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Chapter 25. Personality Disorders

Andrew Skodol, M.D.; Donna Bender, Ph.D.; John Gunderson, M.D.; John Oldham, M.D.
DOI: 10.1176/appi.books.9781585625031.901595

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Personality disorders are associated with significant difficulties in self-appraisal and self-regulation, as well as with impaired interpersonal relationships. Clinicians frequently encounter patients with personality disorders in both outpatient and inpatient settings. Studies indicate that at least 50% of patients evaluated in clinical settings have a personality disorder (Zimmerman et al. 2005), often comorbid with another mental disorder, making personality disorders among the most frequent mental disorders seen by mental health professionals. Personality disorders are also common in the general population, with an estimated prevalence of about 10% (Torgersen 2009). Patients with personality disorders are among the most complex and clinically challenging.

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Ontogeny of personality disorder classification.Note. “——| ” indicates that category was discontinued.Source. Adapted from Skodol AE: “Classification, Assessment, and Differential Diagnosis of Personality Disorders.” Journal of Practical Psychiatry and Behavioral Health 3:261–274, 1997. Copyright 1997, Lippincott Williams & Wilkins. Used with permission.
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Comparison of DSM-5 Section II and Section III general criteria for personality disorder
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Definitions of DSM-5 personality disorder trait domains and facets
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Level of Personality Functioning Scale
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Evidence of treatment effectiveness for personality disorders
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Defining features of DSM-5 Section II and Section III personality disorders
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Comparison of DSM-5 Section II and Section III criteria for antisocial personality disorder (ASPD)
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Comparison of DSM-5 Section II and Section III criteria for borderline personality disorder (BPD)

References

American Psychiatric Association: Diagnostic and Statistical Manual: Mental Disorders. Washington, DC, American Psychiatric Association, 1952
 
American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, 2nd Edition. Washington, DC, American Psychiatric Association, 1968
 
American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, 3rd Edition. Washington, DC, American Psychiatric Association, 1980
 
American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, 3rd Edition, Revised. Washington, DC, American Psychiatric Association, 1987
 
American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, 4th Edition. Washington, DC, American Psychiatric Association, 1994
 
American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text Revision. Washington, DC, American Psychiatric Association, 2000
 
American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, 5th Edition. Arlington, VA, American Psychiatric Association, 2013
 
Barkataki I, Kumari V, Das M, et al: Volumetric structural brain abnormalities in men with schizophrenia or antisocial personality disorder. Behav Brain Res 169:239–247, 2006
[PubMed]
 
Bateman A, Fonagy P: Effectiveness of partial hospitalization in the treatment of borderline personality disorder: a randomized controlled trial. Am J Psychiatry 156:1563–1569, 1999
[PubMed]
 
Bender DS, Skodol AE: Borderline personality as a self-other representational disturbance. J Pers Disord 21:500–517, 2007
[PubMed]
 
Bender DS, Dolan RT, Skodol AE, et al: Treatment utilization by patients with personality disorders. Am J Psychiatry 158:295–302, 2001
[PubMed]
 
Bender DS, Morey LC, Skodol AE: Toward a model for assessing level of personality functioning in DSM-5, part I: a review of theory and methods. J Pers Assess 93:332–346, 2011
[PubMed]
 
Benjamin J, Patterson C, Greenberg BD, et al: Population and familial association between D4 receptor gene and measures of novelty seeking. Nat Genet 12:81–84, 1996
[PubMed]
 
Bierer LM, Yehuda R, Schmeid-ler J, et al: Abuse and neglect in childhood: relationship to personality disorder diagnoses. CNS Spectr 8:737–754, 2003
[PubMed]
 
Birbaumer N, Veit R, Lotze M, et al: Deficient fear conditioning in psychopathy: a functional magnetic resonance imaging study. Arch Gen Psychiatry 62:799–805, 2005
[PubMed]
 
Blonigen DM, Hicks BM, Krueger RF, et al: Psychopathic personality traits: heritability and genetic overlap with internalizing and externalizing psychopathology. Psychol Med 35:637–648, 2005
[PubMed]
 
