Personality Disorders in General
DSM-IV-TR Diagnostic 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 accounted for as a manifestation of another mental disorder.
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).
(Reprinted, with permission, from the Diagnostic and Statistical Manual of Mental Disorders. 4th edn. Text Revision. Washington, DC: American Psychiatric Association, 2000.)
The prevalence of diagnosable personality disorders in the general population has been estimated at 10–20%. This rate is much higher in mental health treatment settings, with as many as 50% of psychiatric patients meeting criteria for one or more personality disorders.
Some personality disorders are diagnosed more frequently in men, and some are more prevalent in women. Thus, for example, borderline personality disorder appears to be more common in women. Antisocial personality disorder predominates in men.
The causes of personality disorders are not well understood. As with essentially every other type of psychiatric disorder, they probably involve various combinations of biologic, temperamental, and social etiologies. Historically, classic psychoanalytic theory suggests that personality disorders occur when a person fails to progress through the usual stages of psychosexual development. Fixation at the oral stage (i.e., the infantile stage) is considered to cause a personality characterized by demanding and dependent behavior, the current parallel being the dependent personality disorder. Fixation at the anal stage (i.e., the stage of toilet training) is thought to lead to obsessionality, rigidity, and emotional aloofness. The current diagnostic parallel is obsessive–compulsive personality disorder. Fixation at the phallic stage (early childhood) is thought to lead to shallowness and difficulty sustaining intimate relationships, the diagnostic parallel being histrionic personality disorder.
Related to the above, developmental and environmental problems have been a major focus of interest to scholars of personality. This is in part because onset occurs early in life and is frequently associated with real and perceived disruptive childhood experiences. Of particular interest has been the extremely high rate of reported neglect and childhood sexual, physical, or emotional abuse in patients with certain personality disorders, especially borderline personality disorder and histrionic personality disorder.
Genetic factors are often influential in the etiology of personality disorders. For example, family, twin, and adoption studies suggest that schizotypal personality disorder is linked to a family history of schizophrenia. Similar studies have delineated genetic factors related to antisocial and borderline disorders.
In the United States of America, Personality disorders are coded on Axis II of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR), so as to separate them from the major mental disorders (i.e., bipolar disorder, schizophrenia, panic disorder), which are coded on Axis I. Both Axis I and Axis II disorders can and frequently do coexist.
Personality disorders as currently described in DSM-IV-TR are described as “an enduring manifestation of inner experience and behavior that deviates markedly from the expectations of the individual’s culture, is pervasive and inflexible, has an onset in adulthood, is stable over time, and leads to distress or impairment.” DSM-IV-TR Personality disorders are representative of long-term functioning and are not limited to episodes of illness.
For purposes of DSM-IV-TR classification, there are 10 personality disorders and these are grouped into three major categories or clusters. Cluster A (paranoid, schizoid and schizotypal) is composed of individuals who are generally odd or eccentric. They may have abnormal cognitions, such as being overly suspicious or exhibiting peculiar expressions or odd speech. Cluster B personality disorders (antisocial, borderline, histrionic, and narcissistic) consist of individuals with dramatic, acting-out behaviors. Cluster C disorders (avoidant, dependent, obsessive–compulsive) include those personality disorders generally marked by prominent anxiety and avoidance of novelty.
Co-occurrence of several personality disorders in a given individual within a given cluster is common, as is co-occurrence across clusters. Furthermore, a patient meeting criteria for a particular personality disorder will also often exhibit some features of other disorders within the same cluster, as well as across clusters. In addition to the 10 personality disorders, DSM-IV-TR includes criteria for two additional disorders, these being the passive–aggressive and the depressive personality disorder. There is also a category entitled personality disorders, not otherwise specified.
As a group, the personality disorders are one of the most difficult and complicated emotional disorders to diagnose and to treat. Diagnosis is difficult in part because the disorders are often difficult to differentiate from each other, due to overlapping symptoms, and because the boundary between normality and psychopathology for each diagnosis is not distinct. Treatment of personality disorders is also difficult. Almost by definition, they are well-established behaviors and/or ways of thinking that are not perceived by the afflicted individual as abnormal or aberrant.
Manifestations of personality disorders are frequently evident early in life. Some behaviors in children such as aggressiveness and stealing predict later personality problems, such as antisocial personality disorder. However, other behaviors, such as childhood social isolation and shyness seem to be of little value in predicting later cluster C disorders.
