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Personality Disorders

A Primer on the DSM-IV Personality Disorders

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Updated April 11, 2014

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The Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR) lists ten personality disorders, including borderline personality disorder (BPD).

What Are Personality Disorders?

Personality disorders are psychiatric conditions that begin in adolescence or early adulthood, continue over many years, and cause a great deal of distress. Personality disorders also often interfere with a person's ability to enjoy life or achieve fulfillment in relationships, work or school.

In the DSM-IV-TR, personality disorders are diagnosed on Axis II of the multi-axial system; this axis is reserved for very long-standing conditions of clinical significance (mental retardation is the only other condition that is diagnosed on Axis II).

Personality disorders are organized into three "clusters" in the DSM-IV-TR. The disorders in each cluster share key features or have overlap in terms of the characteristics of individuals who are diagnosed within that cluster.

The "Cluster A" Personality Disorders

The "Cluster A" personality disorders are characterized by odd or eccentric behavior. Individuals with the personality disorders in this cluster tend to experience major disruptions in relationships because their behavior may be perceived as peculiar, suspicious or detached.

The "Cluster A" personality disorders include:

  • Schizotypal Personality Disorder
  • Paranoid Personality Disorder
  • Schizoid Personality Disorder

The "Cluster B" Personality Disorders

The "Cluster B" personality disorders are characterized by dramatic or erratic behavior. Individuals with the personality disorders in this cluster tend to either experience very intense emotions or engage in very impulsive, theatrical, promiscuous or law-breaking behaviors.

The "Cluster B" personality disorders include:

The "Cluster C" Personality Disorders

The "Cluster C" personality disorders are characterized by anxiety. Individuals with the personality disorders in this cluster tend to experience pervasive anxiety and/or fearfulness.

The "Cluster C" personality disorders include:

  • Dependent Personality Disorder
  • Obsessive-Compulsive Personality Disorder
  • Avoidant Personality Disorder

Treatment for Personality Disorders

Relative to the Axis I (clinical) disorders, there is remarkably little research on the treatment of the personality disorders. Most of the research that exists focuses on the treatment of BPD. For BPD, there are a number of treatments that are considered effective in reducing symptoms (including psychotherapy and medication options).

In general, many experts believe that personality disorders are difficult to treat because they are, by definition, long-standing patterns of personality. That said, this is a question that has not been subjected to a great deal of careful research; more research is needed to examine the effectiveness of treatments for the personality disorders.

Personality Disorders and Comorbidity

There is a great deal of comorbidity between the personality disorders, meaning that a person who meets diagnostic criteria for one personality disorder will often also meet criteria for one or more additional personality disorders. For example, one study found that about 74% of people with BPD also meet diagnostic criteria for at least one other personality disorder.

In fact, many experts have proposed that the high degree of overlap between the personality disorders suggests that they are not, in fact, distinct clinical entities (as they are organized in DSM-IV-TR). It is expected that the way that personality disorders are diagnosed will be changed in the next edition of the DSM (the DSM-V) in order to address this issue.

Sources:

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders DSM-IV-TR Fourth Edition. American Psychiatric Association: 2000.

Grant BF, Chou SP, 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," Journal of Clinical Psychiatry, 69(4): 533-545, 2008.

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