Clarkin JF, Yeomans FE, Kernberg OF: Psychotherapy for Borderline Personality. New York, Wiley, 1999
 
Cloninger CR, Svrakic DM, Przybeck TR: A psychobiological model of temperament and character. Arch Gen Psychiatry 50:975–990, 1993
[PubMed]
 
Costa P, McCrae R: Personality disorders and the five-factor model of personality. J Pers Disord 4:362–371, 1990
 
DiLalla DL, Carey G, Gottesman II, et al: Heritability of MMPI personality indicators of psychopathology in twins reared apart. J Abnorm Psychol 105:491–499, 1996
[PubMed]
 
Dunayevich E, Sax KW, Keck PE Jr, et al: Twelve-month outcome in bipolar patients with and without personality disorders. J Clin Psychiatry 61:134–139, 2000
[PubMed]
 
Edens JF, Marcus DK, Lillienfeld SO, et al: Psychopathic, not psychopath: taxometric evidence for the dimensional structure of psychopathy. J Abnorm Psychol 115:131–144, 2006
[PubMed]
 
Fanous A, Gardner C, Walsh D, et al: Relationship between positive and negative symptoms of schizophrenia and schizotypal symptoms in nonpsychotic relatives. Arch Gen Psychiatry 58:669–673, 2001
[PubMed]
 
Fonagy P, Gergely G, Target M: The parent-infant dyad and the construction of the subjective self. J Child Psychol Psychiatry 48:288–328, 2007
[PubMed]
 
Giesen-Bloo J, van Dyck R, Spinhoven P, et al: Outpatient psychotherapy for borderline personality disorder: randomized trial of schema-focused therapy vs transference-focused psychotherapy. Arch Gen Psychiatry 63:649–658, 2006
[PubMed]
 
Grant BF, Hasin DS, Stinson FR, et al: Prevalences, correlates, and disability of personality disorders in the United States: results from the National Epidemiologic Survey on Alcohol and Related Conditions. J Clin Psychiatry 65:948–958, 2004
[PubMed]
 
Grant BF, Chou P, Goldstein RB, et al: Prevalence, correlates, disability, and comorbidity of DSM-IV borderline personality disorder: results from the Wave 2 National Epidemiologic Survey on alcohol and related conditions. J Clin Psychiatry 69:533–545, 2008
[PubMed]
 
Grant DA, Berg EA: Wisconsin Card Sorting Test. Lutz, FL, Psychological Assessment Resources, 1993
 
Grilo CM, Sanislow CA, Shea MT, et al: Two-year prospective naturalistic study of remission from major depressive disorder as a function of personality disorder co-morbidity. J Consult Clin Psychol 73:78–85, 2005
[PubMed]
 
Gunderson JG, Links PS: Borderline Personality Disorder: A Clinical Guide. Washington, DC, American Psychiatric Publishing, 2008
 
Gunderson JG, Lyons-Ruth K: BPD’s interpersonal hypersensitivity phenotype: a gene-environment-developmental model. J Pers Disord 22:22–41, 2008
[PubMed]
 
Gunderson JG, Daversa MT, Grilo CM, et al: Predictors of 2-year outcome for patients with borderline personality disorder. Am J Psychiatry 163:822–826, 2006
[PubMed]
 
Gunderson JG, Stout RL, McGlashan TH, et al: Ten-year course of borderline personality disorder: psychopathology and functioning from the Collaborative Longitudinal Personality Disorders Study. Arch Gen Psychiatry 68:827–837, 2011
[PubMed]
 
Hare RD, Neumann CS: Structural models of psychopathy. Curr Psychiatry Rep 7:57–64, 2005
[PubMed]
 
Hasin D, Fenton MC, Skodol A, et al: Relationship of personality disorders to the three-year course of alcohol, cannabis, and nicotine disorders. Arch Gen Psychiatry 68:1158–1167, 2011
[PubMed]
 
Hoek HW, Susser E, Buck KA, et al: Schizoid personality disorder after prenatal exposure to famine. Am J Psychiatry 153:1637–1639, 1996
[PubMed]
 
Hollander E, Swann AC, Coccaro EF, et al: Impact of trait impulsivity and state aggression on divalproex versus placebo response in borderline personality disorder. Am J Psychiatry 162:621–624, 2005
[PubMed]
 
