Antisocial Personality Disorder Symptoms | Psych Central Home » Disorders » Personality » Antisocial Personality Disorder Symptoms Antisocial Personality Disorder Symptoms By Steve Bressert, Ph.D. ~ 4 min read Antisocial personality disorder is a disorder that is characterized by a long-standing pattern of disregard for other people’s rights, often crossing the line and violating those rights. A person with antisocial personality disorder (APD) often feels little or no empathy toward other people, and doesn’t see the problem in bending or breaking the law for their own needs or wants. The disorder usually begins in childhood or as a teen and continues into a person’s adult life. Antisocial personality disorder is often referred to as psychopathy or sociopathy in popular culture. However, neither psychopathy nor sociopathy are recognized professional labels used for diagnosis. Individuals with Antisocial Personality Disorder frequently lack empathy and tend to be callous, cynical, and contemptuous of the feelings, rights, and sufferings of others. They may have an inflated and arrogant self-appraisal (e.g., feel that ordinary work is beneath them or lack a realistic concern about their current problems or their future) and may be excessively opinionated, self-assured, or cocky.

They may display a glib, superficial charm and can be quite voluble and verbally facile (e.g., using technical terms or jargon that might impress someone who is unfamiliar with the topic). Lack of empathy, inflated self-appraisal, and superficial charm are features that have been commonly included in traditional conceptions of psychopathy and may be particularly distinguishing of Antisocial Personality Disorder in prison or forensic settings where criminal, delinquent, or aggressive acts are likely to be nonspecific. These individuals may also be irresponsible and exploitative in their sexual relationships. A personality disorder is an enduring pattern of inner experience and behavior that deviates from the norm of the individual’s culture. The pattern is seen in two or more of the following areas: cognition; affect; interpersonal functioning; or impulse control. The enduring pattern is inflexible and pervasive across a broad range of personal and social situations. It typically leads to significant distress or impairment in social, work or other areas of functioning. The pattern is stable and of long duration, and its onset can be traced back to early adulthood or adolescence.

Symptoms of Antisocial Personality Disorder Antisocial personality disorder is diagnosed when a person’s pattern of antisocial behavior has occurred since age 15 (although only adults 18 years or older can be diagnosed with this disorder) and consists of the majority of these symptoms: Failure to conform to social norms with respect to lawful behaviors as indicated by repeatedly performing acts that are grounds for arrest Deceitfulness, as indicated by repeated lying , use of aliases, or conning others for personal profit or pleasure Impulsivity or failure to plan ahead Irritability and aggressiveness, as indicated by repeated physical fights or assaults Reckless disregard for safety of self or others Consistent irresponsibility, as indicated by repeated failure to sustain consistent work behavior or honor financial obligations Lack of remorse, as indicated by being indifferent to or rationalizing having hurt, mistreated, or stolen from another There should also be evidence of Conduct Disorder in the individual as a child, whether or not it was ever formally diagnosed by a professional. Because personality disorders describe long-standing and enduring patterns of behavior, they are most often diagnosed in adulthood. It is uncommon for them to be diagnosed in childhood or adolescence, because a child or teen is under constant development, personality changes and maturation.

According to the DSM-5, antisocial personality disorder cannot be diagnosed in people younger than 18 years old. Antisocial personality disorder is 70 percent more prevalent in males than females. According to research, the 12-month prevalence rate of this disorder is between 0.2 and 3.3 percent in the general population. Like most personality disorders, antisocial personality disorder typically will decrease in intensity with age, with many people experiencing few of the disorder’s symptoms by the time they are in the 40s or 50s. How is Antisocial Personality Disorder Diagnosed? Personality disorders such as antisocial personality disorder are typically diagnosed by a trained mental health professional, such as a psychologist or psychiatrist. Family physicians and general practitioners are generally not trained or well-equipped to make this type of psychological diagnosis. So while you can initially consult a family physician about this problem, they should refer you to a mental health professional for diagnosis and treatment. There are no laboratory, blood or genetic tests that are used to diagnose antisocial personality disorder. Many people with antisocial personality disorder don’t seek out treatment.

People with personality disorders, in general, do not often seek out treatment until the disorder starts to significantly interfere or otherwise impact a person’s life. This most often happens when a person’s coping resources are stretched too thin to deal with stress or other life events. A diagnosis for antisocial personality disorder is made by a mental health professional comparing your symptoms and life history with those listed here. They will make a determination whether your symptoms meet the criteria necessary for a personality disorder diagnosis. Causes of Antisocial Personality Disorder Researchers today don’t know what causes antisocial personality disorder. There are many theories, however, about the possible causes of antisocial personality disorder. Most professionals subscribe to a biopsychosocial model of causation — that is, the causes of are likely due to biological and genetic factors, social factors (such as how a person interacts in their early development with their family and friends and other children), and psychological factors (the individual’s personality and temperament, shaped by their environment and learned coping skills to deal with stress). This suggests that no single factor is responsible — rather, it is the complex and likely intertwined nature of all three factors that are important.

If a person has this personality disorder, research suggests that there is a slightly increased risk for this disorder to be “passed down” to their children. Treatment of Antisocial Personality Disorder Treatment of antisocial personality disorder typically involves long-term psychotherapy with a therapist that has experience in treating this kind of personality disorder. Medications may also be prescribed to help with specific troubling and debilitating symptoms. For more information about treatment, please see antisocial personality disorder treatment . Related Empathy and Personality Disorders - HealthyPlace We have 4532 guests and 11 members online Empathy and Personality Disorders A Page 1 of 4 One thing that separates narcissists and psychopaths from the rest of society is their apparent lack of empathy. Read about empathy and personality disorders. What is Empathy? Normal people use a variety of abstract concepts and psychological constructs to relate to other persons. Emotions are such modes of inter-relatedness. Narcissists and psychopaths are different. Their "equipment" is lacking. They understand only one language: self-interest. Their inner dialog and private language revolve around the constant measurement of utility. They regard others as mere objects, instruments of gratification, and representations of functions.

This deficiency renders the narcissist and psychopath rigid and socially dysfunctional. They don't bond - they become dependent (on narcissistic supply, on drugs, on adrenaline rushes). They seek pleasure by manipulating their dearest and nearest or even by destroying them, the way a child interacts with his toys. Like autists, they fail to grasp cues: their interlocutor's body language, the subtleties of speech, or social etiquette. Narcissists and psychopaths lack empathy. It is safe to say that the same applies to patients with other personality disorders, notably the Schizoid, Paranoid, Borderline, Avoidant, and Schizotypal. Empathy lubricates the wheels of interpersonal relationships. The Encyclopaedia Britannica (1999 edition) defines empathy as: "The ability to imagine oneself in anther's place and understand the other's feelings, desires, ideas, and actions. It is a term coined in the early 20th century, equivalent to the German EinfÃ¼hlung and modelled on "sympathy." The term is used with special (but not exclusive) reference to aesthetic experience.

The most obvious example, perhaps, is that of the actor or singer who genuinely feels the part he is performing. With other works of art, a spectator may, by a kind of introjection, feel himself involved in what he observes or contemplates. The use of empathy is an important part of the counselling technique developed by the American psychologist Carl Rogers." This is how empathy is defined in "Psychology - An Introduction" (Ninth Edition) by Charles G. Morris, Prentice Hall, 1996: "Closely related to the ability to read other people's emotions is empathy - the arousal of an emotion in an observer that is a vicarious response to the other person's situation... Empathy depends not only on one's ability to identify someone else's emotions but also on one's capacity to put oneself in the other person's place and to experience an appropriate emotional response. Just as sensitivity to non-verbal cues increases with age, so does empathy: The cognitive and perceptual abilities required for empathy develop only as a child matures... (page 442) In empathy training, for example, each member of the couple is taught to share inner feelings and to listen to and understand the partner's feelings before responding to them.

