanced a similar concept he called moral insanity, which would be used to diagnose patients for some decades. 'Moral' in this sense referred to affect (emotion or mood) rather than simply the ethical dimension, but it was arguably a significant move for 'psychiatric' diagnostic practice to become so clearly engaged with judgments about individual's social behaviour.[162] Prichard was influenced by his own religious, social and moral beliefs, as well as ideas in German psychiatry.[163] These categories were much different and broader than later definitions of personality disorder, while also being developed by some into a more specific meaning of moral degeneracy akin to later ideas about 'psychopaths'. Separately, Richard von Krafft-Ebing popularized the terms sadism and masochism, as well as homosexuality, as psychiatric issues.

The German psychiatrist Koch sought to make the moral insanity concept more scientific, and in 1891 suggested the phrase 'psychopathic inferiority', theorized to be a congenital disorder. This referred to continual and rigid patterns of misconduct or dysfunction in the absence of apparent "mental retardation" or illness, supposedly without a moral judgment. Described as deeply rooted in his Christian faith, his work established the concept of personality disorder as used today.[164]

### 20th century

[edit]

In the early 20th century, another German psychiatrist, Emil Kraepelin, included a chapter on psychopathic inferiority in his influential work on clinical psychiatry for students and physicians. He suggested six types – excitable, unstable, eccentric, liar, swindler and quarrelsome. The categories were essentially defined by the most disordered criminal offenders observed, distinguished between criminals by impulse, professional criminals, and morbid vagabonds who wandered through life. Kraepelin also described three paranoid (meaning then delusional) disorders, resembling later concepts of schizophrenia, delusional disorder and paranoid personality disorder. A diagnostic term for the latter concept would be included in the DSM from 1952, and from 1980 the DSM would also include schizoid, schizotypal; interpretations of earlier (1921) theories of Ernst Kretschmer led to a distinction between these and another type later included in the DSM, avoidant personality disorder.

In 1933 Russian psychiatrist Pyotr Borisovich Gannushkin published his book Manifestations of Psychopathies: Statics, Dynamics, Systematic Aspects, which was one of the first attempts to develop a detailed typology of psychopathies. Regarding maladaptation, ubiquity, and stability as the three main symptoms of behavioral pathology, he distinguished nine clusters of psychopaths: cycloids (including constitutionally depressive, constitutionally excitable, cyclothymics, and emotionally labile), asthenics (including psychasthenics), schizoids (including dreamers), paranoiacs (including fanatics), epileptoids, hysterical personalities (including pathological liars), unstable psychopaths, antisocial psychopaths, and constitutionally stupid.[165] Some elements of Gannushkin's typology were later incorporated into the theory developed by a Russian adolescent psychiatrist, Andrey Yevgenyevich Lichko, who was also interested in psychopathies along with their milder forms, the so-called accentuations of character.[166]

In 1939, psychiatrist David Henderson published a theory of 'psychopathic states' that contributed to popularly linking the term to anti-social behavior. Hervey M. Cleckley's 1941 text, The Mask of Sanity, based on his personal categorization of similarities he noted in some prisoners, marked the start of the modern clinical conception of psychopathy and its popularist usage.[167]

Towards the mid 20th century, psychoanalytic theories were coming to the fore based on work from the turn of the century being popularized by Sigmund Freud and others. This included the concept of character disorders, which were seen as enduring problems linked not to specific symptoms but to pervasive internal conflicts or derailments of normal childhood development. These were often understood as weaknesses of character or willful deviance, and were distinguished from neurosis or psychosis. The term 'borderline' stems from a belief some individuals were functioning on the edge of those two categories, and a number of the other personality disorder categories were also heavily influenced by this approach, including dependent, obsessive–compulsive and histrionic,[168] the latter starting off as a conversion symptom of hysteria particularly associated with women, then a hysterical personality, then renamed histrionic personality disorder in later versions of the DSM. A passive aggressive style was defined clinically by Colonel William Menninger during World War II in the context of men's reactions to military compliance, which would later be referenced as a personality disorder in the DSM.[169] Otto Kernberg was influential with regard to the concepts of borderline and narcissistic personalities later incorporated in 1980 as disorders into the DSM.

Meanwhile, a more general personality psychology had been developing in academia and to some extent clinically. Gordon Allport published theories of personality traits from the 1920s—and Henry Murray advanced a theory called personology, which influenced a later key advocate of personality disorders, Theodore Millon. Tests were developing or being applied for personality evaluation, including projective tests such as the Rorschach test, as well as questionnaires such as the Minnesota Multiphasic Personality Inventory. Around mid-century, Hans Eysenck was analysing traits and personality types, and psychiatrist Kurt Schneider was popularising a clinical use in place of the previously more usual terms 'character', 'temperament' or 'constitution'.

American psychiatrists officially recognized concepts of enduring personality disturbances in the first Diagnostic and Statistical Manual of Mental Disorders in the 1950s, which relied heavily on psychoanalytic concepts. Somewhat more neutral language was employed in the DSM-II in 1968, though the terms and descriptions had only a slight resemblance to current definitions. The DSM-III published in 1980 made some major changes, notably putting all personality disorders onto a second separate 'axis' along with "mental retardation", intended to signify more enduring patterns, distinct from what were considered axis one mental disorders. 'Inadequate' and 'asthenic' personality disorder' categories were deleted, and others were expanded into more types, or changed from being personality disorders to regular disorders. Sociopathic personality disorder, which had been the term for psychopathy, was renamed Antisocial Personality Disorder. Most categories were given more specific 'operationalized' definitions, with standard criteria psychiatrists could agree on to conduct research and diagnose patients.[170] In the DSM-III revision, self-defeating personality disorder and sadistic personality disorder were included as provisional diagnoses requiring further study. They were dropped in the DSM-IV, though a proposed 'depressive personality disorder' was added; in addition, the official diagnosis of passive–aggressive personality disorder was dropped, tentatively renamed 'negativistic personality disorder.'[171]

International differences have been noted in how attitudes have developed towards the diagnosis of personality disorder. Kurt Schneider argued they were 'abnormal varieties of psychic life' and therefore not necessarily the domain of psychiatry, a view said to still have influence in Germany today. British psychiatrists have also been reluctant to address such disorders or consider them on par with other mental disorders, which has been attributed partly to resource pressures within the National Health Service, as well as to negative medical attitudes towards behaviors associated with personality disorders. In the US, the prevailing healthcare system and psychoanalytic tradition has been said to provide a rationale for private therapists to diagnose some personality disorders more broadly and provide ongoing treatment for them.[172]

* Psychology portal

## References

[edit]