Jang KL, Livesley WJ, Vernon PA, et al: Heritability of personality disorder traits: a twin study. Acta Psychiatr Scand 94:438–444, 1996
[PubMed]
 
Joyce PR, McKenzie JM, Luty SE, et al: Temperament, childhood environment and psychopathology as risk factors for avoidant and borderline personality disorders. Aust N Z J Psychiatry 37:756–764, 2003
[PubMed]
 
Kendler KS, Czajkowski N, Tambs K, et al: Dimensional representations of DSM-IV Cluster A personality disorders in a population-based sample of Norwegian twins: a multivariate study. Psychol Med 36:1583–1591, 2006
[PubMed]
 
Kendler KS, Myers J, Torgersen S, et al: The heritability of Cluster A personality disorders assessed by both personal interview and questionnaire. Psychol Med 37:655–665, 2007
[PubMed]
 
Kernberg OF: Borderline Conditions and Pathological Narcissism. New York, Jason Aronson, 1975
 
Keshavan M, Shad M, Soloff P, et al: Efficacy and tolerability of olanzapine in the treatment of schizotypal personality disorder. Schizophr Res 71:97–101, 2004
[PubMed]
 
Kessler RC: The impairments caused by social phobia in the general population: implications for intervention. Acta Psychiatr Scand Suppl 417:19–27, 2003
[PubMed]
 
Kluger AN, Siegfried Z, Ebstein RP: A meta-analysis of the association between DRD4 polymorphism and novelty seeking. Mol Psychiatry 7:712–717, 2002
[PubMed]
 
Koenigsberg HW, Reynolds D, Goodman M, et al: Risperidone in the treatment of schizotypal personality disorder. J Clin Psychiatry 64:628–634, 2003
[PubMed]
 
Kohut H: The Analysis of the Self: A Systematic Approach to the Psychoanalytic Treatment of Narcissistic Personality Disorders. New York, International Universities Press, 1971
 
Krueger RF, Markon KE, Patrick CJ, et al: Externalizing psychopathology in adulthood: a dimensional-spectrum conceptualization and its implications for DSM-V. J Abnorm Psychol 114:537–550, 2005
[PubMed]
 
Krueger RF, Derringer J, Markon KE, et al: Initial construction of a maladaptive personality trait model and inventory for DSM-5. Psychol Med 42:1879–1890, 2012
[PubMed]
 
Kupfer DJ, First MB, Regier DE (eds): A Research Agenda for DSM-V. Washington, DC, American Psychiatric Association, 2002
 
Leichsenring F, Leibing E: The effectiveness of psychodynamic therapy and cognitive behavior therapy in the treatment of personality disorders: a meta-analysis. Am J Psychiatry 160:1223–1232, 2003
[PubMed]
 
Lenzenweger MF, Johnson MD, Willett JB: Individual growth curve analysis illuminates stability and change in personality disorder features: the longitudinal study of personality disorders. Arch Gen Psychiatry 61:1015–1024, 2004
[PubMed]
 
Lenzenweger MF, Lane MC, Loranger AW, et al: DSM-IV personality disorders in the national comorbidity survey replication. Biol Psychiatry 62:553–564, 2007
[PubMed]
 
Lesch KP, Bengel D, Heils A: Association of anxiety-related traits with a polymorphism in the serotonin transporter gene regulatory region. Science 274:1527–1531, 1996
[PubMed]
 
Levy KN, Meehan KB, Weber M, et al: Attachment and borderline personality disorder: implications for psychotherapy. Psychopathology 38:64–74, 2005
[PubMed]
 
Lieb K, Zanarini MC, Schmahl C, et al: Borderline personality disorder. Lancet 364:453–461, 2004
[PubMed]
 
Linehan MM, Comtois KA, Murray AM, et al: Two-year randomized controlled trial and follow-up of dialectical behavior therapy vs. therapy by experts for suicidal behaviors and borderline personality disorder. Arch Gen Psychiatry 63:757–766, 2006
[PubMed]
 
