PSYCHIATRY: PERSONALITY DISORDERS

Reclusive, self-sequestered, hermitical; self-protectively secluded from omnipresent threats and destructive forces; hypervigilant and defensive against imagined dangers.

Malignant paranoid

+ Sadistic

Belligerent, cantankerous, intimidating, vengeful, callous, and tyrannical; hostility vented primarily in fantasy; projects own venomous outlook onto others; persecutory delusions.

Obdurate paranoid

+ Obsessive-compulsive

Self-assertive, unyielding, stubborn, steely, implacable, unrelenting, dyspeptic, peevish, and cranky stance; legalistic and self-righteous; discharges previously restrained hostility; renounces self-other conflict.

Querulous paranoid

Contentious, caviling, fractious, argumentative, faultfinding, unaccommodating, resentful, choleric, jealous, peevish, sullen, endless wrangles, whiny, waspish, snappish.

SCHIZOID PERSONALITY DISORDER

DSM-V

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: -
1. Neither desires nor enjoys close relationships, including being part of a family.
2. Almost always chooses solitary activities.
3. Has little, if any, interest in having sexual experiences with another person.
4. Takes pleasure in few, if any, activities.
5. Lacks close friends or confidants other than first-degree relatives.
6. Appears indifferent to the praise or criticism of others.
7. Shows emotional coldness, detachment, or flattened affectivity.

ICD-10

Characterized by withdrawal from affectional, social and other contacts with preference for fantasy, solitary activities, and introspection.
There is a limited capacity to express feelings and to experience pleasure.

VARIANTS

Affectless schizoid

+ Obsessive-compulsive

Passionless, unresponsive, unaffectionate, chilly, uncaring, unstirred, spiritless, lackluster, unexcitable, unperturbed, cold; all emotions diminished.

Depersonalized schizoid

+ Schizotypal

Disengaged from others and self; self is disembodied or distant object; body and mind sundered, cleaved, dissociated, disjoined, eliminated.

Languid schizoid

Marked inertia; deficient activation level; intrinsically phlegmatic, lethargic, weary, leaden, lackadaisical, exhausted, enfeebled.

Remote schizoid

+ Avoidant, schizotypal

Distant and removed; inaccessible, solitary, isolated, homeless, disconnected, secluded, aimlessly drifting; peripherally occupied.

SCHIZOTYPAL PERSONALITY DISORDER (SCHIZOTYPAL DISORDER)

DSM-V

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: -
1. Ideas of reference (excluding delusions of reference).
2. Odd beliefs or magical thinking that influences behavior and is inconsistent with subcultural norms (e.g., superstitiousness, belief in clairvoyance, telepathy, or "sixth sense": in children and adolescents, bizarre fantasies or preoccupations).
3. Unusual perceptual experiences, including bodily illusions.
4. Odd thinking and speech (e.g., vague, circumstantial, metaphorical, overelaborate, or stereotyped).
5. Suspiciousness or paranoid ideation.
6. Inappropriate or constricted affect.
7. Behavior or appearance that is odd, eccentric, or peculiar.
8. Lack of close friends or confidants other than first-degree relatives.
9. Excessive social anxiety that does not diminish with familiarity and tends to be associated with paranoid fears rather than negative judgments about self.

ICD-11

An enduring pattern of unusual speech, perceptions, beliefs and behaviours that are not of sufficient intensity or duration to meet the diagnostic requirements of Schizophrenia, Schizoaffective Disorder, or Delusional Disorder. The pattern includes several of the following symptoms: -
Constricted affect, such that the individual appears cold and aloof;
Behaviour or appearance that is odd, eccentric, unusual, or peculiar and is inconsistent with cultural or subcultural norms;
Poor rapport with others and a tendency towards social withdrawal;
Unusual beliefs or magical thinking influencing the person's behaviour in ways that are inconsistent with subcultural norms, but not reaching the diagnostic requirements for a delusion;
Unusual perceptual distortions such as intense illusions, depersonalization, derealization, or auditory or other hallucinations;
Suspiciousness or paranoid ideas;
Vague, circumstantial, metaphorical, overelaborate, or stereotyped thinking, manifest in odd speech without gross incoherence;
Obsessive ruminations without a sense that the obsession is foreign or unwanted, often with body dysmorphic, sexual, or aggressive content.

