The different personality disorder diagnoses

An official definition of personality disorder, as taken from the American Psychiatric Association’s Diagnostic and Statistical Manual – IV is presented below.

An enduring pattern of inner experience and behaviour that deviates markedly from the expectations of the individual’s culture, is pervasive and inflexible, has an onset in adolescence or early adulthood, is stable over time and leads to distress or impairment.

Different classification systems are used for diagnosis. Table 1.1 provides some guidance for the terms used in the American Psychiatric Association’s Diagnostic and Statistical Manual, now in its fifth edition (DSM-IV). Within this diagnostic manual, personality disorders are defined by the clusters of traits, attitudes or behaviours which are characteristic of the diagnosis. The disorders are also grouped into three clusters according to their primary presenting features. They are referred to as the odd or eccentric disorders (Cluster A; Schizoid, Paranoid, Schizotypal), the dramatic and erratic disorders (Cluster B; Antisocial, Borderline, Histrionic and Narcissistic) and the anxious and fearful disorders (Cluster C; Avoidant, Dependent, and Obsessive-Compulsive).

More detailed information on each personality disorder, as well as advice on risk assessment and management can be found in Problem behaviour’s section of the website under Top Tips.

Note: although personality disorder may be present in about 10% of the general population, it is not usually linked to offending behaviour. However, in the offending population – although estimates vary – it is probably present in at least 50% of the population. This high prevalence is rather misleading, as it is likely that the specific diagnosis – antisocial (or dissocial) personality disorder – accounts for much of this. Given that many young adults with such a diagnosis ‘grow out of it’ – that is, no longer meet the criteria for the diagnosis ten years later – it is likely that the prevalence of personality disorder other than antisocial, in offenders over the age of thirty is very much lower.

DSM – IV Disorders Primary presenting features
Cluster A  
Paranoid Distrust, suspiciousness
Schizoid Absence of attachments to others, flattened emotions
Schizotypal Eccentric behaviour, discomfort with close relationships, unusual perceptual experiences
Cluster B Take it all on yourself,
and offer countless suggestions that you will have to coordinate
Antisocial Disregard for and violation of the rights of others.
Histrionic Attention seeking and excessive emotionality
Narcissistic Grandiosity, need for admiration, lack of empathy.
Borderline Unstable relationships, self image, emotions, and impulsivity.
Cluster C  
Dependent Submissive behaviour, excessive need to be taken care of.
Avoidant Oversensitive to negative evaluation, feelings of inadequacy, social inhibition.
Obsessive- Compulsive Pre-occupation with orderliness, perfection and control.