Linney YM, Murray RM, Peters ER, et al: A quantitative genetic analysis of schizotypal personality traits. Psychol Med 33:803–816, 2003
[PubMed]
 
Livesley J, Jackson D: Dimensional Assessment of Personality Pathology. Port Huron, MI, Sigma, 2000
 
Livesley WJ, Jang KL, Jackson DN, et al: Genetic and environmental contributions to dimensions of personality disorder. Am J Psychiatry 150:1826–1831, 1993
[PubMed]
 
Livesley WJ, Jang KL, Vernon PA: Phenotypic and genetic structure of traits delineating personality disorder. Arch Gen Psychiatry 55:941–948, 1998
[PubMed]
 
Lorber MF: Psychophysiology of aggression, psychopathy, and conduct problems: a meta-analysis. Psychol Bull 130:531–552, 2004
[PubMed]
 
Lyons MJ, True WR, Eisen SA, et al: Differential heritability of adult and juvenile antisocial traits. Arch Gen Psychiatry 52:906–915, 1995
[PubMed]
 
Meyer B, Carver CS: Negative childhood accounts, sensitivity, and pessimism: a study of avoidant personality disorder features in college students. J Pers Disord 14:233–248, 2000
[PubMed]
 
Moffitt TE: The new look of behavioral genetics in developmental psychopathology: gene-environment interplay in antisocial behaviors. Psychol Bull 131:533–554, 2005
[PubMed]
 
Morey LC, Hopwood CJ, Gunderson JG, et al: Comparison of alternative models for personality disorders. Psychol Med 37:983–994, 2007
[PubMed]
 
Morey LC, Shea MT, Markowitz JC, et al: State effects of major depression on the assessment of personality and personality disorder. Am J Psychiatry 167:528–535, 2010
[PubMed]
 
Morey LC, Berghuis H, Bender DS, et al: Toward a model for assessing level of personality functioning in DSM-5, part II: empirical articulation of a core dimension of personality pathology. J Pers Assess 93:347–353, 2011
[PubMed]
 
Munafo MR, Clark TG, Moore LR, et al: Genetic polymorphisms and personality in healthy adults: a systematic review and meta-analysis. Mol Psychiatry 8:471–484, 2003
[PubMed]
 
Oldham J: Borderline personality disorder and suicidality. Am J Psychiatry 163:20–26, 2006
[PubMed]
 
Oldham JM, Skodol AE: Charting the future of Axis II. J Pers Disord 14:17–29, 2000
[PubMed]
 
Raine A, Moffit TE, Caspi A, et al: Neurocognitive impairments in boys on the life-course persistent antisocial path. J Abnorm Psychol 114:38–49, 2005
[PubMed]
 
Reichborn-Kjennerud T, Czajkowski N, Neale MC, et al: Genetic and environmental influences on dimensional representations of DSM-IV Cluster C personality disorders: a population-based multivariate twin study. Psychol Med 37:645–653, 2006
[PubMed]
 
Rettew DC, Zanarini MC, Yen S, et al: Childhood antecedents of avoidant personality disorder: a retrospective study. J Am Acad Child Adolesc Psychiatry 42:1122–1130, 2003
[PubMed]
 
Roberts BW, DelVecchio WF: The rank-order consistency of personality traits from childhood to old age: a quantitative review of longitudinal studies. Psychol Bull 126:3–25, 2000
[PubMed]
 
Roberts BW, Caspi A, Moffitt TE: Work experiences and personality development in young adulthood. J Personal Soc Psychol 84:582–593, 2003
[PubMed]
 
Siever LJ, Davis KL: A psychobiological perspective on the personality disorders. Am J Psychiatry 148:1647–1658, 1991
[PubMed]
 
Siever LJ, Davis KL: The pathophysiology of schizophrenia disorders: perspectives from the spectrum. Am J Psychiatry 161:398–413, 2004
[PubMed]
 
Skodol AE, Gunderson JG, McGlashan TH, et al: Functional impairment in patients with schizotypal, borderline, avoidant, or obsessive-compulsive personality disorder. Am J Psychiatry 159:276–283, 2002
[PubMed]
 