1. ^ a b c d e f g American Psychiatric Association (2013). Diagnostic and Statistical Manual of Mental Disorders (Fifth ed.). Arlington, VA: American Psychiatric Publishing. pp. 646–49\. ISBN 978-0-89042-555-8.
2. ^ Ekselius L (2 October 2018). "Personality disorder: a disease in disguise". Upsala Journal of Medical Sciences. 123 (4): 194–204\. doi:10.1080/03009734.2018.1526235. PMC 6327594. PMID 30539674.
3. ^ Magnavita JJ (2004). "Chapter 1: Classification, prevalence, and etiology of personality disorders: Related issues and controversy". Handbook of personality disorders : theory and practice. Wiley. ISBN 0-471-20116-2. OCLC 52429596.
4. ^ a b Millon T, Davis RD (1996). Disorders of Personality: DSM-IV and Beyond. New York: John Wiley & Sons, Inc. p. 226\. ISBN 978-0-471-01186-6.
5. ^ Berrios GE (1993). "European views on personality disorders: a conceptual history". Comprehensive Psychiatry. 34 (1): 14–30\. doi:10.1016/0010-440X(93)90031-X. PMID 8425387.
6. ^ Ekselius L (2018). "Personality Disorder: A Disease in Disguise". Upsala Journal of Medical Sciences. 123 (4): 194–204\. doi:10.1080/03009734.2018.1526235. PMC 6327594. PMID 30539674.
7. ^ Beckwith H, Moran PF, Reilly J (May 2014). "Personality disorder prevalence in psychiatric outpatients: a systematic literature review". Personality and Mental Health. 8 (2): 91–101\. doi:10.1002/pmh.1252. PMID 24431304.
8. ^ Tyrer P, Reed GM, Crawford MJ (February 2015). "Classification, assessment, prevalence, and effect of personality disorder". Lancet. 385 (9969): 717–726\. doi:10.1016/s0140-6736(14)61995-4. PMID 25706217. S2CID 25755526.
9. ^ Saß H (2001). "Personality Disorders". International Encyclopedia of the Social & Behavioral Sciences: 11301–11308\. doi:10.1016/B0-08-043076-7/03763-3. ISBN 978-0-08-043076-8.
10. ^ Kernberg OF (1984). Severe personality disorders : psychotherapeutic strategies. New Haven: Yale University Press. ISBN 978-0-300-05349-4.
11. ^ a b Ullrich S, Farrington DP, Coid JW (December 2007). "Dimensions of DSM-IV personality disorders and life-success". Journal of Personality Disorders. 21 (6): 657–663\. doi:10.1521/pedi.2007.21.6.657. PMID 18072866. S2CID 30040457.
12. ^ Panos PT, Jackson JW, Hasan O, Panos A (March 2014). "Meta-Analysis and Systematic Review Assessing the Efficacy of Dialectical Behavior Therapy (DBT)". Research on Social Work Practice. 24 (2): 213–223\. doi:10.1177/1049731513503047. PMC 6405261. PMID 30853773.
13. ^ Kliem S, Kröger C, Kosfelder J (December 2010). "Dialectical behavior therapy for borderline personality disorder: a meta-analysis using mixed-effects modeling". Journal of Consulting and Clinical Psychology. 78 (6): 936–951\. doi:10.1037/a0021015. PMID 21114345.
14. ^ Budge SL, Moore JT, Del Re AC, Wampold BE, Baardseth TP, Nienhuis JB (December 2013). "The effectiveness of evidence-based treatments for personality disorders when comparing treatment-as-usual and bona fide treatments". Clinical Psychology Review. 33 (8): 1057–1066\. doi:10.1016/j.cpr.2013.08.003. PMID 24060812.
15. ^ "There are few disorders that carry such a stigma as personality disorders". Helpseeker.net. Archived from the original on 27 October 2023. Retrieved 6 December 2020.
16. ^ McWilliams N (29 July 2011). Psychoanalytic Diagnosis, Second Edition: Understanding Personality Structure in the Clinical Process. Guilford Press. pp. 196–. ISBN 978-1-60918-494-0.
17. ^ a b c d e f g Bach B, First MB (29 October 2018). "Application of the ICD-11 classification of personality disorders". BMC Psychiatry. 18 (1): 351. doi:10.1186/s12888-018-1908-3. ISSN 1471-244X. PMC 6206910. PMID 30373564.
18. ^ a b c Oldham JM (October 2022). "How Will Clinicians Utilize the Alternative DSM-5-TR Section III Model for Personality Disorders in Their Clinical Work?". Focus. 20 (4): 411–412\. doi:10.1176/appi.focus.20220053. ISSN 1541-4094. PMC 10187398. PMID 37200885.
19. ^ a b c d e Clark LA, Vanderbleek EN, Shapiro JL, Nuzum H, Allen X, Daly E, et al. (1 February 2015). "The Brave New World of Personality Disorder-Trait Specified: Effects of Additional Definitions on Coverage, Prevalence, and Comorbidity". Psychopathology Review. a2 (1): 52–82\. doi:10.5127/pr.036314. ISSN 2051-8315. PMC 4469240. PMID 26097740.
20. ^ Department of Psychiatry and Psychotherapy, Medical Faculty, LVR-Klinikum Düsseldorf, Heinrich-Heine-University, Düsseldorf, Germany, Gaebel W, WHO Collaborating Centre on Quality Assurance and Empowerment in Mental Health, Düsseldorf, Germany, Kerst A, Department of Psychiatry and Psychotherapy, Medical Faculty, LVR-Klinikum Düsseldorf, Heinrich-Heine-University, Düsseldorf, Germany, WHO Collaborating Centre on Quality Assurance and Empowerment in Mental Health, Düsseldorf, Germany, et al. (24 December 2020). "Classification and Diagnosis of Schizophrenia or Other Primary Psychotic Disorders: Changes from Icd-10 to Icd-11 and Implementation in Clinical Practice" (PDF). Psychiatria Danubina. 32 (3–4): 320–324\. doi:10.24869/psyd.2020.320. PMID 33370728. "Schizotypal disorder is defined as an enduring pattern of unusual speech, perceptions, beliefs, and behaviours of insufficient intensity to meet requirements for another psychotic disorder in ICD-10 and in ICD11. Yet, schizotypal disorder may be a possible predecessor of schizophrenia (Jablensky 2011, Stein et al. 2020) and is therefore kept in the ICD-11 chapter of primary psychotic disorders, contrary to DSM-5 which classifies schizotypal disorder as a personality disorder."3–4&rft.pages=320-324&rft.date=2020-12-24&rft_id=info:doi/10.24869/psyd.2020.320&rft_id=info:pmid/33370728&rft.au=Department+of+Psychiatry+and+Psychotherapy,+Medical+Faculty,+LVR-Klinikum+Düsseldorf,+Heinrich-Heine-University,+Düsseldorf,+Germany&rft.au=Gaebel,+Wolfgang&rft.au=WHO+Collaborating+Centre+on+Quality+Assurance+and+Empowerment+in+Mental+Health,+Düsseldorf,+Germany&rft.au=Kerst,+Ariane&rft.au=Department+of+Psychiatry+and+Psychotherapy,+Medical+Faculty,+LVR-Klinikum+Düsseldorf,+Heinrich-Heine-University,+Düsseldorf,+Germany&rft.au=WHO+Collaborating+Centre+on+Quality+Assurance+and+Empowerment+in+Mental+Health,+Düsseldorf,+Germany&rft.au=Stricker,+Johannes&rft.au=Department+of+Psychiatry+and+Psychotherapy,+Medical+Faculty,+LVR-Klinikum+Düsseldorf,+Heinrich-Heine-University,+Düsseldorf,+Germany&rft.au=WHO+Collaborating+Centre+on+Quality+Assurance+and+Empowerment+in+Mental+Health,+Düsseldorf,+Germany&rft_id=http://www.psychiatria-danubina.com/UserDocsImages/pdf/dnb_vol32_no3-4/dnb_vol32_no3-4_320.pdf&rfr_id=info:sid/en.wikipedia.org:Personality+disorder" class="Z3988">`{{cite journal}}`: CS1 maint: multiple names: authors list (link)
21. ^ Widiger TA (October 2003). "Personality disorder diagnosis". World Psychiatry. 2 (3): 131–135\. PMC 1525106. PMID 16946918.
22. ^ A Guide to DSM-5: Personality Disorders Medscape Psychiatry, Bret S. Stetka, MD, Christoph U. Correll, 21 May 2013
23. ^ Fariba KA, Gupta V, Torrico TJ, Kass E (2025), "Personality Disorder", StatPearls, Treasure Island (FL): StatPearls Publishing, PMID 32310518, retrieved 16 July 2025