The empathy technique focuses the couple's attention on feelings and requires that they spend more time listening and less time in rebuttal." (page 576). Empathy is the cornerstone of morality. The Encyclopaedia Britannica, 1999 Edition : "Empathy and other forms of social awareness are important in the development of a moral sense. Morality embraces a person's beliefs about the appropriateness or goodness of what he does, thinks, or feels... Childhood is ... the time at which moral standards begin to develop in a process that often extends well into adulthood. The American psychologist Lawrence Kohlberg hypothesized that people's development of moral standards passes through stages that can be grouped into three moral levels... At the third level, that of postconventional moral reasoning, the adult bases his moral standards on principles that he himself has evaluated and that he accepts as inherently valid, regardless of society's opinion. He is aware of the arbitrary, subjective nature of social standards and rules, which he regards as relative rather than absolute in authority. Thus the bases for justifying moral standards pass from avoidance of punishment to avoidance of adult disapproval and rejection to avoidance of internal guilt and self-recrimination.

The person's moral reasoning also moves toward increasingly greater social scope (i.e., including more people and institu§ionid=19&task=edit&cid[]=12653tions) and greater abstraction (i.e., from reasoning about physical events such as pain or pleasure to reasoning about values, rights, and implicit contracts)." "... Others have argued that because even rather young children are capable of showing empathy with the pain of others, the inhibition of aggressive behaviour arises from this moral affect rather than from the mere anticipation of punishment. Some scientists have found that children differ in their individual capacity for empathy, and, therefore, some children are more sensitive to moral prohibitions than others. advertisement Chapter 12: Section 2: Personality Disorders | AllPsych AllPsych > Personality Synopsis > Chapter 12: Section 2: Personality Disorders Chapter 12: Section 2: Personality Disorders Dr. Christopher L.

Heffner August 21, 2014 Chapter 12: Section 2: Personality Disorders 2014-11-17T21:48:40+00:00 Maladaptive Patterns of Interacting Personality Disorders are characterized by an enduring pattern of thinking, feeling, and behaving which is significantly different from the person’s culture and results in negative consequences. This pattern must be longstanding and inflexible for a diagnosis to be made. There are ten types of personality disorders, all of which result in significant distress and/or negative consequences within the individual. These ten disorders are broken down into three personality categories, or clusters as described below. Keep in mind that for a disorder of this type to be diagnosed, the pattern must be longstanding (often several years) ad must be present in all aspects of the person’s life. In other words, if the exhibit the behaviors only with their spouse or parents but no one else, it does not constitute a disorder. Cluster A Paranoid Paranoid Personality Disorder includes a pattern of distrust and suspiciousness in others. These individuals are preoccupied with doubts about people’s motives, have a difficult time trusting others and often look for the ‘real’ motive behind behavior.

They may read into benign remarks, be rigid in their views and quite unforgiving of the behavior of others. Intimacy is difficult as they may be diligent in checking up on their spouse or friends, seeking to expose their infidelity and therefore confirm their suspicions. Schizoid Schizoid Personality Disorder refers to a pattern of detachment from social norms and a restriction of emotions. They often do not enjoy contact with others, not even close friends or family, and prefer solitary activities. They are seen as uninterested in social interaction and indifferent to how others perceive them, whether positive or negative. The individual with this personality disorder may also be seen as lacking emotion, including happiness, excitement, anger, distress, or any other than is considered a normal reaction to people and events. Schizotypal The Schizotypal Personality is often described by others as strange acting and/or thinking. They have eccentric ideas about the world, may be highly superstitious, and talk frequently about their beliefs. They often spend a great deal of effort on activities related to magical thinking, clairvoyance, telepathy, or ESP. They also speak in a metaphorical tone, often coming across as confusing and overly abstract.

They often lack close friends and suffer from social anxieties. Their presentation is seen as odd, as they often dress in a peculiar manner and come across as suspicious and lacking in emotional expression. Cluster B Antisocial Antisocial Personality Disorder is perhaps one of the most recognized and identified in modern literature and entertainment. It has been called Sociopathic Personality and Psychopathic personality in previous versions of the DSM. It refers to a pattern of disregard for the rights of others, including the violation of these rights and the failure to feel empathy for victims. They may be impulsive and act on their anger of misperceived injustice they project onto others. Some research suggests that there is a large percentage of individuals currently incarcerated with this disorder, as their actions and views of the world very frequently get them into trouble with the law. Borderline This is another disorder that has received some attention in the entertainment arena. It includes a pattern of instability in personal relationships, including frequent bouts of clinginess and affection and anger and resentment, often cycling between these two extremes at a rapid pace. They fear abandonment and this fear will often result in anger and aggressive behavior or acts that are used to ‘make’ others love them or stay with them.

These acts include psuedo-suicidal behavior, self-mutilating behavior such as cutting, and instability of mood. Histrionic Histrionic Personality Disorder is seen as a pattern of excessive emotional behavior and attention seeking approaches with others. They are often uncomfortable if they are not the center of attention and may use physical appearance, such as a provocative manner of dress, or explicit sexuality as a means to gain this attention. They often see relationships as more intimate than they really are and are seen as moving very quickly once they become involved with someone (e.g., they may see a person they just met as their best friend or a person they dated once or twice as their future spouse). Narcissistic This disorder is recognized by a pattern of grandiosity, exaggerated self-worth, and need for admiration from others. They are often preoccupied by fantasies of power, success, beauty, or intelligence. They often require excessive attention and admiration as well as demonstrating a sense of entitlement. They may be seen as envious of others, angry, and exploitative. Cluster C Avoidant Avoidant Personality Disorder is seen as a pattern of self-perceived social inadequacies, low self-esteem, and hypersensitivity to criticism.

They avoid activities that involve interaction with others because of these feelings and will avoid any risk taking, even minimal, out of fear of embarrassment of humiliation. Dependent Those with this disorder are often seen as helpless and fearful. They need excessive reassurance from others and will be indecisive without this assurance. They will often go along with the group without expressing any opposing opinion because they lack faith in their decision making process and feel their own beliefs are not as important as the beliefs of others. They fear that they will be left alone and will therefore not be able to take care of themselves. This fear can result in desperate and excessive attempts to obtain nurturance and support. Obsessive-Compulsive Like the disorder that shares its name, Obsessive Compulsive Personality Disorder is seen by a pattern of obsessive cleanliness, perfection, and control. These individuals are often preoccupied with details, rules, and other forms of straightforward indisputable approaches to interacting with the world. They are often inflexible in their ideas, difficult to work with unless others follow their guidelines, and may be considered overly conscientious and devoted to specific activities (such as work or friendships).

While the disorder known as OCD has a similar name, that disorder is more concerned with a more specific pattern of obsessions (e.g., germs) and compulsions (e.g., hand washing). The personality disorder is more focused on an overall pattern of perfectionism and control. Personality disorders facts, information, pictures | Encyclopedia.com articles about Personality disorders Personality Disorders Definition Personality disorders are a group of mental disturbances defined by the fourth edition, text revision (2000) of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) as "enduring pattern[s] of inner experience and behavior" that are sufficiently rigid and deep-seated to bring a person into repeated conflicts with his or her social and occupational environment. DSM-IV specifies that these dysfunctional patterns must be regarded as nonconforming or deviant by the person's culture, and cause significant emotional pain and/or difficulties in relationships and occupational performance. In addition, the patient usually sees the disorder as being consistent with his or her self-image (ego-syntonic) and may blame others for his or her social, educational, or work-related problems.

