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==  Diagnosis  ==

The DSM-IV lists General diagnostic criteria for a personality disorder, which must be met in addition to the specific criteria for a particular named personality disorder. This requires that there be (to paraphrase):^ref

There are 2 main pattern of diagnosing comorbidity:
1) [[Internalizing]]: the core vulnerability which is common to unipolar mood, somatization, anxiety disorder
2) : common factor of ASPD, substance use disorder ^ref
* An enduring pattern of psychological experience and behavior that differs prominently from cultural expectations, as shown in two or more of: [[cognition]] (i.e. perceiving and interpreting the self, other people or events); [[Affect (psychology)|]] (i.e. the range, intensity, [[lability]], and appropriateness of emotional response); interpersonal functioning; or [[impulse control]].470 lines hidden (7371 characters)
Abbreviations used: PPD – Paranoid Personality Disorder, SzPD – Schizoid Personality Disorder, StPD – Schizotypal Personality Disorder, ASPD – Antisocial Personality Disorder, BPD – Borderline Personality Disorder, HPD – Histrionic Personality Disorder, NPD – Narcissistic Personality Disorder, AvPD – Avoidant Personality Disorder, DPD – Dependent Personality Disorder, OCPD – Obsessive-Compulsive Personality Disorder, PAPD – Passive-Aggressive Personality Disorder, DpPD – Depressive Personality Disorder, n/a – not available.

==  Personality disorder traits  ==

{{primary sources|section|date=April 2013}}
There are 2 main pattern of diagnosing comorbidity: 1) [[Internalizing]]: the core vulnerability which is common to unipolar mood, somatization, anxiety disorder 2) : common factor of ASPD, substance use disorder.^ref 

Lower-order factors (externalizing psychopathology)
* Aggression
Aggression reflects pure angry and antagonistic behavior whereas obsessive-compulsive PD reflect rigidity and stubbornness. And there are co-variation between antisocial personality disorder and obsessive-compulsive personality disorder

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{{Infobox disease
 | Name = Personality disorders
 | Image = 
 | Caption = 
 | DiseasesDB = 9889
 | ICD10 = {{ICD10|F|60||f|60}}
 | ICD9 = {{ICD9|301.9}}
 | ICDO = 
 | OMIM = 
 | MedlinePlus = 000939
 | eMedicineSubj = 
 | eMedicineTopic = 
 | MeshID = D010554
}}
{{Personality disorders sidebar}}

'''Personality disorder''' refers to a class of [[Personality psychology|personality]] types and enduring behaviors associated with significant distress or disability, which appear to deviate from social expectations particularly in relating to other humans.<ref name = DSM>[[Diagnostic and Statistical Manual of Mental Disorders]]</ref><ref>{{cite journal|author=Berrios, G E |year=1993|title= European views on personality disorders: a conceptual history|journal=Comprehensive Psychiatry|volume= 34|pages= 14–30|doi=10.1016/0010-440X(93)90031-X|pmid=8425387|issue=1}}</ref><ref name="millon">{{cite book| last = Millon| first = Theodore| authorlink = | coauthors = Roger D. Davis| title = Disorders of Personality: DSM-IV and Beyond| publisher = John Wiley & Sons, Inc.| year = 1996| location = New York| page = 226| isbn = 0-471-01186-X }}</ref>

Personality disorders are included as [[mental disorder]]s on [[Axis II (psychology)|Axis II]] of the [[Diagnostic and Statistical Manual of Mental Disorders|diagnostic manual]] of the [[American Psychiatric Association]] and in the [[International Statistical Classification of Diseases and Related Health Problems#Mental and behavioral disorders|mental and behavioral disorders]] section of the [[International Statistical Classification of Diseases and Related Health Problems|ICD manual]] of the [[World Health Organization]]. Personality, defined psychologically, is the set of enduring behavioral and mental traits that distinguish human beings. Hence, personality disorders are defined by experiences and behaviors that differ from societal norms and expectations.  Those diagnosed with a personality disorder may experience difficulties in cognition, emotiveness, interpersonal functioning or control of impulses. In general, personality disorders are diagnosed in 40–60 percent of psychiatric patients, making them the most frequent of all psychiatric diagnoses.<ref>Saß, H. (2001). "Personality Disorders," pp. 11301-11308 in Smelser, N. J. & Baltes, P. B. (eds.) ''International encyclopedia of the social & behavioral sciences'', Amsterdam: Elsevier {{DOI|10.1016/B0-08-043076-7/03763-3}} ISBN 978-0-08-043076-8</ref>

These behavioral patterns in personality disorders are typically associated with substantial disturbances in some behavioral tendencies of an individual, usually involving several areas of the personality, and are nearly always associated with considerable personal and social disruption. A person is classified as having a personality disorder if their abnormalities of behavior impair their social or occupational functioning. Additionally, personality disorders are inflexible and pervasive across many situations, due in large part to the fact that such behavior may be [[ego-syntonic]] (i.e. the patterns are consistent with the [[Ego Integrity|ego integrity]] of the individual) and are, therefore, perceived to be appropriate by that individual. This behavior can result in maladaptive [[coping skills]], which may lead to personal problems that induce extreme anxiety, distress or depression.<ref>Kernberg, O. (1984). Severe Personality Disorders. New Haven, CT: Yale University Press, ISBN 0300053495.</ref> The onset of these patterns of behavior can typically be traced back to early adolescence and the beginning of adulthood and, in some instances, childhood.<ref name = DSM />

There are many issues with classifying a personality disorder, is it really a disorder; or just hard to get along with.<ref name="Schacteret">Schacter, D. L.; Gilbert, D. T. and Wegner, D. M. (2011) ''Psychology'', 2nd Edition. p. 330, ISBN 1429237198.</ref> There are many categories of definition, some mild and some extreme.<ref name="Schacteret" /> Because the theory and diagnosis of personality disorders stem from prevailing [[Norm (social)|cultural expectations]], their validity is contested by some experts on the basis of invariable subjectivity. They argue that the theory and diagnosis of personality disorders are based strictly on social, or even [[Politics|sociopolitical]] and economic considerations.<ref>{{cite book|author=McWilliams, Nancy |title=Psychoanalytic Diagnosis, Second Edition: Understanding Personality Structure in the Clinical Process|url=http://books.google.com/books?id=BzPOAWB2DncC&pg=PA196|accessdate=2 December 2011|date=29 July 2011|publisher=Guilford Press|isbn=978-1-60918-494-0|pages=196–}}</ref><ref>Hickey, Philip. (2010-05-05) [http://behaviorismandmentalhealth.com/2010/05/05/personality-disorders-are-not-illnesses/ Personality Disorders Are Not Illnesses]. Behaviorismandmentalhealth.com. Retrieved on 2013-04-16.</ref><ref>Ancowitz, Nancy. (2010-08-06) [http://www.psychologytoday.com/blog/self-promotion-introverts/201008/giant-step-backward-introverts A Giant Step Backward for Introverts (Nancy Ancowitz)]. Psychologytoday.com. Retrieved on 2013-04-16.</ref><ref>Bradshaw, James. (2006-11-01) [http://nationalpsychologist.com/2006/11/glasser-headlines-psychotherapy-conference/10879.html Glasser headlines psychotherapy conference]. The National Psychologist. Retrieved on 2013-04-16.</ref>

== Classification ==

The two major systems of classification, the ICD and DSM, have deliberately merged their diagnoses to some extent, but some differences remain. For example, ICD-10 does not include narcissistic personality disorder as a distinct category, while DSM-IV does not include enduring personality change after catastrophic experience or after psychiatric illness. ICD-10 classifies the DSM-IV schizotypal personality disorder as a form of schizophrenia rather than as a personality disorder. DSM-IV places personality disorders on a separate 'axis' to mental disorders, while the ICD does not use a multiaxial system. There are accepted diagnostic issues and controversies with regard to either section, in terms of distinguishing personality disorders as a category from other types of mental disorder or from general personality functioning, or distinguishing particular personality disorder categories from each other.<ref>{{cite journal | pmc = 1525106 | pmid=16946918 | volume=2 | issue=3 | title=Personality disorder diagnosis | year=2003 | month=October | author=Widiger TA | journal=World Psychiatry | pages=131–5}}</ref>  ICD classifies Transsexualism as a personality disorder;<ref>WHO (2010) [http://apps.who.int/classifications/icd10/browse/2010/en#/F60-F69 ICD-10: Disorders of adult personality and behaviour]</ref> the equivalent DSM classification is ''not'' a personality disorder.<ref>DSM-IV [[Diagnostic and Statistical Manual of Mental Disorders]]</ref>

=== World Health Organization ===

The [[ICD-10]] section on mental and behavioral disorders includes categories of personality disorder and enduring personality changes. They are defined as ingrained patterns indicated by inflexible and disabling responses that significantly differ from how the average person in the culture perceives, thinks and feels, particularly in relating to others.<ref>WHO (2010) [http://apps.who.int/classifications/icd10/browse/2010/en#/F60 ICD-10: Specific Personality Disorders]</ref>

The specific personality disorders are: [[Paranoid personality disorder|paranoid]], [[Schizoid personality disorder|schizoid]], [[Dissocial personality disorder|dissocial]], [[Emotionally unstable personality disorder|emotionally unstable]] (borderline type and impulsive type), [[Histrionic personality disorder|histrionic]], [[Anankastic personality disorder|anankastic]], [[Avoidant personality disorder|anxious (avoidant)]] and [[Dependent personality disorder|dependent]].<ref>[http://apps.who.int/classifications/icd10/browse/2010/en#/F60-F69 "International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10) Version for 2010 (Online Version)"]. Apps.who.int. Retrieved on 2013-04-16.</ref>

There is also an 'Other' category involving conditions characterized as [[eccentricity (behavior)|eccentric]], ''[[haltlose personality disorder|haltlose]]'' (derived from "haltlos" (''German'') = drifting, aimless and irresponsible),<ref>{{cite journal|title='Haltlose' type personality disorder (ICD-10 F60.8)|journal=The Psychiatrist|year=2000|volume= 24|pages= 235–236 |doi=10.1192/pb.24.6.235-b|last1=Langmaack|first1=C.|issue=6}}</ref> [[Maturity (psychological)|immature]], [[narcissistic]], [[passive-aggressive]] or [[psychoneurotic]]. An additional category is for unspecified personality disorder, including character [[neurosis]] and [[pathological]] personality.