24. ^ a b American Psychiatric Association, American Psychiatric Association, eds. (2013). "Personality Disorders". Diagnostic and statistical manual of mental disorders: DSM-5 (5th ed.). Washington, D.C: American Psychiatric Association. pp. 645–649\. ISBN 978-0-89042-554-1. "This chapter begins with a general definition of personality disorder that applies to each of the 10 specific personality disorders."
25. ^ Fariba KA, Gupta V, Torrico TJ, Kass E (2025), "Personality Disorder", StatPearls, Treasure Island (FL): StatPearls Publishing, PMID 32310518, retrieved 18 June 2025
26. ^ a b c "Personality disorders - Symptoms and causes". Mayo Clinic. Retrieved 26 January 2019.
27. ^ Esterberg ML, Goulding SM, Walker EF (December 2010). "Cluster A Personality Disorders: Schizotypal, Schizoid and Paranoid Personality Disorders in Childhood and Adolescence". Journal of Psychopathology and Behavioral Assessment. 32 (4): 515–528\. doi:10.1007/s10862-010-9183-8. PMC 2992453. PMID 21116455.
28. ^ Niedtfeld I (July 2017). "Experimental investigation of cognitive and affective empathy in borderline personality disorder: Effects of ambiguity in multimodal social information processing". Psychiatry Research. 253: 58–63\. doi:10.1016/j.psychres.2017.03.037. PMID 28351003. S2CID 13764666.
29. ^ Lenzenweger MF, Clarkin JF, Caligor E, Cain NM, Kernberg OF (2018). "Malignant Narcissism in Relation to Clinical Change in Borderline Personality Disorder: An Exploratory Study". Psychopathology. 51 (5): 318–325\. doi:10.1159/000492228. PMID 30184541. S2CID 52160230.
30. ^ a b c "Personality Disorders". Diagnostic and statistical manual of mental disorders: DSM-5 (5th ed.). Washington, D.C: American Psychiatric Association. 2013. pp. 682–684\. ISBN 978-0-89042-554-1.
31. ^ Diagnostic and statistical manual of mental disorders: DSM-5 (5th ed.). Washington, D.C: American Psychiatric Association. 2013. p. 683\. ISBN 978-0-89042-554-1. "The essential feature of a personality change due to another medical condition is a persistent personality disturbance that is judged to be due to the direct pathophysiological effects of a medical condition."
32. ^ a b c d e f Zimmermann J, Kerber A, Rek K, Hopwood CJ, Krueger RF (13 August 2019). "A Brief but Comprehensive Review of Research on the Alternative DSM-5 Model for Personality Disorders". Current Psychiatry Reports. 21 (9): 92. doi:10.1007/s11920-019-1079-z. ISSN 1535-1645. PMID 31410586.
33. ^ Skodol AE, Morey LC, Bender DS, Oldham JM (1 July 2015). "The Alternative DSM-5 Model for Personality Disorders: A Clinical Application". American Journal of Psychiatry. 172 (7): 606–613\. doi:10.1176/appi.ajp.2015.14101220. ISSN 0002-953X. PMID 26130200.
34. ^ Buer Christensen T, Hummelen B, Paap MC, Eikenaes I, Selvik SG, Kvarstein E, et al. (December 2020). "Evaluation of Diagnostic Thresholds for Criterion A in the Alternative DSM-5 Model for Personality Disorders". Journal of Personality Disorders. 34 (Supplement C): 40–61\. doi:10.1521/pedi_2019_33_455. ISSN 0885-579X. PMID 31682197.
35. ^ a b American Psychiatric Association, American Psychiatric Association, eds. (2013). Diagnostic and statistical manual of mental disorders: DSM-5 (5th ed.). Washington, D.C: American Psychiatric Association. pp. 761–763\. ISBN 978-0-89042-554-1.
36. ^ a b Mulay AL, Cain NM, Waugh MH, Hopwood CJ, Adler JM, Garcia DJ, et al. (2 November 2018). "Personality Constructs and Paradigms in the Alternative DSM-5 Model of Personality Disorder". Journal of Personality Assessment. 100 (6): 593–602\. doi:10.1080/00223891.2018.1477787. ISSN 0022-3891. OSTI 1476391. PMID 29902081.
37. ^ Porter JS, Risler E (January 2014). "The New Alternative DSM-5 Model for Personality Disorders: Issues and Controversies". Research on Social Work Practice. 24 (1): 50–56\. doi:10.1177/1049731513500348. ISSN 1049-7315.
38. ^ a b American Psychiatric Association, ed. (2013). Diagnostic and statistical manual of mental disorders: DSM-5 (5th ed.). Washington, D.C: American Psychiatric Association. pp. 770–771\. ISBN 978-0-89042-554-1. "The current diagnoses of paranoid, schizoid, histrionic, and dependent personality disorders are represented also by the diagnosis of PD-TS; these are defined by moderate or greater impairment in personality functioning and can be specified by the relevant pathological personality trait combinations."
39. ^ Mulder RT (10 May 2021). "ICD-11 Personality Disorders: Utility and Implications of the New Model". Frontiers in Psychiatry. 12. doi:10.3389/fpsyt.2021.655548. ISSN 1664-0640. PMC 8141634. PMID 34040555.
40. ^ a b Bach B, Kramer U, Doering S, di Giacomo E, Hutsebaut J, Kaera A, et al. (1 April 2022). "The ICD-11 classification of personality disorders: a European perspective on challenges and opportunities". Borderline Personality Disorder and Emotion Dysregulation. 9 (1): 12. doi:10.1186/s40479-022-00182-0. ISSN 2051-6673. PMC 8973542. PMID 35361271.
41. ^ a b c d Swales MA (December 2022). "Personality Disorder Diagnoses in ICD-11: Transforming Conceptualisations and Practice". Clinical Psychology in Europe. 4 (Spec Issue): e9635. doi:10.32872/cpe.9635. ISSN 2625-3410. PMC 9881116. PMID 36760321.
42. ^ García LF, Gutiérrez F, García O, Aluja A (12 July 2024). "The Alternative Model of Personality Disorders: Assessment, Convergent and Discriminant Validity, and a Look to the Future". Annual Review of Clinical Psychology. 20 (1): 431–455\. doi:10.1146/annurev-clinpsy-081122-010709. ISSN 1548-5943. PMID 38211624. "The AMPD regards PDs as extreme variants of normal-range personality dimensions, just as the eleventh revision of the International Classification of Diseases (ICD-11; WHO 2022) did a few years later. It takes as a reference framework the FFM, which in fact had been proposed as an early dimensional alternative to categories (Widiger & Costa 2013, Widiger & Simonsen 2005)."
43. ^ Bangash A (2024). "Personality difficulty: A useful addition to the literature on personality disturbance". Personality and Mental Health. 18 (4): 435–437\. doi:10.1002/pmh.1638. ISSN 1932-863X. PMID 39358823.
44. ^ "ICD-11 for Mortality and Morbidity Statistics". icd.who.int. Retrieved 28 April 2022.
45. ^ a b "Disorders of adult personality and behaviour (F60–F69)". The ICD-10 Classification of Mental and Behavioural Disorders – Clinical descriptions and diagnostic guidelines (PDF). WHO (2010). pp. 157–58\. Archived from the original on 16 March 2015.
46. ^ WHO (2010) ICD-10: Specific Personality Disorders
47. ^ "International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10) Version for 2010 (Online Version)". Apps.who.int. Retrieved on 16 April 2013. [dead link]
48. ^ Fuller AK, Blashfield RK, Miller M, Hester T (November 1992). "Sadistic and self-defeating personality disorder criteria in a rural clinic sample". Journal of Clinical Psychology. 48 (6): 827–831\. doi:10.1002/1097-4679(199211)48:6<827::AID-JCLP2270480618>3.0.CO;2-1. PMID 1452772.
49. ^ Theodore Millon (2004). Personality Disorders in Modern Life Archived 7 February 2017 at the Wayback Machine. Wiley, 2nd Edition. ISBN 0-471-23734-5. (GoogleBooks Preview).