Description To meet the diagnosis of personality disorder, which is sometimes called character disorder, the patient's problematic behaviors must appear in two or more of the following areas: perception and interpretation of the self and other people intensity and duration of feelings and their appropriateness to situations relationships with others ability to control impulses Personality disorders have their onset in late adolescence or early adulthood. Doctors rarely give a diagnosis of personality disorder to children on the grounds that children's personalities are still in the process of formation and may change considerably by the time they are in their late teens. In retrospect, however, many individuals with personality disorders could be judged to have shown evidence of the problems in childhood. It is difficult to give close estimates of the percentage of the population that has personality disorders. Patients with certain personality disorders, including antisocial and borderline disorders, are more likely to get into trouble with the law or otherwise attract attention than are patients whose disorders chiefly affect their capacity for intimacy. On the other hand, some patients, such as those with narcissistic or obsessive-compulsive personality disorders, may be outwardly successful because their symptoms are useful within their particular occupations.

It has, however, been estimated that about 15% of the general population of the United States has a personality disorder, with higher rates in poor or troubled neighborhoods. The rate of personality disorders among patients in psychiatric treatment is between 30% and 50%. It is possible for patients to have a so-called dual diagnosis; for example, they may have more than one personality disorder, or a personality disorder together with a substance-abuse problem. By contrast, DSM-IV classifies personality disorders into three clusters based on symptom similarities: Cluster A (paranoid, schizoid, schizotypal): Patients appear odd or eccentric to others. Cluster B (antisocial, borderline, histrionic, narcissistic): Patients appear overly emotional, unstable, or self-dramatizing to others. Cluster C (avoidant, dependent, obsessive-compulsive): Patients appear tense and anxiety-ridden to others. The DSM-IV clustering system does not mean that all patients can be fitted neatly into one of the three clusters. It is possible for patients to have symptoms of more than one personality disorder or to have symptoms from different clusters.

Some psychiatrists maintain that the DSM-IV classification is inadequate and should be expanded to include three additional categories: passive-aggressive personality disorder, characterized by a need to control or punish others through frustrating them or sabotaging plans; cyclothymic personality disorder, characterized by intense mood swings alternating between high spirits and moroseness or gloom; and depressive personality disorder, characterized by a negative and pessimistic approach to life. Since the criteria for personality disorders include friction or conflict between the patient and his or her social environment, these syndromes are open to redefinition as societies change. Successive editions of DSM have tried to be sensitive to cultural differences, including changes over time, when defining personality disorders. One category that had been proposed for DSM-III-R, self-defeating personality disorder, was excluded from DSM-IV on the grounds that its definition reflected prejudice against women. DSM-IV recommends that doctors take a patient's background, especially recent immigration, into account before deciding that he or she has a personality disorder. One criticism that has been made of the general category of personality disorder is that it is based on Western notions of individual uniqueness. Its applicability to people from cultures with different definitions of human personhood is thus open to question.

Furthermore, even within a culture, it can be difficult to define the limits of "normalcy." The personality disorders defined by DSM-IV are as follows: Paranoid Patients with paranoid personality disorder are characterized by suspiciousness and a belief that others are out to harm or cheat them. They have problems with intimacy and may join cults or groups with paranoid belief systems. Some are litigious, bringing lawsuits against those they believe have wronged them. Although not ordinarily delusional, these patients may develop psychotic symptoms under severe stress. It is estimated that 0.5-2.5% of the general population meet the criteria for paranoid personality disorder. Schizoid Schizoid patients are perceived by others as "loners" without close family relationships or social contacts. Indeed, they are aloof and really do prefer to be alone. They may appear cold to others because they rarely display strong emotions. They may, however, be successful in occupations that do not require personal interaction. About 2% of the general population has this disorder. It is slightly more common in men than in women. Schizotypal Patients diagnosed as schizotypal are often considered odd or eccentric because they pay little attention to their clothing and sometimes have peculiar speech mannerisms.

They are socially isolated and uncomfortable in parties or other social gatherings. In addition, people with schizotypal personality disorder often have oddities of thought, including "magical" beliefs or peculiar ideas (for example, a belief in telepathy or UFOs) that are outside of their cultural norms. It is thought that 3% of the general population has schizotypal personality disorder. It is slightly more common in males. Schizotypal disorder should not be confused with schizophrenia, although there is some evidence that the disorders are genetically related. Antisocial Patients with antisocial personality disorder are sometimes referred to as sociopaths or psychopaths. They are characterized by lying, manipulativeness, and a selfish disregard for the rights of others; some may act impulsively. People with antisocial personality disorder are frequently chemically dependent and sexually promiscuous. It is estimated that 3% of males in the general population and 1% of females have antisocial personality disorder. Borderline Patients with borderline personality disorder (BPD) are highly unstable, with wide mood swings, a history of intense but stormy relationships, impulsive behavior, and confusion about career goals, personal values, or sexual orientation.

These often highly conflictual ideas may correspond to an even deeper confusion about their sense of self (identity). People with BPD frequently cut or burn themselves, or threaten or attempt suicide. Many of these patients have histories of severe childhood abuse or neglect. About 2% of the general population have BPD; 75% of these patients are female. Histrionic Patients diagnosed with this disorder impress others as overly emotional, overly dramatic, and hungry for attention. They may be flirtatious or seductive as a way of drawing attention to themselves, yet they are emotionally shallow. Histrionic patients often live in a romantic fantasy world and are easily bored with routine. About 2-3% of the population is thought to have this disorder. Although historically the disorder has been more associated with womenin clinical settings, there may be bias toward diagnosing women with the histrionic personality disorder. Narcissistic Narcissistic patients are characterized by self-importance, a craving for admiration, and exploitative attitudes toward others. They have unrealistically inflated views of their talents and accomplishments, and may become extremely angry if they are criticized or outshone by others. Narcissists may be professionally successful but rarely have long-lasting intimate relationships.

Fewer than 1% of the population has this disorder; about 75% of those diagnosed with it are male. Avoidant Patients with avoidant personality disorder are fearful of rejection and shy away from situations or occupations that might expose their supposed inadequacy. They may reject opportunities to develop close relationships because of their fears of criticism or humiliation. Patients with this personality disorder are often diagnosed with dependent personality disorder as well. Many also fit the criteria for social phobia. Between 0.5-1.0% of the population have avoidant personality disorder. Dependent Dependent patients are afraid of being on their own and typically develop submissive or compliant behaviors in order to avoid displeasing people. They are afraid to question authority and often ask others for guidance or direction. Dependent personality disorder is diagnosed more often in women, but it has been suggested that this finding reflects social pressures on women to conform to gender stereotyping or bias on the part of clinicians. Obsessive-compulsive Patients diagnosed with this disorder are preoccupied with keeping order, attaining perfection, and maintaining mental and interpersonal control.

They may spend a great deal of time adhering to plans, schedules, or rules from which they will not deviate, even at the expense of openness, flexibility, and efficiency. These patients are often unable to relax and may become "workaholics." They may have problems in employment as well as in intimate relationships because they are very stiff and formal, and insist on doing everything their way. About 1% of the population has obsessive-compulsive personality disorder; the male/female ratio is about 2:1. Causes and symptoms Personality disorders are thought to result from a bad interface, so to speak, between a child's temperament and character on one hand and his or her family environment on the other. Temperament can be defined as a person's innate or biologically shaped basic disposition. Human infants vary in their sensitivity to light or noise, their level of physical activity, their adaptability to schedules, and similar traits. Even such traits as shyness or novelty-seeking may be at least in part determined by the biology of the brain and the genes one inherits. Character is defined as the set of attitudes and behavior patterns that the individual acquires or learns over time.