There is also a category for Mixed and other personality disorders, defined as conditions that are often troublesome but do not demonstrate the specific pattern of symptoms in the named disorders. Finally there is a category of Enduring personality changes, not attributable to brain damage and disease. This is for conditions that seem to arise in adults without a diagnosis of personality disorder, following catastrophic or prolonged stress or other psychiatric illness.

=== American Psychiatric Association ===

The [[Diagnostic and Statistical Manual of Mental Disorders]] (currently the [[DSM-IV-TR|DSM-IV]]) lists ten personality disorders, grouped into three clusters in Axis II. The DSM also contains a category for behavioral patterns that do not match these ten disorders, but nevertheless exhibit characteristics of a personality disorder. This category is labeled [[Personality disorder not otherwise specified]].

==== Cluster A (odd or eccentric disorders and fears Social relation) ====

{{distinguish|Type A personality}}
* '''[[Paranoid personality disorder]]:''' characterized by irrational suspicions and mistrust of others.
* '''[[Schizoid personality disorder]]:''' lack of interest in social relationships, seeing no point in sharing time with others, [[anhedonia]], [[introspection]].
* '''[[Schizotypal personality disorder]]:''' characterized by odd behavior or thinking.

==== Cluster B (dramatic, emotional or erratic disorders) ====

{{distinguish|Type B personality}}
* '''[[Antisocial personality disorder]]:''' a pervasive disregard for the rights of others, lack of empathy, and (generally) a pattern of regular criminal activity.
* '''[[Borderline personality disorder]]:''' extreme "black and white" thinking, instability in relationships, self-image, identity and behavior often leading to self-harm and impulsivity.
* '''[[Histrionic personality disorder]]:''' pervasive [[attention-seeking]] behavior including inappropriately seductive behavior and shallow or exaggerated emotions.
* '''[[Narcissistic personality disorder]]:''' a pervasive pattern of [[grandiosity]], need for [[Narcissistic supply|admiration]], and a lack of empathy. Characterized by self-importance, preoccupations with [[Fantasy (psychology)|fantasies]], belief that they are special, including a sense of [[entitlement]] and a need for excessive admiration, and extreme levels of jealousy and arrogance.

==== Cluster C (anxious or fearful disorders) ====

* '''[[Avoidant personality disorder]]:''' pervasive feelings of social inhibition and social inadequacy, extreme sensitivity to negative evaluation and avoidance of social interaction.
* '''[[Dependent personality disorder]]:''' pervasive psychological dependence on other people.
* '''[[Obsessive-compulsive personality disorder]] (not the same as [[obsessive-compulsive disorder]]):''' characterized by rigid conformity to rules, moral codes and excessive orderliness.

==== Appendix B: Criteria Sets and Axes Provided for Further Study ====

Appendix B contains the following disorders.<ref>{{cite web |url=http://www.psychiatryonline.com/content.aspx?aID=5088 |title=Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision |doi=10.1176/appi.books.9780890423349.5088 |publisher=psychiatryonline.com |accessdate=25 November 2010}}</ref>

* '''[[Depressive personality disorder]]''' – is a pervasive pattern of depressive cognitions and behaviors beginning by early adulthood.
* '''[[Passive-aggressive personality disorder|Passive-aggressive (negativistic) personality disorder]]''' – is a pattern of negative attitudes and passive resistance in interpersonal situations.

=== Other ===

Some types of personality disorder were in previous versions of the diagnostic manuals but have been deleted. This includes two types that were in the DSM-III-R appendix as "Proposed diagnostic categories needing further study" without specific criteria, namely [[Sadistic personality disorder]] (a pervasive pattern of cruel, demeaning and aggressive behavior) and [[Self-defeating personality disorder]] (masochistic personality disorder) (characterised by behaviour consequently undermining the person's pleasure and goals).<ref>{{cite journal|author=Fuller, AK, Blashfield, RK, Miller, M, Hester, T |title=Sadistic and self-defeating personality disorder criteria in a rural clinic sample|doi=10.1002/1097-4679(199211)48:6<827::AID-JCLP2270480618>3.0.CO;2–1|year=1992|journal=Journal of Clinical Psychology|volume=48|issue=6|pages=827–31|pmid=1452772}}</ref> The psychologist [[Theodore Millon]] and others consider some relegated diagnoses to be equally valid disorders, and may also propose other personality disorders or subtypes, including mixtures of aspects of different categories of the officially accepted diagnoses.<ref name="millon3">Millon, Theodore (2004) ''Personality Disorders in Modern Life'', John Wiley & Sons, ISBN 0471668508.</ref>

{| class="wikitable"
|-
! style="text-align: center" colspan="6" | '''Personality disorder diagnoses in each edition of American Psychiatric Association's Diagnostic Manual'''<ref name="Widiger 99">Widiger, Thomas (2012). ''The Oxford Handbook of Personality Disorders.'' Oxford University Press. ISBN 978-0199735013.</ref>
|-
! '''DSM-I'''
! '''DSM-II'''
! '''DSM-III'''
! '''DSM-III-R'''
! '''DSM-IV(-TR)'''
! '''DSM-V Proposals'''
|-
| ''Personality''
|
|
|
|
|
|-
| ''Pattern disturbance:''
|
|
|
|
|
|-
| Inadequate
| Inadequate
|
|
|
|
|-
| Schizoid
| Schizoid
| Schizoid
| Schizoid
| Schizoid
|
|-
| Cyclothymic
| Cyclothymic
|
|
|
|
|-
| Paranoid
| Paranoid
| Paranoid
| Paranoid
| Paranoid
|
|-
|
|
| Schizotypal
| Schizotypal
| Schizotypal
| Schizotypal*
|-
| ''Personality''
|
|
|
|
|
|-
| ''Trait disturbance:''
|
|
|
|
|
|-
| Emotionally unstable
| Hysterical
| Histrionic
| Histrionic
| Histrionic
|
|-
|
|
| Borderline
| Borderline
| Borderline
| Borderline
|-
| Compulsive
| Obsessive-compulsive
| Compulsive
| Obsessive-compulsive
| Obsessive-compulsive
| Obsessive-compulsive
|-
| ''Passive-aggressive:''
|
|
|
|
|
|-
| Passive-depressive subtype
|
| Dependent
| Dependent
| Dependent
|
|-
| Passive-aggressive subtype
| Passive-aggressive
| Passive-aggressive
| Passive-aggressive
|
|
|-
| Aggressive subtype
|
|
|
|
|
|-
|
| Explosive
|
|
|
|
|-
|
| Asthenic
|
|
|
|
|-
|
|
| Avoidant
| Avoidant
| Avoidant
| Avoidant
|-
|
|
| Narcissistic
| Narcissistic
| Narcissistic
| Narcissistic**
|-
| ''Sociopathic personality''
|
|
|
|
|
|-
| ''Disturbance:''
|
|
|
|
|
|-
| Antisocial reaction
| Antisocial
| Antisocial
| Antisocial
| Antisocial
| Antisocial-psychopathic
|-
| Dyssocial reaction
|
|
|
|
|
|-
| Sexual deviation
|
|
|
|
|
|-
| ''Addiction''
|
|
|
|
|
|-
|
|
|
| ''Appendix:''
| ''Appendix:''
| ''Appendix:''
|-
|
|
|
| Self-defeating
| Negativistic
| Dependent
|-
|
|
|
| Sadistic
| Depressive
| Histrionic
|-
|
|
|
|
|
| Paranoid
|-
|
|
|
|
|
| Schizoid
|-
|
|
|
|
|
| Negativistic
|-
|
|
|
|
|
| Depressive
|}

''* – Not actually to be classified as a personality disorder; classified instead as a form of schizophrenia-spectrum disorder.''<br />
''** – Originally proposed for deletion; status remains unclear for DSM-5.''