50. ^ a b c d Monaghan C, Bizumic B (7 March 2023). "Dimensional models of personality disorders: Challenges and opportunities". Frontiers in Psychiatry. 14. doi:10.3389/fpsyt.2023.1098452. ISSN 1664-0640. PMC 10028270. PMID 36960458.
51. ^ a b c d e Day NJ, Green A, Denmeade G, Bach B, Grenyer BF (2024). "Narcissistic personality disorder in the ICD-11: Severity and trait profiles of grandiosity and vulnerability". Journal of Clinical Psychology. 80 (8): 1917–1936\. doi:10.1002/jclp.23701. ISSN 1097-4679. PMID 38742471.
52. ^ a b c d McCabe GA, Widiger TA (January 2020). "A comprehensive comparison of the ICD-11 and DSM–5 section III personality disorder models". Psychological Assessment. 32 (1): 72–84\. doi:10.1037/pas0000772. ISSN 1939-134X.
53. ^ Morey LC, Benson KT, Busch AJ, Skodol AE (April 2015). "Personality Disorders in DSM-5: Emerging Research on the Alternative Model". Current Psychiatry Reports. 17 (4). doi:10.1007/s11920-015-0558-0. ISSN 1523-3812.
54. ^ Zimmermann, J., Kerber, A., Rek, K., Hopwood, C. J., & Krueger, R. F. (2019). Integrating clinical and personality assessment: Toward the development of a shared framework. Journal of Personality Assessment, 101(3), 292–304. doi:10.1080/00223891.2018.1483373.
55. ^ Nysaeter TE, Hummelen B, Christensen TB, Eikenaes IU, Selvik SG, Pedersen G, et al. (2 January 2023). "The Incremental Utility of Criteria A and B of the DSM-5 Alternative Model for Personality Disorders for Predicting DSM-IV/DSM-5 Section II Personality Disorders". Journal of Personality Assessment. 105 (1): 111–120\. doi:10.1080/00223891.2022.2039166. ISSN 0022-3891. PMID 35285763.
56. ^ Widiger TA (April 1993). "The DSM-III-R Categorical Personality Disorder Diagnoses: A Critique and an Alternative". Psychological Inquiry. 4 (2): 75–90\. doi:10.1207/s15327965pli0402_1. ISSN 1047-840X.
57. ^ Costa PT, Widiger TA, eds. (2002). Personality disorders and the five-factor model of personality (2nd ed.). Washington, DC: American Psychological Association. ISBN 978-1-55798-826-3.
58. ^ a b Samuel D, Widiger T (December 2008). "A meta-analytic review of the relationships between the five-factor model and DSM-IV-TR personality disorders: A facet level analysis☆". Clinical Psychology Review. 28 (8): 1326–1342\. doi:10.1016/j.cpr.2008.07.002. PMC 2614445. PMID 18708274.
59. ^ Widiger TA, Costa PT., Jr. (2002) "Five-Factor model personality disorder research", pp. 59–87 in Costa Paul T, Jr, Widiger Thomas A. (eds.) Personality disorders and the five-factor model of personality. 2nd ed. Washington, DC: American Psychological Association. ISBN 978-1-55798-826-3.
60. ^ Mullins-Sweatt SN, Widiger TA (2006). "The five-factor model of personality disorder: A translation across science and practice", pp. 39–70 in Krueger R, Tackett J (eds.). Personality and psychopathology: Building bridges. New York: Guilford.
61. ^ Clark LA (2007). "Assessment and diagnosis of personality disorder: perennial issues and an emerging reconceptualization". Annual Review of Psychology. 58: 227–257\. doi:10.1146/annurev.psych.57.102904.190200. PMID 16903806. S2CID 2728977.
62. ^ Bagby RM, Sellbom M, Costa PT, Widiger TA (2008). "Predicting Diagnostic and Statistical Manual of Mental Disorders-IV personality disorders with the five-factor model of personality and the personality psychopathology five". Personality and Mental Health. 2 (2): 55–69\. doi:10.1002/pmh.33.
63. ^ Saulsman LM, Page AC (January 2004). "The five-factor model and personality disorder empirical literature: A meta-analytic review". Clinical Psychology Review. 23 (8): 1055–1085\. doi:10.1016/j.cpr.2002.09.001. PMID 14729423.
64. ^ a b Murray, Robin M. et al (2008). Psychiatry. Fourth Edition. Cambridge University Press. ISBN 978-0-521-60408-6.
65. ^ a b c d e Tasman, Allan et al (2008). Psychiatry. Third Edition. John Wiley & Sons, Ltd. ISBN 978-0470-06571-6.
66. ^ Emmelkamp PM (2013). Personality Disorders. Psychology Press. pp. 54–56\. ISBN 978-1-317-83477-9.
67. ^ Torgersen S (2014). "Prevalence, Sociodemographics and Functional Impairment". The American Psychiatric Publishing textbook of personality disorders (Second ed.). Washington, DC. pp. 122–26\. ISBN 978-1-58562-456-0. OCLC 601366312.`{{cite book}}`: CS1 maint: location missing publisher (link)
68. ^ Serenko A (2023). "Personality disorders as a predictor of counterproductive knowledge behavior: the application of the Millon Clinical Multiaxial Inventory-IV" (PDF). Journal of Knowledge Management. 27 (8): 2249–2282\. doi:10.1108/JKM-10-2021-0796. S2CID 256187160.
69. ^ Oldham JM, Skodol AE, Bender DS, American Psychiatric Publishing, eds. (2014). The American Psychiatric Publishing textbook of personality disorders (Second ed.). Washington, DC: American Psychiatric Publishing, a Division of American Psychiatric Association. ISBN 978-1-58562-456-0.
70. ^ Serenko A (19 October 2023). "Personality disorders as a predictor of counterproductive knowledge behavior: the application of the Millon Clinical Multiaxial Inventory-IV". Journal of Knowledge Management. 27 (8): 2249–2282\. doi:10.1108/JKM-10-2021-0796. ISSN 1367-3270.
71. ^ Schultz IZ, Rogers ES, eds. (2011). Work accommodation and retention in mental health. New York: Springer. ISBN 978-1-4419-0427-0. OCLC 705888562.
72. ^ Ettner SL, Maclean JC, French MT (January 2011). "Does Having a Dysfunctional Personality Hurt Your Career? Axis II Personality Disorders and Labor Market Outcomes: Axis II Personality Disorders and Labor Market Outcomes". Industrial Relations: A Journal of Economy and Society. 50 (1): 149–173\. doi:10.1111/j.1468-232X.2010.00629.x. PMC 3204880. PMID 22053112.
73. ^ Board BJ, Fritzon K (March 2005). "Disordered personalities at work". Psychology, Crime & Law. 11 (1): 17–32\. doi:10.1080/10683160310001634304. ISSN 1068-316X.
74. ^ Dearlove D (September 2003). "Interview: Manfred Kets de Vries: The Dark Side of Leadership". Business Strategy Review. 14 (3): 25–28\. doi:10.1111/1467-8616.00269. ISSN 0955-6419.
75. ^ Nur U, Tyrer P, Merson S, Johnson T (March 2004). "Social function, clinical symptoms and personality disturbance". Irish Journal of Psychological Medicine. 21 (1): 18–21\. doi:10.1017/S0790966700008090. PMID 30308726. S2CID 52962308.
76. ^ Standage KF (September 1979). "The use of Schneider's typology for the diagnosis of personality disorders--an examination of reliability". The British Journal of Psychiatry. 135 (2): 238–242\. doi:10.1192/bjp.135.2.163. PMID 486849. S2CID 3182563.
77. ^ "APA Upgrades APA PsycNET Content Delivery Platform". PsycEXTRA Dataset. 2017. doi:10.1037/e500792018-001. Retrieved 5 May 2025.
78. ^ Krueger RF, Carlson SR (February 2001). "Personality disorders in children and adolescents". Current Psychiatry Reports. 3 (1): 46–51\. doi:10.1007/s11920-001-0072-4. ISSN 1523-3812. PMID 11177759.
79. ^ a b Piedmont RL, Sherman MF, Sherman NC (December 2012). "Maladaptively high and low openness: the case for experiential permeability". Journal of Personality. 80 (6): 1641–1668\. doi:10.1111/j.1467-6494.2012.00777.x. PMID 22320184.