It includes such personal qualities as work and study habits, moral convictions, neatness or cleanliness, and consideration of others. Since children must learn to adapt to their specific families, they may develop personality disorders in the course of struggling to survive psychologically in disturbed or stressful families. For example, nervous or high-strung parents might be unhappy with a baby who is very active and try to restrain him or her at every opportunity. The child might then develop an avoidant personality disorder as the outcome of coping with constant frustration and parental disapproval. As another example, child abuse is believed to play a role in shaping borderline personality disorder. One reason that some therapists use the term developmental damage instead of personality disorder is that it takes the presumed source of the person's problems into account. Some patients with personality disorders come from families that appear to be stable and healthy. It has been suggested that these patients are biologically hypersensitive to normal family stress levels. Levels of the brain chemical (neurotransmitter) dopamine may influence a person's level of novelty-seeking, and serotonin levels may influence aggression. Other factors that have been cited as affecting children's personality development are the mass media and social or group hysteria, particularly after the events of September 11, 2001.

Cases of so-called mass sociogenic illness have been identified, in which a group of children began to vomit or have other physical symptoms brought on in response to an imaginary threat. In two such cases, the children were reacting to the suggestion that toxic fumes were spreading through their school. Some authors believe that overly frequent or age-inappropriate discussions of terrorist attacks or bioterrorism may make children more susceptible to sociogenic illness as well as other distortions of personality. Diagnosis Diagnosis of personality disorders is complicated by the fact that affected persons rarely seek help until they are in serious trouble or until their families (or the law) pressure them to get treatment. The reason for this slowness is that the problematic traits are so deeply entrenched that they seem normal (ego-syntonic) to the patient. Diagnosis of a personality disorder depends in part on the patient's age. Although personality disorders originate during the childhood years, they are considered adult disorders. Some patients, in fact, are not diagnosed until late in life because their symptoms had been modified by the demands of their job or by marriage. After retirement or the spouse's death, however, these patients' personality disorders become fully apparent.

In general, however, if the onset of the patient's problem is in mid- or late-life, the doctor will rule out substance abuse or personality change caused by medical or neurological problems before considering the diagnosis of a personality disorder. It is unusual for people to develop personality disorders "out of the blue" in mid-life. There are no tests that can provide a definitive diagnosis of personality disorder. Most doctors will evaluate a patient on the basis of several sources of information collected over a period of time in order to determine how long the patient has been having difficulties, how many areas of life are affected, and how severe the dysfunction is. These sources of information may include: Interviews The doctor may schedule two or three interviews with the patient, spaced over several weeks or months, in order to rule out an adjustment disorder caused by job loss, bereavement, or a similar problem. An office interview allows the doctor to form an impression of the patient's overall personality as well as obtain information about his or her occupation and family. During the interview, the doctor will note the patient's appearance, tone of voice, body language, eye contact, and other important non-verbal signals, as well as the content of the conversation.

In some cases, the doctor may contact other people (family members, employers, close friends) who know the patient well in order to assess the accuracy of the patient's perception of his or her difficulties. It is quite common for people with personality disorders to have distorted views of their situations or to be unaware of the impact of their behavior on others. Psychologic testing Doctors use psychologic testing to help in the diagnosis of a personality disorder. Most of these tests require interpretation by a professional with specialized training. Doctors usually refer patients to a clinical psychologist for this type of test. PERSONALITY INVENTORIES. Personality inventories are tests with true/false or yes/no answers that can be used to compare the patient's scores with those of people with known personality distortions. The single most commonly used test of this type is the Minnesota Multiphasic Personality Inventory, or MMPI. Another test that is often used is the Millon Clinical Multiaxial Inventory, or MCMI. PROJECTIVE TESTS. Projective tests are unstructured. Unstructured means that instead of giving one-word answers to questions, the patient is asked to talk at some length about a picture that the psychologist has shown him or her, or to supply an ending for the beginning of a story.

Projective tests allow the clinician to assess the patient's patterns of thinking, fantasies, worries or anxieties, moral concerns, values, and habits. Common projective tests include the Rorschach, in which the patient responds to a set of ten inkblots; and the Thematic Apperception Test (TAT), in which the patient is shown drawings of people in different situations and then tells a story about the picture. Treatment At one time psychiatrists thought that personality disorders did not respond very well to treatment. This opinion was derived from the notion that human personality is fixed for life once it has been molded in childhood, and from the belief among people with personality disorders that their own views and behaviors are correct, and that others are the ones at fault. More recently, however, doctors have recognized that humans can continue to grow and change throughout life. Most patients with personality disorders are now considered to be treatable, although the degree of improvement may vary. The type of treatment recommended depends on the personality characteristics associated with the specific disorder. Hospitalization Inpatient treatment is rarely required for patients with personality disorders, with two major exceptions: borderline patients who are threatening suicide or suffering from drug or alcohol withdrawal; and patients with paranoid personality disorder who are having psychotic symptoms.

Psychotherapy Psychoanalytic psychotherapy is suggested for patients who can benefit from insight-oriented treatment. These patients typically include those with dependent, obsessive-compulsive, and avoidant personality disorders. Doctors usually recommend individual psychotherapy for narcissistic and borderline patients, but often refer these patients to therapists with specialized training in these disorders. Psychotherapeutic treatment for personality disorders may take as long as three to five years. Insight-oriented approaches are not recommended for patients with paranoid or antisocial personality disorders. These patients are likely to resent the therapist and see him or her as trying to control or dominate them. Supportive therapy is regarded as the most helpful form of psychotherapy for patients with schizoid personality disorder. Cognitive-behavioral therapy Cognitive-behavioral approaches are often recommended for patients with avoidant or dependent personality disorders. Patients in these groups typically have mistaken beliefs about their competence or likableness. These assumptions can be successfully challenged by cognitive-behavioral methods. More recently, Aaron Beck and his coworkers have successfully extended their approach to cognitive therapy to all ten personality disorders as defined by DSM-IV.

Group therapy Group therapy is frequently useful for patients with schizoid or avoidant personality disorders because it helps them to break out of their social isolation. It has also been recommended for patients with histrionic and antisocial personality disorders. These patients tend to act out, and pressure from peers in group treatment can motivate them to change. Because patients with antisocial personality disorder can destabilize groups that include people with other disorders, it is usually best if these people meet exclusively with others who have APD (in homogeneous groups). Family therapy Family therapy may be suggested for patients whose personality disorders cause serious problems for members of their families. It is also sometimes recommended for borderline patients from overinvolved or possessive families. Medications Medications may be prescribed for patients with specific personality disorders. The type of medication depends on the disorder. In general, however, patients with personality disorders are helped only moderately by medications. ANTIPSYCHOTIC DRUGS. Antipsychotic drugs, such as haloperidol (Haldol), may be given to patients with paranoid personality disorder if they are having brief psychotic episodes.

Patients with borderline or schizotypal personality disorder are sometimes given antipsychotic drugs in low doses; however, the efficacy of these drugs in treating personality disorder is less clear than in schizophrenia. MOOD STABILIZERS. Carbamazepine (Tegretol) is a drug that is commonly used to treat seizures, but is also helpful for borderline patients with rage outbursts and similar behavioral problems. Lithium and valproate may also be used as mood stabilizers, especially among people with borderline personality disorder. ANTIDEPRESSANTS AND ANTI-ANXIETY MEDICATIONS. Medications in these categories are sometimes prescribed for patients with schizoid personality disorder to help them manage anxiety symptoms while they are in psychotherapy. Antidepressants are also commonly used to treat people with borderline personality disorder. Treatment with medications is not recommended for patients with avoidant, histrionic, dependent, or narcissistic personality disorders. The use of potentially addictive medications should be avoided in people with borderline or antisocial personality disorders. However, some avoidant patients who also have social phobia may benefit from monoamine oxidase inhibitors (MAO inhibitors), a particular class of antidepressant.