=== Millon's description of personality disorders ===

Psychologist [[Theodore Millon]], who has written numerous popular works on personality, proposed the following description of personality disorders:

{| class="wikitable"
|-
! style="text-align: center" colspan="2" | '''Millon's brief description of personality disorders'''<ref name="Millon">Millon, Theodore (2004). ''Personality Disorders in Modern Life'', p. 4. John Wiley & Sons, Inc., Hoboken, New Jersey. ISBN 0-471-23734-5.</ref>
|-
! Type of personality disorder
! Description
|-
| '''Paranoid'''
| Guarded, defensive, distrustful and suspiciousness. Hypervigilant to the motives of others to undermine or do harm. Always seeking confirmatory evidence of hidden schemes. Feels righteous, but persecuted.
|-
| '''Schizoid'''
| Apathetic, indifferent, remote, solitary, distant, humorless. Neither desires nor need human attachments. Withdrawal from relationships and prefer to be alone. Little interest in others, often seen as a loner. Minimal awareness of feelings of self or others. Few drives or ambitions, if any.
|-
| '''Schizotypal'''
| Eccentric, self-estranged, bizarre, absent. Exhibits peculiar mannerisms and behaviors. Thinks can read thoughts of others. Preoccupied with odd daydreams and beliefs. Blurs line between reality and fantasy. Magical thinking and strange beliefs.
|-
| '''Antisocial'''
| Impulsive, irresponsible, deviant, unruly. Acts without due consideration. Meets social obligations only when self-serving. Disrespects societal customs, rules, and standards. Sees self as free and independent.
|-
| '''Borderline'''
| Unpredictable, manipulative, unstable. Frantically fears abandonment and isolation. Experiences rapidly fluctuating moods. Shifts rapidly between loving and hating. Sees self and others alternatively as all-good and all-bad. Unstable and frequently changing moods.
|-
| '''Histrionic'''
| Dramatic, seductive, shallow, stimulus-seeking, vain. Overreacts to minor events. Exhibitionistic as a means of securing attention and favors. Sees self as attractive and charming. Constant seeking for others' attention.
|-
| '''Narcissistic'''
| Egotistical, arrogant, grandiose, insouciant. Preoccupied with fantasies of success, beauty, or achievement. Sees self as admirable and superior, and therefore entitled to special treatment.
|-
| '''Avoidant'''
| Hesitant, self-conscious, embarrassed, anxious. Tense in social situations due to fear of rejection. Plagued by constant performance anxiety. Sees self as inept, inferior, or unappealing. Feels alone and empty.
|-
| '''Dependent'''
| Helpless, incompetent, submissive, immature. Withdraws from adult responsibilities. Sees self as weak or fragile. Seeks constant reassurance from stronger figures.
|-
| '''Obsessive–compulsive'''
| Restrained, conscientious, respectful, rigid. Maintains a rule-bound lifestyle. Adheres closely to social conventions. Sees the world in terms of regulations and hierarchies. Sees self as devoted, reliable, efficient, and productive.
|-
| '''Depressive'''
| Somber, discouraged, pessimistic, brooding, fatalistic. Presents self as vulnerable and abandoned. Feels valueless, guilty, and impotent. Judges self as worthy only of criticism and contempt.
|-
| '''Passive–aggressive (Negativistic)'''
| Resentful, contrary, skeptical, discontented. Resist fulfilling others’ expectations. Deliberately inefficient. Vents anger indirectly by undermining others’ goals. Alternately moody and irritable, then sullen and withdrawn.
|-
| '''Sadistic'''
| Explosively hostile, abrasive, cruel, dogmatic. Liable to sudden outbursts of rage. Feels selfsatisfied through dominating, intimidating and humiliating others. Is opinionated and closeminded.
|-
| '''Self-defeating (Masochistic)'''
| Deferential, pleasure-phobic, servile, blameful, self-effacing. Encourages others to take advantage. Deliberately defeats own achievements. Seeks condemning or mistreatful partners.
|}

=== Additional classification factors ===

Except for classifying by category and cluster, it is possible to classify personality disorders using such additional factors as severity, impact on social functioning, and [[Attribution (psychology)|attribution]].<ref name="Murray">Murray, Robin M. et al (2008). ''Psychiatry. Fourth Edition''. Cambridge University Press. ISBN 978-0-521-60408-6.</ref>

==== Severity ====

This involves both the notion of personality difficulty as a measure of subthreshold scores for personality disorder using standard interviews and the evidence that those with the most severe personality disorders demonstrate a “ripple effect” of personality disturbance across the whole range of mental disorders. In addition to subthreshold (personality difficulty) and single cluster (simple personality disorder), this also derives complex or diffuse personality disorder (two or more clusters of personality disorder present) and can also derive severe personality disorder for those of greatest risk.

{| class="wikitable"
|-
! style="text-align: center" colspan="4" | '''Dimensional System of Classifying Personality Disorders'''<ref>Tyrer, P. (2000) ''Personality Disorders: Diagnosis, Management and Course. Second Edition''. London: Arnold Publishers Ltd., pp. 126–32. ISBN 9780723607366.</ref>
|-
! Level of Severity
! Description
! Definition by Categorical System
|-
| '''0'''
| No Personality Disorder
| Does not meet actual or subthreshold criteria for any personality disorder
|-
| '''1'''
| Personality Difficulty
| Meets sub-threshold criteria for one or several personality disorders
|-
| '''2'''
| Simple Personality Disorder
| Meets actual criteria for one or more personality disorders within the same cluster
|-
| '''3'''
| Complex (Diffuse) Personality Disorder
| Meets actual criteria for one or more personality disorders within more than one cluster
|-
| '''4'''
| Severe Personality Disorder
| Meets criteria for creation of severe disruption to both individual and to many in society
|}

There are several advantages to classifying personality disorder by severity:<ref name="Murray" />

* It not only allows for but also takes advantage of the tendency for personality disorders to be comorbid with each other.

* It represents the influence of personality disorder on clinical outcome more satisfactorily than the simple [[Dichotomy|dichotomous]] system of no personality versus personality disorder.

* This system accommodates the new diagnosis of severe personality disorder, particularly “dangerous and severe personality disorder” (DSPD). Politicians and the public both want to know who comprise the most dangerous group.

==== Effect on social functioning ====

Social function is affected by many other aspects of mental functioning apart from that of personality. However, whenever there is persistently impaired social functioning in conditions in which it would normally not be expected, the evidence suggests that this is more likely to be created by personality abnormality than by other clinical variables.<ref>{{cite journal|author=Nur, U., Tyrer, P., Merson, S., & Johnson, T. |year=2004|title=Relationship between clinical symptoms, personality disturbance, and social function: a statistical enquiry|journal= Irish Journal of Psychological Medicine|volume= 21|pages= 19–22}}</ref> The Personality Assessment Schedule<ref>{{cite journal|author=Tyrer, P., & Alexander, J. |year=1979|title=Classification of Personality Disorder|journal= British Journal of Psychiatry|volume= 135|pages= 238–242|doi=10.1192/bjp.135.2.163|pmid=486849|issue=2}}</ref> gives social function priority in creating a hierarchy in which the personality disorder creating the greater social dysfunction is given primacy over others in a subsequent description of personality disorder.

==== Attribution ====

Many who have a personality disorder do not recognize any abnormality and defend valiantly their continued occupancy of their personality role. This group have been termed the Type R, or treatment-resisting personality disorders, as opposed to the Type S or treatment-seeking ones, who are keen on altering their personality disorders and sometimes clamor for treatment.<ref name="Murray" /> The classification of 68 personality disordered patients on the caseload of an assertive community team using a simple scale showed a 3 to 1 ratio between Type R and Type S personality disorders with Cluster C personality disorders being significantly more likely to be Type S, and paranoid and schizoid (Cluster A) personality disorders significantly more likely to be Type R than others.<ref>{{cite journal|author=Tyrer, P., Mitchard, S., Methuen, C., & Ranger, M. |year=2003|title=Treatment-rejecting and treatment-seeking personality disorders: Type R and Type S|journal= Journal of Personality Disorders|volume= 17|pages= 263–268|doi=10.1521/pedi.17.3.263.22152 |issue=3|pmid=12839104}}</ref>

== Diagnosis ==

The DSM-IV lists General diagnostic criteria for a personality disorder, which must be met in addition to the specific criteria for a particular named personality disorder. This requires that there be (to paraphrase):<ref>DSM-IV-TR [http://www.behavenet.com/capsules/disorders/prsnltydsrdr.htm General diagnostic criteria for a Personality Disorder] BehaveNet</ref>

There are 2 main pattern of diagnosing comorbidity:
1) [[Internalizing]]: the core vulnerability which is common to unipolar mood, somatization, anxiety disorder
2) <<link:0>>: common factor of ASPD, substance use disorder <ref name="jiv.sagepub">{{cite journal |doi=10.1177/088626099014006005 |author=Miller, P. M. & [[David Lisak|Lisak, D.]] |year=1999 |page=642 |title= Associations Between Childhood Abuse and Personality Disorder Symptoms in College Males |volume=14 |journal=Journal of Interpersonal Violence |accessdate=May 25, 2010 |url= http://jiv.sagepub.com/cgi/content/abstract/14/6/642 |issue=6}}</ref>
* An enduring pattern of psychological experience and behavior that differs prominently from cultural expectations, as shown in two or more of: [[cognition]] (i.e. perceiving and interpreting the self, other people or events); [[Affect (psychology)|affect]] (i.e. the range, intensity, [[lability]], and appropriateness of emotional response); interpersonal functioning; or [[impulse control]].
* The pattern must appear inflexible and pervasive across a wide range of situations, and lead to clinically significant distress or impairment in important areas of functioning.
* The pattern must be stable and long-lasting, have started as early as at least [[adolescence]] or early adulthood.
* The pattern must not be better accounted for as a manifestation of another mental disorder, or to the direct physiological effects of a substance (e.g. drug or medication) or a general medical condition (e.g. head trauma).

