W. W. Norton & Company | The Personality Puzzle, 4th ed.

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Chapter 18: Disorders of Personality

People are different from each other; when these differences consistently cause problems, they may amount to personality disorders.

The Diagnostic and Statistical Manual (DSM-IV) of the American Psychiatric Association describes a wide variety of mental problems including personality disorders. It attempts to make psychological diagnosis more objective and provides useful categories for various purposes including research and billing.

All personality disorders have two essential characteristics. They are (1) unusually extreme and (2) cause problems for the self or others.

Most, if not all, personality disorders are also social and stable. In addition, some disorders are ego-syntonic, which means they are not experienced as problems by the people who have them.

The DSM-IV lists ten major personality disorders. The dependent, avoidant, and obsessive-compulsive disorders are primarily associated with emotional suffering. The paranoid, histrionic, antisocial, and narcissistic disorders are associated with problems relating to other people. The schizotypal, schizoid, and borderline disorders are associated with serious distortions of thinking and a lack of stable contact with reality. However, all of the disorders include all three kinds of problems.

Obsessive-compulsive personality disorder is a pattern of excessive devotion to rules, organization, and habits along with inflexibility or resistance to change.

Narcissistic personality disorder is a pattern of excessive self-love that includes grandiose and arrogant behaviors, and exploitation of and lack of empathy for others. The trait of narcissism can also vary within the normal range.

Borderline personality disorder is a serious affliction characterized by confused thinking, emotional vulnerability and instability, identity confusion, and dangerous patterns of self-harm.

For each disorder, the DSM-IV provides a list of characteristics and the minimum number that must be present to justify an official diagnosis. This means that people with the same diagnosis might be quite different from each other, so each disorder should be thought of as a prototype rather than as a list of necessary and sufficient features.

Diagnosis of a personality disorder may be based on clinical impressions, self-report inventories, structured interviews, or informants' reports.

The DSM-IV organizes the ten personality disorders into three clusters that describe patterns of thinking, behavior, and emotion. The Big Five list of essential traits is another widely-used approach to organizing the disorders.

When thinking about personality disorders, key issues include:
- Pathologizing undesirable behavior can raise difficult moral issues, and also risks describing so many patterns as mental illnesses that the concept of illness begins to lose its meaning.
- A list of psychological disorders does not imply a definition of mental health.
- Labeling disorders carries serious risks, but also has helpful applications and may be inevitable.
- There is a fine and uncertain line between normal personality variation and personality disorder. Indeed, some personality disorders can be seen as exaggerations of traits that, in moderation, are desirable.