WordNet

bring disorder to (同)disarray
a physical condition in which there is a disturbance of normal functioning; "the doctor prescribed some medicine for the disorder"; "everyone gets stomach upsets from time to time" (同)upset
a disturbance of the peace or of public order
the complex of all the attributes--behavioral, temperamental, emotional and mental--that characterize a unique individual; "their different reactions reflected their very different personalities"; "it is his nature to help others"
a person of considerable prominence; "she is a Hollywood personality"
not arranged in order (同)unordered

PrepTutorEJDIC

〈U〉『無秩序』,混乱,乱雑(confusion) / 《しばしば複数形で》(社会的・政治的な)粉争,騒動 / 〈C〉(肉体的・精神的な)不調,異常,障害 / …‘の'秩序を乱す / 〈心身〉‘に'異常を起こさせる
〈C〉〈U〉(他人と区別する)『個性』,性格 / 〈U〉〈C〉『人格』,人柄,風格 / 〈C〉(特にある方面での)著名人,有名人

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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2018/01/13 19:44:09」(JST)

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Personality disorders (PD) are a class of mental disorders characterized by enduring maladaptive patterns of behavior, cognition, and inner experience, exhibited across many contexts and deviating markedly from those accepted by the individual's culture. These patterns develop early, are inflexible, and are associated with significant distress or disability. The definitions may vary somewhat, according to source.^[2]^[3]^[4] Official criteria for diagnosing personality disorders are listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM) and the fifth chapter of the International Classification of Diseases (ICD). The DSM-5 lists personality disorders in the same way as other mental disorders, rather than on a separate 'axis', as previously.^[5]

Personality, defined psychologically, is the set of enduring behavioral and mental traits that distinguish between individual humans. Hence, personality disorders are defined by experiences and behaviors that differ from societal norms and expectations. Those diagnosed with a personality disorder may experience difficulties in cognition, emotiveness, interpersonal functioning, or impulse control. In general, personality disorders are diagnosed in 40–60% of psychiatric patients, making them the most frequent of psychiatric diagnoses.^[6]

Personality disorders are characterized by an enduring collection of behavioral patterns often associated with considerable personal, social, and occupational disruption. Personality disorders are also inflexible and pervasive across many situations, largely due to the fact that such behavior may be ego-syntonic (i.e. the patterns are consistent with the ego integrity of the individual) and are therefore perceived to be appropriate by that individual. This behavior can result in maladaptive coping skills and may lead to personal problems that induce extreme anxiety, distress, or depression. These behaviour patterns are typically recognized in adolescence, the beginning of adulthood or sometimes even childhood and often have a pervasive negative impact on the quality of life.^[7]^[2]^[8]

Many issues occur with classifying a personality disorder. Because the theory and diagnosis of personality disorders occur within prevailing cultural expectations, their validity is contested by some experts on the basis of inevitable subjectivity. They argue that the theory and diagnosis of personality disorders are based strictly on social, or even sociopolitical and economic considerations.^[9]^[10]

1 Classification
- 1.1 General criteria
- 1.2 In ICD-10
  - 1.2.1 In ICD-11
- 1.3 In DSM-5
- 1.4 Personality clusters
  - 1.4.1 Cluster A (odd or eccentric disorders)
  - 1.4.2 Cluster B (dramatic, emotional or erratic disorders)
  - 1.4.3 Cluster C (anxious or fearful disorders)
- 1.5 Other personality types
- 1.6 Millon's description
- 1.7 Additional factors
  - 1.7.1 Severity
  - 1.7.2 Effect on social functioning
  - 1.7.3 Attribution
2 Impairment
3 Issues
- 3.1 In the workplace
- 3.2 In children
- 3.3 Versus mental disorders
- 3.4 Versus normal personality
  - 3.4.1 Openness to experience
4 Causes and risk factors
- 4.1 Child abuse
- 4.2 Socioeconomic status
- 4.3 Parenting
- 4.4 Genetics
5 Epidemiology
6 Comorbidity
7 Management
- 7.1 Specific approaches
- 7.2 Challenges
8 History
9 References
10 Further reading
11 External links

Classification

The two major systems of classification are the ICD-10 published by the World Health Organization and the DSM-5 by the American Psychiatric Association. Both have deliberately merged their diagnoses to some extent, but some differences remain. For example, ICD-10 does not include narcissistic personality disorder as a distinct category, while DSM-5 does not include enduring personality change after catastrophic experience or after psychiatric illness. ICD-10 classifies the DSM-5 schizotypal personality disorder as a form of schizophrenia rather than as a personality disorder. There are accepted diagnostic issues and controversies with regard to distinguishing particular personality disorder categories from each other.^[11]

General criteria

Both diagnostic systems provide a definition and six criteria for a general personality disorder. These criteria should be met by all personality disorder cases before a more specific diagnosis can be made.

The ICD-10 lists these general guideline criteria:^[12]

Markedly disharmonious attitudes and behavior, generally involving several areas of functioning; e.g. affectivity, arousal, impulse control, ways of perceiving and thinking, and style of relating to others;
The abnormal behavior pattern is enduring, of long standing, and not limited to episodes of mental illness;
The abnormal behavior pattern is pervasive and clearly maladaptive to a broad range of personal and social situations;
The above manifestations always appear during childhood or adolescence and continue into adulthood;
The disorder leads to considerable personal distress but this may only become apparent late in its course;
The disorder is usually, but not invariably, associated with significant problems in occupational and social performance.

The ICD adds: "For different cultures it may be necessary to develop specific sets of criteria with regard to social norms, rules and obligations."^[12]

In DSM-5, any personality disorder diagnosis must meet the following criteria:^[13]

An enduring pattern of inner 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 (i.e., ways of perceiving and interpreting self, other people, and events).
Affectivity (i.e., the range, intensity, lability, and appropriateness of emotional response).
Interpersonal functioning.
Impulse control.

The enduring pattern is inflexible and pervasive across a broad range of personal and social situations.
The enduring pattern leads to clinically significant distress or impairment in social, occupational, or other important areas of functioning.
The pattern is stable and of long duration, and its onset can be traced back at least to adolescence or early adulthood.
The enduring pattern is not better explained as a manifestation or consequence of another mental disorder.
The enduring pattern is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition (e.g., head trauma).

In ICD-10

Chapter V in the ICD-10 contains the mental and behavioral disorders and includes categories of personality disorder and enduring personality changes. They are defined as ingrained patterns indicated by inflexible and disabling responses that significantly differ from how the average person in the culture perceives, thinks, and feels, particularly in relating to others.^[14]

The specific personality disorders are: paranoid, schizoid, dissocial, emotionally unstable (borderline type and impulsive type), histrionic, anankastic, anxious (avoidant) and dependent.^[15]

Besides the ten specific PD, there are the following categories:

Other specific personality disorders (involves PD characterized as eccentric, haltlose, immature, narcissistic, passive–aggressive, or psychoneurotic.)
Personality disorder, unspecified (includes "character neurosis" and "pathological personality").
Mixed and other personality disorders (defined as conditions that are often troublesome but do not demonstrate the specific pattern of symptoms in the named disorders).
Enduring personality changes, not attributable to brain damage and disease (this is for conditions that seem to arise in adults without a diagnosis of personality disorder, following catastrophic or prolonged stress or other psychiatric illness).

In ICD-11

In the proposed revision of ICD-11, all discrete personality disorder diagnoses will be removed and replaced by the single diagnosis "personality disorder". Instead, there will be specifiers called "prominent personality traits" and the possibility to classify degrees of severity ranging from "mild", "moderate", and "severe" based on the dysfunction in interpersonal relationships and everyday life of the patient.^[16]^[17]

In DSM-5

The most recent fifth edition of the Diagnostic and Statistical Manual of Mental Disorders stresses that a personality disorder is an enduring and inflexible pattern of long duration that leads to significant distress or impairment and is not due to use of substances or another medical condition.

DSM-5 lists ten specific personality disorders: paranoid, schizoid, schizotypal, antisocial, borderline, histrionic, narcissistic, avoidant, dependent and obsessive-compulsive personality disorder.

The DSM-5 also contains three diagnoses for personality patterns that do not match these ten disorders, but nevertheless exhibit characteristics of a personality disorder:^[13]

Personality change due to another medical condition – personality disturbance due to the direct effects of a medical condition.
Other specified personality disorder – general criteria for a personality disorder are met but fails to meet the criteria for a specific disorder, with the reason given.
Unspecified personality disorder – general criteria for a personality disorder are met but the personality disorder is not included in the DSM-5 classification.

Personality clusters

The specific personality disorders are grouped into the following three clusters based on descriptive similarities:

Cluster A (odd or eccentric disorders)

Play media

Video explanation of cluster A personality disorders

Cluster A personality disorders are often associated with schizophrenia: in particular, schizotypal personality disorder shares some of its hallmark symptoms, e.g., acute discomfort in close relationships, cognitive or perceptual distortions, and eccentricities of behavior, with schizophrenia. However, people diagnosed with odd-eccentric personality disorders tend to have a greater grasp on reality than do those diagnosed with schizophrenia. Patients suffering from these disorders can be paranoid and have difficulty being understood by others, as they typically have odd or eccentric modes of speaking and an unwillingness and inability to form and maintain close relationships. Though their perceptions may be unusual, it is important to distinguish these anomalies from delusions or hallucinations as people suffering from these would be diagnosed with other conditions. There is significant evidence that suggests that a small proportion of people with Type A personality disorders, especially schizotypal personality disorder, have the potential to develop schizophrenia and other psychotic disorders. These disorders also have a higher probability of occurring among individuals whose first-degree relatives have either schizophrenia or a Cluster A personality disorder.^[18]

Paranoid personality disorder: characterized by a pattern of irrational suspicion and mistrust of others, interpreting motivations as malevolent.
Schizoid personality disorder: lack of interest and detachment from social relationships, apathy, and restricted emotional expression.
Schizotypal personality disorder: pattern of extreme discomfort interacting socially, and distorted cognitions and perceptions.