VARIANTS

Insipid schizotypal

+ Dependent, depressive, schizoid

Sense of stangeness and nonbeing; overtly drab, sluggish, inexpressive; internally bland, barren, indifferent, and insensitive; thoughts obscured, vague, and tangential; bizzarre telepathic powers.

Timorous schizotypal

+ Avoidant, negativistic

Warily apprehensive, watchful, suspicious, guarded, shrinking, deadens excess sensitivity; alienated from self and others; intentionally blocks, reverses, or disqualifies own thoughts.

CLUSTER B: DRAMATIC, EMOTIONAL, ERRATIC

ANTISOCIAL (DISSOCIAL) PERSONALITY DISORDER

DSM-V

A pervasive pattern of disregard for and violation of the rights of others, occurring since age 15 years, as indicated by three (or more) of the following: -
1. Failure to conform to social norms with respect to lawful behaviors, as indicated by repeatedly performing acts that are grounds for arrest.
2. Deceitfulness, as indicated by repeated lying, use of aliases, or conning others for personal profit or pleasure.
3. Impulsivity or failure to plan ahead.
4. Irritability and aggressiveness, as indicated by repeated physical fights or assaults.
5. Reckless disregard for safety of self or others.
6. Consistent irresponsibility, as indicated by repeated failure to sustain consistent work behavior or honor financial obligations.
7. Lack of remorse, as indicated by being indifferent to or rationalizing having hurt, mistreated, or stolen from another.

ICD-10

Characterized by disregard for social obligations, and callous unconcern for the feelings of others.
There is gross disparity between behaviour and the prevailing social norms.
Behaviour is not readily modifiable by adverse experience, including punishment.
There is a low tolerance to frustration and a low threshold for discharge of aggression, including violence;
there is a tendency to blame others, or to offer plausible rationalizations for the behaviour bringing the patient into conflict with society.

Includes: amoral; asocial; psychopathic; sociopathic

VARIANTS

Covetous antisocial

Feels intentionally denied and deprived; rapacious, begrudging, discontentedly yearning; envious, seeks retribution, and avariciously greedy; pleasure more in taking than in having.

Malevolent antisocial

+ Paranoid, sadistic

Belligerent, mordant, rancorous, vicious, malignant, brutal, resentful; anticipates betrayal and punishment; desires revenge; truculent, callous, fearless; guiltless.

Nomadic antisocial

+ Avoidant, schizoid

Feels jinxed, ill-fated, doomed, and cast aside; peripheral, drifters; gypsy-like roamers, vagrants; dropouts and misfits; intinerant vagabonds, tramps, wanderers; impulsively not benign.

Reputation-defending antisocial

+ Narcissistic

Needs to be thought of as unflawed, unbreakable, invincible, indomitable; formidable, inviolable; intransigent when status is questioned; overreactive to slights.

Risk-taking antisocial

+ Histrionic

Dauntless, venturesome, intrepid, bold, audacious, daring; reckless, foolhardy, impulsive, heedless; unbalanced by hazard; pursues perilous ventures.

BORDERLINE (EMOTIONALLY UNSTABLE) PERSONALITY DISORDER

DSM-V

A pervasive pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsivity, beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following: -
1. Frantic efforts to avoid real or imagined abandonment. (Note: Do not include suicidal or self-mutilating behavior covered in Criterion 5.)
2. A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation.
3. Identity disturbance: markedly and persistently unstable self-image or sense of self.
4. Impulsivity in at least two areas that are potentially self-damaging (e.g., spending, sex, substance abuse, reckless driving, binge eating). (Note: Do not include suicidal or self-mutilating behavior covered in Criterion 5.)
5. Recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior.
6. Affective instability due to a marked reactivity of mood (e.g., intense episodic dysphoria, irritability, or anxiety usually lasting a few hours and only rarely more than a few days).
7. Chronic feelings of emptiness.
8. Inappropriate, intense anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights).
9. Transient, stress-related paranoid ideation or severe dissociative symptoms.

