In this chapter, we will explore the essential information and clinical knowledge psychiatrists need to know about Personality Disorders. We will delve into the various types of personality disorders’ diagnostic criteria, and distinguishing features. Furthermore, we will provide an overview of objective and projective tests used for the assessment of these disorders, as well as outline the most effective treatment approaches. A strong foundation in this area is vital for psychiatrists aiming to excel on the ABPN Psychiatry Board Exam or PRITE, and to provide comprehensive care for their patients with personality disorders during training.
The personality disorders that will be outlined below used to be organized into three clusters (Clusters A, B, and C). However, personality disorders are no longer organized in this way and will not be grouped in this chapter.
Paranoid personality disorder
- Characterized by a pervasive and unjustified mistrust and suspicion of others, leading to interpersonal difficulties and maladaptive behaviors
- Common symptoms include:
- Suspicion that others are exploiting, harming, or deceiving them
- Preoccupation with unjustified doubts about the loyalty or trustworthiness of friends or associates
- Reluctance to confide in others
- Finding hidden demeaning or threatening meanings in benign remarks or events
- Perceptions of attacks on their character or reputation that are not apparent to others
- Suspicions, without justification, regarding the fidelity of their spouse or sexual partner
- Often begins by early adulthood
- More common in males than females
- Differential diagnosis:
- Schizophrenia, delusional disorder, substance abuse disorder
- Treatment:
- Cognitive-behavioral therapy (CBT), psychodynamic therapy
- Establishing a therapeutic alliance can be difficult due to patients’ distrust; a consistent and empathetic approach is essential
Avoid direct confrontation of paranoid beliefs; instead, gently challenge distortions and encourage alternative perspectives.
Schizoid personality disorder
- Characterized by a pervasive pattern of detachment from social relationships and a restricted range of emotional expression
- Common symptoms include:
- Neither desiring nor enjoying close relationships
- Choosing solitary activities
- Low sexual desire
- A paucity of close friends
- Indifference to praise or criticism
- Emotional coldness
- More common in men and those with a family history of schizophrenia or schizotypal personality disorder
- Differential diagnosis:
- Autism spectrum disorder (ASD), avoidant personality disorder, depression, and antisocial personality disorder.
- Treatment:
- CBT, psychodynamic therapy, social skills training
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