6 Personality Disorders

Question 1

A _____ disorder is a persistent pattern of emotions, cognitions, and behavior that results in enduring emotional distress for the person affected and/or for others and may cause difficulties with work and relationships.

Someone other than the person with the personality disorder must decide whether the disorder is causing significant functional impairment, because the affected person often cannot make such a judgment.

Answer 1

personality

Question 2

The personality disorders were included in a separate axis, Axis _____, because as a group they were seen as distinct.

Answer 2

II

Question 3

Cluster A is called the _____ cluster; it includes paranoid, schizoid, and schizotypal personality disorders.

Answer 3

odd or eccentric

Question 4

Cluster B is the _____ cluster; it consists of antisocial, borderline, histrionic, and narcissistic personality disorders.

Answer 4

dramatic, emotional, or erratic

Question 5

Cluster C is the _____ cluster; it includes avoidant, dependent, and obsessive-compulsive personality disorders.

Answer 5

anxious or fearful

Question 6

A. A pervasive distrust and suspiciousness of others such that their motives are interpreted as malevolent, beginning by early adulthood and present in a variety of contexts, as indicated by four (or more) of the following:

1. Suspects, without sufficient basis, that others are exploiting, harming, or deceiving him or her.
2. Is preoccupied with unjustified doubts about the loyalty or trustworthiness of friends or associates
3. Is reluctant to confide in others because of unwarranted fear that the information will be used maliciously against him or her.
4. Reads hidden demeaning or threatening meanings into benign remarks or events.
5. Persistently bears grudges (i.e., is unforgiving of insults, injuries, or slights)
6. Perceives attacks on his or her character or reputation that are not apparent to others and is quick to react angrily or to counterattack.
7. Has recurrent suspicions, without justification, regarding fidelity of spouse or sexual partner.

B. Does not occur exclusively during the course of schizophrenia, a bipolar disorder or depressive disorder with psychotic features, or another psychotic disorder and is not attributable to the physiological effects of another medical condition.

Note: If criteria are met prior to the onset of schizophrenia, add “premorbid,” i.e., “_____ personality disorder (premorbid).”

Answer 6

Paranoid Personality Disorder

Question 7

People with _____ personality disorder may be argumentative, may complain, or may be quiet. This style of interaction is communicated, sometimes nonverbally, to others, often resulting in discomfort among those who come in contact with them because of this volatility.

These individuals are sensitive to criticism and have an excessive need for autonomy. Having this disorder increases the risk of suicide attempts and violent behavior, and these people tend to have a poor overall quality of life.

Answer 7

paranoid

Question 8

Relatives of individuals with _____ may be more likely to have paranoid, and schizotypal personality disorder than people who do not have a relative with schizophrenia.

Answer 8

schizophrenia

Question 9

Retrospective research—asking people with this disorder to recall events from their childhood—suggests that early mistreatment or traumatic childhood experiences may play a role in the development of _____ personality disorder.

Answer 9

paranoid

Question 10

A. A pervasive pattern of detachment from social relationships and a restricted range of expression of emotions in interpersonal settings, beginning by early adulthood and present in a variety of contexts, as indicated by four (or more) of the following:

1. Neither desires nor enjoys close relationships, including being part of a family.
2. Almost always chooses solitary activities.
3. Has little, if any, interest in having sexual experiences with another person.
4. Tal

Answer 10

Schizoid Personality Disorder

Question 11

For them, social isolation may be extremely painful

Answer 11

Schizoid Personality Disorder

Question 12

Abuse and neglect in childhood, childhood shyness, parents of children
with autism, is reported as a precursor to later adult _____ personality disorder.