80. ^ a b Piedmont RL, Sherman MF, Sherman NC, Dy-Liacco GS, Williams JE (June 2009). "Using the five-factor model to identify a new personality disorder domain: the case for experiential permeability". Journal of Personality and Social Psychology. 96 (6): 1245–1258\. doi:10.1037/a0015368. PMID 19469599.
81. ^ a b Torgersen S (2009). "The nature (and nurture) of personality disorders". Scandinavian Journal of Psychology. 50 (6): 624–632\. doi:10.1111/j.1467-9450.2009.00788.x. ISSN 1467-9450. PMID 19930262.
82. ^ a b c d e Grant BF, Hasin DS, Stinson FS, Dawson DA, Chou SP, Ruan WJ, et al. (July 2004). "Prevalence, correlates, and disability of personality disorders in the United States: results from the national epidemiologic survey on alcohol and related conditions". The Journal of Clinical Psychiatry. 65 (7): 948–958\. doi:10.4088/JCP.v65n0711. PMID 15291684.
83. ^ Del Giudice M (2018), Del Giudice M (ed.), "Individual and Sex Differences", Evolutionary Psychopathology, Oxford University Press, pp. 68–94, doi:10.1093/med-psych/9780190246846.003.0003, ISBN 978-0-19-024684-6, retrieved 8 June 2024
84. ^ Mitchell KJ (2018). Innate: how the wiring of our brains shapes who we are. Princeton: Princeton University Press. pp. 54, 84–86\. ISBN 978-0-691-17388-7.
85. ^ a b Cohen P, Brown J, Smaile E (2001). "Child abuse and neglect and the development of mental disorders in the general population". Development and Psychopathology. 13 (4): 981–999\. doi:10.1017/S0954579401004126. PMID 11771917. S2CID 24036702.
86. ^ "What Causes Psychological Disorders?". American Psychological Association. 2010. Archived from the original on 20 November 2010.
87. ^ a b c Cohen P, Chen H, Gordon K, Johnson J, Brook J, Kasen S (April 2008). "Socioeconomic background and the developmental course of schizotypal and borderline personality disorder symptoms". Development and Psychopathology. 20 (2): 633–650\. doi:10.1017/S095457940800031X. PMC 3857688. PMID 18423098.
88. ^ Schwarze CE, Hellhammer DH, Stroehle V, Lieb K, Mobascher A (October 2015). "Lack of Breastfeeding: A Potential Risk Factor in the Multifactorial Genesis of Borderline Personality Disorder and Impaired Maternal Bonding". Journal of Personality Disorders. 29 (5): 610–626\. doi:10.1521/pedi_2014_28_160. PMID 25248013.
89. ^ Ericka Ball Cooper, Amanda Venta, Carla Sharp (2018). "The role of maternal care in borderline personality disorder and dependent life stress". Borderline Personality Disorder and Emotion Dysregulation. 5 5\. doi:10.1186/s40479-018-0083-y. PMC 5861727. PMID 29588857.`{{cite journal}}`: CS1 maint: multiple names: authors list (link)
90. ^ "What causes personality disorders?". American Psychological Association. Archived from the original on 13 March 2010. Retrieved 9 August 2017.
91. ^ Deckers T (February 2015). "How does Socio-Economic Status Shape a Child's Personality?" (PDF). Human Capital and Economic Opportunity Global Working Group. Archived from the original (PDF) on 5 November 2018. Retrieved 9 August 2017.
92. ^ Van Damme L, Colins O, De Maeyer J, Vermeiren R, Vanderplasschen W (June 2015). "Girls' quality of life prior to detention in relation to psychiatric disorders, trauma exposure and socioeconomic status". Quality of Life Research. 24 (6): 1419–1429\. doi:10.1007/s11136-014-0878-2. PMID 25429824. S2CID 28876461.
93. ^ Walsh Z, Shea MT, Yen S, Ansell EB, Grilo CM, McGlashan TH, et al. (December 2013). "Socioeconomic-status and mental health in a personality disorder sample: the importance of neighborhood factors". Journal of Personality Disorders. 27 (6): 820–831\. doi:10.1521/pedi_2012_26_061. PMC 4628287. PMID 22984860.
94. ^ Nunes PM, Wenzel A, Borges KT, Porto CR, Caminha RM, de Oliveira IR (August 2009). "Volumes of the hippocampus and amygdala in patients with borderline personality disorder: a meta-analysis". Journal of Personality Disorders. 23 (4): 333–345\. doi:10.1521/pedi.2009.23.4.333. PMID 19663654.
95. ^ Kaya S, Yildirim H, Atmaca M (May 2020). "Reduced hippocampus and amygdala volumes in antisocial personality disorder". Journal of Clinical Neuroscience. 75: 199–203\. doi:10.1016/j.jocn.2020.01.048. PMID 32334739. S2CID 210711736.
96. ^ a b c "Borderline personality disorder: recognition and management". NICE. 28 January 2009. Retrieved 4 June 2025.
97. ^ a b c "Antisocial personality disorder: prevention and management". NICE. 28 January 2009. Retrieved 4 June 2025.
98. ^ a b Lampe L, Malhi GS (2018). "Avoidant personality disorder: current insights". Psychology Research and Behavior Management. 11: 55–66\. doi:10.2147/PRBM.S121073. PMC 5848673. PMID 29563846.
99. ^ a b Maccaferri GE, Dunker-Scheuner D, De Roten Y, Despland JN, Sachse R, Kramer U (2020). "Psychotherapy of Dependent Personality Disorder: The Relationship of Patient–Therapist Interactions to Outcome". Psychiatry. 83 (2): 179–194\. doi:10.1080/00332747.2019.1675376. PMID 31614097.
100. ^ Beitz K, Bornstein RF (2006). "Dependent Personality Disorder". Practitioner's Guide to Evidence-Based Psychotherapy. Springer US. pp. 230–237\. doi:10.1007/978-0-387-28370-8_22. ISBN 978-0-387-28369-2.
101. ^ Hujing CL, Yalch MM (2024). "Histrionic Personality Disorder". Encyclopedia of Sexual Psychology and Behavior. Springer International Publishing. pp. 1–3\. doi:10.1007/978-3-031-08956-5_2502-1. ISBN 978-3-031-08956-5.
102. ^ Weinberg I, Ronningstam E (2022). "Narcissistic Personality Disorder: Progress in Understanding and Treatment". Focus. 20 (4): 368–377\. doi:10.1176/appi.focus.20220052. PMC 10187400. PMID 37200887.
103. ^ Levy KN, Rosenstein LK (2020). "Narcissistic Personality Disorder". The Wiley Encyclopedia of Personality and Individual Differences. Wiley. pp. 109–114\. doi:10.1002/9781118970843.ch282. ISBN 978-1-118-97074-4.
104. ^ a b Pinto A, Teller J, Wheaton MG (2022). "Obsessive-Compulsive Personality Disorder: A Review of Symptomatology, Impact on Functioning, and Treatment". Focus. 20 (4): 389–396\. doi:10.1176/appi.focus.20220058. PMC 10187387. PMID 37200888.
105. ^ a b Finch EF, Choi-Kain LW, Iliakis EA, Eisen JL, Pinto A (2021). "Good Psychiatric Management for Obsessive–Compulsive Personality Disorder". Current Behavioral Neuroscience Reports. 8 (4): 160–171\. doi:10.1007/s40473-021-00239-4.
106. ^ a b Wong KK (18 September 2020). "Paranoid Personality Disorder". The Wiley Encyclopedia of Personality and Individual Differences. Wiley. pp. 175–179\. doi:10.1002/9781118970843.ch293. ISBN 978-1-118-97074-4.
107. ^ a b c Li T (2021). "An Overview of Schizoid Personality Disorder" (PDF). Proceedings of the 2021 4th International Conference on Humanities Education and Social Sciences (ICHESS 2021). Vol. 615\. pp. 1657–1663\. doi:10.2991/assehr.k.211220.280. ISBN 978-94-6239-495-7. Retrieved 4 June 2025.
108. ^ Nielsen KD, Hovmand OR, Jørgensen MS, Meisner M, Arnfred SM (2023). "Psychotherapy for patients with schizotypal personality disorder: A scoping review". Clinical Psychology & Psychotherapy. 30 (6): 1264–1278\. doi:10.1002/cpp.2901. PMID 37675964.
109. ^ Bateman AW, Gunderson J, Mulder R (2015). "Treatment of personality disorder". The Lancet. 385 (9969): 735–743\. doi:10.1016/S0140-6736(14)61394-5. PMID 25706219.
