Brief Lecture Notes for Unit 10b
Three things to note: (1) A few of the categories below have been dropped from the most recent version of the DSM for political rather than scientific reasons. I include them below anyway for the sake of completeness, but they are controversial (particularly, the Sadistic and Self-Defeating PD's) partly because they raise questions about individual versus systemic pathology. (2) Note the overlap between some Axis II labels and corresponding Axis I labels (e.g., paranoid, schizo-, obsessive-compulsive), further suggesting the continuity of mental health/illness. (3) Though your text talks about three clusters of PD's, I've maintained a four-cluster system to attempt to link the PD's more closely to the Big Five and the Interpersonal Circumplex.
Cluster I (Reserved)
Paranoid PD (extreme version of Vigilant Style)
Typically suspicious, hypersensitive, rigid, envious, and argumentative, these individuals tend to see themselves as blameless but readily assign fault to others and engage in frequent defensive projection (see lecture for more on the distinction between naive and defensive forms of projection). Keenly aware of power and status, they tend to be envious of those with higher status and disdainful of those with lower status. Often they are highly secretive because of their suspiciousness toward others. (They do not show literal delusionality of an Axis I paranoid sort, however.)
Schizoid PD (extreme version of Solitary Style)
An inability to form social relationships (even of a superficial nature) coupled with a lack of interest in doing so is characteristic of this type. Strongly alexithymic and lacking social skills, they are often seen by others as cold, distant, and aloof, and are usually extreme loners, but seem or claim not to mind. They may be happiest when alone.
Schizotypal PD (extreme version of Idiosyncratic Style)
Seclusiveness, oversensitivity, and eccentricity in thought and behavior are characteristic of this style. There is no actual loss of reality contact as there would be in an Axis I cognitive disorder like schizophrenia, but highly personalized and superstitious thinking that is difficult for others to interpret or relate to is typical. Ties to reality are loosened but not completely broken.
Cluster II (Outgoing)
Borderline PD (extreme version of Mercurial Style)
Instability and an erratic pattern of behavior, including drastic mood swings and "acting out" behavior, is characteristic of this type. Sometimes angry or hostile behaviors predominate, but just as often there is simply a sense of poorly defined personality boundaries, a weak sense of self, or an impulsive, unpredictable style. Often these people report feeling "empty" and struggle with issues of meaning and purpose. In extreme cases, self-mutilation is likely.
Histrionic PD (extreme version of Dramatic Style)
Immaturity, excitability, craving for excitement, and a social style that emphasizes exaggeration and self-dramatization are hallmarks of this style. Interpersonal relationships are often stormy, with self-centeredness, vanity, shallowness, "double bind" forms of seductive or flirtatious behavior, insincerity, and sometimes dependency and gullibility (hidden under a persona of sophistication) typical patterns.
Narcissistic PD (extreme version of Self-Confident Style)
The key pattern is one of an exaggerated sense of self-importance and an extreme preoccupation with receiving attention. There is little if any overt hostility, but high levels of grandiosity and an expectation of special treatment from others. Others' needs are frequently disregarded, but not in a wanton manner, simply as a result of unconscious entitlement. Egocentrism (the inability to take others' perspectives) is a central symptom.
Cluster III (Cooperative)
Avoidant PD (extreme version of Sensitive Style)
Risk-averse, threctic, and hypersensitive to rejection, this individual is highly attuned to and apprehensive about any sign of social denigration or derogation. Fear of criticism, rebuff, embarrassment, and the like impede attempts to initiate relationships (particularly in high-threat situations such as relationships with the opposite sex), yet there is a strong desire for affection and often a struggle with loneliness. (Unlike with the schizoid type, aloneness is not enjoyed.)
Dependent PD (extreme version of Devoted Style)
An extreme level of dependence on others (usually one or two specific others who serve as "attachment figures") characterizes this type. These individuals build their lives around others and may adopt a "co-dependent" style to keep others involved with them. They lack self-confidence and feel helpless on their own, but may function well when not required to act independent of the support person(s) in their life.
Obsessive-Compulsive PD (extreme version of Conscientious Style)
Excessive concern for rules, order, efficiency, structure, and work, along with high control needs (of self, others, and environment), an inability to relax, and a generally alexithymic style define this type. Such individuals are often overinhibited, hyperdeliberate, needlessly conscientious or perfectionistic, irrationally dutiful, and rigid. They rarely, if ever, relax or do anything "just for fun". They may become obsessed with details. (However, they do not show the more focused clinical symptoms of Axis I OCD's.)
Self-Defeating PD (extreme version of Self-Sacrificing Style)
The persistent avoidance of pleasurable experiences (to the point of masochism) and a paradoxical involvement in relationships with abusive others is characteristic of this style. Personal success, achievement, or recognition is avoided, and often leads to a sense of guilt, depression, or self-punishment rather than happiness or pleasure. Often the individual elicits rejecting responses from others and then feels hurt, yet seems unable to act in ways that would elicit more positive responses from others or to seek out more affirming others.
Cluster IV (Competitive)
Antisocial PD (extreme version of Adventurous Style)
A habitual violation of the rights of others (in a clearly hostile or "conscienceless" way, as opposed to the more "naively entitled" or childlike manner of the Narcissistic PD above), with no apparent capacity for guilt, remorse, or empathy, characterizes this style. Others are seen as objects to be used, not people to be loved. Aggressive utilitarianism -- in which others exist merely to serve the individual's needs and have no inherent value of their own -- is primary.
Passive-Aggressive PD (extreme version of Leisurely Style)
This person is angry at an underlying level but disguises that anger, expressing it in indirect ways such as chronic procrastination, motivated forgetting, pouting, intentional inefficiency, stubbornness, paradoxical literalism, obstructionistic behavior and the like. Resenting demands others place on them but not wishing to (or not being able to) confront them directly, these individuals subvert the system to avoid unwanted demands without having to resort to direct confrontation or self-assertion.
Sadistic PD (extreme version of Aggressive Style)
Chronically deliberate behavior of a cruel, intentionally hurtful, demeaning, or maliciously aggressive sort characterizes this person. Unlike with the Antisocial PD person, who will hurt people as needed to achieve a goal but who otherwise is not directly motivated to be cruel, the Sadistic PD individual enjoys cruelty as an end in itself and has a history of inflicting physical and psychological cruelty on others as a means of achieving personal power. Humiliation, intimidation, bullying, and the like are common, as are preoccupations with violence.