Skodol AE, Pagano MP, Bender DS, et al: Stability of functional impairment in patients with schizotypal, borderline, avoidant, or obsessive-compulsive personality disorder over two years. Psychol Med 35:443–451, 2005
[PubMed]15841879
 
Skodol AE, Grilo CM, Keyes K, et al: Relationship of personality disorders to the course of major depressive disorder in a nationally representative sample. Am J Psychiatry 168:257–264, 2011
[PubMed]
 
Stanley B, Siever LJ: The interpersonal dimension of borderline personality disorder: toward a neuropeptide model. Am J Psychiatry 167:24–39, 2010
[PubMed]
 
Stein MB, Chartier MJ, Lizak MV, et al: Familial aggregation of anxiety-related quantitative traits in generalized social phobia: clues to understanding “disorder” heritability? Am J Med Genet 105:79–83, 2001
[PubMed]
 
Suzuki M, Zhou S-Y, Takahashi T, et al: Differential contributions of prefrontal and temporolimbic pathology to mechanisms of psychosis. Brain 128:2109–2122, 2005
[PubMed]
 
Torgersen S: Prevalence, sociodemographics, and functional impairment, in Essentials of Personality Disorders. Edited by Oldham JM, Skodol AE, Bender DS. Washington, DC, American Psychiatric Publishing, 2009, pp 83–102
 
Torgersen S, Onstad S, Skre I, et al: “True” schizotypal personality disorder: a study of co-twins and relatives of schizophrenic probands. Am J Psychiatry 150:1661–1667, 1993
[PubMed]
 
Torgersen S, Lygren S, Øien PA, et al: A twin study of personality disorders. Compr Psychiatry 41:416–425, 2000
[PubMed]
 
Torgersen S, Kringlen E, Cramer V: The prevalence of personality disorders in a community sample. Arch Gen Psychiatry 58:590–596, 2001
[PubMed]
 
Torgersen S, Edvardsen J, Øien PA, et al: Schizotypal personality disorder inside and outside the schizophrenia spectrum. Schizophr Res 54:33–38, 2002
[PubMed]
 
Verheul R, Widiger TA: A meta-analysis of the prevalence and usage of the personality disorder not otherwise specified (PDNOS) diagnosis. J Pers Disord 18:309–319, 2004
[PubMed]
 
Westen D, Shedler J, Bradley R: A prototype approach to personality disorder diagnosis. Am J Psychiatry 163:846–856, 2006
[PubMed]
 
Widiger TA, Samuel DB: Diagnostic categories or dimensions?A question for the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. J Abnorm Psychol 114:494–504, 2005
[PubMed]
 
Widiger TA, Simonsen E: Alternative dimensional models of personality disorder: finding a common ground. J Pers Disord 19:110–130, 2005
[PubMed]
 
World Health Organization: International Statistical Classification of Diseases and Related Health Problems, 10th Revision. Geneva, World Health Organization, 1992
 
Yonkers KA, Dyck IR, Warshaw M, et al: Factors predicting the clinical course of generalised anxiety disorder. Br J Psychiatry 176:544–549, 2000
[PubMed]
 
Zanarini MC, Frankenberg FR, Hennen J, et al: Prediction of the 10-year course of borderline personality disorder. Am J Psychiatry 163:827–832, 2006
[PubMed]
 
Zanarini MC, Frankenburg FR, Reich DB, et al: Attainment and stability of sustained symptomatic remission and recovery among patients with borderline personality disorder and axis II comparison subjects: a 16-year prospective follow-up study. Am J Psychiatry 169:476–483, 2012
[PubMed]
 
Zimmerman M, Coryell W: DSM-III personality disorder diagnoses in a nonpatient sample: demographic correlates and comorbidity. Arch Gen Psychiatry 46:682–689, 1989
[PubMed]
 
Zimmerman M, Coryell W: Diagnosing personality disorders in the community: a comparison of self-report and interview measures. Arch Gen Psychiatry 47:527–531, 1990
[PubMed]
 
Zimmerman M, Rothchild L, Chelminski I: The prevalence of DSM-IV personality disorders in psychiatric outpatients. Am J Psychiatry 162:1911–1918, 2005
[PubMed]
 
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