Cluster B (dramatic, emotional or erratic disorders)

Play media

Video explanation of cluster B personality disorders

Antisocial personality disorder: pervasive pattern of disregard for and violation of the rights of others, lack of empathy, bloated self-image, manipulative and impulsive behavior.
Borderline personality disorder: pervasive pattern of abrupt mood swings, instability in relationships, self-image, identity, behavior and affect, often leading to self-harm and impulsivity.
Histrionic personality disorder: pervasive pattern of attention-seeking behavior and excessive emotions.
Narcissistic personality disorder: pervasive pattern of grandiosity, need for admiration, and a perceived or real lack of empathy.

Cluster C (anxious or fearful disorders)

Play media

Video explanation of cluster C personality disorders

Avoidant personality disorder: pervasive feelings of social inhibition and inadequacy, extreme sensitivity to negative evaluation.
Dependent personality disorder: pervasive psychological need to be cared for by other people.
Obsessive-compulsive personality disorder: characterized by rigid conformity to rules, perfectionism, and control to the point of satisfaction and exclusion of leisurely activities and friendships (distinct from obsessive-compulsive disorder).

Other personality types

Some types of personality disorder were in previous versions of the diagnostic manuals but have been deleted. Examples include sadistic personality disorder (pervasive pattern of cruel, demeaning, and aggressive behavior) and self-defeating personality disorder or masochistic personality disorder (characterised by behaviour consequently undermining the person's pleasure and goals). They were listed in the DSM-III-R appendix as "Proposed diagnostic categories needing further study" without specific criteria.^[19] The psychologist Theodore Millon and others consider some relegated diagnoses to be equally valid disorders, and may also propose other personality disorders or subtypes, including mixtures of aspects of different categories of the officially accepted diagnoses.^[20]

Personality disorder diagnoses in each edition of the Diagnostic and Statistical Manual^[13]^[21]^:17
DSM-I	DSM-II	DSM-III	DSM-III-R	DSM-IV(-TR)	DSM-5
Inadequate^[a]	Inadequate	Deleted^[21]^:19
Schizoid^[a]	Schizoid	Schizoid	Schizoid	Schizoid	Schizoid
Cyclothymic^[a]	Cyclothymic	Reclassified^[21]^{:16, 19}
Paranoid^[a]	Paranoid	Paranoid	Paranoid	Paranoid	Paranoid
		Schizotypal	Schizotypal	Schizotypal	Schizotypal^[b]
Emotionally unstable^[c]	Hysterical^[21]^:18	Histrionic	Histrionic	Histrionic	Histrionic
—	—	Borderline^[21]^:19	Borderline	Borderline	Borderline
Compulsive^[c]	Obsessive-compulsive	Compulsive	Obsessive-compulsive	Obsessive-compulsive	Obsessive-compulsive
Passive-aggressive, Passive-depressive subtype^[c]	Deleted^[21]^:18	Dependent^[21]^:19	Dependent	Dependent	Dependent
Passive-aggressive, Passive-aggressive subtype^[c]	Passive-aggressive	Passive-aggressive	Passive-aggressive	Negativistic^[21]^:21
Passive-aggressive, Aggressive subtype^[c]
—	Explosive^[21]^:18	Deleted^[21]^:19
—	Asthenic^[21]^:18	Deleted^[21]^:19
—	—	Avoidant^[21]^:19	Avoidant	Avoidant	Avoidant
—	—	Narcissistic^[21]^:19	Narcissistic	Narcissistic	Narcissistic
Antisocial reaction^[d]	Antisocial	Antisocial	Antisocial	Antisocial	Antisocial
Dyssocial reaction^[d]
Sexual deviation^[d]	Reclassified^[21]^{:16, 18}
Addiction^[d]	Reclassified^[21]^{:16, 18}
Appendix
			Self-defeating	Negativistic	Dependent
			Sadistic	Depressive	Histrionic
					Paranoid
					Schizoid
					Negativistic
					Depressive

^ ^a ^b ^c ^d DSM-I Personality Pattern disturbance subsection.^[21]^:16
^ Also classified as a schizophrenia-spectrum disorder in addition to personality disorder.
^ ^a ^b ^c ^d ^e DSM-I Personality Trait disturbance subsection.^[21]^:16
^ ^a ^b ^c ^d DSM-I Sociopathic personality disturbance subsection.^[21]^:16

Millon's description

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

Millon's brief description of personality disorders^[20]^:4
Type of personality disorder	Description
Paranoid	Guarded, defensive, distrustful and suspicious. Hypervigilant to the motives of others to undermine or do harm. Always seeking confirmatory evidence of hidden schemes. Feel righteous, but persecuted. People with paranoid personality disorder experience a pattern of pervasive distrust and suspicion of others that lasts a long time. They are generally difficult to work with and are very hard to form relationships with. They are also known to be somewhat short-tempered.^[22]^{[unreliable medical source?]}
Schizoid	Apathetic, indifferent, remote, solitary, distant, humorless. Neither desire nor need human attachments. Withdrawn from relationships and prefer to be alone. Little interest in others, often seen as a loner. Minimal awareness of the feelings of themselves or others. Few drives or ambitions, if any. Is an uncommon condition in which people avoid social activities and consistently shy away from interaction with others. It affects more males than females. To others, they may appear somewhat dull or humorless. Because they don't tend to show emotion, they may appear as though they don't care about what's going on around them.^[23]
Schizotypal	Eccentric, self-estranged, bizarre, absent. Exhibit peculiar mannerisms and behaviors. Think they can read thoughts of others. Preoccupied with odd daydreams and beliefs. Blur line between reality and fantasy. Magical thinking and strange beliefs. People with schizotypal personality disorder are often described as odd or eccentric and usually have few, if any, close relationships. They generally don't understand how relationships form or the impact of their behavior on others.^[24]
Antisocial	Impulsive, irresponsible, deviant, unruly. Act without due consideration. Meet social obligations only when self-serving. Disrespect societal customs, rules, and standards. See themselves as free and independent. People with antisocial personality disorder depict a long pattern of disregard for other people's rights. They often cross the line and violate these rights.^[25]^{[unreliable medical source?]}
Borderline	Unpredictable, manipulative, unstable. Frantically fears abandonment and isolation. Experience rapidly fluctuating moods. Shift rapidly between loving and hating. See themselves and others alternatively as all-good and all-bad. Unstable and frequently changing moods. People with borderline personality disorder have a pervasive pattern of instability in interpersonal relationships.^[26]^{[unreliable medical source?]}
Histrionic	Dramatic, seductive, shallow, stimulus-seeking, vain. Overreact to minor events. Exhibitionistic as a means of securing attention and favors. See themselves as attractive and charming. Constantly seeking others' attention. Disorder is characterized by constant attention-seeking, emotional overreaction, and suggestibility. Their tendency to over-dramatize may impair relationships and lead to depression, but they are often high-functioning.^[27]^{[unreliable medical source?]}
Narcissistic	Egotistical, arrogant, grandiose, insouciant. Preoccupied with fantasies of success, beauty, or achievement. See themselves as admirable and superior, and therefore entitled to special treatment. Is a mental disorder in which people have an inflated sense of their own importance and a deep need for admiration. Those with narcissistic personality disorder believe that they're superior to others and have little regard for other people's feelings.
Avoidant	Hesitant, self-conscious, embarrassed, anxious. Tense in social situations due to fear of rejection. Plagued by constant performance anxiety. See themselves as inept, inferior, or unappealing. They experience long-standing feelings of inadequacy and are very sensitive of what others think about them.^[28]^{[unreliable medical source?]}
Dependent	Helpless, incompetent, submissive, immature. Withdrawn from adult responsibilities. See themselves as weak or fragile. Seek constant reassurance from stronger figures. They have the need to be taken care of by a person. They fear being abandoned or separated from important people in their life.^[29]^{[unreliable medical source?]}
Obsessive–compulsive	Restrained, conscientious, respectful, rigid. Maintain a rule-bound lifestyle. Adhere closely to social conventions. See the world in terms of regulations and hierarchies. See themselves as devoted, reliable, efficient, and productive.
Depressive	Somber, discouraged, pessimistic, brooding, fatalistic. Present themselves as vulnerable and abandoned. Feel valueless, guilty, and impotent. Judge themselves as worthy only of criticism and contempt. Hopeless, Suicidal, Restless. This disorder can lead to aggressive acts and hallucinations.^[30]^{[unreliable medical source?]}
Passive–aggressive (Negativistic)	Resentful, contrary, skeptical, discontented. Resist fulfilling others’ expectations. Deliberately inefficient. Vent anger indirectly by undermining others’ goals. Alternately moody and irritable, then sullen and withdrawn. Withhold emotions. Will not communicate when there is something problematic to discuss.^[31]^{[unreliable medical source?]}
Sadistic	Explosively hostile, abrasive, cruel, dogmatic. Liable to sudden outbursts of rage. Gain satisfaction through dominating, intimidating and humiliating others. They are opinionated and close-minded. Enjoy performing brutal acts on others. Find pleasure in abusing others. Would likely engage in a sadomasochist relationship, but will not play the role of a masochist.^[32]^{[unreliable medical source?]}
Self-defeating (Masochistic)	Deferential, pleasure-phobic, servile, blameful, self-effacing. Encourage others to take advantage of them. Deliberately defeat own achievements. Seek condemning or mistreatful partners. They are suspicious of people who treat them well. Would likely engage in a sadomasochist relationship.^[32]^{[unreliable medical source?]}