The ICD-10 'clinical descriptions and diagnostic guidelines' introduces its specific personality disorder diagnoses with some general guideline criteria that are similar. To quote:<ref>WHO (2010) [http://www.who.int/classifications/icd/en/bluebook.pdf ICD-10: Clinical descriptions and diagnostic guidelines: Disorders of adult personality and behavior]</ref>
* Markedly disharmonious attitudes and behavior, generally involving several areas of functioning; e.g. affectivity, arousal, impulse control, ways of perceiving and thinking, and style of relating to others;
* The abnormal behavior pattern is enduring, of long standing, and not limited to episodes of mental illness;
* The abnormal behavior pattern is pervasive and clearly maladaptive to a broad range of personal and social situations;
* The above manifestations always appear during childhood or adolescence and continue into adulthood;
* The disorder leads to considerable personal distress but this may only become apparent late in its course;
* The disorder is usually, but not invariably, associated with significant problems in occupational and social performance.

The ICD adds: "For different cultures it may be necessary to develop specific sets of criteria with regard to social norms, rules and obligations."

In clinical practice, individuals are generally diagnosed by an interview with a [[psychiatrist]] based on a [[mental status examination]], which may take into account observations by relatives and others. One tool of diagnosing personality disorders is a process involving interviews with scoring systems. The patient is asked to answer questions, and depending on their answers, the trained interviewer tries to code what their responses were. This process is fairly time consuming.

== Normal personality ==

The issue of the relationship between normal personality and personality disorders is one of the important issues in personality and clinical psychology. The personality disorders classification ([[DSM IV TR]] and [[ICD-10]]) follows a categorical approach that views personality disorders as discrete entities that are distinct from each other and from normal personality. In contrast, the [[dimensional approach to personality disorders|dimensional approach]] is an alternative approach that personality disorders represent maladaptive extensions of the same traits that describe normal personality. [[Thomas Widiger]]<ref>{{cite journal|author=Widiger, T. A. |year=1993|title=The DSM-III-R categorical personality disorder diagnoses: A critique and an alternative|journal= Psychological Inquiry|volume= 4|pages= 75–90|doi=10.1207/s15327965pli0402_1|issue=2|pmid=9989563|last2=Shedler|first2=J}}</ref> and his collaborators have contributed to this debate significantly. He discussed the constraints of the categorical approach and argued for the dimensional approach to the personality disorders. Specifically, he proposed that [[Five Factor Model]] of personality is alternative to the classification of personality disorders. For example, this view specifies that Borderline Personality Disorder can be understood as a combination of emotional lability (i.e., high neuroticism), impulsivity (i.e., low conscientiousness), and hostility (i.e., low agreeableness). Many studies across cultures have explored the relationship between personality disorders and the Five Factor Model<ref>Costa, P.T., & Widiger, T.A. (2001). Personality disorders and the five-factor model of personality (2nd ed.). Washington, DC: American Psychological Association.</ref> This research has demonstrated that personality disorders largely correlate in expected ways with measures of the Five Factor Model<ref>{{cite journal|author=Samuel, D.B. & Widiger, T.A.|year=2008|title=A meta-analytic review of the relationships between the five-factor model and DSM personality disorders: A facet level analysis|journal=Clinical Psychology Review|volume=28|issue=8|pages=1326–1342|pmc=2614445|url=http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2614445/pdf/nihms82022.pdf|doi=10.1016/j.cpr.2008.07.002|pmid=18708274}}</ref> and has set the stage for including the Five Factor Model within the upcoming [[DSM-5]].<ref>Widiger, Thomas A., Costa, Paul T. (2012). ''Personality Disorders and the Five-Factor Model of Personality, Third Edition''. ISBN 978-1-4338-1166-1.</ref>

{| class="wikitable"
|-
! style="text-align: center" colspan="13" | '''DSM-IV-TR Personality Disorders from the Perspective of the Five-Factor Model of General Personality Functioning'''<ref name="Tasman">Tasman, Allan et al (2008). ''Psychiatry. Third Edition''. John Wiley & Sons, Ltd. ISBN 978-0470-06571-6.</ref>
|-
! Factors
! PPD
! SzPD
! StPD
! ASPD
! BPD
! HPD
! NPD
! AvPD
! DPD
! OCPD
! PAPD
! DpPD
|-
| ''Neuroticism (vs. emotional stability)''
|-
| Anxiousness (vs. unconcerned)
| n/a
| n/a
| High
| Low
| High
| n/a
| n/a
| High
| High
| High
| n/a
| n/a
|-
| Angry hostility (vs. dispassionate)
| High
| n/a
| n/a
| High
| High
| n/a
| High
| n/a
| n/a
| n/a
| High
| n/a
|-
| Depressiveness (vs. optimistic)
| n/a
| n/a
| n/a
| n/a
| High
| n/a
| n/a
| n/a
| n/a
| n/a
| n/a
| High
|-
| Self-consciousness (vs. shameless)
| n/a
| n/a
| High
| Low
| n/a
| Low
| Low
| High
| High
| n/a
| n/a
| High
|-
| Impulsivity (vs. restrained)
| n/a
| n/a
| n/a
| High
| High
| High
| n/a
| Low
| n/a
| Low
| n/a
| n/a
|-
| Vulnerability (vs. fearless)
| n/a
| n/a
| n/a
| Low
| High
| n/a
| n/a
| High
| High
| n/a
| n/a
| n/a
|-
| ''Extraversion (vs. introversion)''
|-
| Warmth (vs. coldness)
| Low
| Low
| Low
| n/a
| n/a
| n/a
| Low
| n/a
| High
| n/a
| Low
| Low
|-
| Gregariousness (vs. withdrawal)
| Low
| Low
| Low
| n/a
| n/a
| High
| n/a
| Low
| n/a
| n/a
| n/a
| Low
|-
| Assertiveness (vs. submissiveness)
| n/a
| n/a
| n/a
| High
| n/a
| n/a
| High
| Low
| Low
| n/a
| Low
| n/a
|-
| Activity (vs. passivity)
| n/a
| Low
| n/a
| High
| n/a
| High
| n/a
| n/a
| n/a
| n/a
| Low
| n/a
|-
| Excitement seeking (vs. lifeless)
| n/a
| Low
| n/a
| High
| n/a
| High
| High
| Low
| n/a
| Low
| n/a
| Low
|-
| Positive emotionality (vs. anhedonia)
| n/a
| Low
| Low
| n/a
| n/a
| High
| n/a
| Low
| n/a
| n/a
| n/a
| n/a
|-
| ''Openness (vs. closedness)''
|-
| Fantasy (vs. concrete)
| n/a
| n/a
| High
| n/a
| n/a
| High
| n/a
| n/a
| n/a
| n/a
| n/a
| n/a
|-
| Aesthetics (vs. disinterest)
| n/a
| n/a
| n/a
| n/a
| n/a
| n/a
| n/a
| n/a
| n/a
| n/a
| n/a
| n/a
|-
| Feelings (vs. alexithymia)
| n/a
| Low
| n/a
| n/a
| High
| High
| Low
| n/a
| n/a
| Low
| n/a
| n/a
|-
| Actions (vs. predictable)
| Low
| Low
| n/a
| High
| High
| High
| High
| Low
| n/a
| Low
| Low
| n/a
|-
| Ideas (vs. closed-minded)
| Low
| n/a
| High
| n/a
| n/a
| n/a
| n/a
| n/a
| n/a
| Low
| Low
| Low
|-
| Values (vs. dogmatic)
| Low
| n/a
| n/a
| n/a
| n/a
| n/a
| n/a
| n/a
| n/a
| Low
| n/a
| n/a
|-
| ''Agreeableness (vs. antagonism)''
|-
| Trust (vs. mistrust)
| Low
| n/a
| n/a
| Low
| n/a
| High
| Low
| n/a
| High
| n/a
| n/a
| Low
|-
| Straightforwardness (vs. deception)
| Low
| n/a
| n/a
| Low
| n/a
| n/a
| Low
| n/a
| n/a
| n/a
| Low
| n/a
|-
| Altruism (vs. exploitative)
| Low
| n/a
| n/a
| Low
| n/a
| n/a
| Low
| n/a
| High
| n/a
| n/a
| n/a
|-
| Compliance (vs. aggression)
| Low
| n/a
| n/a
| Low
| n/a
| n/a
| Low
| n/a
| High
| n/a
| Low
| n/a
|-
| Modesty (vs. arrogance)
| n/a
| n/a
| n/a
| Low
| n/a
| n/a
| Low
| High
| High
| n/a
| n/a
| High
|-
| Tender-mindedness (vs. tough-minded)
| Low
| n/a
| n/a
| Low
| n/a
| n/a
| Low
| n/a
| High
| n/a
| n/a
| n/a
|-
| ''Conscientiousness (vs. disinhibition)''
|-
| Competence (vs. laxness)
| n/a
| n/a
| n/a
| n/a
| n/a
| n/a
| n/a
| n/a
| n/a
| High
| Low
| n/a
|-
| Order (vs. disorderly)
| n/a
| n/a
| Low
| n/a
| n/a
| n/a
| n/a
| n/a
| n/a
| n/a
| High
| Low
|-
| Dutifulness (vs. irresponsibility)
| n/a
| n/a
| n/a
| Low
| n/a
| n/a
| n/a
| n/a
| n/a
| High
| Low
| High
|-
| Achievement striving (vs. lackadaisical)
| n/a
| n/a
| n/a
| n/a
| n/a
| n/a
| n/a
| n/a
| n/a
| High
| n/a
| n/a
|-
| Self-discipline (vs. negligence)
| n/a
| n/a
| n/a
| Low
| n/a
| Low
| n/a
| n/a
| n/a
| High
| Low
| n/a
|-
| Deliberation (vs. rashness)
| n/a
| n/a
| n/a
| Low
| Low
| Low
| n/a
| n/a
| n/a
| High
| n/a
| High
|}

'''Abbreviations used:''' ''PPD – Paranoid Personality Disorder, SzPD – Schizoid Personality Disorder, StPD – Schizotypal Personality Disorder, ASPD – Antisocial Personality Disorder, BPD – Borderline Personality Disorder, HPD – Histrionic Personality Disorder, NPD – Narcissistic Personality Disorder, AvPD – Avoidant Personality Disorder, DPD – Dependent Personality Disorder, OCPD – Obsessive-Compulsive Personality Disorder, PAPD – Passive-Aggressive Personality Disorder, DpPD – Depressive Personality Disorder, n/a – not available.''