ICD-10

Characterized by a definite tendency to act impulsively and without consideration of the consequences;
the mood is unpredictable and capricious.
There is a liability to outbursts of emotion and an incapacity to control the behavioural explosions.
There is a tendency to quarrelsome behaviour and to conflicts with others, especially when impulsive acts are thwarted or censored.
Two types may be distinguished: -
- the impulsive type, characterized predominantly by emotional instability and lack of impulse control, and
- the borderline type, characterized in addition by disturbances in self-image, aims, and internal preferences, by chronic feelings of emptiness, by intense and unstable interpersonal relationships, and by a tendency to self-destructive behaviour, including suicide gestures and attempts.

Includes: aggressive; explosive

VARIANTS

Discouraged borderline

+ Avoidant, dependent, depressive

Pliant, submissive, loyal, humble; feels vulnerable and in constant jeopardy; feels hopeless, depressed, helpless, and powerless.

Impulsive borderline

+ Antisocial, histrionic

Capricious, superficial, flighty, distractible, frenetic, and seductive; fearing loss, becomes agitated, and gloomy and irritable; potentially suicidal.

Petulant borderline

Negativistic, impatient, restless, as well as stubborn defiant, sullen, pessimistic, and resentful; easily slighted and quickly disillusioned.

Self-destructive borderline

+ Depressive, self-defeating

Inward-turning, intropunitively angry; conforming, deferential, and ingratiating behaviors have deteriorated; increasingly high-strung and moody; possible suicide.

HISTRIONIC PERSONALITY DISORDER

DSM-V

A pervasive pattern of excessive emotionality and attention seeking, beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following: -
1. Is uncomfortable in situations in which he or she is not the center of attention.
2. Interaction with others is often characterized by inappropriate sexually seductive or provocative behavior.
3. Displays rapidly shifting and shallow expression of emotions.
4. Consistently uses physical appearance to draw attention to self.
5. Has a style of speech that is excessively impressionistic and lacking in detail.
6. Shows self-dramatization, theatricality, and exaggerated expression of emotion.
7. Is suggestible (i.e., easily influenced by others or circumstances).
8. Considers relationships to be more intimate than they actually are.

ICD-10

Characterized by shallow and labile affectivity, self-dramatization, theatricality, exaggerated expression of emotions, suggestibility, egocentricity, self-indulgence, lack of consideration for others, easily hurt feelings, and continuous seeking for appreciation, excitement and attention.

Includes: hysterical; psychoinfantile

VARIANTS

Appeasing histrionic + Dependent, obsessive-compulsive Seeks to placate, mend, patch up, smooth over troubles; knack for settling differences, moderating tempers by yielding, compromising, conceding; sacrifices self for commendation; fruitlessly placates the unplacatable.	Disingenuous histrionic + Antisocial Underhanded, double-dealing, scheming, contriving, plotting, crafty, false-hearted; egocentric, insincere, deceitful, calculating, guileful.	Infantile histrionic + Borderline Labile, high-strung, volatile emotions; childlike hysteria and nascent pouting; demanding, overwrought; fastens and clutches to another; is overly attached, hangs on, stays fused to and clinging.
Tempestuous histrionic + Negativistic Impulsive, out of control; moody complaints, sulking; precipitous emotion, stormy, impassioned, easily wrought-up, periodically inflamed, turbulent.	Theatrical histrionic Affected, mannered, put-on; postures are striking, eyecatching, graphic; markets self-appearance; is synthesized, stagy; simulates desirable/dramatic poses.	Vivacious histrionic + Narcissistic Vigorous, charming, bubbly, brisk, spirited, flippant, impulsive; seeks momentary cheerfulness and playful adventures; animated, energetic, ebullient.

NARCISSISTIC PERSONALITY DISORDER

DSM-V

A pervasive pattern of grandiosity (in fantasy or behavior), need for admiration, and lack of empathy, beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following: -
1. Has a grandiose sense of self-importance (e.g., exaggerates achievements and talents, expects to be recognized as superior without commensurate achievements).
2. Is preoccupied with fantasies of unlimited success, power, brilliance, beauty, or ideal love.
3. Believes that he or she is "special" and unique and can only be understood by, or should associate with, other special or high-status people (or institutions). 4. Requires excessive admiration.
5. Has a sense of entitlement (i.e., unreasonable expectations of especially favorable treatment or automatic compliance with his or her expectations).
6. Is interpersonally exploitative (i.e., takes advantage of others to achieve his or her own ends).
7. Lacks empathy: is unwilling to recognize or identify with the feelings and needs of others.
8. Is often envious of others or believes that others are envious of him or her.
9. Shows arrogant, haughty behaviors or attitudes.