Answer 12

schizoid

Question 13

A. A pervasive pattern of social and interpersonal deficits marked by acute discomfort with, and reduced capacity for, close relationships as well as by cognitive or perceptual distortions and eccentricities of behavior, beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following:

1. Ideas of reference (excluding delusions of reference).
2. Odd beliefs or magical thinking that influences behavior and is inconsistent with subcultural norms (e.g., superstitiousness, belief in clairvoyance, telepathy, or “sixth sense”: in children and adolescents, bizarre fantasies or preoccupations).
3. Unusual perceptual experiences, including bodily illusions.
4. Odd thinking and speech (e.g., vague, circumstantial, metaphorical, overelaborate, or stereotyped).
5. Suspiciousness or paranoid ideation.
6. Inappropriate or constricted affect.
7. Behavior or appearance that is odd, eccentric, or peculiar.
8. Lack of close friends or confidants other than first-degree relatives.
9. Excessive social anxiety that does not diminish with familiarity and tends to be associated with paranoid fears rather than negative judgments about self.

B. Does not occur exclusively during the course of schizophrenia, a bipolar disorder or depressive disorder with psychotic features, another psychotic disorder, or autism spectrum disorder.

Note: If criteria are met prior to the onset of schizophrenia, add “premorbid,” e.g., “_____ personality disorder (premorbid).”

Answer 13

Schizotypal Personality Disorder

Question 14

People with _____ personality disorder are typically socially isolated, like those with schizoid personality disorder. In addition, they also behave in ways that would seem unusual to many of us, and they tend to be suspicious and to have odd beliefs.

Answer 14

schizotypal

Question 15

Schizotypal personality disorder is considered by some to be on a continuum (that is, on the same spectrum) with schizophrenia, but without some of the more debilitating symptoms, such as _____.

Answer 15

hallucinations and delusions

Question 16

Suspicious and have paranoid thoughts, express little emotion, and may dress or behave in unusual ways (for example, wear many layers of clothing in the summertime or mumble to themselves)

Answer 16

Schizotypal Personality

Question 17

Some estimate that between 30% and 50% of the people with schizotypal personality disorder who request clinical help also meet the criteria for _____ disorder.

Answer 17

major depressive

Question 18

People with _____ personality disorder are among the most puzzling of the individuals a clinician will see in a practice and are characterized as having a history of failing to comply with social norms.

Answer 18

antisocial

Question 19

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

1. Failure to conform to social norms with respect to lawful behaviors, as indicated by repeatedly performing acts that are grounds for arrest.
2. Deceitfulness, as indicated by repeated lying, use of aliases, or conning others for personal profit or pleasure.
3. Impulsivity or failure to plan ahead.
4. Irritability and aggressiveness, as indicated by repeated physical fights or assaults.
5. Reckless disregard for safety of self or others.
6. Consistent irresponsibility, as indicated by repeated failure to sustain consistent work behavior or honor financial obligations.
7. Lack of remorse, as indicated by being indifferent to or rationalizing having hurt, mistreated, or stolen from another.

B. The individual is at least age 18 years

C. There is evidence of conduct disorder with onset before age 15 years.

D. The occurrence of _____ behavior is not exclusively during the course of schizophrenia or bipolar disorder.

Answer 19

Antisocial Personality Disorder

Question 20

Philippe Pinel identified what he called _____ (mania without delirium) to describe people with unusual emotional responses and impulsive rages but no deficits in reasoning ability.

Answer 20

manie sans délire

Question 21

Other labels have included moral insanity, egopathy,sociopathy, and psychopathy.

Answer 21

Antisocial Personality Disorder

Question 22

Six of the criteria that Hare includes in his _____ Checklist (PCL-R) are as follows:

1. Glibness/superficial charm
2. Grandiose sense of self-worth
3. Pathological lying
4. Conning/manipulative
5. Lack of remorse or guilt
6. Callous/lack of empathy

Answer 22

Revised Psychopathy

Question 23

A. A repetitive and persistent pattern of behavior in which the basic rights of others or major age-appropriate societal norms or rules are violated, as manifested by the presence of at least three of the following 15 criteria in the past 12 months from any of the categories below, with at least one criterion present in the past 6 months:

Aggression to People and Animals
1. Often bullies, threatens, or intimidates others.
2. Often initiates physical fights.
3. Has used a weapon that can cause serious physical harm to others (e.g., a bat, brick, broken bottle, knife, gun).
4. Has been physically cruel to people
5. Has been physically cruel to animals.
6. Has stolen while confronting a victim (e.g., mugging, purse snatching, extortion, armed robbery).
7. Has forced someone into sexual activity.
Destruction of Property
8. Has deliberately engaged in fire setting with the intention of causing serious damage.
9. Has deliberately destroyed others’ property (other than by fire setting).
Deceitful ness or Theft
10. Has broken into someone else’s house, building, or car.
11. Often lies to obtain goods or favors or to avoid obligations (i.e., “cons” others).
12. Has stolen items of nontrivial value without confronting a victim (e.g., shoplifting, but without breaking and entering: forgery).
Serious Violations of Rules
13. Often stays out at night despite parental prohibitions, beginning before age 13 years.
14. Has run away from home overnight at least twice while living in the parental or parental surrogate home, or once without returning for a lengthy period.
15. Is often truant from school, beginning before age 13 years.

B. The disturbance in behavior causes clinically significant impairment in social, academic, or occupational functioning.

C. If the individual is age 18 years or older, criteria are not met for antisocial personality disorder.

Specify whether:

312. 81 (F91.1) Childhood-onset type: Individuals show at least one symptom characteristic of _____ disorder prior to age 10 years.
313. 82 (F91.2) Adolescent-onset type: Individuals show no symptom characteristic of _____ disorder prior to age 10 years.
314. 89 (F91.9) Unspecified onset: Criteria for a diagnosis of _____ disorder are met, but there is not enough information available to determine whether the onset of the first symptom was before or after age 10 years.

Specify if:
With limited prosocial emotions: To qualify for this specifier, an individual must have displayed at least two of the following characteristics persistently over at least 12 months and in multiple relationships and settings. These characteristics reflect the individual’s typical pattern of interpersonal and emotional functioning over this period and not just occasional occurrences in some situations. Thus, to assess the criteria for the specifier, multiple information sources are necessary. In addition to the individual’s self-report, it is necessary to consider reports by others who have known the individual for extended periods of time (e.g., parents, teachers, co-workers, extended family members, peers).

Lack of remorse or guilt: Does not feel bad or guilty when he or she does something wrong (exclude remorse when expressed only when caught and/or facing punishment). The individual shows a general lack of concern about the negative consequences of his or her actions. For example, the individual is not remorseful after hurting someone or does not care about the consequences of breaking rules.
Callous—lack of empathy: Disregards and is unconcerned about the feelings of others. The individual is described as cold and uncaring. The person appears more concerned about the effects of his or her actions on himself or herself, rather than their effects on others, even when they result in substantial harm to others
Unconcerned about performance: Does not show concern about poor/problematic performance at school, at work, or in other important activities. The individual does not put forth the effort necessary to perform well, even when expectations are clear, and typically blames others for his or her poor performance.
Shallow or deficient affect: Does not express feelings or show emotions to others, except in ways that seem shallow, insincere, or superficial (e.g., actions contradict the emotion displayed; can turn emotions “on” or “off’ quickly) or when emotional expressions are used for gain (e.g., emotions displayed to manipulate or intimidate others).

Specify current severity:
Mild: Few if any _____ problems in excess of those required to make the diagnosis are present, and _____ problems cause relatively minor harm to others (e.g., lying, truancy, staying out after dark without permission, other rule breaking).
Moderate: The number of _____ problems and the effect on others are intermediate between those specified in “mild” and those in “severe” (e.g., stealing without confronting a victim, vandalism).
Severe: Many _____ problems in excess of those required to make the diagnosis are present, or _____ problems cause considerable harm to others (e.g., forced sex, physical cruelty, use of a weapon, stealing while confronting a victim, breaking and entering).

Answer 23

Conduct Disorder

Question 24

It is important to note the developmental nature of antisocial behavior. DSM-5 provides a separate diagnosis for children who engage in behaviors that violate society’s norms: _____ disorder.