Additional factors

In addition to classifying by category and cluster, it is possible to classify personality disorders using additional factors such as severity, impact on social functioning, and attribution.^[33]

Severity

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

**Dimensional System of Classifying Personality Disorders**^[34]
Level of Severity	Description	Definition by Categorical System
0	No Personality Disorder	Does not meet actual or subthreshold criteria for any personality disorder
1	Personality Difficulty	Meets sub-threshold criteria for one or several personality disorders
2	Simple Personality Disorder	Meets actual criteria for one or more personality disorders within the same cluster
3	Complex (Diffuse) Personality Disorder	Meets actual criteria for one or more personality disorders within more than one cluster
4	Severe Personality Disorder	Meets criteria for creation of severe disruption to both individual and to many in society

There are several advantages to classifying personality disorder by severity:^[33]

It not only allows for but also takes advantage of the tendency for personality disorders to be comorbid with each other.
It represents the influence of personality disorder on clinical outcome more satisfactorily than the simple dichotomous system of no personality disorder versus personality disorder.
This system accommodates the new diagnosis of severe personality disorder, particularly "dangerous and severe personality disorder" (DSPD).

Effect on social functioning

Social function is affected by many other aspects of mental functioning apart from that of personality. However, whenever there is persistently impaired social functioning in conditions in which it would normally not be expected, the evidence suggests that this is more likely to be created by personality abnormality than by other clinical variables.^[35] The Personality Assessment Schedule^[36] gives social function priority in creating a hierarchy in which the personality disorder creating the greater social dysfunction is given primacy over others in a subsequent description of personality disorder.

Attribution

Many who have a personality disorder do not recognize any abnormality and defend valiantly their continued occupancy of their personality role. This group have been termed the Type R, or treatment-resisting personality disorders, as opposed to the Type S or treatment-seeking ones, who are keen on altering their personality disorders and sometimes clamor for treatment.^[33] The classification of 68 personality disordered patients on the caseload of an assertive community team using a simple scale showed a 3 to 1 ratio between Type R and Type S personality disorders with Cluster C personality disorders being significantly more likely to be Type S, and paranoid and schizoid (Cluster A) personality disorders significantly more likely to be Type R than others.^[37]

Impairment

It is generally assumed that all personality disorders are linked to impaired functioning and a reduced quality of life (QoL) because that is a basic diagnostic requirement. But research shows that this may be true only for some types of personality disorder.

In several studies, higher disability and lower QoL were predicted by avoidant, dependent, schizoid, paranoid, schizotypal and antisocial personality disorder. This link is particurlarly strong for avoidant, schizotypal and borderline PD. However, obsessive-compulsive PD was not related to a compromised QoL or dysfunction. A prospective study reported that all PD were associated with significant impairment 15 years later, except for obsessive compulsive and narcissistic personality disorder.^[38]

One study investigated some aspects of "life success" (status, wealth and successful intimate relationships). It showed somewhat poor functioning for schizotypal, antisocial, borderline and dependent PD, schizoid PD had the lowest scores regarding these variables. Paranoid, histrionic and avoidant PD were average. Narcissistic and obsessive compulsive PD, however, had high functioning and appeared to contribute rather positively to these aspects of life success.^[8]

There is also a direct relationship between the number of diagnostic criteria and quality of life. For each additional personality disorder criteron that a person meets there is an even reduction in quality of life.^[39]

Issues

In the workplace

Depending on the diagnosis, severity and individual, and the job itself, personality disorders can be associated with difficulty coping with work or the workplace—potentially leading to problems with others by interfering with interpersonal relationships. Indirect effects also play a role; for example, impaired educational progress or complications outside of work, such as substance abuse and co-morbid mental disorders, can plague sufferers. However, personality disorders can also bring about above-average work abilities by increasing competitive drive or causing the sufferer to exploit his or her co-workers.^[40]^[41]

In 2005 and again in 2009, psychologists Belinda Board and Katarina Fritzon at the University of Surrey, UK, interviewed and gave personality tests to high-level British executives and compared their profiles with those of criminal psychiatric patients at Broadmoor Hospital in the UK. They found that three out of eleven personality disorders were actually more common in executives than in the disturbed criminals:

Histrionic personality disorder: including superficial charm, insincerity, egocentricity and manipulation
Narcissistic personality disorder: including grandiosity, self-focused lack of empathy for others, exploitativeness and independence.
Obsessive-compulsive personality disorder: including perfectionism, excessive devotion to work, rigidity, stubbornness and dictatorial tendencies.^[42]

According to leadership academic Manfred F.R. Kets de Vries, it seems almost inevitable that some personality disorders will be present in a senior management team.^[43]

In children

Early stages and preliminary forms of personality disorders need a multi-dimensional and early treatment approach. Personality development disorder is considered to be a childhood risk factor or early stage of a later personality disorder in adulthood.^[44] In addition, in Robert F. Krueger's review of their research indicates that some children and adolescents do suffer from clinically significant syndromes that resemble adult personality disorders, and that these syndromes have meaningful correlates and are consequential. Much of this research has been framed by the adult personality disorder constructs from Axis II of the Diagnostic and Statistical Manual. Hence, they are less likely to encounter the first risk they described at the outset of their review: clinicians and researchers are not simply avoiding use of the PD construct in youth. However, they may encounter the second risk they described: under-appreciation of the developmental context in which these syndromes occur. That is, although PD constructs show continuity over time, they are probabilistic predictors; not all youths who exhibit PD symptomatology become adult PD cases.^[44]

Versus mental disorders

The disorders in each of the three clusters may share with each other underlying common vulnerability factors involving cognition, affect and impulse control, and behavioral maintenance or inhibition, respectively. But they may also have a spectrum relationship to certain syndromal mental disorders:^[45]

Paranoid, schizoid or schizotypal personality disorders may be observed to be premorbid antecedents of delusional disorders or schizophrenia.
Borderline personality disorder is seen in association with mood and anxiety disorders, with impulse control disorders, eating disorders, ADHD, or a substance use disorder. It is sometimes seen as a mild form of bipolar disorder.
Avoidant personality disorder is seen with social anxiety disorder.

Versus normal personality

The issue of the relationship between normal personality and personality disorders is one of the important issues in personality and clinical psychology. The personality disorders classification (DSM 5 and ICD-10) follows a categorical approach that views personality disorders as discrete entities that are distinct from each other and from normal personality. In contrast, the dimensional approach is an alternative approach that personality disorders represent maladaptive extensions of the same traits that describe normal personality.

Thomas Widiger and his collaborators have contributed to this debate significantly.^[46] He discussed the constraints of the categorical approach and argued for the dimensional approach to the personality disorders. Specifically, he proposed the Five Factor Model of personality as an alternative to the classification of personality disorders. For example, this view specifies that Borderline Personality Disorder can be understood as a combination of emotional lability (i.e., high neuroticism), impulsivity (i.e., low conscientiousness), and hostility (i.e., low agreeableness). Many studies across cultures have explored the relationship between personality disorders and the Five Factor Model.^[47] This research has demonstrated that personality disorders largely correlate in expected ways with measures of the Five Factor Model^[48] and has set the stage for including the Five Factor Model within DSM-5.^[49]

