Abnormal Final

Antisocial Personality Disorder

Antisocial personality disorder is an inability to conform to the social norms that ordinarily govern many aspects of a person's adolescent and adult behavior. Although characterized by continual antisocial or criminal acts, the disorder is not synonymous with criminality (the 10th revision of International Statistical Classification of Diseases and Related Health Problems [ICD-10] uses the name dissocial personality disorder).

Personality Disorder not Otherwise Specified

In DSM-IV-TR, the category personality disorder not otherwise specified is reserved for disorders that do not fit into any of the personality disorder categories described above. Passive-aggressive personality disorder and depressive personality disorder are now listed as examples of personality disorder not otherwise specified. A narrow spectrum of behavior or a particular trait—such as oppositionalism, sadism, or masochism—can also be classified in this category. A patient with features of more than one personality disorder but without the complete criteria of any one disorder can be assigned this classification. The DSM-IV-TR criteria for personality disorder not otherwise specified are presented in Table 27-13.

Obsessive-Compulsive Personality Disorder

Obsessive-compulsive personality disorder is characterized by emotional constriction, orderliness, perseverance, stubbornness, and indecisiveness. The essential feature of the disorder is a pervasive pattern of perfectionism and inflexibility. (ICD-10 uses the name anancastic personality disorder.)

Borderline Personality Disorder

Patients with borderline personality disorder stand on the border between neurosis and psychosis and they are characterized by extraordinarily unstable affect, mood, behavior, object relations, and self-image. The disorder has also been called ambulatory schizophrenia, as-if personality (a term coined by Helene Deutsch), pseudoneurotic schizophrenia (described by Paul Hoch and Phillip Politan), and psychotic character disorder (described by John Frosch). ICD-10 uses the term emotionally unstable personality disorder.

Personality Change due to a General Medical Condition

Personality change due to a general medical condition (see Table 10.5-13) deserves some discussion here. ICD-10 includes the category personality and behavioral disorders due to brain disease, damage, and dysfunction, which includes organic personality disorder (see Table 10.5-18), postencephalitic syndrome, and postconcussional syndrome. Personality change due to a general medical condition is characterized by a marked change in personality style and traits from a previous level of functioning. Patients must show evidence of a causative organic factor antedating the onset of the personality change.

Avoidant Personality Disorder

Persons with avoidant personality disorder show extreme sensitivity to rejection and may lead a socially withdrawn life. Although shy, they are not asocial and show a great desire for companionship, but they need unusually strong guarantees of uncritical acceptance. Such persons are commonly described as having an inferiority complex. (ICD-10 uses the term anxious personality disorder.)

Dependent Personality Disorder

Persons with dependent personality disorder subordinate their own needs to those of others, get others to assume responsibility for major areas of their lives, lack self-confidence, and may experience intense discomfort when alone for more than a brief period. The disorder has been called passive-dependent personality. Freud described an oral-dependent personality dimension characterized by dependence, pessimism, fear of sexuality, self-doubt, passivity, suggestibility, and lack of perseverance; his description is similar to the DSM-IV-TR categorization of dependent personality disorder.

Depressive Personality Disorder

Persons with depressive personality disorder are characterized by lifelong traits that fall along the depressive spectrum. They are pessimistic, anhedonic, duty bound, self-doubting, and chronically unhappy. The disorder is newly classified in DSM-IV-TR, but melancholic personality was described by early 20th century European psychiatrists such as Ernst Kretschmer.

Histrionic Personality Disorder

Persons with histrionic personality disorder are excitable and emotional and behave in a colorful, dramatic, extroverted fashion. Accompanying their flamboyant aspects, however, is often an inability to maintain deep, long-lasting attachments.

Narcissistic Personality Disorder

Persons with narcissistic personality disorder are characterized by a heightened sense of self-importance and grandiose feelings of uniqueness.

Paranoid Personality Disorder

Persons with paranoid personality disorder are characterized by long-standing suspiciousness and mistrust of persons in general. They refuse responsibility for their own feelings and assign responsibility to others. They are often hostile, irritable, and angry. Bigots, injustice collectors, pathologically jealous spouses, and litigious cranks often have paranoid personality disorder.

Passive-Aggressive Personality Disorder

Persons with passive-aggressive personality disorder are characterized by covert obstructionism, procrastination, stubbornness, and inefficiency. Such behavior is a manifestation of passively expressed underlying aggression. In DSM-IV-TR, the disorder is also called negativistic personality disorder.

Schizotypal Personality Disorder

Persons with schizotypal personality disorder are strikingly odd or strange, even to laypersons. Magical thinking, peculiar notions, ideas of reference, illusions, and derealization are part of a schizotypal person's everyday world.

Sadomasochistic Personality Disorder

Sadism is the desire to cause others pain by being either sexually abusive or generally physically or psychologically abusive. It is named for the Marquis de Sade, a late 18th century writer of erotica describing persons who experienced sexual pleasure while inflicting pain on others. Freud believed that sadists ward off castration anxiety and are able to achieve sexual pleasure only when they can do to others what they fear will be done to them.

Sadistic Personality Disorder

Sadistic personality disorder is not included in DSM-IV-TR, but it still appears in the literature and may be of descriptive use. Beginning in early adulthood, persons with sadistic personality disorder show a pervasive pattern of cruel, demeaning, and aggressive behavior that is directed toward others. Physical cruelty or violence is used to inflict pain on others, not to achieve another goal, such as mugging a person to steal. Persons with the disorder like to humiliate or demean persons in front of others and have usually treated or disciplined persons uncommonly harshly, especially children. In general, persons with sadistic personality disorder are fascinated by violence, weapons, injury, or torture. To be included in this category, such persons cannot be motivated solely by the desire to derive sexual arousal from their behavior; if they are so motivated, the paraphilia of sexual sadism should be diagnosed.

Schizoid Personality Disorder

Schizoid personality disorder is diagnosed in patients who display a lifelong pattern of social withdrawal. Their discomfort with human interaction, their introversion, and their bland, constricted affect are noteworthy. Persons with schizoid personality disorder are often seen by others as eccentric, isolated, or lonely.