== Personality disorder traits ==

{{primary sources|section|date=April 2013}}
There are 2 main pattern of diagnosing comorbidity: 1) [[Internalizing]]: the core vulnerability which is common to unipolar mood, somatization, anxiety disorder 2) <<link:1>>: common factor of ASPD, substance use disorder.<ref>{{cite pmid|22448802}}</ref>

Lower-order factors (externalizing psychopathology)
* Aggression
Aggression reflects pure angry and antagonistic behavior whereas obsessive-compulsive PD reflect rigidity and stubbornness. And there are co-variation between antisocial personality disorder and obsessive-compulsive personality disorder
* Emotional Dysregulation reflect lability (specific to the domains of anger and arousal making this factor more specific to disinhibited negative emotional arousal). There are greater contribution of generalized distress and negative emotional valence to the construct
* Impulsivity is common features across socially deviant, reckless, and sensation-seeking, and it is negatively associated with perfectionism and moral inflexibility
Other externalizing factor:
* gender
* age
* greater exposure to trauma
* exposure to combat trauma

Higher-order factor (internalizing):
* Social Alienation
* Exhibitionism
* Dependency/ Insecure Attachments
There are three traits:
* Odd/Peculiar is marked by cognitive and affective aberrations (associated with social isolation and psychological distress
* Mistrust measure anxiety and perseveration about potential harm and trustworthiness of other. It is also associated with a primary anxiety disorder.Social avoidance and detachment will be the consequence
* Compulsivity/ Achievement is a rigid and adherence to rules and a single-minded focus on productivity and goals at the expense of social relationships

== In children and adolescents ==

{{Main|Personality development disorder}}
{{primary sources|section|date=April 2013}}
Early stages and preliminary forms of personality disorders need a multi-dimensional and early treatment approach. '''Personality development disorder''' is considered to be a childhood risk factor or early stage of a later personality disorder in adulthood.<ref name = Krueger>{{cite journal|author=Krueger, R. |doi=10.1007/s11920-001-0072-4|title=Personality disorders in children and adolescents|year=2001|last2=Carlson|first2=Scott R.|journal=Current Psychiatry Reports|volume=3|pages=46–51|pmid=11177759|issue=1}}</ref>
In addition, in Robert F.Krueger's review of their research indicates that some children and adolescents do suffer from clinically significant syndromes that resemble adult personal disorders, and that these syndromes have meaningful correlates and are consequential. Much of this research has been framed by the adult personality disorder constructs from Axis II of the Diagnostic and Statistical Manual. Hence, they are less likely to encounter the first risk they described at the outset of their review: clinicians and researchers are not simply avoiding use of the PD construct in youth. However, they may encounter the second risk they described: under-appreciation of the developmental context in which these syndromes occur. That is, although PD constructs show continuity over time, they are probabilistic predictors; not all youths who exhibit PD symptomatology become adult PD cases.<ref name = Krueger />

== Causes ==

{{primary sources|section|date=April 2013}}
There are numerous possible [[causes of mental disorders]], and they may vary depending on the disorder, the individual, and the circumstances. There may be genetic dispositions as well as particular life experiences, which may or may not include particular incidents of trauma or abuse.

A study of almost 600 male college students, averaging almost 30 years of age and who were not drawn from a clinical sample, examined the relationship between childhood experiences of sexual and physical abuse and currently reported personality disorder symptoms. Childhood abuse histories were found to be definitively associated with greater levels of symptomatology. Severity of abuse was found to be statistically significant, but clinically negligible, in symptomatology variance spread over Cluster A, B and C scales.<ref name="jiv.sagepub" />

[[Child abuse]] and [[neglect]] consistently evidence themselves as antecedent risks to the development of personality disorders in adulthood.<ref name = "Cohen">{{cite journal|author=Cohen, Patricia; Brown, Jocelyn and Smailes, Elizabeth|url=http://journals.cambridge.org/action/displayAbstract;jsessionid=541A1066792903751CB4BC855C0857B1.journals?fromPage=online&aid=92711|title=Child Abuse and Neglect and the Development of Mental Disorders in the General Population|journal= Development and Psychopathology|year= 2001|volume= 13|issue= 4|pages=981–999|pmid=11771917}}</ref> In the following study, efforts were taken to match retrospective reports of abuse with a clinical population that had demonstrated psychopathology from childhood to adulthood who were later found to have experienced abuse and neglect. In a study of 793 mothers and children, researchers asked mothers if they had screamed at their children, and told them that they didn’t love them or threatened to send them away. Children who had experienced such verbal abuse were three times as likely as other children (who didn't experience such verbal abuse) to have borderline, narcissistic, obsessive-compulsive or paranoid personality disorders in adulthood.<ref>{{cite web|title=What Causes Psychological Disorders? |work=American Pyschological Association|year= 2010|url=http://apa.org/topics/personality/disorders-causes.aspx|archiveurl=http://web.archive.org/web/20101120002217/http://apa.org/topics/personality/disorders-causes.aspx|archivedate=2010-11-20}}</ref> The [[sexual abuse|sexually abused]] group demonstrated the most consistently elevated patterns of psychopathology. Officially verified [[physical abuse]] showed an extremely strong correlation with the development of antisocial and impulsive behavior. On the other hand, cases of abuse of the neglectful type that created childhood pathology were found to be subject to partial remission in adulthood.<ref name = "Cohen" />

== Prevalence ==

The [[prevalence]] of personality disorder in the general community was largely unknown until surveys starting from the 1990s. In 2008 the [[median]] rate of diagnosable PD was estimated at 10.6%, based on six major studies across three nations. This rate of around one in ten, especially as associated with high use of services, is described as a major [[public health]] concern requiring attention by researchers and clinicians.<ref>{{cite journal|last=Lenzenweger|first=Mark F.|title=Epidemiology of Personality Disorders|journal=Psychiatric Clinics of North America|year=2008|volume=31|issue=3|pages=395–403|doi=10.1016/j.psc.2008.03.003|pmid=18638642}}</ref>

The prevalence of individual personality disorders ranges from about 2% to 3% for the more common varieties, such as schizotypal, antisocial, borderline, and histrionic, to 0.5–1% for the least common, such as narcissistic and avoidant.<ref name="Tasman" />

A screening survey across 13 countries by the [[World Health Organization]] using [[DSM-IV]] criteria, reported in 2009 a prevalence estimate of around 6% for personality disorders. The rate sometimes varied with [[demographic]] and [[socioeconomic]] factors, and functional impairment was partly explained by co-occurring mental disorders.<ref>{{cite journal|last=Huang|first=Y.|coauthors=Kotov, R., de Girolamo, G., Preti, A., Angermeyer, M., Benjet, C., Demyttenaere, K., de Graaf, R., Gureje, O., Karam, A. N., Lee, S., Lepine, J. P., Matschinger, H., Posada-Villa, J., Suliman, S., Vilagut, G., Kessler, R. C.|title=DSM-IV personality disorders in the WHO World Mental Health Surveys|journal=The British Journal of Psychiatry|date=30 June 2009|volume=195|issue=1|pages=46–53|doi=10.1192/bjp.bp.108.058552|pmid=19567896|pmc=2705873}}</ref> In the US, screening data from the [[National Comorbidity Survey|National Comorbidity Survey Replication]] between 2001 and 2003, combined with interviews of a subset of respondents, indicated a population prevalence of around 9% for personality disorders in total. Functional disability associated with the diagnoses appeared to be largely due to co-occurring mental disorders (Axis I in the DSM).<ref>{{cite journal|last=Lenzenweger|first=Mark F.|coauthors=Lane, Michael C., Loranger, Armand W., Kessler, Ronald C.|title=DSM-IV Personality Disorders in the National Comorbidity Survey Replication|journal=Biological Psychiatry|year=2006|volume=62|issue=6|pages=553–564|doi=10.1016/j.biopsych.2006.09.019|pmid=17217923|pmc=2044500}}</ref>

A UK national [[epidemiological]] study (based on DSM-IV screening criteria), reclassified into levels of severity rather than just diagnosis, reported in 2010 that the majority of people show some personality difficulties in one way or another (short of threshold for diagnosis), while the prevalence of the most complex and severe cases (including meeting criteria for multiple diagnoses in different clusters) was estimated at 1.3%. Even low levels of personality symptoms were associated with functional problems, but the most severely in need of services was a much smaller group.<ref>{{cite journal|last=Yang|first=M.|coauthors=Coid, J., Tyrer, P.|title=Personality pathology recorded by severity: national survey|journal=The British Journal of Psychiatry|date=31 August 2010|volume=197|issue=3|pages=193–199|doi=10.1192/bjp.bp.110.078956|pmid=20807963}}</ref>

There are also some [[gender]] differences in the frequency of personality disorders. They are shown in the table below.