Prognosis The prognosis for recovery depends in part on the specific disorder. Although some patients improve as they grow older and have positive experiences in life, personality disorders are generally life-long disturbances with periods of worsening (exacerbations) and periods of improvement (remissions). Others, particularly schizoid patients, have better prognoses if they are given appropriate treatment. Beck and his coworkers estimate that effective cognitive therapy with patients with personality disorders takes two to three years on average. Patients with paranoid personality disorder are at some risk for developing delusional disorders or schizophrenia. The personality disorders with the poorest prognoses are the antisocial and the borderline. Borderline patients are at high risk for developing substance abuse disorders or bulimia. About 80% of hospitalized borderline patients attempt suicide at some point during treatment, and about 5% succeed in committing suicide. Borderline patients are also the most likely to sue their mental health professional for malpractice. Prevention The most effective preventive strategy for personality disorders is early identification and treatment of children at risk. High-risk groups include abused children, children from troubled families, children with close relatives diagnosed with personality disorders, children of substance abusers, and children who grow up in cults or extremist political groups.

KEY TERMS Character— An individual's set of emotional, cognitive, and behavioral patterns learned and accumulated over time. Character disorder— Another name for personality disorder. Cognitive therapy— A form of psychotherapy that focuses on changing people's patterns of emotional reaction by correcting distorted patterns of thinking and perception. Developmental damage— A term that some therapists prefer to personality disorder, on the grounds that it is more respectful of the patient's capacity for growth and change. Ego-syntonic— Consistent with one's sense of self, as opposed to ego-alien or dystonic (foreign to one's sense of self). Ego-syntonic traits typify patients with personality disorders. Neuroleptic— Another name for older antipsychotic medications, such as haloperidol. The term does not apply to such newer atypical agents as clozapine (Clozaril). Personality— The organized pattern of behaviors and attitudes that makes a human being distinctive. Personality is formed by the ongoing interaction of temperament, character, and environment. Projective tests— Psychological tests that probe into personality by obtaining open-ended responses to such materials as pictures or stories. Projective tests are often used to evaluate patients with personality disorders.

Rorschach test— A well-known projective test that requires the patient to describe what he or she sees in each of 10 inkblots. It is named for the Swiss psychiatrist who invented it. Temperament— A person's natural or genetically determined disposition. Resources BOOKS American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 4th ed., revised. Washington, D.C.: American Psychiatric Association, 2000. Beck, Aaron T., Arthur Freeman, Denise D. Davis, et al. Cognitive Therapy of Personality Disorders. 2nd ed. New York : The Guilford Press, 2004. Beers, Mark H., MD, and Robert Berkow, MD., editors. "Personality Disorders." In The Merck Manual of Diagnosis and Therapy. Whitehouse Station, NJ: Merck Research Laboratories, 2004. PERIODICALS Battle, C. L., M. T. Shea, D. M. Johnson, et al.

"Childhood Maltreatment Associated with Adult Personality Disorders: Findings from the Collaborative Longitudinal Personality Disorders Study." Journal of Personality Disorders 18 (April 2004): 193-211. Bienenfeld, David, MD. "Personality Disorders." eMedicine August 18, 2004. 〈〉 . Doyle, C. R., J. Akhtar, R. Mrvos, and E. P. Krenzelok. "Mass Sociogenic Illness—Real and Imaginary." Veterinary and Human Toxicology 46 (April 2004): 93-95. Gutheil, T. G. "Suicide, Suicide Litigation, and Borderline Personality Disorder." Journal of Personality Disorders 18 (June 2004): 248-256. Jordan , A. "The Role of Media in Children's Development: An Ecological Perspective." Journal of Developmental and Behavioral Pediatrics 25 (June 2004): 196-206. ORGANIZATIONS American Academy of Child and Adolescent Psychiatry (AACAP).

3615 Wisconsin Avenue, NW, Washington, DC 20016-3007. (202) 966-7300. Fax: (202) 966-2891. 〈〉 . American Psychiatric Association (APA). 1400 K Street, NW, Washington, DC 20005. 〈〉 . National Institute of Mental Health (NIMH). 6001 Executive Boulevard, Room 8184, MSC 9663, Bethesda, MD 20892-9663. (301) 443-4513. 〈〉 . Cite this article Pick a style below, and copy the text for your bibliography. MLA Personality disorders Definition Personality disorders (PD) are a group of psychiatric conditions characterized by experience and behavior patterns that cause serious problems with respect to any two of the following: thinking, mood, personal relations, and the control of impulses. Description Most personality disorders are associated with problems in personal development and character which peak during adolescence and are then defined as personality disorders. Children and adolescents with a personality disorder have great difficulty dealing with others.

They tend to be inflexible, rigid, with inadequate response to the changes and demands of life. They have a narrow view of the world and find it hard to participate in social activities. There are many formally identified personality disorders, each with its own types of associated behaviors. Most PDs, however, fall into three distinct categories or clusters, namely: cluster A, which includes disorders characterized by odd or eccentric behavior; cluster B, which includes disorders marked by dramatic, emotional or erratic behavior; and cluster C, which includes disorders accompanied by anxious and fearful behavior. The most common disorders in each cluster are given below. Cluster A disorders These disorders include the following: Schizoid personality disorder. Schizoid personalities are introverted, withdrawn, solitary, emotionally cold, and distant. Often absorbed with their own thoughts and feelings, they fear closeness and intimacy with others. People suffering from schizoid personality tend to be more daydreamers than practical action takers, often living "in a world of their own." Paranoid personality disorder. Paranoid personalities interpret the actions of others as deliberately threatening or demeaning.

People with paranoid personality disorder are untrusting, unforgiving, and often resort to angry or aggressive outbursts without justification because they see others as unfaithful, disloyal, or dishonest. Paranoid personalities are often jealous, guarded, secretive, and scheming, and may appear to be emotionally "cold" or excessively serious. Schizotypal personality disorder. Schizotypal personalities tend to have odd or eccentric manners of speaking or dressing. They often have strange, outlandish, or paranoid beliefs and thoughts. People with schizotypal personality disorder have difficulties bonding with others and experience extreme anxiety in social situations. They tend to react inappropriately or not react at all during a conversation, or they may talk to themselves. They also have delusions characterized by "magical thinking," for example, by saying that they can foretell the future or read other people's minds. Cluster B disorders Cluster B disorders include the following: Antisocial personality disorder . Antisocial personalities typically ignore the normal rules of social behavior. These individuals are impulsive, irresponsible, and callous. They often have a history of violent and irresponsible behavior, aggressive and even violent relationships.

They have no respect for other people and feel no remorse about the effects of their behavior on others. Antisocial personalities are at high risk for substance abuse, since it helps them to relieve tension, irritability, and boredom. Borderline personality disorder. Borderline personalities are unstable in interpersonal relationships, behavior, mood, and self-image. They are prone to sudden and extreme mood changes, stormy relationships, unpredictable and often self-destructive behavior. These personalities have great difficulty with their own sense of identity and often experience the world in extremes, viewing experiences and others as either "black" or "white." They often form intense personal attachments only to quickly dissolve them over a perceived offense. Fears of abandonment and rejection often lead to an excessive dependency on others. Self-mutilation or suicidal threats may be used to get attention or manipulate others. Impulsive actions, persistent feelings of boredom or emptiness, and intense anger outbursts are other traits of this disorder. Narcissistic personality disorder. Narcissistic personalities tend to have an exaggerated sense of self-importance, and are absorbed by fantasies of unlimited success. They also seek constant attention, and are oversensitive to failure, often complaining about multiple physical disorders.

They also tend to be prone to extreme mood swings between self-admiration and insecurity, and tend to exploit interpersonal relationships. Cluster C disorders Cluster C disorders include the following: Avoidant personality disorder. Avoidant personalities are often fearful of rejection and unwilling to become involved with others. They are characterized by excessive social discomfort, shyness , fear of criticism, and avoidance of social activities that involve interpersonal contact. They are afraid of saying something considered foolish by others and are deeply hurt by any disapproval from others. They tend to have no close relationships outside the family circle and are upset at their inability to form meaningful relationships. Dependent personality disorder . As the name implies, dependent personalities exhibit a pattern of dependent and submissive behavior, relying on others to make decisions for them. They fear rejection, need constant reassurance and advice, and are oversensitive to criticism or disapproval. They feel uncomfortable and helpless if they are alone and can be devastated when a close relationship ends. Typically lacking in self-confidence, the dependent personality rarely initiates projects or does things independently. Compulsive personality disorder. Compulsive personalities are conscientious, reliable, dependable, orderly, and methodical, but with an inflexibility that often makes them incapable of adapting to changing circumstances.