110. ^ a b Magnavita, Jeffrey J. (2004) Handbook of personality disorders: theory and practice, John Wiley and Sons, ISBN 978-0-471-48234-5.
111. ^ a b Storebø OJ, Stoffers-Winterling JM, Völlm BA, Kongerslev MT, Mattivi JT, Jørgensen MS, et al. (4 May 2020). "Psychological therapies for people with borderline personality disorder". Cochrane Database of Systematic Reviews. 2020 (11): CD012955. doi:10.1002/14651858.CD012955.pub2. PMC 7199382. PMID 32368793.
112. ^ a b Stoffers-Winterling JM, Storebø OJ, Pereira Ribeiro J, Kongerslev MT, Völlm BA, Mattivi JT, et al. (14 November 2022). "Pharmacological interventions for people with borderline personality disorder". Cochrane Database of Systematic Reviews. 2022 (11): CD012956. doi:10.1002/14651858.CD012956.pub2. PMC 9662763. PMID 36375174.
113. ^ a b Keepers GA, Fochtmann LJ, Anzia JM, Benjamin S, Lyness JM, Mojtabai R, et al. (1 November 2024). "The American Psychiatric Association Practice Guideline for the Treatment of Patients With Borderline Personality Disorder". American Journal of Psychiatry. 181 (11): 1024–1028\. doi:10.1176/appi.ajp.24181010. PMID 39482953.
114. ^ Weinbrecht A, Schulze L, Boettcher J, Renneberg B (2016). "Avoidant Personality Disorder: a Current Review". Current Psychiatry Reports. 18 (3): 29. doi:10.1007/s11920-016-0665-6. PMID 26830887.
115. ^ Disney KL (2013). "Dependent personality disorder: A critical review". Clinical Psychology Review. 33 (8): 1184–1196\. doi:10.1016/j.cpr.2013.10.001. PMID 24185092.
116. ^ Lengel GJ (2020). "Histrionic Personality Disorder". The Wiley Encyclopedia of Personality and Individual Differences. Wiley. pp. 187–191\. doi:10.1002/9781118970843.ch295. ISBN 978-1-118-97074-4.
117. ^ Yang M (31 October 2023). "Overview on Histrionic Personality Disorder". Communications in Humanities Research. 7 (1): 221–226\. doi:10.54254/2753-7064/7/20230886.
118. ^ a b Kirchner SK, Roeh A, Nolden J, Hasan A (3 October 2018). "Diagnosis and treatment of schizotypal personality disorder: evidence from a systematic review". npj Schizophrenia. 4 (1): 20. doi:10.1038/s41537-018-0062-8. PMC 6170383. PMID 30282970.
119. ^ Hollon SD, Beck AT. Lambert MJ (ed.). Bergin and Garfield's Handbook of Psychotherapy.
120. ^ a b Beck JS (2011), Cognitive behavior therapy: Basics and beyond (2nd ed.), New York: The Guilford Press, pp. 19–20
121. ^ Field TA, Beeson ET, Jones LK (2015), "The New ABCs: A Practitioner's Guide to Neuroscience-Informed Cognitive-Behavior Therapy" (PDF), Journal of Mental Health Counseling, 37 (3): 206–20, doi:10.17744/1040-2861-37.3.206, archived from the original (PDF) on 15 August 2016, retrieved 6 July 2016
122. ^ Benjamin CL, Puleo CM, Settipani CA, et al. (2011), "History of cognitive-behavioral therapy in youth", Child and Adolescent Psychiatric Clinics of North America, 20 (2): 179–189, doi:10.1016/j.chc.2011.01.011, PMC 3077930, PMID 21440849
123. ^ a b c Chapman AL (2006). "Dialectical behavior therapy: current indications and unique elements". Psychiatry (Edgmont). 3 (9): 62–8\. PMC 2963469. PMID 20975829.
124. ^ "An Overview of Dialectical Behavior Therapy – Psych Central". 17 May 2016. Retrieved 19 January 2015.
125. ^ Sperry L (2016). Handbook of diagnosis and treatment of DSM-5 personality disorders: assessment, case conceptualization, and treatment (Third ed.). New York, NY: Routledge, Taylor & Francis Group. pp. 26–27\. ISBN 978-0-415-84190-0.
126. ^ Sng AA, Janca A (January 2016). "Mindfulness for personality disorders". Current Opinion in Psychiatry. 29 (1): 70–76\. doi:10.1097/YCO.0000000000000213. PMID 26651010. S2CID 235472.
127. ^ Creswell JD (January 2017). "Mindfulness Interventions". Annual Review of Psychology. 68: 491–516\. doi:10.1146/annurev-psych-042716-051139. PMID 27687118.
128. ^ a b c d Marin LK, Foster C, Goodman M (2022), Huprich SK (ed.), "Pharmacotherapy for personality disorders.", Personality disorders and pathology: Integrating clinical assessment and practice in the DSM-5 and ICD-11 era., Washington: American Psychological Association, pp. 305–321, doi:10.1037/0000310-014, ISBN 978-1-4338-3576-6, retrieved 13 July 2025
129. ^ Khalifa NR, Gibbon S, Völlm BA, Cheung NH, McCarthy L (3 September 2020). "Pharmacological interventions for antisocial personality disorder". Cochrane Database of Systematic Reviews. 2020 (9): CD007667. doi:10.1002/14651858.CD007667.pub3. PMC 8094881. PMID 32880105.
130. ^ Gibbon S, Khalifa NR, Cheung NH, Völlm BA, McCarthy L (3 September 2020). "Psychological interventions for antisocial personality disorder". Cochrane Database of Systematic Reviews. 2020 (9): CD007668. doi:10.1002/14651858.CD007668.pub3. PMC 8094166. PMID 32880104.
131. ^ "Antipsychotics are commonly prescribed to people with personality disorders, contrary to guidelines". NIHR Evidence. 10 November 2022. doi:10.3310/nihrevidence_54520. S2CID 253467990.
132. ^ Hardoon S, Hayes J, Viding E, McCrory E, Walters K, Osborn D (March 2022). "Prescribing of antipsychotics among people with recorded personality disorder in primary care: a retrospective nationwide cohort study using The Health Improvement Network primary care database". BMJ Open. 12 (3): e053943. doi:10.1136/bmjopen-2021-053943. PMC 8968526. PMID 35264346.
133. ^ Blumenthal S (3 April 2014). "Psychoanalytic diagnosis: understanding personality structure in the clinical process". Psychoanalytic Psychotherapy. 28 (2) (2nd ed.): 233–234\. doi:10.1080/02668734.2014.909673. ISSN 0266-8734. S2CID 144761197.
134. ^ Tyrer P, Mitchard S, Methuen C, Ranger M (June 2003). "Treatment rejecting and treatment seeking personality disorders: Type R and Type S". Journal of Personality Disorders. 17 (3): 263–268\. doi:10.1521/pedi.17.3.263.22152. PMID 12839104.
135. ^ Davison SE (2002). "Principles of managing patients with personality disorder". Advances in Psychiatric Treatment. 8 (1): 1–9\. doi:10.1192/apt.8.1.1. S2CID 6874579.
136. ^ Wu T, Hu J, Davydow D, Huang H, Spottswood M, Huang H (2022). "Demystifying borderline personality disorder in primary care". Frontiers in Medicine. 9: 1024022. doi:10.3389/fmed.2022.1024022. ISSN 2296-858X. PMC 9668888. PMID 36405597. "Creating a safe environment while firmly establishing boundaries within the patient-provider relationship is critical when treating patients with BPD. However, setting boundaries in a way that simultaneously reinforces the therapeutic alliance can be challenging. We recommend establishing boundaries from the beginning, as this can help eliminate the risk of surprise and potential outrage when patients' needs cannot be immediately met."
137. ^ BENDER DS (March 2005). "The Therapeutic Alliance in the Treatment of Personality Disorders". Journal of Psychiatric Practice. 11 (2): 73–87\. doi:10.1097/00131746-200503000-00002. ISSN 1538-1145. PMID 15803042.
138. ^ McVey, D. & Murphy, N. (eds.) (2010) Treating Personality Disorder: Creating Robust Services for People with Complex Mental Health Needs, ISBN 0-203-84115-8
139. ^ Lenzenweger MF (September 2008). "Epidemiology of personality disorders". The Psychiatric Clinics of North America. 31 (3): 395–403, vi. doi:10.1016/j.psc.2008.03.003. PMID 18638642.