A number of psychological tests have been developed to assess personality traits and disorders. Of particular prominence are the Millon Clinical Multiaxial Inventory (MCMI), and the Minnesota Multiphasic Personality Inventory (MMPI).
The MCMI is a self-administered, true-false inventory that provides information on personality style, significant personality patterns and associated clinical disorders. The inventory includes 344 items, grouped into 22 overlapping scales. These consist of 4 validity scales, 11 clinical scales, 5 treatment issue scales, and 2 interpersonal scales. Unlike the MCMI, the Minnesota Multiphasic Personality Inventory was developed to aid in the diagnosis of mental disorders. However, it is often used to describe individuals more globally. It consists of over 500 items and includes nine basic clinical scales (i.e., hypochondrias, depression, hysteria, psychopathic deviance, masculinity/femininity, paranoia, anxiety, schizophrenia, and mania). Validity scales are also included. Other assessment instruments have been developed, as have various semistructured interview protocols such as the Structured Clinical Interview for DSM-IV-TR, which can be used to diagnose personality disorders.
There are no proven biological markers that are highly specific for the personality disorders. However, certain associations have been reported. For example, low platelet monoamine oxidase activity has been found in patients who have schizotypal personality disorder. Also, low 5-hydroxyindoleacetic acid is found in the cerebrospinal fluid of patients who have borderline personality disorder associated with suicide attempts and aggressive behavior. Hypersensitivity to an acetylcholine-enhancing drug is characteristic of borderline personality disorder patients who have mood lability. In addition, abnormal dexamethasone suppression tests are less likely to be found in personality disorder patients with depression than in patients with pure major depressive disorder. More recently, certain genetic profiles are being defined for specific personality disorders.
Personality disorders frequently are associated with Axis I disorders of nearly all types. Mood, anxiety, and substance-abuse disorders are the most common correlates. Conversely, it has been reported that over 50% of patients hospitalized with major depressive disorder also have a diagnosable personality disorder. In many cases a personality disorder is thought to predispose the individual to the recurrence and greater intensity of an Axis I disorder, thus indicating a poorer prognosis. Also, the presence of an Axis I diagnosis can complicate the process of establishing a personality disorder diagnosis, since common symptoms of personality disorders (e.g., interpersonal withdrawal or dependency) can be influenced by mood state. Furthermore, the personality disorders are not mutually exclusive. The majority of patients meeting criteria for one personality disorder will also meet criteria for other personality disorders.
Although useful for purposes of communication between professionals, the categorical classification of personality disorders presented in the DSM-IV-TR is considered by many professionals to be deeply flawed, and possibly irrelevant.
Thus, although DSM-IV-TR offers clinical criteria-based personality disorder subtypes, many professionals believe that these are artificial constructs.
The idea that mental illness generally and personality disorder specifically can be accurately defined categorically is currently in dispute. The arbitrariness of having a specific set and number of characteristics necessary to make a diagnosis may be too exclusive, or not exclusive enough. Similarly, the question of whether certain personality disorders such as schizotypal, avoidant, and borderline personality disorders are actually a part of a continuum of Axis I disorders remains very much an open and controversial question. How one draws the line between being normal and having a pathologic condition is also a question not erased by arbitrarily classifying disorders, based on reaching a threshold number of symptoms.
Considering personality and personality disorders to be a grouping of symptoms of core traits or temperaments, measured on a continuum, represents a viable or at least an additional alternative to the current categorical diagnostic standards of DSM-IV-TR. Indeed, such a strategy is the norm in normal personality research, where dimensional evaluations show greater reliability and correlations than do categoric ones.
There are several ways to consider a dimensional approach to diagnoses. One is to measure the actual characteristics of a given personality diagnosis (i.e., rating each component as not present to highly present) and then deriving a total score. Another approach has been to show the relative presence of each symptom, as related to the others, or to present a relative profile on each personality disorder (i.e., high schizoid, low paranoid, low borderline, high avoidant, etc.). Alternatively, core personality traits or temperament variables can be measured, and the various characteristics related to specific personality disorders.