They have such high standards of achievement that they constantly strive for perfection. Never satisfied with their performance or with that of others, they take on more and more responsibilities. They also pay excessive attention to detail, which makes it very hard for them to make decisions and complete tasks. When their feelings are not under strict control, when events are unpredictable, or when they must rely on others, compulsive personalities often feel a sense of isolation and helplessness. Demographics In 2001 to 2002, fully 16.4 million Americans (7.9% of all adults) had obsessive-compulsive personality disorder; 9.2 million (4.4%) had paranoid personality disorder; 7.6 million (3.6%) had antisocial personality disorder; 6.5 million (3.1%) had schizoid personality disorder; 4.9 million (2.4%) had avoidant personality disorder; and 1.0 million (0.5%) had dependent personality disorder. According to the National Institutes of Health, nearly 31 million Americans meet criteria for at least one personality disorder.

A 2004 survey showed that nearly 14.8 percent of adult Americans met diagnostic criteria for personality disorders as defined by the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders. The risk of having avoidant, dependent, and paranoid personality disorders is greater for females than males, whereas risk of having antisocial personality disorder is greater for males than females. There are no gender differences in the risk of having compulsive or schizoid personality disorders. In general, other risk factors contributing to the emergence of personality disorders include being Native American or African American; being a young adult; having a low socioeconomic status; and having any other status than married. Causes and symptoms The exact cause of personality disorders is unknown. However, evidence points to genetic and environmental factors such as a history of personality disorders in the family. Some experts believe that traumatic events occurring in early childhood exert a crucial influence upon behavior later in life. Others propose that people are genetically predisposed to personality disorders or that they have an underlying biological disturbance (anatomical, electrical, or neurochemical).

Symptoms vary widely depending on the specific type of PD, but according to the American Psychiatric Association, individuals with personality disorders have most of the following symptoms in common: self-centeredness that manifests itself through a "me-first," self-preoccupied attitude lack of individual accountability that results in a "victim mentality" and blaming others for their problems lack of empathy and caring manipulative and exploitative behavior What Are Personality Disorders? Personality, or personality style, is someone’s usual pattern of thinking, feeling, and behaving. Personality style is made up of a number of personality traits or characteristics. A personality disorder is a problematic personality style that negatively affects most areas of a person’s life. Personality disorders are diagnosed only in adults, but they reflect difficult personality styles that have been present since adolescence or young adulthood. Personality disorders can cause lifelong psychological problems and difficulty in relating to others. There are 10 different personality disorders that mental health experts may diagnose. Each has its own set of characteristics, and each causes problems of a certain nature. The 10 personality disorders fall into three groups, called clusters, based on similarities in the personality traits of the disorders in each group.

One cluster includes personality disorders that feature unusual points of view or odd or eccentric behavior of various sorts. In this cluster are the following disorders: Paranoid: People with paranoid (PAIR-a-noyd) personality disorder distrust other people and may become overly suspicious, believing that other people’s actions are always meant to harm them. Someone with paranoid personality disorder may find it difficult to form friendships, and may be very guarded, argumentative, or cold toward others. Schizoid: A person with schizoid (SKIT-zoyd) personality disorder is typically a loner and does not often show emotion. Such people will not make friends easily and do not even care to spend time with their families. A person with this disorder usually chooses a solitary job and activities and has very little, if any, social life. Schizotypal: People who have schizotypal (skit-zo-TIE-pal) disorder can be fearful and distrustful of others. They are usually unable to make friends outside their own families. They also can have strange beliefs and superstitions.

Often, they will dress oddly or act in a peculiar way that does not seem to “fit in.” Another cluster includes personality disorders that feature personality styles that are overly dramatic, overly emotional, overly reactive, or unpredictable. In this cluster are the following disorders: Antisocial: A person with antisocial personality disorder is typically in trouble with the law and has no respect for the rights of other people. Such people frequently lie and cheat, and they try to take advantage of others for their own profit or enjoyment. They can be very irritable and often get into fights or even attack others. They also may be quite reckless and put themselves or others in danger, and they frequently do not understand or care that they have done something wrong or hurt another person. Borderline: A person with borderline personality disorder has difficulty being in relationships. People with this disorder fear that they will be abandoned, and the fear can become so strong that it makes them try to hurt or even kill themselves. Their relationships are often overly intense and they may be very demanding of the time and attention of anyone who is close to them. They may abruptly end relationships and can quickly and drastically change their views about their friends if they think their friends have let them down.

Histrionic: Histrionic (his-tree-AH-nik) personality disorder makes people want to be the center of attention. To draw attention, people with this disorder can be very dramatic, often making up exaggerated stories about themselves. They flirt to attract people, and they may dress and act in a showy or overly sexy way. They may publicly exaggerate their emotions, perhaps through temper tantrums or fits of crying. People with this disorder can be too trusting of other people and too easily influenced by them. Narcissistic: People who have narcissistic (nar-se-SIS-tik) personality disorder are unusually self-concerned. They often exaggerate their talents and accomplishments. They think of themselves as superior to others, and they tend to imagine themselves as very wealthy or powerful or beautiful or intelligent. Because they feel that they are unique, they also need other people to admire them and to treat them as special. But they usually do not care much about the feelings or needs of other people. In fact, they often take advantage of other people to get what they want. A third cluster includes difficult personalities that feature anxious, fearful, or extremely cautious behavior.

In this cluster are the following disorders Avoidant: People with avoidant personality disorder fear criticism and disapproval, and for this reason they tend to steer clear of jobs or activities where they must work together with other people. They do not make new friends easily, and they typically are quiet and shy because they fear that other people will embarrass and make fun of them. They often feel out of place in social situations. Dependent: A person who has dependent personality disorder has a hard time making even small, everyday decisions, for example, what to wear. People with this disorder often rely on others to take care of them and make all their choices in life. When they are alone, they feel helpless, and they typically look around for someone to care for and support them. The ancient Greek myth of Narcissus tells the story of a beautiful young man who fell in love with his own reflection. So entranced by his image reflected in the water, he threw himself into the pool and drowned. The term “narcissistic,” or conceited and self-centered, derives from this myth. The Bridgeman Art Library International Ltd.

Obsessive-Compulsive: People with obsessive-compulsive (obSES-iv-kom-PUL-siv) personality disorder have a deep need for order and control. They pay close attention to rules, lists, and schedules, and they can be very hard on themselves when they do not meet their own high standards of perfection. Some may be incredibly neat and orderly, but others may tend to be pack rats, hoarding money or even saving worthless or unnecessary objects just in case they might need them one day. (Obsessive-compulsive personality disorder is not the same as obsessive-compulsive disorder.) How Are Personality Disorders Diagnosed? Personality disorders are difficult to diagnose. This is because many, if not all, of these sorts of traits also are found in normal personalities. A personality disorder is diagnosed only when a personality trait, or a set of traits, is present to such an extreme that it causes an individual to have problems almost every day in almost all interactions. Several of the personality disorders have traits that overlap, making it difficult to tell one from another. Judging personality styles can be subjective, and different people may have different ideas about each personality style.