140. ^ a b c d e f g Schulte Holthausen B, Habel U (October 2018). "Sex Differences in Personality Disorders". Current Psychiatry Reports. 20 (12) 107. doi:10.1007/s11920-018-0975-y. PMID 30306417. S2CID 52959021.
141. ^ Huang Y, Kotov R, de Girolamo G, Preti A, Angermeyer M, Benjet C, et al. (July 2009). "DSM-IV personality disorders in the WHO World Mental Health Surveys". The British Journal of Psychiatry. 195 (1): 46–53\. doi:10.1192/bjp.bp.108.058552. PMC 2705873. PMID 19567896.
142. ^ Lenzenweger MF, Lane MC, Loranger AW, Kessler RC (September 2007). "DSM-IV personality disorders in the National Comorbidity Survey Replication". Biological Psychiatry. 62 (6): 553–564\. doi:10.1016/j.biopsych.2006.09.019. PMC 2044500. PMID 17217923.
143. ^ Collins A, Barnicot K, Sen P (June 2020). "A Systematic Review and Meta-Analysis of Personality Disorder Prevalence and Patient Outcomes in Emergency Departments". Journal of Personality Disorders. 34 (3): 324–347\. doi:10.1521/pedi_2018_32_400. PMID 30307832. S2CID 52963562.
144. ^ Sansone RA, Sansone LA (April 2011). "Personality disorders: a nation-based perspective on prevalence". Innovations in Clinical Neuroscience. 8 (4): 13–18\. PMC 3105841. PMID 21637629.
145. ^ Yang M, Coid J, Tyrer P (September 2010). "Personality pathology recorded by severity: national survey". The British Journal of Psychiatry. 197 (3): 193–199\. doi:10.1192/bjp.bp.110.078956. PMID 20807963. S2CID 14040222.
146. ^ Connolly AJ, Cobb-Richardson P, Ball SA (December 2008). "Personality disorders in homeless drop-in center clients" (PDF). Journal of Personality Disorders. 22 (6): 573–588\. doi:10.1521/pedi.2008.22.6.573. PMID 19072678. Archived from the original (PDF) on 17 June 2009. Retrieved 31 January 2017. "With regard to Axis II, Cluster A personality disorders (paranoid, schizoid, schizotypal) were found in almost all participants (92% had at least one diagnosis), and Cluster B (83% had at least one of antisocial, borderline, histrionic, or narcissistic) and C (68% had at least one of avoidant, dependent, obsessive–compulsive) disorders also were highly prevalent"
147. ^ a b c d e f g h i j k l m n o p q r s Widiger T (2012). The Oxford Handbook of Personality Disorders. Oxford University Press. ISBN 978-0-19-973501-3.
148. ^ Triebwasser J, Chemerinski E, Roussos P, Siever LJ (December 2013). "Paranoid personality disorder". Journal of Personality Disorders. 27 (6): 795–805\. doi:10.1521/pedi_2012_26_055. PMID 22928850.
149. ^ Coid J, Yang M, Tyrer P, Roberts A, Ullrich S (May 2006). "Prevalence and correlates of personality disorder in Great Britain". The British Journal of Psychiatry. 188 (5): 423–431\. doi:10.1192/bjp.188.5.423. PMID 16648528. S2CID 4881014.
150. ^ Pulay AJ, Stinson FS, Dawson DA, Goldstein RB, Chou SP, Huang B, et al. (16 May 2009). "Prevalence, correlates, disability, and comorbidity of DSM-IV schizotypal personality disorder: results from the wave 2 national epidemiologic survey on alcohol and related conditions". Primary Care Companion to the Journal of Clinical Psychiatry. 11 (2): 53–67\. doi:10.4088/pcc.08m00679. PMC 2707116. PMID 19617934.
151. ^ a b Alegria AA, Blanco C, Petry NM, Skodol AE, Liu SM, Grant B, et al. (July 2013). "Sex differences in antisocial personality disorder: results from the National Epidemiological Survey on Alcohol and Related Conditions". Personality Disorders. 4 (3): 214–222\. doi:10.1037/a0031681. PMC 3767421. PMID 23544428.
152. ^ Sprock J (2000). "Gender-Typed Behavioral Examples of Histrionic Personality Disorder". Journal of Psychopathology and Behavioral Assessment. 22 (2): 107–122\. doi:10.1023/a:1007514522708. ISSN 0882-2689. S2CID 141244223.
153. ^ Stinson FS, Dawson DA, Goldstein RB, Chou SP, Huang B, Smith SM, et al. (July 2008). "Prevalence, correlates, disability, and comorbidity of DSM-IV narcissistic personality disorder: results from the wave 2 national epidemiologic survey on alcohol and related conditions". The Journal of Clinical Psychiatry. 69 (7): 1033–1045\. doi:10.4088/jcp.v69n0701. PMC 2669224. PMID 18557663.
154. ^ Grijalva E, Newman DA, Tay L, Donnellan MB, Harms PD, Robins RW, et al. (March 2015). "Gender differences in narcissism: a meta-analytic review". Psychological Bulletin. 141 (2): 261–310\. doi:10.1037/a0038231. PMID 25546498.
155. ^ DSM-IV-TR. p. 788.
156. ^ Rotenstein OH, McDermut W, Bergman A, Young D, Zimmerman M, Chelminski I (February 2007). "The validity of DSM-IV passive-aggressive (negativistic) personality disorder". Journal of Personality Disorders. 21 (1): 28–41\. doi:10.1521/pedi.2007.21.1.28. PMID 17373888.
157. ^ Grant JE, Mooney ME, Kushner MG (April 2012). "Prevalence, correlates, and comorbidity of DSM-IV obsessive-compulsive personality disorder: results from the National Epidemiologic Survey on Alcohol and Related Conditions". Journal of Psychiatric Research. 46 (4): 469–475\. doi:10.1016/j.jpsychires.2012.01.009. PMID 22257387.
158. ^ DSM-III-R. p. 373.
159. ^ DSM-III-R. p. 370.
160. ^ a b Diagnostic and Statistical Manual of Mental Disorders (4th ed.). 1994.
161. ^ Mental Health, AlmostReal(2025) The Art of Cultivating a Balanced Lifestyle: Navigating Modernity with Grace
162. ^ Jones DW (2016). Disordered personalities and Crime: An analysis of the history of moral insanity. London: Routledge. ISBN 9780415502177. Retrieved 23 August 2024.
163. ^ Augstein HF (July 1996). "J C Prichard's concept of moral insanity--a medical theory of the corruption of human nature". Medical History. 40 (3): 311–343\. doi:10.1017/S0025727300061329. PMC 1037128. PMID 8757717.
164. ^ Gutmann P (June 2008). "Julius Ludwig August Koch (1841-1908): Christian, philosopher and psychiatrist" (PDF). History of Psychiatry. 19 (74 Pt 2): 202–214\. doi:10.1177/0957154X07080661. hdl:2262/51635. PMID 19127839. S2CID 2223023.
165. ^ Ганнушкин П. Б. (2000). Клиника психопатий, их статика, динамика, систематика. Издательство Нижегородской государственной медицинской академии. ISBN 5-86093-015-1.
166. ^ Личко А. Е. (2010) Психопатии и акцентуации характера у подростков. Речь, ISBN 978-5-9268-0828-2.
167. ^ Arrigo BA (1 June 2001). "The Confusion Over Psychopathy (I): Historical Considerations". International Journal of Offender Therapy and Comparative Criminology. 45 (3): 325–44\. doi:10.1177/0306624X01453005. S2CID 145400985.
168. ^ Amy Heim & Drew Westen (2004) Theories of personality and personality disorders Archived 11 January 2012 at the Wayback Machine
169. ^ Lane C (1 February 2009). "The Surprising History of Passive–Aggressive Personality Disorder" (PDF). Theory & Psychology. 19 (1): 55–70\. CiteSeerX 10.1.1.532.5027. doi:10.1177/0959354308101419. S2CID 147019317.
170. ^ Hoermann, Simone; Zupanick, Corinne E. and Dombeck, Mark (January 2011) The History of the Psychiatric Diagnostic System Continued. mentalhelp.net.
171. ^ Oldham JM (2005). "Personality Disorders". Focus. 3 (3): 372–82\. doi:10.1176/foc.3.3.372.
172. ^ Kendell RE (February 2002). "The distinction between personality disorder and mental illness". The British Journal of Psychiatry. 180 (2): 110–115\. doi:10.1192/bjp.180.2.110. PMID 11823318. S2CID 90434.

