What Is Personality Disorder?

The DSM-IV-TR (American Psychiatric Association 1994, 689) defines personality disorder (PD) as:

1. A. An enduring pattern of experience and behavior that deviates markedly from the expectations of an individual’s culture. This pattern is manifested in two (or more) of the following areas:

   1. 1. Cognition (i.e., ways of perceiving and interpreting self, other people, and events);

   2. 2. Affectivity (i.e., the range, intensity, lability, and appropriateness of emotional response);

   3. 3. Interpersonal functioning; and

   4. 4. Impulse control.

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

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

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

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

   9. F. The enduring pattern is not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition (e.g., head trauma).

Unlike schizophrenia, bipolar disorder, and other Axis I conditions, PD is not conventionally understood as an illness or disease. Rather, as the name implies, it is a disorder of the personality: an ‘enduring pattern of experience and behavior.’ Metaphorically speaking, it is a condition that is internal to the kind of person someone is, a part of who they are. It is not an external condition that befalls them.

Very roughly, personality is the set of characteristics or traits that make us the kind of person we are: the ways we are inclined to think, feel, and act in response to particular circumstances, as well as more generally. All of us have one. PD occurs when the set of characteristics or traits that make a person the kind of person they are causes severe psychological distress and impairment in social, occupational, or other important contexts: the ways a person is inclined to think, feel, and act do them harm, directly or via the effects they have on relationships, work, and life more generally conceived. Diagnosis of a PD requires that these characteristics or traits be long-standing, pervasive, difficult to control or change, and markedly different from cultural expectations. Equally, the distress and impairment caused must be sufficiently extreme to warrant clinical attention: the person needs clinical care and help. Nonetheless, all of us possess characteristics or traits that sometimes incline us to think, feel, and act in ways that cause us distress and adversely affect our social, occupational, or other functioning. PD lies on a continuum with normal human personality.

The broad category of PD is currently divided into three subcategories or ‘clusters.’ Cluster A comprises paranoid, schizoid, and schizotypal PD. These are more colloquially known as the odd and eccentric or ‘mad’ PDs. Cluster B comprises narcissistic, borderline, histrionic, and antisocial PD. These are more colloquially known as the dramatic, emotional, and erratic or ‘bad’ PDs. Cluster C comprises obsessive-compulsive, avoidant, and dependent PD. These are more colloquially known as the anxious and fearful or ‘sad’ PDs. A person cannot be diagnosed with any particular PD unless there is clinically significant distress and impairment. But, given that this condition is met, which kind of PD they have depends on what kind of personality they have–on the nature of the problematic pattern of experience and behavior.

Stepping back and considering the wider context, the picture painted of PD is bleak. PD is associated with genetic factors (Jang and Vernon 2001) and also environmental conditions (Paris 2001). These include dysfunctional families, where there is breakdown, death, institutional care, and parental psychopathology; traumatic childhood experiences, with high levels of sexual, emotional, and physical abuse or neglect; and social stressors, such as war, poverty, and migration. There are high levels of comorbidity among PDs, and between PDs and psychotic disorders, eating disorders, anxiety, depression, and substance abuse (Moran 2002). Finally, there is also a strong association between PD and violence and crime, self-harm, and suicide (Moran 2002). As this picture...