Even experts may not agree about whether a certain trait in an individual is extreme or simply a variation of normal. Also, when some people have problems as a result of trauma or difficult events in their lives, they may appear to have problems affecting most parts of their lives. Generally, however, these problems are temporary. Researchers continue to work on finding new ways of classifying and diagnosing personality disorders that will be more reliable and accurate. What Causes Personality Disorders? Since each personality disorder is different, there are separate theories about how each one may develop. There is still much to learn about the factors involved in each of these disorders. Most theories focus on a combination of inborn* traits and early experiences that influence and shape how someone begins to think, feel, and act. Cluster B: Antisocial, Borderline, Histrionic, and Narcissistic Personality Disorders About Watch and Favorite Watch Watching this resources will notify you when proposed changes or new versions are created so you can keep track of improvements that have been made. Favorite Favoriting this resource allows you to save it in the “My Resources” tab of your account. There, you can easily access this resource later when you’re ready to customize it or assign it to your students.

Cluster B: Antisocial, Borderline, Histrionic, and Narcissistic Personality Disorders Cluster B personality disorders are characterized by personality styles that are impulsive, dramatic, highly emotional, and erratic. Learning Objective Summarize the similarities and differences in diagnostic criteria, etiology, and treatment options among the Cluster B personality disorders Key Points Cluster B disorders include antisocial , histrionic, narcissistic, and borderline personality disorders . People with these disorders usually are impulsive , overly dramatic, highly emotional, and erratic. A person with antisocial personality disorder continuously violates the rights of others; often lies, fights, and has problems with the law; can be deceitful and manipulative in order to gain profit or pleasure; and lacks feelings for others and remorse over misdeeds. Borderline personality disorder is characterized by instability in self-image, mood, and behavior. The person cannot tolerate being alone; has unstable and intense relationships with others; and exhibits behavior that is impulsive, unpredictable, and sometimes self-damaging.

A person with histrionic personality disorder is excessively overdramatic, emotional, and theatrical; feels uncomfortable when not the center of others’ attention ; exhibits inappropriately seductive or provocative behavior; and may alienate friends with demands for constant attention. People with narcissistic personality disorder have an overinflated and unjustified sense of self-importance and are preoccupied with fantasies of success. They believe they are entitled to special treatment from others, take advantage of others, and lack empathy . Terms Register for FREE to remove ads and unlock more features! Learn more Full Text The DSM-5 recognizes 10 personality disorders, organized into 3 different clusters. Cluster B disorders include antisocial personality disorder, histrionic personality disorder, narcissistic personality disorder, and borderline personality disorder. People with these disorders usually are impulsive, overly dramatic, highly emotional, and erratic. Antisocial Personality Disorder Defining Antisocial Personality Disorder Antisocial personality disorder (ASPD) is characterized by a pervasive pattern of disregard for (or violation of) the rights of others. There may be a poor moral sense or conscience and a history of crime, legal problems, impulsivity, and aggressive behavior.

One of the most important features of ASPD is the individual's lack of remorse or guilt for the acts they have committed. While many individuals break the law and engage in antisocial behavior, it is not appropriate to assume that antisocial behaviors indicate the antisocial personality disorder. Individuals with ASPD do not feel as though they are doing anything wrong, necessarily, and are able to internally justify all of their behaviors and actions. Though the word "antisocial" is often used to indicate someone who does not like interacting with others, or may be shy or reserved, these characteristics have little to nothing to do with ASPD, and should not necessarily be associated. ASPD is sometimes referred to as psychopathy or sociopathy, though the criteria might be slightly different depending on the method of diagnosis.

DSM-5 Diagnostic Criteria for Antisocial Personality Disorder The DSM-5 describes ASPD as a pervasive pattern of disregard for, and violation of, the rights of others occurring since age 15, as indicated by three (or more ) of the following: Failure to conform to social norms with respect to lawful behaviors, as indicated by repeatedly performing acts that are grounds for arrest; Deceitfulness, as indicated by repeated lying, use of aliases, or conning others for personal profit or pleasure; Impulsivity or failure to plan ahead; Irritability and aggressiveness, as indicated by repeated physical fights or assaults; Reckless disregard for safety of one's self or others; Consistent irresponsibility, as indicated by repeated failure to sustain consistent work behavior or honor financial obligations; and Lack of remorse, as indicated by being indifferent to or rationalizing having hurt, mistreated, or stolen from another. The individual must be at least 18 years old; there must be evidence of conduct disorder with onset before age 15; and the occurrence of antisocial behavior must not exclusively be during the course of schizophrenia or a bipolar manic episode. Features of conduct disorder (CD) are necessary for a diagnosis of ASPD.

CD is childhood behavior disorder characterized by aggressive and destructive activities that violate social norms and the rights of others. Etiology of Antisocial Personality Disorder ASPD seems to be caused by a combination of both genetic and environmental influences. Genetic influences draw on the temperament and the kind of personality a person is born with, and environmental influences include the way in which a person grows up and the experiences they have had. Traumatic events can lead to a disruption of the standard development of the central nervous system , which can generate a release of hormones that can change normal patterns of development. One of the neurotransmitters that have been discussed in individuals with ASPD is serotonin . ASPD is seen in up to 30% of psychiatric outpatients. The prevalence of the disorder is even higher in selected populations , such as prisons, where there is a preponderance of violent offenders. Approximately 47% of male prisoners and 21% of female prisoners have ASPD. Similarly, the prevalence of ASPD is higher among patients in alcohol or other drug abuse treatment programs than in the general population. Furthermore, ASPD is diagnosed three times more frequently in men than in women.

Treatment of Antisocial Personality Disorder ASPD is considered to be a difficult personality disorder to treat. Because of their very low or absent capacity for remorse, individuals with ASPD often lack sufficient motivation and fail to see the costs associated with antisocial acts. Those with ASPD may stay in treatment only as required by an external source, such as a parole. Residential programs that provide a carefully controlled environment of structure and supervision along with peer confrontation have been recommended. Various therapeutic approaches such as schema therapy and multisystemic therapy (MST) have been indicated as potential avenues for treatment. No medications have been approved by the FDA to treat ASPD, although certain psychiatric medications (such as antipsychotic, antidepressant, or mood-stabilizing medications) may alleviate conditions sometimes associated with the disorder. Borderline Personality Disorder Defining Borderline Personality Disorder The central features of borderline personality disorder (BPD) are a pattern of impulsivity and instability in mood, interpersonal relationships, and self-image. These patterns emerge in early adulthood and persist throughout the lifetime, though they can improve with treatment. One tell-tale symptom is intense fear of abandonment, which underlies the unstable relationships characteristic of BPD.

People with BPD often engage in idealization and devaluation of others, alternating between high positive regard and great disappointment. If they sense any indication of negative emotion , criticism, or abandonment, they will completely devalue that once-idealized person and may even seek to hurt them. Other symptoms may include intense anger and irritability, self-mutilation, and suicidal behavior.

DSM-5 Diagnostic Criteria for Borderline Personality Disorder According to the DSM-5, a diagnosis of borderline personality disorder needs to meet at least five of the following criteria, and can only be diagnosed after the age of 18: Frantic efforts to avoid real or imagined abandonment (not including suicidal behavior); A pattern of unstable and intense interpersonal relationships that alternate between extremes of idealization and devaluation; Identity disturbance: markedly and persistently unstable self-image or sense of self; Impulsivity in at least two areas that are potentially self-damaging (not including suicidal behavior), such as excessive spending, unprotected sex , substance abuse, reckless driving, and/or binge eating; Recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior; Affective instability due to a marked reactivity of mood, such as intense episodic dysphoria , irritability, or anxiety lasting between a few hours and a few days; Chronic feelings of emptiness; Inappropriate, intense anger or difficulty controlling anger; and Transient, stress -related paranoid ideation or severe dissociative symptoms. Etiology of Borderline Personality Disorder The causes of BPD are complex and not fully agreed upon.