## Further reading

[edit]

* Marshall WL, Serin R (1997). "Personality Disorders.". In Turner SM, Hersen R (eds.). Adult Psychopathology and Diagnosis. New York: Wiley. pp. 508–541.
* Murphy N, McVey D (2010). Treating Severe Personality Disorder]: Creating Robust Services for Clients with Complex Mental Health Needs. London: Routledge. Archived from the original on 15 July 2011.
* Millon T, Davis RD (1996). Disorders of personality : DSM-IV and beyond (2nd ed.). New York: Wiley. ISBN 978-0-471-01186-6.
* Yudofsky SC (2005). Fatal Flaws: Navigating Destructive Relationships With People With Disorders of Personality and Character (1st ed.). Washington, DC. ISBN 978-1-58562-214-6.`{{cite book}}`: CS1 maint: location missing publisher (link)

## External links

[edit]

Library resources about
Personality disorders

* * *

* Resources in your library

* Personality Disorders Foundation
* National Mental Health Association personality disorder fact sheet Archived 16 December 2010 at the Wayback Machine
* Personality Disorders information leaflet from The Royal College of Psychiatrists

Classification|

* ICD-11: 6D10
* ICD-10: F60
* ICD-9-CM: 301.9
* MeSH: D010554
* DiseasesDB: 9889
* SNOMED CT: 33449004

|

External resources|

* MedlinePlus: 000939
* eMedicine: article/294307

* v
* t
* e

Personality disorder classification

General classifications|

* Dimensional
* Categorical
* Multi-axial
* Prototypal
* Relational
* Structural

ICD classifications|

| ICD-10|

| Schizotypal|

* Schizotypal

|

Specific|

* Anankastic personality disorder
* Anxious (avoidant)
* Dependent
* Dissocial
* Emotionally unstable
* Histrionic
* Paranoid
* Schizoid

Other|

* Eccentric
* Haltlose
* Immature
* Narcissistic
* Passive–aggressive
* Psychoneurotic

Organic|

* Organic

Unspecified|

* Unspecified

ICD-11|

| Personality disorder|

* Mild
* Moderate
* Severe
* Severity unspecified

|

Prominent personality traits or patterns|

* Negative affectivity
* Detachment
* Dissociality
* Disinhibition
* Anankastia
* Borderline pattern

DSM classifications|

| DSM-III-R only|

* Sadistic
* Self-defeating (masochistic)

|

DSM-IV only|

Personality disorder not otherwise specified

| Appendix B (proposed)|

* Depressive
* Negativistic (passive–aggressive)

|

DSM-5|

| Cluster A (odd)|

* Paranoid
* Schizoid
* Schizotypal

|

Cluster B (dramatic)|

* Antisocial
* Borderline
* Histrionic
* Narcissistic

Cluster C (anxious)|

* Avoidant
* Dependent
* Obsessive-compulsive

Other|

* Other specified
* Unspecified
* Personality change due to another medical condition

Alternative DSM-5 Model
for Personality Disorders|

| Specific|

* Antisocial
* Avoidant
* Borderline
* Narcissistic
* Obsessive-compulsive
* Schizotypal

|

General|

* Trait Specified

* v
* t
* e

Mental disorders (Classification)

Adult personality and behavior

| Sexual|

* Ego-dystonic sexual orientation
* Paraphilia
* Fetishism
* Voyeurism
* Sexual anhedonia
* Sexual anorexia
* Sexual maturation disorder
* Sexual relationship disorder

|

Other|

* Factitious disorder
* Munchausen syndrome
* Fear of intimacy
* Gender dysphoria
* Intermittent explosive disorder
* Dermatillomania
* Kleptomania
* Pyromania
* Trichotillomania
* Personality disorder

Childhood and learning

| Emotional and behavioral|

* ADHD
* Conduct disorder
* ODD
* Emotional and behavioral disorders
* Separation anxiety disorder
* Movement disorders
* Stereotypic
* Social functioning
* DAD
* RAD
* Selective mutism
* Speech
* Cluttering
* Stuttering
* Tic disorder
* Tourette syndrome

|

Intellectual disability|

* X-linked intellectual disability
* Lujan–Fryns syndrome

Psychological development
(developmental disabilities)|

* Pervasive
* Specific

Mood (affective)

* Bipolar
* Bipolar I
* Bipolar II
* Bipolar NOS
* Cyclothymia
* Depression
* Atypical depression
* Dysthymia
* Major depressive disorder
* Melancholic depression
* Seasonal affective disorder
* Mania

Neurological and symptomatic

| Autism spectrum|

* Autism
* Asperger syndrome
* High-functioning autism
* PDD-NOS
* Savant syndrome

|

Dementia|

* AIDS dementia complex
* Alzheimer's disease
* Creutzfeldt–Jakob disease
* Frontotemporal dementia
* Huntington's disease
* Mild cognitive impairment
* Parkinson's disease
* Pick's disease
* Sundowning
* Vascular dementia
* Wandering

Other|

* Delirium
* Organic brain syndrome
* Post-concussion syndrome

Neurotic, stress-related and somatoform

| Adjustment|

* Adjustment disorder with depressed mood

|

Anxiety|

| Phobia|

* Agoraphobia
* Childhood phobia
* Social anxiety
* Social phobia
* Anthropophobia
* Specific social phobia
* Specific phobia
* Claustrophobia

|

Other|

* Generalized anxiety disorder
* OCD
* Panic attack
* Panic disorder
* Paranoia
* Stress
* Acute stress reaction
* PTSD

Dissociative|

* Depersonalization-derealization disorder
* Dissociative identity disorder
* Dissociative amnesia
* Dissociative fugue
* Dissociative disorder not otherwise specified
* Other specified dissociative disorder

Somatic symptom|

* Body dysmorphic disorder
* Conversion disorder
* Ganser syndrome
* Globus pharyngeus
* Psychogenic non-epileptic seizures
* False pregnancy
* Hypochondriasis
* Mass psychogenic illness
* Nosophobia
* Psychogenic pain
* Somatization disorder

Physiological and physical behavior

| Eating|

* Anorexia nervosa
* Bulimia nervosa
* Rumination syndrome
* Other specified feeding or eating disorder

|

Nonorganic sleep|

* Hypersomnia
* Insomnia
* Parasomnia
* Night terror
* Nightmare
* REM sleep behavior disorder

Postnatal|

* Postpartum depression
* Postpartum psychosis

Sexual desire|

* Hypersexuality
* Hypoactive sexual desire disorder

Psychoactive substances, substance abuse and substance-related

* Drug overdose
* Hallucinogen persisting perception disorder
* Intoxication
* Physical dependence
* Rebound effect
* Stimulant psychosis
* Substance dependence
* Substance-induced psychosis
* Withdrawal

Schizophrenia, schizotypal and delusional

| Delusional|

* Delusional disorder
* Folie à deux

|

Psychosis and
schizophrenia-like|

* Brief reactive psychosis
* Schizoaffective disorder
* Schizophreniform disorder

Schizophrenia|

* Childhood schizophrenia
* Disorganized (hebephrenic) schizophrenia
* Pseudoneurotic schizophrenia
* Simple-type schizophrenia

Other|

* Catatonia

Symptoms and uncategorized

* Impulse-control disorder
* Klüver–Bucy syndrome
* Psychomotor agitation
* Stereotypy
* Caregiver burden

Category

Authority control databases

National|

* Germany
* United States
* Czech Republic
* Latvia
* Israel

Other|

* Yale LUX

*[v]: View this template
*[t]: Discuss this template
*[e]: Edit this template