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

DSM-IV-TR Personality Disorders from the Perspective of the Five-Factor Model of General Personality Functioning^[45] (including previous DSM revisions)
Factors	PPD	SzPD	StPD	ASPD	BPD	HPD	NPD	AvPD	DPD	OCPD	PAPD	DpPD	SDPD	SaPD
Neuroticism (vs. emotional stability)
Anxiousness (vs. unconcerned)	N/A	N/A	High	Low	High	N/A	N/A	High	High	High	N/A	N/A	N/A	N/A
Angry hostility (vs. dispassionate)	High	N/A	N/A	High	High	N/A	High	N/A	N/A	N/A	High	N/A	N/A	N/A
Depressiveness (vs. optimistic)	N/A	N/A	N/A	N/A	High	N/A	N/A	N/A	N/A	N/A	N/A	High	N/A	N/A
Self-consciousness (vs. shameless)	N/A	N/A	High	Low	N/A	Low	Low	High	High	N/A	N/A	High	N/A	N/A
Impulsivity (vs. restrained)	N/A	N/A	N/A	High	High	High	N/A	Low	N/A	Low	N/A	N/A	N/A	N/A
Vulnerability (vs. fearless)	N/A	N/A	N/A	Low	High	N/A	N/A	High	High	N/A	N/A	N/A	N/A	N/A
Extraversion (vs. introversion)
Warmth (vs. coldness)	Low	Low	Low	N/A	N/A	N/A	Low	N/A	High	N/A	Low	Low	N/A	High
Gregariousness (vs. withdrawal)	Low	Low	Low	N/A	N/A	High	N/A	Low	N/A	N/A	N/A	Low	N/A	High
Assertiveness (vs. submissiveness)	N/A	N/A	N/A	High	N/A	N/A	High	Low	Low	N/A	Low	N/A	N/A	N/A
Activity (vs. passivity)	N/A	Low	N/A	High	N/A	High	N/A	N/A	N/A	N/A	Low	N/A	High	N/A
Excitement seeking (vs. lifeless)	N/A	Low	N/A	High	N/A	High	High	Low	N/A	Low	N/A	Low	N/A	High
Positive emotionality (vs. anhedonia)	N/A	Low	Low	N/A	N/A	High	N/A	Low	N/A	N/A	N/A	N/A	N/A	High
Open-mindedness (vs. closed-minded)
Fantasy (vs. concrete)	N/A	N/A	High	N/A	N/A	High	N/A	N/A	N/A	N/A	N/A	N/A	Low	High
Aesthetics (vs. disinterest)	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A
Feelings (vs. alexithymia)	N/A	Low	N/A	N/A	High	High	Low	N/A	N/A	Low	N/A	N/A	N/A	High
Actions (vs. predictable)	Low	Low	N/A	High	High	High	High	Low	N/A	Low	Low	N/A	Low	N/A
Ideas (vs. closed-minded)	Low	N/A	High	N/A	N/A	N/A	N/A	N/A	N/A	Low	Low	Low	Low	N/A
Values (vs. dogmatic)	Low	High	N/A	N/A	N/A	N/A	N/A	N/A	N/A	Low	N/A	N/A	High	N/A
Agreeableness (vs. antagonism)
Trust (vs. mistrust)	Low	N/A	N/A	Low	N/A	High	Low	N/A	High	N/A	N/A	Low	High	Low
Straightforwardness (vs. deception)	Low	N/A	N/A	Low	N/A	N/A	Low	N/A	N/A	N/A	Low	N/A	High	Low
Altruism (vs. exploitative)	Low	N/A	N/A	Low	N/A	N/A	Low	N/A	High	N/A	N/A	N/A	High	Low
Compliance (vs. aggression)	Low	N/A	N/A	Low	N/A	N/A	Low	N/A	High	N/A	Low	N/A	High	Low
Modesty (vs. arrogance)	N/A	N/A	N/A	Low	N/A	N/A	Low	High	High	N/A	N/A	High	High	Low
Tender-mindedness (vs. tough-minded)	Low	N/A	N/A	Low	N/A	N/A	Low	N/A	High	N/A	N/A	N/A	N/A	Low
Conscientiousness (vs. disinhibition)
Competence (vs. laxness)	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	High	Low	N/A	Low	High
Order (vs. disorderly)	N/A	N/A	Low	N/A	N/A	N/A	N/A	N/A	N/A	N/A	High	Low	N/A	N/A
Dutifulness (vs. irresponsibility)	N/A	N/A	N/A	Low	N/A	N/A	N/A	N/A	N/A	High	Low	High	High	N/A
Achievement striving (vs. lackadaisical)	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	N/A	High	N/A	N/A	High	Low
Self-discipline (vs. negligence)	N/A	N/A	N/A	Low	N/A	Low	N/A	N/A	N/A	High	Low	N/A	High	Low
Deliberation (vs. rashness)	N/A	N/A	N/A	Low	Low	Low	N/A	N/A	N/A	High	N/A	High	High	Low

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

As of 2002, there were over fifty published studies relating the five factor model (FFM) to personality disorders.^[50] Since that time, quite a number of additional studies have expanded on this research base and provided further empirical support for understanding the DSM personality disorders in terms of the FFM domains.^[51] In her seminal review of the personality disorder literature published in 2007, Lee Anna Clark asserted that "the five-factor model of personality is widely accepted as representing the higher-order structure of both normal and abnormal personality traits".^[52]

The five factor model has been shown to significantly predict all 10 personality disorder symptoms and outperform the Minnesota Multiphasic Personality Inventory (MMPI) in the prediction of borderline, avoidant, and dependent personality disorder symptoms.^[53]

Research results examining the relationships between the FFM and each of the ten DSM personality disorder diagnostic categories are widely available. For example, in a study published in 2003 titled "The five-factor model and personality disorder empirical literature: A meta-analytic review",^[54] the authors analyzed data from 15 other studies to determine how personality disorders are different and similar, respectively, with regard to underlying personality traits. In terms of how personality disorders differ, the results showed that each disorder displays a FFM profile that is meaningful and predictable given its unique diagnostic criteria. With regard to their similarities, the findings revealed that the most prominent and consistent personality dimensions underlying a large number of the personality disorders are positive associations with neuroticism and negative associations with agreeableness.

Openness to experience

At least three aspects of openness to experience are relevant to understanding personality disorders: cognitive distortions, lack of insight and impulsivity. Problems related to high openness that can cause problems with social or professional functioning are excessive fantasising, peculiar thinking, diffuse identity, unstable goals and nonconformity with the demands of the society.^[55]

High openness is characteristic to schizotypal personality disorder (odd and fragmented thinking), narcissistic personality disorder (excessive self-valuation) and paranoid personality disorder (sensitivity to external hostility). Lack of insight (shows low openness) is characteristic to all personality disorders and could explain the persistence of maladaptive behavioral patterns.^[56]

The problems associated with low openness are difficulties adapting to change, low tolerance for different worldviews or lifestyles, emotional flattening, alexithymia and a narrow range of interests.^[55] Rigidity is the most obvious aspect of (low) openness among personality disorders and that shows lack of knowledge of one's emotional experiences. It is most characteristic of obsessive-compulsive personality disorder; the opposite of it known as impulsivity (here: an aspect of openness that shows a tendency to behave unusually or autistically) is characteristic of schizotypal and borderline personality disorders.^[56]

Causes and risk factors

Currently, there are no definitive proven causes for personality disorders. However, there are numerous possible causes and known risk factors supported by scientific research that vary depending on the disorder, the individual, and the circumstance. Overall, findings show that genetic disposition and life experiences, such as trauma and abuse, play a key role in the development of personality disorders.

Child abuse

Child abuse and neglect consistently show up as risk factors to the development of personality disorders in adulthood.^[57] A study looked at retrospective reports of abuse of participants that had demonstrated psychopathology throughout their life and were later found to have past experience with abuse. In a study of 793 mothers and children, researchers asked mothers if they had screamed at their children, and told them that they did not love them or threatened to send them away. Children who had experienced such verbal abuse were three times as likely as other children (who did not experience such verbal abuse) to have borderline, narcissistic, obsessive-compulsive or paranoid personality disorders in adulthood.^[58] The sexually abused group demonstrated the most consistently elevated patterns of psychopathology. Officially verified physical abuse showed an extremely strong correlation with the development of antisocial and impulsive behavior. On the other hand, cases of abuse of the neglectful type that created childhood pathology were found to be subject to partial remission in adulthood.^[57]

Socioeconomic status

Socioeconomic status has also been looked at as a potential cause for personality disorders. There is a strong association with low parental/neighborhood socioeconomic status and personality disorder symptoms.^[59] In a recent study comparing parental socioeconomic status and a child's personality, it was seen that children who were from higher socioeconomic backgrounds were more altuistic, less risk seeking, and had overall higher IQs.^[60] These traits correlate with a low risk of developing personality disorders later on in life. In a study looking at female children who were detained for disciplinary actions found that psychological problems were most negatively associated with socioeconomic problems.^[61] Furthermore, social disorganization was found to be inversely correlated with personality disorder symptoms.^[62]

Parenting

Evidence shows that personality disorders may begin with parental personality issues. These cause the parent to have their own difficulties in adulthood, such as difficulties reaching higher education, obtaining jobs, and securing dependable relationships. By either genetic or modeling mechanisms, children can pick up these traits.^[59] Additionally, poor parenting has been shown to have symptom elevating effects on personality disorders.^[59] More specifically, lack of maternal bonding has also been correlated with personality disorders. In a study comparing 100 healthy individuals to 100 borderline personality disorder patients, analysis showed that BPD patients were significantly more likely not to have been breastfed as a baby (42.4% in BPD vs. 9.2% in healthy controls).^[63] These researchers suggested that this act may be essential in fostering maternal relationships. Additionally, it has been found that personality disorders show a negative correlation with two attachment variables: maternal availability and dependability. When left unfostered, other attachment and interpersonal problems occur later in life ultimately leading to development of personality disorders.^[64]

Genetics

Currently, genetic research for the understanding of the development of personality disorders is severely lacking. However, there are a few possible risk factors currently in discovery. Researchers are currently looking into genetic mechanisms for traits such as aggression, fear and anxiety, which are associated with diagnosed individuals. More research is being conducted into disorder specific mechanisms.^[65]

Epidemiology

The prevalence of personality disorder in the general community was largely unknown until surveys starting from the 1990s. In 2008 the median rate of diagnosable PD was estimated at 10.6%, based on six major studies across three nations. This rate of around one in ten, especially as associated with high use of services, is described as a major public health concern requiring attention by researchers and clinicians.^[66]

The prevalence of individual personality disorders ranges from about 2% to 3% for the more common varieties, such as schizotypal, antisocial, borderline, and histrionic, to 0.5–1% for the least common, such as narcissistic and avoidant.^[45]

