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Chapter 20. Personality Disorders

Andrew E. Skodol, M.D.; John G. Gunderson, M.D.
DOI: 10.1176/appi.books.9781585623402.308205

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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 an Axis I disorder, making personality disorders among the most frequently seen by mental health professionals. Personality disorders are also common in the general population, with an estimated prevalence of about 12% (Torgersen 2005).

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FIGURE 20–1. Ontogeny of personality disorder classification.Note. "——│" indicates that category was discontinued.Source. Reprinted 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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TABLE 20–1. DSM-IV-TR personality clusters, specific types, and their defining clinical features
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TABLE 20–2. The five-factor model of personality
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TABLE 20–3. The seven-factor model of personality: temperament and character inventory
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TABLE 20–4. Features of interviews and self-report instruments for the assessment of personality disorders
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TABLE 20–5. Evidence of treatment effectiveness for personality disorders
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TABLE 20–6. DSM-IV-TR diagnostic criteria for paranoid personality disorder
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TABLE 20–7. Treatment of paranoid personality disorder
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TABLE 20–8. DSM-IV-TR diagnostic criteria for schizoid personality disorder
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TABLE 20–9. Treatment of schizoid personality disorder
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TABLE 20–10. DSM-IV-TR diagnostic criteria for schizotypal personality disorder
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TABLE 20–11. Treatment of schizotypal personality disorder
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TABLE 20–12. DSM-IV-TR diagnostic criteria for antisocial personality disorder
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TABLE 20–13. Treatment of antisocial personality disorder
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TABLE 20–14. DSM-IV-TR diagnostic criteria for borderline personality disorder
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TABLE 20–15. Treatment of borderline personality disorder
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TABLE 20–16. Medication efficacy in borderline personality disorder
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TABLE 20–17. DSM-IV-TR diagnostic criteria for histrionic personality disorder
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TABLE 20–18. Treatment of histrionic personality disorder
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TABLE 20–19. DSM-IV-TR diagnostic criteria for narcissistic personality disorder
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TABLE 20–20. Treatment of narcissistic personality disorder
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TABLE 20–21. DSM-IV-TR diagnostic criteria for avoidant personality disorder
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TABLE 20–22. Treatment of avoidant personality disorder
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TABLE 20–23. DSM-IV-TR diagnostic criteria for dependent personality disorder
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TABLE 20–24. Treatment of dependent personality disorder
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TABLE 20–25. DSM-IV-TR diagnostic criteria for obsessive-compulsive personality disorder
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TABLE 20–26. Treatment of obsessive-compulsive personality disorder
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TABLE 20–27. DSM-IV-TR research criteria for depressive personality disorder
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TABLE 20–28. DSM-IV-TR research criteria for passive-aggressive personality disorder (negativistic personality disorder)
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Personality disorders are common in clinical settings and in the community.

Personality disorders can be challenging to diagnose.

Personality disorders cause significant problems for those who have them and for others and are costly to society.

Personality disorders often complicate the treatment of other mental disorders.

Personality disorders result from an interaction between temperamental (genetic/biological) and psychological (developmental/environmental) factors.

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Sample questions:
1.
Since DSM-III (American Psychiatric Association 1980), personality disorders have been grouped into three clusters: A, B, and C. Which of the following disorders fall within cluster C?
2.
An important theoretical issue is whether the personality disorders are best classified as dimensions or categories. Which of the following arguments supports a categorical approach to personality disorder classification?
3.
A number of studies that have compared patients with personality disorders with patients with no personality disorders or with Axis I disorders have found that patients with personality disorders. . .
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