{| class="wikitable"
|-
! style="text-align: center" colspan="2" | '''Gender differences in the frequency of personality disorders'''<ref name="Tasman" />
|-
! Type of personality disorder
! Sex
|-
| Paranoid personality disorder
| '''Male'''
|-
| Schizoid personality disorder
| '''Male'''
|-
| Schizotypal personality disorder
| '''Male'''
|-
| Antisocial personality disorder
| '''Male'''
|-
| Borderline personality disorder
| '''Female'''
|-
| Histrionic personality disorder
| '''Female'''
|-
| Narcissistic personality disorder
| '''Male'''
|-
| Avoidant personality disorder
| '''Equal'''
|-
| Dependent personality disorder
| '''Female'''
|-
| Obsessive–compulsive personality disorder
| '''Male'''
|}

== Comorbidity ==

=== Comorbidity in personality disorders ===

There is a considerable personality disorder diagnostic co-occurrence. Patients who meet the DSM-IV-TR diagnostic criteria for one personality disorder are likely to meet the diagnostic criteria for another.<ref name="Tasman" /> Diagnostic categories provide clear, vivid descriptions of discrete personality types but the personality structure of actual patients might be more accurately described by a constellation of maladaptive personality traits.

{| class="wikitable"
|-
! style="text-align: center" colspan="12" | '''DSM-III-R personality disorder diagnostic co-occurrence aggregated across six research sites'''<ref name="Tasman" />
|-
! Type of Personality Disorder
! PPD
! SzPD
! StPD
! ASPD
! BPD
! HPD
! NPD
! AvPD
! DPD
! OCPD
! PAPD
|-
| Paranoid (PPD)
|
| 8
| 19
| 15
| 41
| 28
| 26
| 44
| 23
| 21
| 30
|-
| Schizoid (SzPD)
| 38
|
| 39
| 8
| 22
| 8
| 22
| 55
| 11
| 20
| 9
|-
| Schizotypal (StPD)
| 43
| 32
|
| 19
| 4
| 17
| 26
| 68
| 34
| 19
| 18
|-
| Antisocial (ASPD)
| 30
| 8
| 15
|
| 59
| 39
| 40
| 25
| 19
| 9
| 29
|-
| Borderline (BPD)
| 31
| 6
| 16
| 23
|
| 30
| 19
| 39
| 36
| 12
| 21
|-
| Histrionic (HPD)
| 29
| 2
| 7
| 17
| 41
|
| 40
| 21
| 28
| 13
| 25
|-
| Narcissistic (NPD)
| 41
| 12
| 18
| 25
| 38
| 60
|
| 32
| 24
| 21
| 38
|-
| Avoidant (AvPD)
| 33
| 15
| 22
| 11
| 39
| 16
| 15
|
| 43
| 16
| 19
|-
| Dependent (DPD)
| 26
| 3
| 16
| 16
| 48
| 24
| 14
| 57
|
| 15
| 22
|-
| Obsessive-Compulsive (OCPD)
| 31
| 10
| 11
| 4
| 25
| 21
| 19
| 37
| 27
|
| 23
|-
| Passive-Aggressive (PAPD)
| 39
| 6
| 12
| 25
| 44
| 36
| 39
| 41
| 34
| 23
|
|}

''Sites used DSM-III-R criterion sets. Data obtained for purposes of informing the development of the DSM-IV-TR personality disorder diagnostic criteria.''

=== Relationship between personality disorder subtypes and other mental disorders ===

The disorders in each of the three clusters may share some underlying common vulnerability factors involving cognition, affect and impulse control, and behavioral maintenance or inhibition, respectively, and may have a spectrum relationship to certain syndromal mental disorders:<ref name="Tasman" />

* Paranoid or schizotypal personality disorders may be observed to be premorbid antecedents of [[delusional disorder]]s or [[schizophrenia]].

* Borderline personality disorder is seen in association with [[Mood disorder|mood]] and [[anxiety disorder]]s and with [[impulse control disorder]]s, [[eating disorders]], [[Attention deficit hyperactivity disorder|ADHD]], or a [[substance use disorder]].

* Avoidant personality disorder is seen with [[social anxiety disorder]].

== Interventions ==

=== Specific approaches ===

There are many different forms (modalities) of treatment used for personality disorders:<ref>Magnavita, Jeffrey J. (2004) [http://books.google.com/books?id=jhtvBV3i0rkC Handbook of personality disorders: theory and practice], John Wiley and Sons, ISBN 978-0-471-48234-5.</ref>
* Individual [[psychotherapy]] has been a mainstay of treatment. There are long-term and short-term ([[Brief psychotherapy|brief]]) forms.
* [[Family therapy]], including couples therapy.
* [[Group therapy]] for personality dysfunction is probably the second most used.
* [[Psychoeducation|Psychological-education]] may be used as an addition.
* [[Self-help groups for mental health|Self-help groups]] may provide resources for personality disorders.
* [[Psychiatric medications]] for treating symptoms of personality dysfunction or co-occurring conditions.
* [[Milieu therapy]], a kind of group-based residential approach, has a history of use in treating personality disorders, including [[therapeutic communities]].

There are different specific theories or schools of therapy within many of these modalities. They may, for example, emphasize [[Psychodynamic psychotherapy|psychodynamic]] techniques, or [[Cognitive behavioral therapy|cognitive or behavioral]] techniques. In clinical practice, many therapists use an 'eclectic' approach, taking elements of different schools as and when they seem to fit to an individual client. There is also often a focus on [[Common factors theory|common themes]] that seem to be beneficial regardless of techniques, including attributes of the therapist (e.g. trustworthiness, competence, caring), processes afforded to the client (e.g. ability to express and confide difficulties and emotions), and the match between the two (e.g. aiming for mutual respect, trust and boundaries).

{| class="wikitable"
|-
! style="text-align: center" colspan="4" | '''Response of Patients with Personality Disorders to Biological and Psychosocial Treatments'''<ref name="Tasman" />
|-
! Cluster
! Evidence for [[Neurological disorder|Brain Dysfunction]]
! Response to Biological Treatments
! Response to Psychosocial Treatments
|-
| '''A'''
| Evidence for relationship of schizotypal personality to [[schizophrenia]]; otherwise none known
| Schizotypal patients may improve on [[antipsychotic]] medication; otherwise not indicated
| Poor. [[Supportive psychotherapy]] may help
|-
| '''B'''
| Evidence suggestive for antisocial and borderline personalities; otherwise none known
| [[Antidepressant]]s, [[antipsychotic]]s, or [[mood stabilizer]]s may help for borderline personality; otherwise not indicated
| Poor in antisocial personality. Variable in borderline, narcissistic, and histrionic personalities
|-
| '''C'''
| None known
| No direct response. Medications may help with comorbid [[anxiety]] and [[Depression (mood)|depression]]
| Most common treatment for these disorders. Response variable
|}

=== Challenges ===

The management and treatment of personality disorders can be a challenging and controversial area, for by definition the difficulties have been enduring and affect multiple areas of functioning. This often involves [[Interpersonal relationship|interpersonal]] issues, and there can be difficulties in seeking and obtaining help from organizations in the first place, as well as with establishing and maintaining a specific [[therapeutic relationship]]. On the one hand, an individual may not consider themselves to have a mental health problem, while on the other, [[community mental health services]] may view individuals with personality disorders as too complex or difficult, and may directly or indirectly [[social exclusion|exclude]] individuals with such diagnoses or associated behaviors.<ref>{{cite journal|last=Davison|first=S. E.|title=Principles of managing patients with personality disorder|journal=Advances in Psychiatric Treatment|year=2002|volume=8|issue=1|pages=1–9|doi=10.1192/apt.8.1.1|url=http://apt.rcpsych.org/content/8/1/1.full}}</ref> The disruptiveness people with personality disorders can create in an organisation makes these, arguably, the most challenging conditions to manage. In a four year organizational study by [http://oxford.academia.edu/MichaelFischer Fischer] at the [[University of Oxford]], he found people with personality disorders created 'trouble' that escalated to disrupt organizational functioning, producing interorganizational 'turbulence'.  Whereas skilful clinical and hospital leadership proved key to restoring therapeutic functioning, the imposition of external risk controls by health officials critically undermined trust between patients and clinicians, provoking a crisis and organizational breakdown.<ref>{{cite journal|last=Fischer|first=Michael D|title=Organizational Turbulence, Trouble and Trauma: Theorizing the Collapse of a Mental Health Setting|journal=Organization Studies|date=28 September 2012|volume=33|issue=9|pages=1153–1173|doi=10.1177/0170840612448155}}</ref> <ref>{{cite journal|last=Fischer|first=Michael Daniel|coauthors=Ferlie, Ewan|title=Resisting hybridisation between modes of clinical risk management: Contradiction, contest, and the production of intractable conflict|journal=Accounting, Organizations and Society|date=1 January 2013|volume=38|issue=1|pages=30–49|doi=10.1016/j.aos.2012.11.002}}</ref>

Apart from all these issues, an individual may not consider their personality to be disordered or the cause of problems. This perspective may be caused by the patient's ignorance or lack of [[insight]] into their own condition, an [[Egosyntonic and egodystonic|ego-syntonic]] perception of the problems with their personality that prevents them from experiencing it as being in conflict with their goals and self-image, or by the simple fact that there is no distinct or objective boundary between 'normal' and 'abnormal' personalities. Unfortunately, there is substantial [[social stigma]] and discrimination related to the diagnosis.