A screening survey across 13 countries by the World Health Organization using DSM-IV criteria, reported in 2009 a prevalence estimate of around 6% for personality disorders. The rate sometimes varied with demographic and socioeconomic factors, and functional impairment was partly explained by co-occurring mental disorders.^[67] In the US, screening data from the National Comorbidity Survey Replication between 2001 and 2003, combined with interviews of a subset of respondents, indicated a population prevalence of around 9% for personality disorders in total. Functional disability associated with the diagnoses appeared to be largely due to co-occurring mental disorders (Axis I in the DSM).^[68]

A UK national epidemiological study (based on DSM-IV screening criteria), reclassified into levels of severity rather than just diagnosis, reported in 2010 that the majority of people show some personality difficulties in one way or another (short of threshold for diagnosis), while the prevalence of the most complex and severe cases (including meeting criteria for multiple diagnoses in different clusters) was estimated at 1.3%. Even low levels of personality symptoms were associated with functional problems, but the most severely in need of services was a much smaller group.^[69]

Personality disorders (especially Cluster A) are also very common among homeless people.^[70]

There are some sex differences in the frequency of personality disorders which are shown in the table below.^[21]^:206

**Sex differences in the frequency of personality disorders**
Type of personality disorder	Predominant sex
Paranoid personality disorder	Male
Schizoid personality disorder	Male
Schizotypal personality disorder	Male
Antisocial personality disorder	Male
Borderline personality disorder	Female
Histrionic personality disorder	Female
Narcissistic personality disorder	Male
Avoidant personality disorder	Male
Dependent personality disorder	Female
Depressive personality disorder	Female
Passive-aggressive personality disorder	Male
Obsessive-compulsive personality disorder	Male
Self-defeating personality disorder	Female
Sadistic personality disorder	Male

Comorbidity

There is a considerable personality disorder diagnostic co-occurrence. Patients who meet the DSM-IV-TR diagnostic criteria for one personality disorder are likely to meet the diagnostic criteria for another.^[45] Diagnostic categories provide clear, vivid descriptions of discrete personality types but the personality structure of actual patients might be more accurately described by a constellation of maladaptive personality traits.

DSM-III-R personality disorder diagnostic co-occurrence aggregated across six research sites^[45]
Type of Personality Disorder	PPD	SzPD	StPD	ASPD	BPD	HPD	NPD	AvPD	DPD	OCPD	PAPD
Paranoid (PPD)	—	8	19	15	41	28	26	44	23	21	30
Schizoid (SzPD)	38	—	39	8	22	8	22	55	11	20	9
Schizotypal (StPD)	43	32	—	19	4	17	26	68	34	19	18
Antisocial (ASPD)	30	8	15	—	59	39	40	25	19	9	29
Borderline (BPD)	31	6	16	23	—	30	19	39	36	12	21
Histrionic (HPD)	29	2	7	17	41	—	40	21	28	13	25
Narcissistic (NPD)	41	12	18	25	38	60	—	32	24	21	38
Avoidant (AvPD)	33	15	22	11	39	16	15	—	43	16	19
Dependent (DPD)	26	3	16	16	48	24	14	57	—	15	22
Obsessive-Compulsive (OCPD)	31	10	11	4	25	21	19	37	27	—	23
Passive-Aggressive (PAPD)	39	6	12	25	44	36	39	41	34	23	—

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

Abbreviations used: PPD – Paranoid Personality Disorder, SzPD – Schizoid Personality Disorder, StPD – Schizotypal Personality Disorder, ASPD – Antisocial Personality Disorder, BPD – Borderline Personality Disorder, HPD – Histrionic Personality Disorder, NPD – Narcissistic Personality Disorder, AvPD – Avoidant Personality Disorder, DPD – Dependent Personality Disorder, OCPD – Obsessive-Compulsive Personality Disorder, PAPD – Passive-Aggressive Personality Disorder.

Management

Specific approaches

There are many different forms (modalities) of treatment used for personality disorders:^[71]

Individual psychotherapy has been a mainstay of treatment. There are long-term and short-term (brief) forms.
Family therapy, including couples therapy.
Group therapy for personality dysfunction is probably the second most used.
Psychological-education may be used as an addition.
Self-help groups may provide resources for personality disorders.
Psychiatric medications for treating symptoms of personality dysfunction or co-occurring conditions.
Milieu therapy, a kind of group-based residential approach, has a history of use in treating personality disorders, including therapeutic communities.
The practice of mindfulness that includes developing the ability to be nonjudgmentally aware of unpleasant emotions appears to be a promising clinical tool for managing different types of personality disorders.^[72]^[73]

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

Response of Patients with Personality Disorders to Biological and Psychosocial Treatments^[45]
Cluster	Evidence for Brain Dysfunction	Response to Biological Treatments	Response to Psychosocial Treatments
A	Evidence for relationship to schizophrenia; otherwise none known	Schizotypal patients may improve on antipsychotic medication; otherwise not indicated	Poor. Supportive psychotherapy may help
B	Evidence for relationship to bipolar disorder; otherwise none known	Antidepressants, antipsychotics, or mood stabilizers may help for borderline personality; otherwise not indicated	Poor in antisocial personality. Variable in borderline, narcissistic, and histrionic personalities
C	Evidence for relationship to generalized anxiety disorder; otherwise none known	No direct response. Medications may help with comorbid anxiety and depression	Most common treatment for these disorders. Response variable

Challenges

The management and treatment of personality disorders can be a challenging and controversial area, for by definition the difficulties have been enduring and affect multiple areas of functioning. This often involves interpersonal issues, and there can be difficulties in seeking and obtaining help from organizations in the first place, as well as with establishing and maintaining a specific therapeutic relationship. On the one hand, an individual may not consider themselves to have a mental health problem, while on the other, community mental health services may view individuals with personality disorders as too complex or difficult, and may directly or indirectly exclude individuals with such diagnoses or associated behaviors.^[74] The disruptiveness that people with personality disorders can create in an organisation makes these, arguably, the most challenging conditions to manage.

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

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

Therapists in this area can become disheartened by lack of initial progress, or by apparent progress that then leads to setbacks. Clients may be perceived as negative, rejecting, demanding, aggressive or manipulative. This has been looked at in terms of both therapist and client; in terms of social skills, coping efforts, defense mechanisms, or deliberate strategies; and in terms of moral judgments or the need to consider underlying motivations for specific behaviors or conflicts. The vulnerabilities of a client, and indeed a therapist, may become lost behind actual or apparent strength and resilience. It is commonly stated that there is always a need to maintain appropriate professional personal boundaries, while allowing for emotional expression and therapeutic relationships. However, there can be difficulty acknowledging the different worlds and views that both the client and therapist may live with. A therapist may assume that the kinds of relationships and ways of interacting that make them feel safe and comfortable have the same effect on clients. As an example of one extreme, people who may have been exposed to hostility, deceptiveness, rejection, aggression or abuse in their lives, may in some cases be made confused, intimidated or suspicious by presentations of warmth, intimacy or positivity. On the other hand, reassurance, openness and clear communication are usually helpful and needed. It can take several months of sessions, and perhaps several stops and starts, to begin to develop a trusting relationship that can meaningfully address a client's issues.^[75]

History

Before the 20th century

Personality disorder is a term with a distinctly modern meaning, owing in part to its clinical usage and the institutional character of modern psychiatry. The currently accepted meaning must be understood in the context of historical changing classification systems such as DSM-IV and its predecessors. Although highly anachronistic, and ignoring radical differences in the character of subjectivity and social relations, some have suggested similarities to other concepts going back to at least the ancient Greeks.^[4]^:35 For example, the Greek philosopher Theophrastus described 29 'character' types that he saw as deviations from the norm, and similar views have been found in Asian, Arabic and Celtic cultures. A long-standing influence in the Western world was Galen's concept of personality types, which he linked to the four humours proposed by Hippocrates.

Such views lasted into the 18th century, when experiments began to question the supposed biologically based humours and 'temperaments'. Psychological concepts of character and 'self' became widespread. In the 19th century, 'personality' referred to a person's conscious awareness of their behavior, a disorder of which could be linked to altered states such as dissociation. This sense of the term has been compared to the use of the term 'multiple personality disorder' in the first versions of the DSM.^[76]

Physicians in the early 19th century started to diagnose forms of insanity that involved disturbed emotions and behaviors but seemingly without significant intellectual impairment or delusions or hallucinations. Philippe Pinel referred to this as 'manie sans délire' – mania without delusions – and described a number of cases mainly involving excessive or inexplicable anger or rage. James Cowles Prichard advanced a similar concept he called moral insanity, which would be used to diagnose patients for some decades. 'Moral' in this sense referred to affect (emotion or mood) rather than ethics, but it was arguably based in part on religious, social and moral beliefs, with a pessimism about medical intervention so that social control should take precedence.^[77] These categories were much different and broader than later definitions of personality disorder, while also being developed by some into a more specific meaning of moral degeneracy akin to later ideas about 'psychopaths'. Separately, Richard von Krafft-Ebing popularized the terms sadism and masochism, as well as homosexuality, as psychiatric issues.