Many different scales have been developed to classify trait/temperament variables. One popular scale is the NEO-PI or five-factor model of personality. Here, personality is divided into five major components, each with a set of subordinate facets. The five major components are: neuroticism (the predisposition to experience anxiety, depression, and hostility), extroversion (the tendency to be outgoing or gregarious as opposed to shy), openness to experience, agreeableness, and conscientiousness.
Another frequently utilized scale is the Cloninger Tridimensional Personality Questionnaire. This Questionnaire divides into four major components: novelty seeking, harm avoidance, reward dependence, and persistence. Other scales are designed to measure impulsiveness and the tendency to engage in dangerous activities.
There is evidence that certain personality patterns and traits, especially in the extreme, are associated with specific categorically defined personality disorders and psychopathology.
However, some personality traits change over time. Thus, with aging, individuals become less extroverted, more agreeable and show less neuroticism and are more conscientious. Over time, individuals become less emotional and better socialized. Although there are differences in the expression of traits between different personality diagnoses, the trait differences between diagnoses are considerably less than those between individuals who have and do not have a personality disorder.
Personality disorders are difficult to treat, in part because they often do not cause personal distress. Because the personality disorders are experienced as a fundamental part of the individual, rather than as a distressing symptom, the affected individual often has limited insight into the nature of his or her problems. Therefore, people with personality disorders are likely to present for treatment only during times of crisis or with the resurgence of major psychiatric symptoms such as depression or anxiety, or when others such as family or coworkers are disturbed by their behavior.
Patients with personality disorders tend to be challenging to their therapists. They are often angry, manipulative, demanding, or defensive. However, improvement in personality disorders often occurs over time.
Specific psychotherapy techniques, either in individual or group settings, including behavioral, cognitive, or interpersonal therapies may be effective. Here, the alliance and collaboration between therapist and patient or patient and group appears to be a critical component of successful treatment.
Personality disorders in general are highly associated with disability in the general population, and generally, when coexistent, worsen the prognosis and relapse rates of Axis I disorders.
Although limited evidence confirms that certain personality disorder diagnoses are stable over time, it is not clear that this is a valid assumption overall. Indeed, several personality disorders (i.e., borderline personality disorder, antisocial personality disorder) are likely to improve over time, or change from one disorder to another, with some features of a disorder replaced by others as the patient ages. Thus, personality disorders characterized by impulsivity and anger, such as borderline and antisocial personality disorders tend to show some reduction in these features as the individual reaches middle age.
Individual Personality Disorders
DSM-IV-TR Diagnostic Criteria
A pervasive distrust and suspiciousness of others such that their motives are interpreted as malevolent, beginning by early adulthood and present in a variety of contexts, as indicated by four (or more) of the following:
suspects, without sufficient basis, that others are exploiting, harming, or deceiving him or her
is preoccupied with unjustified doubts about the loyalty or trustworthiness of friends or associates
is reluctant to confide in others because of unwarranted fear that the information will be used maliciously against him or her
reads hidden demeaning or threatening meanings into benign remarks or events
persistently bears grudges, i.e., is unforgiving of insults, injuries, or slights
perceives attacks on his or her character or reputation that are not apparent to others and is quick to react angrily or to counterattack
has recurrent suspicions, without justification, regarding fidelity of spouse or sexual partner
Does not occur exclusively during the course of schizophrenia, a mood disorder with psychotic features, or another psychotic disorder and is not due to the direct physiological effects of a general medical condition.
(Reprinted, with permission, from the Diagnostic and Statistical Manual of Mental Disorders. 4th edn. Text Revision. Washington, DC: American Psychiatric Association, 2000.)
The prevalence of paranoid personality disorder has been estimated at 0.5–4.5% of the general population. It is relatively common in clinical settings, particularly among psychiatric inpatients. Individuals with a paranoid personality disorder typically rarely seek treatment on their own. They are usually referred by family members, coworkers or employers. The disorder appears to be slightly more common in women than in men.
Although the etiology of paranoid personality disorder is uncertain, both genetic and environmental aspects are thought to play an etiologic role. For example, the risk of developing the disorder is somewhat enhanced in families with a history of schizophrenia and delusional disorders. Environmentally, the risk for this disorder appears to be increased if the individual’s parents exhibited irrational outbursts of anger, and where the frequent fear the individual experienced as a child is projected onto others later in life.