The term 'personality disorder' encompasses a wide range of issues, each with different a level of severity or disability; thus, personality disorders can require fundamentally different approaches and understandings. To illustrate the scope of the matter, consider that while some disorders or individuals are characterized by continual social withdrawal and the shunning of relationships, others may cause ''fluctuations'' in forwardness. The extremes are worse still: at one extreme lie [[self-harm]] and [[self-neglect]], while at another extreme some individuals may commit [[violence]] and [[crime]]. There can be other factors such as problematic [[Substance use disorder|substance use or dependency]] or [[behavioral addiction]]s. A person may meet criteria for multiple personality disorder diagnoses and/or other mental disorders, either at particular times or continually, thus making coordinated input from multiple services a potential requirement.

Therapists in this area can become disheartened by lack of initial progress, or by apparent progress that then leads to setbacks. Clients may be experienced as negative, [[Social rejection|rejecting]], demanding, [[aggressive]] or [[Psychological manipulation|manipulative]]. This has been looked at in terms of both therapist and client; in terms of [[social skills]], [[coping (psychology)|coping efforts]], [[defence mechanisms]], or deliberate [[Strategy|strategies]]; and in terms of [[moral]] judgements or the need to consider underlying [[motivations]] for specific behaviors or [[Social conflict|conflicts]]. The [[vulnerabilities]] of a client, and indeed therapist, may become lost behind actual or apparent strength and [[resilience]]. It is commonly stated that there is always a need to maintain appropriate professional [[personal boundaries]], while allowing for [[emotional expression]] and therapeutic relationships. However, there can be difficulty acknowledging the different worlds and understandings that client and therapist may live with. A therapist may assume that the kinds of relationships and ways of interacting that make them feel safe and comfortable, have the same effect on clients. As an example at one extreme, people who may in their lives have been used to hostility, deceptiveness, rejection, aggression or [[abuse]], may in some cases be made confused, intimidated or suspicious by presentations of warmth, [[intimacy]] or positivity. On the other hand, reassurance, openness and clear communication are usually helpful and needed. It can take several months of sessions, and perhaps several stops and starts, to begin to develop a trusting relationship that can meaningfully address issues.<ref>McVey, D. & Murphy, N. (eds.) (2010)  [http://www.routledge.com/books/details/9780415404808/ Treating Personality Disorder: Creating Robust Services for People with Complex Mental Health Needs], ISBN 0-203-84115-8</ref>

== Occupational functioning ==

Depending on the diagnosis, severity and individual, and the job itself, personality disorders can be associated with difficulty coping with work or the workplace- potentially leading to problems with others by interfering with [[interpersonal relationships]].  Indirect effects also play a role; for example, impaired educational progress or complications outside of work, such as [[substance abuse]] and co-morbid mental diseases, can plague sufferers. However, personality disorders can also bring about above-average work abilities by increasing competitive drive or causing the sufferer to exploit his or her co-workers.<ref>Ettner, Susan L. 2011. "Personality Disorders and Work." In [http://books.google.co.uk/books?id=g_HASArJsoIC&vq=personality+disorder&source=gbs_navlinks_s Work Accommodation and Retention in Mental Health], Chapter 9</ref><ref>{{cite journal|last=Ettner|first=Susan L.|coauthors=Maclean, Johanna Catherine, French, Michael T.|title=Does Having a Dysfunctional Personality Hurt Your Career? Axis II Personality Disorders and Labor Market Outcomes|journal=Industrial Relations: A Journal of Economy and Society|date=1 January 2011|volume=50|issue=1|pages=149–173|doi=10.1111/j.1468-232X.2010.00629.x|url=http://onlinelibrary.wiley.com/doi/10.1111/j.1468-232X.2010.00629.x/full#b15}}</ref>

In 2005, psychologists Belinda Board and Katarina Fritzon at the [[University of Surrey]], UK, interviewed and gave personality tests to high-level British executives and compared their profiles with those of criminal psychiatric patients at [[Broadmoor Hospital]] in the UK.  They found that three out of eleven personality disorders were actually more common in executives than in the disturbed criminals:

* [[Histrionic personality disorder]]: including [[superficial charm]], insincerity, [[egocentricity]] and [[psychological manipulation|manipulation]]
* [[Narcissistic personality disorder]]: including [[grandiosity]], self-focused lack of [[empathy]] for others, exploitativeness and independence.
* [[Obsessive-compulsive personality disorder]]: including [[Perfectionism (psychology)|perfectionism]], excessive devotion to work, rigidity, stubbornness and dictatorial tendencies.<ref name="Board2005">{{Cite journal
 | last = Board | first = Belinda Jane
 | year = 2005
 | title = Disordered personalities at work
 | journal = Psychology Crime and Law
 | volume = 11
 | page = 17
 | doi = 10.1080/10683160310001634304
 | first2 = Katarina
 | last2 = Fritzon
}}</ref>

According to leading leadership academic [[Manfred F.R. Kets de Vries]], it seems almost inevitable these days that there will be some personality disorders in a senior management team.<ref>{{cite journal|author=de Vries, Manfred F. R. Kets |title= The Dark Side of Leadership|journal= Business Strategy Review |volume=14|issue=3|page= 26 |year=2003}}</ref>

== History ==

Personality disorder is a term with a distinctly modern meaning, owing in part to its clinical usage and the institutional character of modern psychiatry. The currently accepted meaning must be understood in the context of historical changing classification systems such as DSM-IV and its predecessors. Although highly anachronistic, and ignoring radical differences in the character of subjectivity and social relations, some have suggested similarities to other concepts going back to at least the [[Ancient Greek medicine|ancient Greeks]].<ref name="millon">{{cite book
| first=Theordore
| last= Millon
| year= 1996
| title=Disorders of Personality: DSM-IV-TM and Beyond
| edition= first edition, personal disorders
| publisher=John Wiley and Sons
| location=New York
| page= 35
| isbn=  0-471-01186-X }}</ref> For example, the Greek philosopher [[Theophrastus]] described 29 'character' types that he saw as deviations from the norm, and similar views have been found in Asian, Arabic and Celtic cultures. A long-standing influence in the Western world was [[Galen]]'s concept of personality types which he linked to the [[four humours]] proposed by [[Hippocrates]].

Such views lasted into the 18th century, when experiments began to question the supposed biologically based humours and 'temperaments'. Psychological concepts of character and 'self' became widespread. In the 19th century, 'personality' referred to a person's conscious awareness of their behavior, a disorder of which could be linked to altered states such as [[Dissociation (psychology)|dissociation]]. This sense of the term has been compared to the use of the term 'multiple personality disorder' in the first versions of the DSM.<ref>Suryanarayan, Geetha (2002) [http://www.asia.cmpmedica.com/cmpmedica_my/disppdf.cfm?fname=suryanHistory.pdf The History of the Concept of Personality Disorder and its Classification], The Medicine Publishing Company Ltd.</ref>

Physicians in the early 19th century started to diagnose forms of [[insanity]] that involved disturbed emotions and behaviors but seemingly without significant intellectual impairment or [[delusions]] or [[hallucinations]]. [[Philippe Pinel]] referred to this as 'manie sans délire' – insanity without delusion – and described a number of cases mainly involving excessive or inexplicable anger or rage. [[James Cowles Prichard]] advanced a similar concept he called [[moral insanity]], which would be used to diagnose patients for some decades. 'Moral' in this sense referred to [[Affect (psychology)|affect]] (emotion or mood) rather than necessarily ethics, but it was arguably based in part on religious, social and moral beliefs, with a pessimism about medical intervention so that social control should take precedence.<ref>{{cite journal|pmid=8757717|year=1996|last1=Augstein|first1=HF|title=J C Prichard's concept of moral insanity—a medical theory of the corruption of human nature|volume=40|issue=3|pages=311–43|pmc=1037128|journal=Medical history|doi=10.1017/S0025727300061329}}</ref> These categories were much different and broader than later definitions of personality disorder, while also being developed by some into a more specific meaning of moral degeneracy akin to later ideas about 'psychopaths'. Separately, [[Richard von Krafft-Ebing]] popularized the terms [[Sadism and masochism as medical terms|sadism and masochism]], as well as [[homosexuality]], as psychiatric issues.

The German psychiatrist [[Julius Ludwig August Koch|Koch]] sought to make the moral insanity concept more scientific, suggesting in 1891 the phrase 'psychopathic inferiority', theorized to be a [[congenital disorder]]. This referred to continual and rigid patterns of misconduct or dysfunction in the absence of apparent mental retardation or illness, supposedly without a moral judgement. Described as deeply rooted in his Christian faith, his work has been described as a fundamental text on personality disorders that is still of use today.<ref>{{cite journal|pmid=19127839|year=2008|last1=Gutmann|first1=P|title=Julius Ludwig August Koch (1841–1908): Christian, philosopher and psychiatrist|volume=19|issue=74 Pt 2|pages=202–14|journal=History of psychiatry|doi=10.1177/0957154X07080661}}</ref>

=== 20th century ===

In the early 20th century, another German psychiatrist, [[Emil Kraepelin]], included a chapter on psychopathic inferiority in his influential work on clinical psychiatry for students and physicians. He suggested six types – excitable, unstable, eccentric, liar, swindler and quarrelsome. The categories were essentially defined by the most disordered criminal offenders observed, distinguished between criminals by impulse, professional criminals, and morbid [[Vagabond (person)|vagabonds]] who wandered through life. Kraepelin also described three paranoid (meaning then delusional) disorders, resembling later concepts of schizophrenia, delusional disorder and paranoid personality disorder. A diagnostic term for the latter concept would be included in the DSM from 1952, and from 1980 the DSM would also include schizoid and schizotypal personality disorders; interpretations of earlier (1921) theories of [[Ernst Kretschmer]] led to a distinction between these and another type later included in the DSM, avoidant personality disorder.