Most researchers agree that a history of childhood trauma can be a contributing factor. Recently, more attention has been given to investigating the role played by congenital brain abnormalities, genetics, neurobiological factors, and environmental factors other than trauma. Sixty-five percent of the variability in symptoms among different individuals with BPD can be explained by genetic differences. There are also some brain abnormalities associated with BPD. The hippocampus tends to be smaller in those who suffer from this disorder, as it is in people with post-traumatic stress disorder ( PTSD ). However in BPD, unlike PTSD, the amygdala also tends to be smaller. Since the amygdala is a major structure involved in managing negative emotions, this may explain the intense fear, sadness, anger, and shame experienced by people with BPD. The prefrontal cortex tends to be less active in people with BPD, especially when recalling memories of abandonment. Treatment of Borderline Personality Disorder Psychotherapy is the primary treatment for borderline personality disorder. Treatments should be based on the needs of the individual, rather than upon the general diagnosis of BPD.

Various forms of therapeutic treatments include dynamic deconstructive psychotherapy (DDP), mentalization-based treatment (MBT), transference-focused psychotherapy, dialectical behavior therapy (DBT), general psychiatric management, and schema-focused therapy. While DBT is the therapy that has been studied the most, empirical research and case studies have shown that most of these treatments are effective for treating BPD. Medications are useful for treating comorbid (co-occurring) disorders such as depression and anxiety. Short-term hospitalization has not been found to be more effective than community care for improving outcomes or long-term prevention of suicidal behavior in those with BPD. Stigma and Controversy Surrounding Borderline Personality Disorder There is an ongoing debate about the terminology of this disorder, especially the word "borderline". The concern is that the diagnosis of BPD stigmatizes people and supports discriminatory practices by suggesting that the personality of the individual is flawed. There are many stigmatizing features of BPD, including emotional instability, intense unstable interpersonal relationships, a need for intimacy , and a fear of rejection. As a result, people with BPD often evoke intense emotions in those around them.

Pejorative terms are often used to describe people with BPD (such as difficult, treatment resistant, manipulative, demanding, and attention-seeking) and may become a self-fulfilling prophecy , as the negative treatment of these individuals triggers further self-destructive behavior. Women are three times more likely to be diagnosed with BPD, corroborating the false stereotype of the "hyper-emotional, unstable woman" that will not conform to traditional female roles. In fact, a large criticism of BPD from a feminist perspective is that the diagnosis forces women into traditional gender roles for fear of being stereotyped. Many survivors of childhood abuse who are diagnosed with BPD are re-traumatized by negative responses from healthcare providers. Some argue that people diagnosed with BPD should instead be diagnosed with PTSD, as this would acknowledge the impact of abuse on the person's behavior. Others argue that that a diagnosis of PTSD does not encompass all aspects of the disorder and is neurologically and characteristically different than BPD.

Histrionic Personality Disorder Defining Histrionic Personality Disorder Histrionic personality disorder (HPD) is a personality disorder characterized by a pattern of excessive attention-seeking emotions, usually beginning in early adulthood, including inappropriately seductive behavior and an excessive need for approval. Histrionic people are lively, dramatic, vivacious, enthusiastic, and flirtatious. People with HPD have a high need for attention, make loud and inappropriate appearances, exaggerate their behaviors and emotions, and crave stimulation. They may exhibit sexually provocative behavior, express strong emotions with an impressionistic style, and can be easily influenced by others. HPD is diagnosed four times more often in women as it is in men, which critics argue suggests a culturally-based gender bias .

DSM-5 Diagnostic Criteria for Histrionic Personality Disorder According to the DSM-5, a diagnosis of histrionic personality disorder is indicated by at least five of the following: The person is uncomfortable in situations in which he or she is not the center of attention; Interaction with others is often characterized by inappropriate sexually seductive or provocative behavior; The person displays rapidly shifting and shallow expression of emotions; The person consistently uses physical appearance to draw attention to self; The person has a style of speech that is excessively impressionistic and lacking in detail; The person shows self-dramatization, theatricality, and exaggerated expression of emotion; The person is suggestible, i.e., easily influenced by others or circumstances; The person considers relationships to be more intimate than they actually are. Etiology of Histrionic Personality Disorder Little research has been done to find evidence as to what causes histrionic personality disorder and where it stems from. There are a few theories , however, that relate to the lineage of its diagnosis. Psychoanalytic theories incriminate authoritarian or distant attitudes by one (mainly the mother) or both parents, along with conditional love based on expectations the child can never fully meet.

Another theory suggests that histrionic personality disorder and antisocial personality disorder could have a possible relationship to one another. Research has found two-thirds of patients diagnosed with histrionic personality disorder also meet criteria similar to that of the antisocial personality disorder. Some family history studies have found that histrionic personality disorder, as well as borderline and antisocial personality disorders, tends to run in families, but it is not clear if this is due to genetic or environmental factors. Treatment of Histrionic Personality Disorder Treatment is often prompted by depression associated with dissolved romantic relationships. Medication does little to affect the personality disorder, but may be helpful with symptoms such as depression. The primary forms of treatment for HPD itself involve psychotherapy, including cognitive therapy . Narcissistic Personality Disorder Defining Narcissistic Personality Disorder Narcissistic personality disorder (NPD) is a personality disorder in which a person is excessively preoccupied with personal adequacy, power, prestige, and vanity, and is mentally unable to see the destructive damage they are causing to themselves and others. People with NPD are characterized by exaggerated feelings of self-importance. They have a sense of entitlement and demonstrate grandiosity in their beliefs and behavior.

They have a strong need for admiration, but lack feelings of empathy. It is estimated that this condition affects one percent of the population, with rates greater for men. First formulated in 1968, NPD was historically called megalomania and is a form of severe egocentrism . DSM-5 Diagnostic Criteria for Narcissistic Personality Disorder Symptoms of this disorder, as defined by the DSM-5, include significant impairments in self functioning (such as excessive reference to others for self-definition and self-esteem regulation; exaggerated self-appraisal; goal-setting based on gaining approval from others; personal standards that are unreasonably high; etc.) along with impairments in interpersonal functioning (such as lack of empathy; over- or underestimating one's own effect on others; superficial relationships that exist to serve self-esteem regulation; etc.). They must also experience feelings of grandiosity (including entitlement or self-centeredness) and attention seeking behavior. Etiology of Narcissistic Personality Disorder The cause of this disorder is unknown; however, Groopman and Cooper (2006) listed the following factors identified by various researchers as possibilities: An oversensitive temperament (personality traits) at birth.

Excessive admiration that is never balanced with realistic feedback. Excessive praise for good behaviors or excessive criticism for bad behaviors in childhood. Overindulgence and overvaluation by parents, other family members, or peers. Being praised for perceived exceptional looks or abilities by adults. Severe emotional abuse in childhood. Unpredictable or unreliable caregiving from parents. Learning manipulative behaviors from parents or peers. Valued by parents as a means to regulate their own self-esteem. Recent research has identified a structural abnormality in the brains of those with NPD, specifically noting less volume of gray matter in the left anterior insula. This brain region relates to empathy, compassion, emotional regulation, and cognitive functioning. Treatment of Narcissistic Personality Disorder People rarely seek therapy for NPD, partly because many NPD sufferers deny they have a problem. Most, if not all, cannot see the destructive damage they cause to themselves and to others and usually only seek treatment at the insistence of relatives and friends. Psychotherapy is generally used to treat NPD. Schema therapy, a form of therapy developed by Jeffrey Young that integrates several therapeutic approaches (psychodynamic, cognitive, behavioral etc.), also offers an approach for the treatment of NPD.

Anger, rage, impulsivity, and impatience can be worked on with skill training. Group treatment has its benefits as the effectiveness of receiving peer feedback rather than the clinician’s may be more accepted.

Question: What personality disorder is characterized by destructive excitement seeking and a lack of empathy?
Answer: Psychopathy