The German psychiatrist Koch sought to make the moral insanity concept more scientific, and in 1891 suggested the phrase 'psychopathic inferiority', theorized to be a congenital disorder. This referred to continual and rigid patterns of misconduct or dysfunction in the absence of apparent mental retardation or illness, supposedly without a moral judgment. Described as deeply rooted in his Christian faith, his work has been described as a fundamental text on personality disorders that is still of use today.^[78]

20th century

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

In 1933 Russian psychiatrist Pyotr Borisovich Gannushkin published his book Manifestations of psychopathies: statics, dynamics, systematic aspects, which was one of the first attempts to develop a detailed typology of psychopathies. Regarding maladaptation, ubiquity, and stability as the three main symptoms of behavioral pathology, he distinguished 9 clusters of psychopaths: cycloids (including constitutionally depressive, constitutionally excitable, cyclothymics, and emotionally labile), asthenics (including psychasthenics), schizoids (including dreamers), paranoiacs (including fanatics), epileptoids, hysterical personalities (including pathological liars), unstable psychopaths, antisocial psychopaths, and constitutionally stupid.^[79] Some elements of Gannushkin's typology were later incorporated into the theory developed by a Russian adolescent psychiatrist, Andrey Yevgenyevich Lichko, who was also interested in psychopathies along with their milder forms, the so-called accentuations of character.^[80]

In 1939, psychiatrist David Henderson published a theory of 'psychopathic states' that contributed to popularly linking the term to anti-social behavior. Hervey M. Cleckley’s 1941 text, The Mask of Sanity, based on his personal categorization of similarities he noted in some prisoners, marked the start of the modern clinical conception of psychopathy and its popularist usage.^[81]

Towards the mid 20th century, psychoanalytic theories were coming to the fore based on work from the turn of the century being popularized by Sigmund Freud and others. This included the concept of character disorders, which were seen as enduring problems linked not to specific symptoms but to pervasive internal conflicts or derailments of normal childhood development. These were typically understood as weaknesses of character or willful deviance, and were distinguished from neurosis or psychosis. The term 'borderline' stems from a belief that some individuals were functioning on the edge of those two categories, and a number of the other personality disorder categories were also heavily influenced by this approach, including dependent, obsessive-compulsive and histrionic,^[82] the latter starting off as a conversion symptom of hysteria particularly associated with women, then a hysterical personality, then renamed histrionic personality disorder in later versions of the DSM. A passive aggressive style was defined clinically by Colonel William Menninger during World War II in the context of men's reactions to military compliance, which would later be referenced as a personality disorder in the DSM.^[83] Otto Kernberg was influential with regard to the concepts of borderline and narcissistic personalities later incorporated in 1980 as disorders into the DSM.

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

American psychiatrists officially recognised concepts of enduring personality disturbances in the first Diagnostic and Statistical Manual of Mental Disorders in the 1950s, which relied heavily on psychoanalytic concepts. Somewhat more neutral language was employed in the DSM-II in 1968, though the terms and descriptions had only a slight resemblance to current definitions. The DSM-III published in 1980 made some major changes, notably putting all personality disorders onto a second separate 'axis' along with mental retardation, intended to signify more enduring patterns, distinct from what were considered axis one mental disorders. 'Inadequate' and 'asthenic' personality disorder' categories were deleted, and others were expanded into more types, or changed from being personality disorders to regular disorders. Sociopathic personality disorder, which had been the term for psychopathy, was renamed Antisocial Personality Disorder. Most categories were given more specific 'operationalized' definitions, with standard criteria that psychiatrists could agree on in order to conduct research and diagnose patients.^[84] In the DSM-III revision, self-defeating personality disorder and sadistic personality disorder were included as provisional diagnoses requiring further study. They were dropped in the DSM-IV, though a proposed 'depressive personality disorder' was added; in addition, the official diagnosis of passive-aggressive personality disorder was dropped, tentatively renamed 'negativistic personality disorder.'^[85]

International differences have been noted in how attitudes have developed towards the diagnosis of personality disorder. Kurt Schneider had argued that they were simply 'abnormal varieties of psychic life' and therefore not necessarily the domain of psychiatry, a view said to still have influence in Germany today. British psychiatrists have also been reluctant to address such disorders or consider them on par with other mental disorders, which has been attributed partly to resource pressures within the National Health Service, as well as to negative medical attitudes towards behaviors associated with personality disorders. In the US, the prevailing healthcare system and psychanalytic tradition has been said to provide a rationale for private therapists to diagnose some personality disorders more broadly and provide ongoing treatment for them.^[86]