In 1933 Russian psychiatrist [[Pyotr Gannushkin|Pyotr Borisovich Gannushkin]] published his book ''Manifestations of psychopathies: statics, dynamics, systematic aspects'', which was one of the first attempts to develop a detailed [[Pyotr Gannushkin#The theory of psychopathies|typology of psychopathies]]. Regarding maladaptaion, ubiquity, and stability as the three main symptoms of behavioral pathology, he distinguished 9 clusters of psychopaths: cycloids (including constitutionally depressive, constitutionally excitable, cyclothymics, and emotionally labile), asthenics (including psychasthenics), schizoids (including dreamers), paranoiacs (including fanatics), epileptoids, hysterical personalities (including pathological liars), unstable psychopaths, antisocial psychopaths, and constitutionally stupid.<ref name="Gannushkin 01">Ганнушкин П. Б. (2000). ''Клиника психопатий, их статика, динамика, систематика''. Издательство Нижегородской государственной медицинской академии. ISBN 5-86093-015-1.</ref> Some elements of Gannushkin's typology were later incorporated into the theory developed by a Russian adolescent psychiatrist, [[Andrey Yevgenyevich Lichko]], who was also interested in psychopathies along with their milder forms, the so-called [[Andrey Yevgenyevich Lichko#Accentuations of character|accentuations of character]].<ref name="Lichko 02">Личко А. Е. (2010) Психопатии и акцентуации характера у подростков. Речь, ISBN 978-5-9268-0828-6.</ref>

Psychiatrist David Henderson published in 1939 a theory of 'psychopathic states' which ended up contributing to the term becoming popularly linked to anti-social behavior. [[Hervey M. Cleckley]]’s 1941 text, [[The Mask of Sanity]], based on his personal categorization of similarities he noted in some prisoners, marked the start of the modern clinical conception of psychopathy and its popularist usage.<ref>{{cite journal|last=Arrigo|first=B. A.|title=The Confusion Over Psychopathy (I): Historical Considerations|journal=International Journal of Offender Therapy and Comparative Criminology|date=1 June 2001|volume=45|issue=3|pages=325–344|doi=10.1177/0306624X01453005|url=http://193.146.160.29/gtb/sod/usu/%24UBUG/repositorio/10281816_Arrigo.pdf}}</ref>

Towards the mid 20th century, psychoanalytic theories were coming to the fore based on work from the turn of the century being popularized by [[Sigmund Freud]] and others. This included the concept of 'character disorders', which were seen as enduring problems linked not to specific symptoms but to pervasive internal conflicts or derailments of normal childhood development. These were typically understood as weaknesses of character or willful deviance, and were distinguished from [[neurosis]] or [[psychosis]]. The term 'borderline' stems from a belief that some individuals were functioning on the edge of those two categories, and a number of the other personality disorder categories were also heavily influenced by this approach, including dependent, obsessive-compulsive and histrionic,<ref>Amy Heim & Drew Westen (2004) [http://www.psychsystems.net/Publications/2005/17.%20theories%20of%20personality%20and%20personality%20disorders_Heim_textbook%20of%20pers%20disorders%202005.pdf Theories of personality and personality disorders]</ref> the latter starting off as a conversion symptom of hysteria particularly associated with women, then a hysterical personality, then renamed histrionic personality disorder in later versions of the DSM. A passive aggressive style was defined clinically by Colonel [[William Menninger]] during World War II in the context of men's reactions to military compliance, which would later be referenced as a personality disorder in the DSM.<ref name="Lane">{{cite journal|last=Lane|first=C.|title=The Surprising History of Passive-Aggressive Personality Disorder|journal=Theory & Psychology|date=1 February 2009|volume=19|issue=1|pages=55–70|doi=10.1177/0959354308101419|url=http://www.christopherlane.org/documents/Lane.PAPDisorder.pdf}}</ref> [[Otto Kernberg]] was influential with regard to the concepts of the borderline and narcissistic personalities which were later incorporated as disorders into the DSM in 1980.

Meanwhile, a more general [[personality psychology]] had been developing in academia and to some extent clinically. [[Gordon Allport]] was publishing theories of [[personality traits]] from the 1920s, and [[Henry Murray]] advanced a theory called 'personology' which influenced a later key advocate of personality disorders, [[Theodore Millon]]. Tests were developing or being applied for personality evaluation, including [[projective test]]s such as the [[Rorschach test|Rorshach]], as well as questionnaires such as the [[Minnesota Multiphasic Personality Inventory]]. Around mid-century, [[Hans Eysenck]] was analysing traits and [[personality types]], and psychiatrist [[Kurt Schneider]] was popularising a clinical use in place of the previously more usual terms 'character', 'temperament' or 'constitution'.

American psychiatrists officially recognised concepts of enduring personality disturbances in the first [[Diagnostic and Statistical Manual of Mental Disorders]] in the 1950s, which relied heavily on psychoanalytic concepts. Somewhat more neutral language was employed in the DSM-II in 1968, though the terms and descriptions had only a slight resemblance to current definitions. The DSM-III published in 1980 made some major changes, notably putting all personality disorders onto a second separate 'axis' along with mental retardation, intended to signify more enduring patterns, distinct from what were considered axis one mental disorders. 'Inadequate' and '[[asthenic]]' personality disorder' categories were deleted, and others were unpacked into more types, or changed from being personality disorders to regular disorders. Sociopathic Personality Disorder, which had been the term for psychopathy, was renamed Antisocial Personality Disorder. Most categories were given more specific 'operationalized' definitions, with standard criteria that psychiatrists could agree on in order to conduct research and diagnose patients.<ref>Hoermann, Simone; Zupanick, Corinne E. and Dombeck, Mark (January 2011) [http://www.mentalhelp.net/poc/view_doc.php?type=doc&id=560&cn=8 The History of the Psychiatric Diagnostic System Continued]. mentalhelp.net.</ref> In the DSM-III revision, self-defeating personality disorder and sadistic personality disorder were included as provisional diagnoses requiring further study. They were dropped in the DSM-IV, though a proposed 'depressive personality disorder' was added; in addition, the official diagnosis of passive-aggressive personality disorder was dropped, tentatively renamed 'negativistic personality disorder.'<ref>{{cite journal|author=Oldham, John M. |title=Personality Disorders|journal=FOCUS|year=2005|volume=3|pages=372–382|url=http://focus.psychiatryonline.org/article.aspx?Volume=3&page=372&journalID=21}}</ref>

International differences have been noted in how attitudes have developed towards the diagnosis of personality disorder. Kurt Schneider had argued that they were simply 'abnormal varieties of psychic life' and therefore not necessarily the domain of psychiatry, a view said to still have influence in Germany today. British psychiatrists have also been reluctant to address such disorders or consider them on a par with other mental disorders, which has been attributed partly to resource pressures within the National Health Service, as well as to negative medical attitudes towards behaviors associated with personality disorders. In the US, the prevailing healthcare system and psychanalytic tradition has been said to provide a rationale for private therapists to diagnose some personality disorders more broadly and provide ongoing treatment for them.<ref>{{cite journal|author=Kendell, RE|doi=10.1192/bjp.180.2.110|title=The distinction between personality disorder and mental illness|year=2002|journal=The British Journal of Psychiatry|volume=180|issue=2|page=110}}</ref>

== References ==
{{Reflist|35em}}

== Further reading ==

* American Psychiatric Association. (2000). [[Diagnostic and Statistical Manual of Mental Disorders]]. 4th ed. (text revision). (DSM-IV-TR). Arlington, VA.
* Häcker, H. O. Stapf (2004). Dorsch Psychologisches Wörterbuch, Verlag Hans Huber, Bern
* Marshall,  W. & Serin, R. (1997) Personality Disorders. In Sm.M. Turner & R. Hersen (Eds.) Adult Psychopathology and Diagnosis.  New York: Wiley. 508–541
* Murphy, N. & McVey, D. (2010) [http://www.pdmh-consultancy.com/publication-detail/4/ Treating Severe Personality Disorder]: Creating Robust Services for Clients with Complex Mental Health Needs. London: Routledge
* [[Theodore Millon|Millon, Theodore]] (and Roger D. Davis, contributor) – ''Disorders of Personality: DSM IV and Beyond'' – 2nd ed. – New York, John Wiley and Sons, 1995 ISBN 0-471-01186-X
* Yudofsky, Stuart C. M.D. (2005) Fatal Flaws: Navigating Destructive Relationships With People With Disorders of Personality and Character, by ISBN 1-58562-214-1

== External links ==
* [http://www.millon.net/ The Institute for Advanced Studies in Personology and Psychopathology] the official website for Theodore Millon, Ph.D., D.Sc.
* [http://counsellingresource.com/distress/personality-disorders/foundation/index.html Personality Disorders Foundation]
* [http://personalitydisorder.org.uk/ National Personality Disorder website for England]
* [http://apt.rcpsych.org/cgi/content/full/9/5/349?ck=nck Dangerous severe personality disorder]
* [http://www.nmha.org/go/information/get-info/personality-disorders National Mental Health Association Personality Disorder Fact Sheet]
* [http://www.rcpsych.ac.uk/mentalhealthinfoforall/problems/personalitydisorders.aspx Personality Disorders information leaflet from The Royal College of Psychiatrists]

{{DEFAULTSORT:Personality Disorder}}
[[Category:Personality disorders| ]]
[[Category:Abnormal psychology]]
[[Category:Psychopathology]]
[[Category:Psychiatric diagnosis]]

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