Answer 24

conduct

Question 25

The likelihood of an adult having antisocial personality disorder increases if, as a child, he or she had both _____ disorder and _____ disorder

Answer 25

conduct, attention deficit/hyperactivity

Question 25

The likelihood of an adult having antisocial personality disorder increases if, as a child, he or she had both _____ disorder and _____ disorder

Answer 25

conduct, attention deficit/hyperactivity

Question 26

Crowe found that the _____ offspring of felons had significantly higher rates of arrests, conviction, and antisocial personality than did the _____ offspring of normal mothers, which suggests at least some genetic influence on criminality and antisocial behavior.

Answer 26

adopted

Question 27

According to the underarousal hypothesis, psychopaths have abnormally low levels of _____.

Answer 27

cortical arousal

Question 28

Rates of antisocial behavior begin to decline rather markedly around the age of ______.

Why antisocial behavior often declines around middle age remains unanswered.

Answer 28

40

Question 29

Deficits in _____ functioning are thought to make individuals unable to recognize cues that signal threat, making them relatively fearless, which suggests that these children had problems in this area of the brain.

Answer 29

amygdala

Question 30

A pervasive pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsivity, beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following:

1. Frantic efforts to avoid real or imagined abandonment. (Note: Do not include suicidal or self-mutilating behavior covered in Criterion 5.)
2. A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation
3. Identity disturbance: markedly and persistently unstable self-image or sense of self
4. Impulsivity in at least two areas that are potentially self-damaging (e.g., spending, sex, substance abuse, reckless driving, binge eating). (Note: Do not include suicidal or self-mutilating behavior covered in Criterion 5.)
5. Recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior.
6. Affective instability due to a marked reactivity of mood (e.g., intense episodic dysphoria, irritability, or anxiety usually lasting a few hours and only rarely more than a few days).
7. Chronic feelings of emptiness
8. Inappropriate, intense anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights)
9. Transient, stress-related paranoid ideation or severe dissociative symptoms.

Answer 30

Borderline Personality Disorder

Question 31

As with antisocial personality disorder, people with borderline personality disorder tend to improve during their _____.

Answer 31

30s and 40s

Question 32

Individuals with _____ personality disorder tend to be overly dramatic and often seem almost to be acting, which is why the term _____, which means theatrical in manner, is used.

Answer 32

histrionic

Question 33

A pervasive pattern of excessive emotionality and attention seeking, beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following:

1. Is uncomfortable in situations in which he or she is not the center of attention.
2. Interaction with others is often characterized by inappropriate sexually seductive or provocative behavior.
3. Displays rapidly shifting and shallow expression of emotions.
4. Consistently uses physical appearance to draw attention to self.
5. Has a style of speech that is excessively impressionistic and lacking in detail.
6. Shows self-dramatization, theatricality, and exaggerated expression of emotion.
7. Is suggestible (i.e., easily influenced by others or circumstances).
8. Considers relationships to be more intimate than they actually are.

Answer 33

Histrionic Personality Disorder

Question 34

A pervasive pattern of grandiosity (in fantasy or behavior), need for admiration, and lack of empathy, beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following:

1. Has a grandiose sense of self-importance (e.g., exaggerates achievements and talents, expects to be recognized as superior without commensurate achievements).
2. Is preoccupied with fantasies of unlimited success, power, brilliance, beauty, or ideal love.
3. Believes that he or she is “special” and unique and can only be understood by, or should associate with, other special or high-status people (or institutions).
4. Requires excessive admiration.
5. Has a sense of entitlement (i.e., unreasonable expectations of especially favorable treatment or automatic compliance with his or her expectations).
6. Is interpersonally exploitative (i.e., takes advantage of others to achieve his or her own ends).
7. Lacks empathy: is unwilling to recognize or identify with the feelings and needs of others.
8. Is often envious of others or believes that others are envious of him or her.
9. Shows arrogant, haughty behaviors or attitudes

Answer 34

Narcissistic Personality Disorder

Question 35

When confronted with other successful people, they can be extremely envious and arrogant. And because they often fail to live up to their own expectations, they are often _____.