Although the finding is not a strong one, paranoid personality disorder patients do have more biological relatives with schizophrenia than with controls. The link between paranoid personality disorder and schizoid personality disorder is quite weak, although measurable.
There is some evidence that paranoid personality disorder is more common among individuals with a family history of schizophrenia or delusional disorder, persecutory type, compared to controls. However, this is not a particularly strong finding.
The cardinal feature of paranoid personality disorder is the presence of generalized distrust or suspiciousness. Individuals feel that they have been treated unfairly, are resentful of this mistreatment, and bear long-lasting grudges against those who have slighted them. They place a high premium on autonomy and react in a hostile manner to others who seek to control them and they can be violent. These patients are often unsuccessful in intimate relationships because of their suspiciousness and aloofness.
When interviewed, patients with a paranoid personality disorder are formal, businesslike, skeptical, and mistrustful, and exhibit poor or fixated eye contact. They consistently project blame for their difficulties onto others, externalizing their own emotions while paying keen attention to the emotions and attitudes of others. Underlying their formal and at times moralistic presentation is considerable hostility and resentment.
There is considerable overlap between patients with paranoid personality disorder, patients with schizoid personality disorder, and those with schizotypal personality disorder. Of those patients with schizoid personality disorder, 47% were also diagnosed as also having a paranoid personality disorder. In addition, the disorder often appears in combination with schizotypal personality disorder, although this in part is because of the shared feature of paranoid ideation. Other common personality disorder comorbidities include the borderline and narcissistic personality disorders. When paranoid personality disorder is comorbid with narcissistic personality disorder, the paranoid features serve to justify the patient’s delusions of persecution, with the obstructions of others seen as evidence of the merit of the patient’s overvalued ideas. Paranoid personality disorder is similar to several Axis I disorders. These include delusional disorder—persecutory type, schizophrenia, and paranoid type. Paranoid personality disorder is distinguished from the above Axis I disorders by the absence of delusions, hallucinations, and defective reality testing, although differentiation is not always easy.
There is little available data to suggest that pharmacologic interventions are of significant benefit in paranoid personality afflicted individuals. Although not demonstrated by controlled clinical trials, low-dose antipsychotic medications may decrease the patient’s paranoia and anxiety. Under situations of stress, some patients decompensate, and the paranoid ideation reaches delusional proportions. In such cases antipsychotic medication can be of obvious benefit.
Group therapy can be quite difficult for patients with paranoid personality disorder. Their lack of basic trust and their suspiciousness often prevent them from being integrated fully into groups. Their wariness and suspiciousness may become self-fulfilling, as their hostility makes other members uncomfortable and rejecting. Paranoid personality disorder patients sometimes present for treatment as couples or as a family. Working with them in this context is also difficult, since such patients often feel that the therapist and family members are working against them.
Patients with paranoid personality disorder represent a unique challenge to the psychotherapist. They lack trust, and thus, rarely enter treatment unless there is another coexisting emotional disorder, such as a mood or anxiety disorder, or coercion from a family member or employee. They have difficulty relinquishing control, and may not tolerate the ambiguity associated with the less directive interventions. Among behavioral techniques used, social skills role playing, particularly involving appropriate expression of assertiveness has been reported. No therapeutic techniques have actually been proven efficacious in treating paranoid personality disorder patients. However, clinical wisdom suggests that cognitive techniques that focus on the patient’s overgeneralizations (e.g., “That person didn’t talk to me; therefore, he hates me.”) and their propensity to dichotomize the social world into trustworthy and hostile are useful. With psychodynamic and interpersonal approaches, interpretations are used sparingly, and treatment focuses on the gradual recognition of the origins and negative consequences of the patient’s mistrust.
Little is known about the long-term outcome of paranoid personality disorder. Although the disorder is difficult to treat, patients generally appear to have a greater adaptive capacity than do those who have personality disorders associated with severe social detachment. However, under stress, patients with paranoid personality disorder usually withdraw and avoid interpersonal attachments, thus perpetuating their mistrust, and they may become overtly psychotic.
