personality disorder personality disorder 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 from those accepted by the individual's culture. these patterns develop early, are inflexible, and are associated with significant distress or disability. the definitions vary by source and remain a matter of controversy. official criteria for diagnosing personality disorders are listed in the sixth chapter of the international classification of diseases (icd) and in the american psychiatric association's diagnostic and statistical manual of mental disorders (dsm). personality disordersspecialtypsychiatry; clinical psychologyfrequency9-11% personality disorders cluster a (odd) paranoid schizoid schizotypal cluster b (dramatic) antisocial borderline histrionic narcissistic cluster c (anxious) avoidant dependent obsessive–compulsive not otherwise specified depressive depressive cyclothymic others passive–aggressive masochistic sadistic psychopathy haltlose immature post-traumatic organic personality, defined psychologically, is the set of enduring behavioral and mental traits that distinguish individual humans. hence, personality disorders are defined by experiences and behaviors that deviate from social norms and expectations. those diagnosed with a personality disorder may experience difficulties in cognition, emotiveness, interpersonal functioning, or impulse control. for psychiatric patients, the prevalence of personality disorders is estimated between 40 and 60%. the behavior patterns of personality disorders are typically recognized by adolescence, the beginning of adulthood or sometimes even childhood and often have a pervasive negative impact on the quality of life. treatment for personality disorders is primarily psychotherapeutic. evidence-based psychotherapies for personality disorders include cognitive behavioral therapy, and dialectical behavior therapy especially for borderline personality disorder. a variety of psychoanalytic approaches are also used. personality disorders are associated with considerable stigma in popular and clinical discourse alike. despite various methodological schemas designed to categorize personality disorders, many issues occur with classifying a personality disorder because the theory and diagnosis of such disorders occur within prevailing cultural expectations; thus, 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. classification and symptoms the two latest editions of the major systems of classification are: the international classification of diseases (11th revision, icd-11) published by the world health organization the diagnostic and statistical manual of mental disorders (fifth edition, dsm-5) by the american psychiatric association. the icd is a collection of alpha-numerical codes which have been assigned to all known clinical states, and provides uniform terminology for medical records, billing, statistics and research. the dsm defines psychiatric diagnoses based on research and expert consensus. both have deliberately aligned their diagnoses to some extent, but some differences remain. for example, the icd-10 included narcissistic personality disorder in the group of other specific personality disorders, while dsm-5 does not include enduring personality change after catastrophic experience. the icd-10 classified 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. dissociative identity disorder, previously known as multiple personality as well as multiple personality disorder, has always been classified as a dissociative disorder and never was regarded as a personality disorder. 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 leading to significant distress or impairment and is not due to use of substances or another medical condition. the dsm-5 lists personality disorders in the same way as other mental disorders, rather than on a separate 'axis', as previously. 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 not matching these ten disorders, but nevertheless exhibit characteristics of a personality disorder: 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. these specific personality disorders are grouped into the following three clusters based on descriptive similarities: cluster a (odd or eccentric disorders) cluster a personality disorders are often associated with schizophrenia: in particular, schizotypal personality disorder shares some of its hallmark symptoms with schizophrenia, e.g., acute discomfort in close relationships, cognitive or perceptual distortions, and eccentricities of behavior. however, people diagnosed with odd-eccentric personality disorders tend to have a greater grasp on reality than those with schizophrenia. people with these disorders can be paranoid and have difficulty being understood by others, as they often have odd or eccentric modes of speaking and an unwillingness and inability to form and maintain close relationships. though their perceptions may be unusual, these anomalies are distinguished from delusions or hallucinations as people with these would be diagnosed with other conditions. significant evidence suggests a small proportion of people with cluster 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. paranoid personality disorder: characterized by a pattern of irrational suspicion and mistrust of others, interpreting motivations as malevolent. schizoid personality disorder: exhibiting a cold affect and detachment from social relationships, apathy, and restricted emotional expression. schizotypal personality disorder: pattern of extreme discomfort interacting socially, and distorted cognition and perceptions. cluster b (emotional or erratic disorders) cluster b personality disorders are characterized by dramatic, impulsive, self-destructive, emotional behavior and sometimes incomprehensible interactions with others. antisocial personality disorder: pervasive pattern of disregard for and violation of the rights of others, lack of empathy and remorse, callousness, bloated self-image, manipulative and impulsive behavior. borderline personality disorder: pervasive pattern of abrupt emotional outbursts, fear of abandonment, unhealthy attachment, altered empathy, 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, including excessive emotions, an impressionistic style of speech, inappropriate seduction, exhibitionism, and egocentrism. narcissistic personality disorder: pervasive pattern of superior grandiosity, haughtiness, need for admiration, deceiving others, and a lack of empathy. in a more severe expression, criminal behavior is present, but such individuals are remorseful. cluster c (anxious or fearful 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). dsm-5 general criteria both the dsm-5 and the icd-11 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 dsm-5 indicates that any personality disorder diagnosis must meet the following criteria: 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). icd-11