Personality disorder

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Overview
Personality disorder, formerly referred to as a Character Disorder is a class of mental disorders  characterized by rigid and on-going patterns of thought and action (Cognitive modules). The underlying belief systems informing these patterns are referred to as fixed fantasies. The inflexibility and pervasiveness of these behavioral patterns often cause serious personal and social difficulties, as well as a general impairment of functioning.

Background
Personality disorders are defined by the American Psychiatric Association (APA) as "an enduring pattern of inner experience and behavior that deviates markedly from the expectations of the culture of the individual who exhibits it". These patterns, as noted, are inflexible and pervasive across many situations, due in large part to the fact that such behavior is ego-syntonic (i.e., the patterns are consistent with the ego integrity of the individual), and therefore, perceived to be appropriate by that individual. The onset of these patterns of behavior can typically be traced back to the beginning of adulthood, and, in rare instances, early adolescence.

This definition allows significant deviance from societal norms, such as conscientious objection to a social regime, to be classified as a mental disorder. In the former Soviet Union and elsewhere this has been used to justify treatment of political dissidents as though they were psychologically disturbed.

DSM-IV-TR criteria
Personality disorders are noted on Axis II of the Diagnostic and Statistical Manual of Mental Disorders, or DSM-IV-TR (fourth edition, text revision), of the American Psychiatric Association.

General diagnostic criteria
Diagnosis of a personality disorder must satisfy the following general criteria in addition to the specific criteria listed under the specific personality disorder under consideration.

A. Experience and behavior that deviates markedly from the expectations of the individual's culture. This pattern is manifested in two (or more) of the following areas:
 * cognition (perception and interpretation of self, others and events)
 * affect (the range, intensity, lability, and appropriateness of emotional response)
 * interpersonal functioning
 * impulse control

B. The enduring pattern is inflexible and pervasive across a broad range of personal and social situations.

C. The enduring pattern leads to clinically significant distress or impairment in social, occupational, or other important areas of functioning.

D. The pattern is stable and of long duration and its onset can be traced back at least to adolescence or early adulthood.

E. The enduring pattern is not better accounted for as a manifestation or consequence of another mental disorder.

F. The enduring pattern is not due to the direct physiological effects of a substance or a general medical condition such as head injury.

People under 18 years old who fit the criteria of a personality disorder are usually not diagnosed with such a disorder, although they may be diagnosed with a related disorder. In order to diagnose an individual under the age of 18 with a personality disorder, symptoms must be present for at least one year. Antisocial personality disorder, by definition, cannot be diagnosed at all in persons under 18.

List of personality disorders defined in the DSM
The DSM-IV lists ten personality disorders, grouped into three clusters. 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 NOS (Not Otherwise Specified).

Cluster A (odd or eccentric disorders)
 * Paranoid personality disorder
 * Schizoid personality disorder
 * Schizotypal personality disorder

Cluster B (dramatic, emotional, or erratic disorders)
 * Antisocial personality disorder
 * Borderline personality disorder
 * Histrionic personality disorder
 * Narcissistic personality disorder

Cluster C (anxious or fearful disorders)
 * Avoidant personality disorder
 * Dependent personality disorder (not the same as Dysthymia)
 * Obsessive-compulsive personality disorder (not the same as Obsessive-compulsive disorder)

Revisions and exclusions from past DSM editions
The revision of the previous edition of the DSM, DSM-III-R, also contained the Passive-Aggressive Personality Disorder, the Self-Defeating Personality Disorder, and the Sadistic Personality Disorder. Passive-Aggressive Personality Disorder is a pattern of negative attitudes and passive resistance in interpersonal situations. Self-defeating personality disorder is characterised by behaviour that consequently undermines the person's pleasure and goals. Sadistic Personality Disorder is a pervasive pattern of cruel, demeaning, and aggressive behavior. These categories were removed in the current version of the DSM, because it is questionable whether these are separate disorders. Passive-Aggressive Personality Disorder and Depressive personality disorder were placed in an appendix of DSM-IV for research purposes.

Etiological studies
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 presently 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. [http://www.ingentaselect.com/vl=2446665/cl=50/nw=1/rpsv/cw/sage/08862605/contp1.htm Miller and Lisak. Journal of Interpersonal Violence. June 1999]

Child abuse and neglect consistently evidence themselves as antecedent risks to the development of personality disorders in adulthood. In this particular 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. The sexually abused group demonstrated the most consistently elevated patterns of psychopathology. Officially verified physical abuse showed an extremely strong role in 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. Cohen, Patricia, Brown, Jocelyn, Smailes, Elizabeth. "Child Abuse and Neglect and the Development of Mental Disorders in the General Population" Development and Psychopathology. 2001. Vol 13, No 4, pp981-999. ISSN 0954-5794

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 managers than in the disturbed criminals:


 * histrionic personality disorder: including superficial charm, insincerity, egocentricity and manipulation
 * narcissistic personality disorder: including grandiosity, self-focused lack of empathy for others, exploitativeness and independence.

They described the business people as successful psychopaths and the criminals as unsuccessful psychopaths.