DSM-IV-TR Diagnostic Criteria
A pervasive pattern of detachment from social relationships and a restricted range of expression of emotions in interpersonal settings, beginning by early adulthood and present in a variety of contexts, as indicated by four (or more) of the following:
neither desires nor enjoys close relationships, including being part of a family
almost always chooses solitary activities
has little, if any, interest in having sexual experiences with another person
takes pleasure in few, if any, activities
lacks close friends or confidants other than first-degree relatives
appears indifferent to the praise or criticism of others
shows emotional coldness, detachment, or flattened affectivity
Does not occur exclusively during the course of schizophrenia, a mood disorder with psychotic features, another psychotic disorder, or a pervasive developmental disorder and is not due to the direct physiological effects of a general medical condition.
(Reprinted, with permission, from the Diagnostic and Statistical Manual of Mental Disorders. 4th edn. Text Revision. Washington, DC: American Psychiatric Association, 2000.)
Estimates of the prevalence of schizoid personality disorder in the general population vary with the criteria used, ranging from 0.5–7% and individuals with this disorder are relatively uncommon in clinical settings. The disorder occurs more often in men than in women and may be more severe in men. The general withdrawal of patients with schizoid personality disorder means that they rarely disturb others, and in part this accounts for their rare appearance in treatment settings.
The diagnosis of schizoid personality disorder has become restricted to people with a profound defect in the ability to form personal relationships and to respond to others in a meaningful way.
The causes of schizoid personality disorder are not well understood. Genetic factors are suspected, and some reports suggest that patients with this disorder often come from environments that are deficient in emotional nurturing. There is also evidence that famine may be associated with schizoid personality disorder, as it appears to be with schizophrenia.
The symptoms of schizoid personality disorder resemble the negative symptoms of schizophrenia. Thus, an increased prevalence of schizoid personality disorder among individuals with a family history of schizophrenia might be expected.
However, schizoid personality disorder does not appear to have a strong genetic relationship to schizophrenia. Finally, many of the features of Asperger syndrome also resemble schizoid personality disorder, and the possibility of a relationship to autism exists.
In the case of the schizoid personality, the individual is not necessarily distressed or disturbing of others. Thus, the life history of patients with schizoid personality disorder is typically characterized by a preference for solitary pursuits. These individuals may have none or only a few intimate relationships, and show little apparent interest in people, outside of internal fantasy. Social detachment and restricted emotional expressivity, i.e., affective constriction, make these patients appear aloof, distant, and difficult to engage. Schizoid personality patients are more likely to demonstrate interest when describing abstract pursuits that require no emotional involvement. Although reality testing is generally intact, schizoid personality disorder patients’ lack of social contact precludes the correction of their somewhat idiosyncratic interpretations of social transactions.
Patients with schizoid personality disorder resemble individuals with avoidant personality disorder (to be described later). They can be distinguished from those with avoidant personality disorder by their indifference to others. They also may be confused with patients with schizotypal personality disorder. In contrast to schizotypal personality disorder, the schizoid personality disorder patient is affectively flat and unresponsive, rather than behaviorally eccentric, with odd thoughts, although both disorders often co-occur. Finally, the schizoid personality disorder patient may share a number of symptoms in common with patients with Asperger syndrome.
Little is known about the effective pharmacologic treatment of schizoid personality disorder. Thus far, effective pharmacotherapy has not been demonstrated for the disorder as such, although associated anxiety and depression when it occurs may be treated with antidepressant and other medications.
Often individuals with schizoid personality disorder come to treatment at the request of family members. In some cases, family-based interventions may be helpful in clarifying for the patient the family’s expectations, and perhaps in addressing any intolerance and invasiveness on the part of the family that could be worsening the patient’s withdrawal.
Group therapy can also be helpful as a source of directed feedback from others that would otherwise be missed or ignored. Such a setting can also allow for the modeling and acquisition of needed social skills. However, the initial participation of the schizoid personality disorder patient will invariably be minimal, and the therapist may sometimes need to act to prevent the patient from being the hostile target of other group members. However, as with so many therapies, the above assertions are based on clinical wisdom, and have not been proven experimentally.
Psychotherapeutic interventions tend to be difficult to accomplish in the patient with schizoid personality disorder. Such patients are often not psychologically minded and typically experience little perceived distress. The tendency of these patients to intellectualize and distance themselves from emotional experience can also restrict the impact of treatment.
The therapeutic alliance is often impeded by the low value that these individuals place on relationships. However, clinical wisdom suggests that more cognitively based treatment approaches may receive greater initial acceptance. Distorted expectancies and perceptions about the importance and usefulness of relationships with others can be explored.