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^ ^a ^b ^c ^d ^e ^f Tasman, Allan et al (2008). Psychiatry. Third Edition. John Wiley & Sons, Ltd. ISBN 978-0470-06571-6.
^ Widiger, T. A. (1993). "The DSM-III-R categorical personality disorder diagnoses: A critique and an alternative". Psychological Inquiry. 4 (2): 75–90. doi:10.1207/s15327965pli0402_1.
^ Costa, P.T., & Widiger, T.A. (2001). Personality disorders and the five-factor model of personality (2nd ed.). Washington, DC: American Psychological Association.
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^ Widiger, Thomas A., Costa, Paul T. (2012). Personality Disorders and the Five-Factor Model of Personality, Third Edition. ISBN 978-1-4338-1166-1.
^ Widiger TA, Costa PT., Jr. (2002) "Five-Factor model personality disorder research", pp. 59–87 in Costa Paul T, Jr, Widiger Thomas A. (eds.) Personality disorders and the five-factor model of personality. 2nd ed. Washington, DC: American Psychological Association. ISBN 978-1-55798-826-3.
^ Mullins-Sweatt SN, Widiger TA (2006). "The five-factor model of personality disorder: A translation across science and practice", pp. 39–70 in Krueger R, Tackett J (eds.). Personality and psychopathology: Building bridges. New York: Guilford.
^ Clark, L. A. (2007). "Assessment and diagnosis of personality disorder: Perennial issues and an emerging reconceptualization". Annual Review of Psychology. 58: 227–57. doi:10.1146/annurev.psych.57.102904.190200. PMID 16903806.
^ Bagby, R. Michael; Sellbom, Martin; Costa, Paul T.; Widiger, Thomas A. (2008). "Predicting Diagnostic and Statistical Manual of Mental Disorders-IV personality disorders with the five-factor model of personality and the personality psychopathology five". Personality and Mental Health. 2 (2): 55–69. doi:10.1002/pmh.33.
^ Saulsman, L. M.; Page, A. C. (2004). "The five-factor model and personality disorder empirical literature: A meta-analytic review". Clinical Psychology Review. 23 (8): 1055–85. doi:10.1016/j.cpr.2002.09.001. PMID 14729423.
^ ^a ^b Piedmont, R. L., Sherman, M. F., Sherman, N. C. (2012). "Maladaptively High and Low Openness: The Case for Experiential Permeability". Journal of Personality. 80 (6): 1641–68. doi:10.1111/j.1467-6494.2012.00777.x. PMID 22320184.
^ ^a ^b Piedmont, R. L., Sherman, M. F., Sherman, N. C., Dy-Liacco, G. S., Williams, J. E. G. (2009). "Using the Five-Factor Model to Identify a New Personality Disorder Domain: The Case for Experiential Permeability". Journal of Personality and Social Psychology. 96 (6): 1245–58. doi:10.1037/a0015368. PMID 19469599.
^ ^a ^b Cohen, Patricia; Brown, Jocelyn; Smailes, Elizabeth (2001). "Child Abuse and Neglect and the Development of Mental Disorders in the General Population". Development and Psychopathology. 13 (4): 981–99. PMID 11771917.
^ "What Causes Psychological Disorders?". American Psychological Association. 2010. Archived from the original on 2010-11-20.
^ ^a ^b ^c Cohen, Patricia; Chen, Henian; Gordon, Kathy; Johnson, Jeffrey; Brook, Judith; Kasen, Stephanie (2008/04). "Socioeconomic background and the developmental course of schizotypal and borderline personality disorder symptoms". Development and Psychopathology. 20 (2): 633–50. doi:10.1017/S095457940800031X. ISSN 1469-2198. Check date values in: |date= (help)
^ Deckers, Thomas (February 2015). "How does Socio-Economic Status Shape a Child's Personality?" (PDF). Human Capital and Economic Opportunity Global Working Group.
^ Damme, Lore Van; Colins, Olivier; Maeyer, Jessica De; Vermeiren, Robert; Vanderplasschen, Wouter (2015-06-01). "Girls' quality of life prior to detention in relation to psychiatric disorders, trauma exposure and socioeconomic status". Quality of Life Research. 24 (6): 1419–29. doi:10.1007/s11136-014-0878-2. ISSN 0962-9343.
^ Walsh, Zach; Shea, M. Tracie; Yen, Shirley; Ansell, Emily B.; Grilo, Carlos M.; McGlashan, Thomas H.; Stout, Robert L.; Bender, Donna S.; Skodol, Andrew E. (2012-09-17). "Socioeconomic-Status and Mental Health in a Personality Disorder Sample: The Importance of Neighborhood Factors". Journal of Personality Disorders. 27 (6): 820–31. doi:10.1521/pedi_2012_26_061. ISSN 0885-579X.
^ Schwarze, Cornelia E.; Hellhammer, Dirk H.; Stroehle, Verena; Lieb, Klaus; Mobascher, Arian (2014-09-23). "Lack of Breastfeeding: A Potential Risk Factor in the Multifactorial Genesis of Borderline Personality Disorder and Impaired Maternal Bonding". Journal of Personality Disorders. 29 (5): 610–26. doi:10.1521/pedi_2014_28_160. ISSN 0885-579X.
^ Michelle, Ball, Ericka (2016-10-20). "The Moderating Role of Maternal Attachment on Borderline Personality Disorder Features and Dependent Life Stress".
^ "What causes personality disorders?". American Psychological Association. Retrieved 2017-08-09.
^ Lenzenweger, Mark F. (2008). "Epidemiology of Personality Disorders". Psychiatric Clinics of North America. 31 (3): 395–403. doi:10.1016/j.psc.2008.03.003. PMID 18638642.
^ Huang, Y.; Kotov, R.; de Girolamo, G.; Preti, A.; Angermeyer, M.; Benjet, C.; Demyttenaere, K.; de Graaf, R.; Gureje, O.; Karam, A. N.; Lee, S.; Lepine, J. P.; Matschinger, H.; Posada-Villa, J.; Suliman, S.; Vilagut, G.; Kessler, R. C. (30 June 2009). "DSM-IV personality disorders in the WHO World Mental Health Surveys". The British Journal of Psychiatry. 195 (1): 46–53. doi:10.1192/bjp.bp.108.058552. PMC 2705873 . PMID 19567896.
^ Lenzenweger, Mark F.; Lane, Michael C.; Loranger, Armand W.; Kessler, Ronald C. (2006). "DSM-IV Personality Disorders in the National Comorbidity Survey Replication". Biological Psychiatry. 62 (6): 553–64. doi:10.1016/j.biopsych.2006.09.019. PMC 2044500 . PMID 17217923.
^ Yang, M.; Coid, J.; Tyrer, P. (31 August 2010). "Personality pathology recorded by severity: national survey". The British Journal of Psychiatry. 197 (3): 193–99. doi:10.1192/bjp.bp.110.078956. PMID 20807963.
^ Connolly, Adrian J. (2008). "Personality disorders in homeless drop-in center clients" (PDF). Journal of Personality Disorders. 22 (6): 573–88. doi:10.1521/pedi.2008.22.6.573. PMID 19072678. With regard to Axis II, Cluster A personality disorders (paranoid, schizoid, schizotypal) were found in almost all participants (92% had at least one diagnosis), and Cluster B (83% had at least one of antisocial, borderline, histrionic, or narcissistic) and C (68% had at least one of avoidant, dependent, obsessive-compulsive) disorders also were highly prevalent.
^ Magnavita, Jeffrey J. (2004) Handbook of personality disorders: theory and practice, John Wiley and Sons, ISBN 978-0-471-48234-5.
^ Sng AA, Janca A (2016). "Mindfulness for personality disorders". Current Opinion in Psychiatry. 29 (1): 70–76. doi:10.1097/YCO.0000000000000213. PMID 26651010.
^ Creswell J.D. (2016). "Mindfulness Interventions". Annual Review of Psychology. 68: 70–76. doi:10.1146/annurev-psych-042716-051139. PMID 27687118.
^ Davison, S. E. (2002). "Principles of managing patients with personality disorder". Advances in Psychiatric Treatment. 8 (1): 1–9. doi:10.1192/apt.8.1.1.
^ McVey, D. & Murphy, N. (eds.) (2010) Treating Personality Disorder: Creating Robust Services for People with Complex Mental Health Needs, ISBN 0-203-84115-8
^ Suryanarayan, Geetha (2002) The History of the Concept of Personality Disorder and its Classification, The Medicine Publishing Company Ltd.
^ Augstein, HF (1996). "J C Prichard's concept of moral insanity—a medical theory of the corruption of human nature". Medical History. 40 (3): 311–43. doi:10.1017/S0025727300061329. PMC 1037128 . PMID 8757717.
^ Gutmann, P (2008). "Julius Ludwig August Koch (1841–1908): Christian, philosopher and psychiatrist". History of Psychiatry. 19 (74 Pt 2): 202–14. doi:10.1177/0957154X07080661. PMID 19127839.
^ Ганнушкин П. Б. (2000). Клиника психопатий, их статика, динамика, систематика. Издательство Нижегородской государственной медицинской академии. ISBN 5-86093-015-1.
^ Личко А. Е. (2010) Психопатии и акцентуации характера у подростков. Речь, ISBN 978-5-9268-0828-2.
^ Arrigo, B. A. (1 June 2001). "The Confusion Over Psychopathy (I): Historical Considerations" (PDF). International Journal of Offender Therapy and Comparative Criminology. 45 (3): 325–44. doi:10.1177/0306624X01453005. ^{[permanent dead link]}
^ Amy Heim & Drew Westen (2004) Theories of personality and personality disorders Archived 2012-01-11 at the Wayback Machine.
^ Lane, C. (1 February 2009). "The Surprising History of Passive-Aggressive Personality Disorder" (PDF). Theory & Psychology. 19 (1): 55–70. doi:10.1177/0959354308101419.
^ Hoermann, Simone; Zupanick, Corinne E. and Dombeck, Mark (January 2011) The History of the Psychiatric Diagnostic System Continued. mentalhelp.net.
^ Oldham, John M. (2005). "Personality Disorders". FOCUS. 3: 372–82. doi:10.1176/foc.3.3.372 (inactive 2018-01-04).
^ Kendell, RE (2002). "The distinction between personality disorder and mental illness". The British Journal of Psychiatry. 180 (2): 110–15. doi:10.1192/bjp.180.2.110.

External links

Personality Disorders Foundation
National Mental Health Association personality disorder fact sheet
Personality Disorders information leaflet from The Royal College of Psychiatrists

UpToDate Contents

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1. 人格障害 personality disorders
2. 境界性人格障害：疫学、臨床的特徴、経過、評価、診断、および鑑別診断 borderline personality disorder epidemiology clinical features course assessment diagnosis and differential diagnosis
3. 境界性人格障害の治療 treatment of borderline personality disorder
4. 反社会性人格障害：疫学、臨床症状、経過および診断 antisocial personality disorder epidemiology clinical manifestations course and diagnosis
5. 反社会性人格障害の治療 treatment of antisocial personality disorder

English Journal

Combined group and individual schema therapy for borderline personality disorder: A pilot study.

Dickhaut V1, Arntz A2.Author information 1Community Mental Health Center Maastricht, The Netherlands.2Clinical Psychological Science, Maastricht University, PO Box 616, The Netherlands. Electronic address: Arnoud.Arntz@maastrichtuniversity.nl.AbstractBACKGROUND AND OBJECTIVES: Schema Therapy (ST) is a highly effective treatment for Borderline Personality Disorder (BPD). In a group format, delivery costs could be reduced and recovery processes catalyzed by specific use of group processes. As patients may also need individual attention, we piloted the combination of individual and group-ST.
Journal of behavior therapy and experimental psychiatry.J Behav Ther Exp Psychiatry.2014 Jun;45(2):242-51. doi: 10.1016/j.jbtep.2013.11.004. Epub 2013 Dec 3.
BACKGROUND AND OBJECTIVES: Schema Therapy (ST) is a highly effective treatment for Borderline Personality Disorder (BPD). In a group format, delivery costs could be reduced and recovery processes catalyzed by specific use of group processes. As patients may also need individual attention, we piloted
PMID 24342235

The effect and mechanisms of implementation intentions on prospective memory in individuals with and without schizotypal personality features.

Chen XJ1, Wang Y, Liu LL, Shi HS, Wang J, Cui JF, Shum DH, Chan RC.Author information 1a Neuropsychology and Applied Cognitive Neuroscience Laboratory , Chinese Academy of Sciences , Beijing , China.AbstractProspective memory (PM) refers to remembering to do something at a future time. Studies have shown that implementation intention can improve PM performance. The present study aimed to examine the effect and mechanism of implementation intention on PM in individuals prone for schizotypal personality disorder (SPD proneness) in a laboratory condition. A total of 51 participants with SPD proneness and 51 controls were administered a PM task. They were further randomly assigned to an implementation intention condition and a typical instruction condition. All participants completed the PM task with low and high cognitive load conditions. The results showed that implementation intention improved PM performances in both SPD prone and control groups, indicating that implementation intention was an effective strategy for improving PM performance. However, the mechanisms were different for the two groups. For controls, implementation intention did not affect their cognitive resources allocation strategy. Participants with SPD proneness allocated significantly more cognitive resources to the PM task in the implementation intention condition.
Memory (Hove, England).Memory.2014 Jun;22(4):349-59. doi: 10.1080/09658211.2013.792841. Epub 2013 May 1.
Prospective memory (PM) refers to remembering to do something at a future time. Studies have shown that implementation intention can improve PM performance. The present study aimed to examine the effect and mechanism of implementation intention on PM in individuals prone for schizotypal personality
PMID 23634898

Safety climate, hardiness, and musculoskeletal complaints: a mediated moderation model.