Answer 35

depressed

Question 36

People diagnosed with the next three personality disorders we highlight—avoidant, dependent, and obsessive-compulsive—share common features with people who have anxiety disorders. These _____ personality disorders are described next.

Answer 36

anxious or fearful

Question 37

A pervasive pattern of social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation, beginning by early adulthood and present in a variety of contexts, as indicated by four (or more) of the following:

1. Avoids occupational activities that involve significant interpersonal contact because of fears of criticism, disapproval, or rejection.
2. Is unwilling to get involved with people unless certain of being liked.
3. Shows restraint within intimate relationships because of the fear of being shamed or ridiculed. ‘
4. Is preoccupied with being criticized or rejected in social situations.
5. Is inhibited in new interpersonal situations because of feelings of inadequacy.
6. Views self as socially inept, personally unappealing, or inferior to others.
7. Is unusually reluctant to take personal risks or to engage in any new activities because they may prove embarrassing.

Answer 37

Avoidant Personality Disorder

Question 38

Their extremely low self-esteem—coupled with a fear of rejection—causes them to be limited in their friendships and _____ on those they feel comfortable with.

Answer 38

dependent

Question 39

Theodore Millon, who initially proposed this diagnosis, notes that it is important to distinguish between individuals who are asocial because they are apathetic, affectively flat, and relatively uninterested in interpersonal relationships (comparable to what DSM-5 terms _____ personality disorder) and,

Answer 39

schizoid

Question 40

A pervasive and excessive need to be taken care of that leads to submissive and clinging behavior and fears of separation, beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following:

1. Has difficulty making everyday decisions without an excessive amount of advice and reassurance from others.
2. Needs others to assume responsibility for most major areas of his or her life.
3. Has difficulty expressing disagreement with others because of fear of loss of support or approval. (Note: Do not include realistic fears of retribution.)
4. Has difficulty initiating projects or doing things on his or her own (because of a lack of self-confidence in judgment or abilities rather than a lack of motivation or energy).
5. Goes to excessive lengths to obtain nurturance and support from others, to the point of volunteering to do things that are unpleasant.
6. Feels uncomfortable or helpless when alone because of exaggerated fears of being unable to care for himself or herself.
7. Urgently seeks another relationship as a source of care and support when a close relationship ends.
8. Is unrealistically preoccupied with fears of being left to take care of himself or herself.

Answer 40

Dependent Personality Disorder

Question 41

Individuals with _____ personality disorder sometimes agree with other people when their own opinion differs so as not to be rejected.

Answer 41

dependent

Question 42

A pervasive pattern of preoccupation with orderliness, perfectionism, and mental and interpersonal control, at the expense of flexibility, openness, and efficiency, beginning by early adulthood and present in a variety of contexts, as indicated by four (or more) of the following:

1. Is preoccupied with details, rules, lists, order, organization, or schedules to the extent that the major point of the activity is lost
2. Shows perfectionism that interferes with task completion (e.g., is unable to complete a project because his or her own overly strict standards are not met).
3. Is excessively devoted to work and productivity to the exclusion of leisure activities and friendships (not accounted for by obvious economic necessity).
4. Is overconscientious, scrupulous, and inflexible about matters of morality, ethics, or values (not accounted for by cultural or religious identification)
5. Is unable to discard worn-out or worthless objects even when they have no sentimental value.
6. Is reluctant to delegate tasks or to work with others unless they submit to exactly his or her way of doing things
7. Adopts a miserly spending style toward both self and others; money is viewed as something to be hoarded for future catastrophes.
8. Shows rigidity and stubbornness

Answer 42

Obsessive-Compulsive Personality Disorder

Question 43

_____ personality disorder may also play a role among some sex offenders—in particular, pedophiles. Brain-imaging research on pedophiles suggests that brain functioning in these individuals is similar to those with _____ personality disorder.

Answer 43

Obsessive-compulsive