Patients with schizoid personality disorder display problems at an earlier age, i.e., in early childhood, than do patients with other personality disorders. Social disinterest tends to self-perpetuate isolation, as does flattened affect. However, relative to patients with other personality disorders, those with schizoid personality disorder are less likely to experience anxiety or depression, particularly if they are not in social, educational, or occupational situations that tax their limited social skills. Also, the number of individuals with schizoid personality disorder who are not in mental health care may be large, and such individuals may be relatively well-adjusted to their lives.
DSM-IV-TR Diagnostic Criteria
A pervasive pattern of social and interpersonal deficits marked by acute discomfort with, and reduced capacity for, close relationships, as well as by cognitive or perceptual distortions and eccentricities of behavior, beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following:
ideas of reference (excluding delusions of reference)
odd beliefs or magical thinking that influence behavior or is inconsistent with cultural norms (e.g., superstitious, belief in clairvoyance, telepathy, or “sixth sense”; in children and adolescents, bizarre fantasies or preoccupations)
unusual perceptual experiences (including bodily illusions)
odd thinking and speech (e.g., vague, circumstantial, metaphorical, overelaborative, or stereotyped)
suspiciousness or paranoid ideation
inappropriate or constricted affect
behavior or appearance that is odd, eccentric, or peculiar
lack of close friends or confidants other than first-degree relatives
Does not occur exclusively during the course of schizophrenia, a mood disorder with psychotic features, another psychotic disorder, or a pervasive developmental disorder.
(Reprinted, with permission, from the Diagnostic and Statistical Manual of Mental Disorders. 4th edn. Text Revision. Washington, DC: American Psychiatric Association, 2000.)
The prevalence rate of schizotypal personality disorder has been estimated at approximately 3–5% of the general population. Furthermore, up to 30% of general psychiatric outpatients have one or more schizotypal traits, with comorbidity existing with mood, substance-use, and anxiety disorders. Men are slightly more likely to have the disorder.
Schizotypal personality disorder occurs significantly more frequently among the biological relatives of schizophrenic individuals than in the general population. This finding, together with the results of twin studies, suggests a genetic relationship to schizophrenia. Of all of the personality disorders, schizotypal personality disorder most strongly shows a continuum with schizophrenia. Thus, it is likely that those etiologic factors which induce schizophrenia are similar to those which induce schizotypal personality disorder.
The concept of schizotypal personality disorder originally developed because of the fact that relatives of schizophrenic patients often had symptoms similar to schizophrenia. There is also evidence that biologic and neuro-cognitive markers of schizophrenia are shared with patients with schizotypal personality disorder. Schizotypal personality disorder is currently thought to be a component of schizophrenia spectrum disorders (which also includes schizoaffective disorder, schizophreniform disorder, and psychotic mood disorders). As such it may not clearly be an actual personality disorder.
Schizotypal personality disorder is characterized by peculiar behavior, odd thoughts, odd speech, unusual perceptive experiences, and magical beliefs. These patients usually have negative or poor rapport and show social dysfunction, social anxiety, and a lack of motivation. They are frequently underachievers with regard to occupational status.
The disorder may be manifested during childhood or adolescence as social isolation and peculiar behavior or language. Although the features of the disorder resemble schizophrenia, rates of depression and anxiety are also quite high among such patients. The latter features often constitute the presenting complaint, rather than the ongoing cognitive anomalies.
A dimensional system can be applied to the characterization of schizotypal personality disorder patients precisively and cluster A disorders patient’s in general. The components of the cluster A diagnoses, such as aloofness, mistrust, suspiciousness, eccentricity, vulnerability, anxiousness, interpersonal sensitivity, introspection and introversion, negative temperament, perceptual cognitive distortions, restricted expression, and evidence of intimacy avoidance can be considered on a continuum, allowing placement in a given individual between normalcy and psychopathology.
Alternatively, cluster A disorders can be considered from the perspective of personality traits and temperamental characteristics. Thus, for example, schizotypal personality disorder patients are associated with high levels of neuroticism and low levels of conscientiousness, agreeableness, and extroversion. Furthermore, Cluster A personality disorder patients in general show high levels of introversion, most dramatically in individuals with schizoid personality disorder.
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