Golubovich J1, Chang CH2, Eatough EM3.Author information 1Michigan State University, Department of Psychology, 316 Physics Road, Room 348, East Lansing, MI 48824, USA. Electronic address: golubovi@msu.edu.2Michigan State University, Department of Psychology, 316 Physics Road, Room 348, East Lansing, MI 48824, USA. Electronic address: cchang@msu.edu.3The City University of New York, Baruch College, Department of Psychology, One Bernard Baruch Way, New York, NY 10010, USA. Electronic address: erin.eatough@baruch.cuny.edu.AbstractThis study explores the mechanisms linking the psychosocial characteristics of the workplace with employees' work-related musculoskeletal complaints. Poor safety climate perceptions represent a stressor that may elicit frustration, and subsequently, increase employees' reports of musculoskeletal discomforts. Results from an employee sample supported that when employees' perceived safety was considered a priority, they experienced less frustration and reported fewer work-related upper body musculoskeletal symptoms. Psychological hardiness, a personality trait that is indicative of individuals' resilience and success in managing stressful circumstances, moderated these relationships. Interestingly, employees with high hardiness were more affected by poor safety climate.
Applied ergonomics.Appl Ergon.2014 May;45(3):757-66. doi: 10.1016/j.apergo.2013.10.008. Epub 2013 Oct 26.
This study explores the mechanisms linking the psychosocial characteristics of the workplace with employees' work-related musculoskeletal complaints. Poor safety climate perceptions represent a stressor that may elicit frustration, and subsequently, increase employees' reports of musculoskeletal dis
PMID 24169091

Japanese Journal

パーソナリティ障害とうつ病 (特集うつ病の診たてと治療)

林直樹
精神科 = Psychiatry 26(6), 380-385, 2015-06
NAID 40020486437

アトピー性皮膚炎に身体醜形障害を併存する1例をめぐる考察 : 皮膚症状への"とらわれ"に対する外来森田療法

川上正憲,中村敬,中山和彦
心身医学 55(4), 359-366, 2015-04-01
アトピー性皮膚炎に身体醜形障害を併存する1例を報告した.神経質性格を基盤にしたアトピー性皮膚炎の患者が,皮膚症状に対する「とらわれの精神病理構造」を認める場合,外来森田療法は有用である.治療者は,彼女の語り,および彼女の実存を主体的,実存的に我がものとして引き受け,「生の欲望」の涵養を行った(実存的交わり:ヤスパース).また,本症例は皮膚科医師に「顔の皮膚症状は良くなっている」と言われているにもか …
NAID 110009923721

パーソナリティ特性とうつ病 (特集うつ病の危険因子と予防)

黒木俊秀,七田千穂
臨床精神医学 44(4), 457-463, 2015-04
NAID 40020407222

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★リンクテーブル★

リンク元	「人格障害」「パーソナリティー障害」
拡張検索	「multiple personality disorder」「compulsive personality disorder」
関連記事	「disorder」「personality」

「人格障害」

	Library resources about; Personality disorders
	Resources in your library;

Classification	V · T · D ICD-10: F60; ICD-9-CM: 301.9; MeSH: D010554; DiseasesDB: 9889;
External resources	MedlinePlus: 000939; eMedicine: article/294307;

Personality disorders
Specialty	Psychiatry
Frequency	9–15%
	[edit on Wikidata]

　　[★]

英: personality disorder
関: 性格障害

精神系 090515 I

DSM-IV

A群人格障害

他人から見て奇異、風変わりな印象を与え、内向的で社会から孤立し、引きこもる傾向があり、社会の辺縁に身を置く。

妄想性人格障害 paranoid personality disorder 301.0

他者への根強い不信の念があり、しかるべき根拠がないのに、自分に対する敵意を感じたり、馬鹿にする、他人が利用する、危害を加えるなどという疑念を抱く。

統合失調質人格障害 schizoid personality disorder 301.20

きわめて内向的で、人との接触に乏しく、自分の中に引きこもり、周囲から変わり者と見なされていることも少なくない。親しい友人や信頼できる友人がなく、他人との親密な関係に欠ける。他人との感情の分かち合い、優しさ、温かさがない。

統合失調型人格障害 schizotypal personality disorder 301.22

統合失調質人格障害の諸特徴にくわえて、他人に対する被害的内容を中心とした関係念慮、テレパシーや超能力への関心、また話が要領を得ず論理的なまとまりを欠く、不適切な思考が出没するといった明らかな病的障害が認められるもの。

B群人格障害

情動面の激しさと不安定さがあり、外向的だが、時に他者に対する関係は嵐が来たように激しく攻撃的となる。

反社会性人格障害 antisocial personality disorder 301.7

行動：他者に対する攻撃性が目立ち、喧嘩、他者への暴力、器物破損などが繰り返される。社会規範が守れず、盗みや暴力、あるいは薬物乱用のため警察に逮捕されることが少なくない。職を転々と変えたりして、持続的な就労がなされない。社会的な責任感を欠き、無責任な行動だらしなさが目立つ。
感情・情動：不安定かつ荒々しい気象で、些細なことを我慢できず易怒的となる。罪悪感、後悔の念、優しさに欠け、他者に対する憎しみ、冷酷な感情を抱く。また不安感は乏しい。
対人関係：自己中心的で共感性を欠き、しばしば誇大的で、他者に対し、支配的あるいは操作的な態度が目立ち、長期的な人間関係を維持できない。

境界性人格障害 borderline personality disorder 301.83

人格の様々な領域における不安定性と自己の空虚感が目立つ
感情・情動：挿間的に出現する強い不快感、いらいら、不安の出現
行動：こうした空虚感や抑うつを伴う感情・情動不安定の中で、突然、手首切傷や薬を大量に服用した自殺企図、あるいは性的逸脱、薬物乱用、浪費、過食などが衝動的な行為の形で出現する。
対人関係：友人や初対面の人を前にして限られた時間なら表面的には如才ない。身近な他者に対し、しがみつくような形の依存的態度が目立ち、他者との適切な距離がとれない。

演技性人格障害 histrionic personality disorder 301.50

対人関係にもっとも大きな特徴がある。劇場の演技に比較される、他人の注意を引こうとする度を過ぎた自己顕示的行動が多い。

自己愛性人格障害 narcissistic personality disorder 301.81

自分には実際以上に優れた才能、力があるという度を超した自負心を持つ
他人の注意を自分にずっと引きつけ、賞賛されたいという自己顕示的欲求を持つ
他者の自己評価には過敏で、些細な批判的な言葉や態度で容易に傷つき、手ひどい羞恥心や屈辱感を味わう。

C群人格障害

不安げで、臆病で内向的

回避性人格障害 avoidant personality disorder 301.82

他人と親しく交わりたい、他人に自分を受け入れてもらいたいという願望を強く持っている者の、自信がなく、劣等感があり、低い自己評価のため他者の批判や拒絶を気にし、恥をかくことや非難されることをおそれて、対人関係は浅くなる。

依存性人格障害 dependent personality disorder 301.6

自分の信頼できる人に著しい依存を見せ、面倒を見てもらいたいという強い願望を持ち、その人へ自分をゆだね、没主体的な従属的な振る舞いをする。

強迫性人格障害 obsessive-compulsive personality disorder 301.4

過度の秩序意識や、几帳面さと完全主義が認められ、そのため、日常生活や仕事の場面で柔軟性を欠き、かたくなな態度が目立つ。

USMLE

Q book p.405 12

「パーソナリティー障害」

　　[★]

英: personality disorder
関: 人格変化

「multiple personality disorder」

　　[★] 多重人格障害

(病名)多重人格障害

関: dissociative identity disorder、dual personality、multiple personality

「compulsive personality disorder」

　　[★]

強迫性人格障害

関: compulsive personality、obsessive-compulsive personality disorder

「disorder」

　　[★]

障害：個人的苦痛や機能の障害があるので「疾病」とは言えるものの、その背景にある臓器障害がもう一つはっきりしない場合に用いられる。(PSY.9)

n.

an untidy state; a lack of order or organization (⇔order)
violent behaviour of large groups of people
an illness that cause a part of the body to stop functioning correctly

注意

disease <> illness <> disorder

vt.

乱す、乱雑にする。(人)の(心身の)調子を狂わせる。

vi.

「personality」

　　[★]

n.

性格、人格

関: character

[dsm1pattern-22] DSM-I Personality Pattern disturbance subsection.^[21]^:16

[23] Also classified as a schizophrenia-spectrum disorder in addition to personality disorder.

[dsm1trait-24] DSM-I Personality Trait disturbance subsection.^[21]^:16

[dsm1sociopathic-25] DSM-I Sociopathic personality disturbance subsection.^[21]^:16

[DSM5-1] American Psychiatric Association (2013), Diagnostic and Statistical Manual of Mental Disorders (5th ed.), Arlington: American Psychiatric Publishing, p. 646, ISBN 0890425558

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Classification	V · T · D ICD-10: F60 ICD-9-CM: 301.9 MeSH: D010554 DiseasesDB: 9889
External resources	MedlinePlus: 000939 eMedicine: article/294307

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personality disorder

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Contents

Classification

General criteria

In ICD-10

In ICD-11

In DSM-5

Personality clusters

Cluster A (odd or eccentric disorders)

Cluster B (dramatic, emotional or erratic disorders)

Cluster C (anxious or fearful disorders)

Other personality types

Millon's description

Additional factors

Severity

Effect on social functioning

Attribution

Impairment

Issues

In the workplace

In children

Versus mental disorders

Versus normal personality

Openness to experience

Causes and risk factors

Child abuse

Socioeconomic status

Parenting

Genetics

Epidemiology

Comorbidity

Management

Specific approaches

Challenges

History

References

Further reading

External links

UpToDate Contents

English Journal

Japanese Journal

Related Links

Related Pictures

★リンクテーブル★

「人格障害」

DSM-IV

A群人格障害

B群人格障害

C群人格障害

USMLE

「パーソナリティー障害」

「multiple personality disorder」

「compulsive personality disorder」

「disorder」

「personality」