VARIANTS

Amorous narcissist + Histrionic Sexually seductive, enticing, beguiling, tantalizing; glib and clever; disinclines real intimacy; indulges hedonistic desires; bewitches and inveigles the needy and naïve; pathological lying and swindling.	Closet narcissist + Borderline May appear quite normal at first glance. Many people with the closet narcissistic subtype just seem warm, a bit insecure and needy, and somewhat neurotic. They find indirect ways to get attention.	Compensatory narcissist + Avoidant, negativistic Seeks to counteract or cancel out deep feelings of inferiority and lack of self-esteem; offsets deficits by creating illustions of being superior, exceptional, admirable, noteworthy; self-worth results from self-enhancement.	Elitist narcissist Feels privileged and empowered by virtue of special childhood status and pseudo-achievements; entitled façade bears little relation to reality; seeks favored and good life; is upwardly mobile; cultivates special status and avantages by association.
Fragile narcissist Experience feelings of grandiosity and inadequacy, suggesting alternating cognitive representations of self (superior versus inferior), defensive grandiosity, or a grandiosity that emerges under threat.	Grandiose/malignant narcissist + Antisocial, sadistic Exploit others with little regard for their welfare, and (unlike other narcissistic patients) their grandiosity appears to be primary rather than defensive or compensatory.	High-functioning/exhibitionistic narcissist Are grandiose, competitive, attention seeking, and sexually seductive or provocative, and also have significant psychological strengths (e.g., being articulate, energetic, interpersonally comfortable, achievement oriented).	Unprincipled narcissist + Antisocial Deficient conscience; unscrupulous, amoral, disloyal, fradulent, deceptive, arrogant, exploitive; a con man and charlatan; dominating, contemptuous, vindictive.

CLUSTER C: ANXIOUS, FEARFUL

AVOIDANT (ANXIOUS) PERSONALITY DISORDER

DSM-V

A pervasive pattern of social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation, beginning by early adulthood and present in a variety of contexts, as indicated by four (or more) of the following: -
1. Avoids occupational activities that involve significant interpersonal contact because of fears of criticism, disapproval, or rejection.
2. Is unwilling to get involved with people unless certain of being liked.
3. Shows restraint within intimate relationships because of the fear of being shamed or ridiculed.
4. Is preoccupied with being criticized or rejected in social situations.
5. Is inhibited in new interpersonal situations because of feelings of inadequacy.
6. Views self as socially inept, personally unappealing, or inferior to others.
7. Is unusually reluctant to take personal risks or to engage in any new activities because they may prove embarrassing.

ICD-10

Characterized by feelings of tension and apprehension, insecurity and inferiority.
There is a continuous yearning to be liked and accepted, a hypersensitivity to rejection and criticism with restricted personal attachments, and a tendency to avoid certain activities by habitual exaggeration of the potential dangers or risks in everyday situations.

VARIANTS

Cold-avoidant Characterised by an inability to experience and express positive emotion towards others.	Conflicted avoidant + Negativistic Internal discord and dissension; fears independence and dependence; unsettled; unreconciled within self; hesitating, confused, tormented, paroxysmic, embittered; unresolvable angst.	Exploitable-avoidant Characterised by an inability to express anger towards others or to resist coercion from others. May be at risk for abuse by others.
Hypersensitive avoidant + Paranoid Intensely wary and suspicious; alternately panicky, terrified, edgy, and timorous, then thin-skinned, high-strung, petulant, and prickly.	Phobic avoidant + Dependent General apprehensiveness displaced with avoidable tangible precipant; qualms and disquietude symbolized by repugnant and specific dreadful object or circumstances.	Self-deserting avoidant + Depressive Blocks or fragments self-awareness; discards painful images and memories; casts away untenable thoughts and impulses; ultimately jettisons self (suicidal).

DEPENDENT PERSONALITY DISORDER

DSM-V

A pervasive and excessive need to be taken care of that leads to submissive and clinging behavior and fears of separation, beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following: -
1. Has difficulty making everyday decisions without an excessive amount of advice and reassurance from others.
2. Needs others to assume responsibility for most major areas of his or her life.
3. Has difficulty expressing disagreement with others because of fear of loss of support or approval. (Note: Do not include realistic fears of retribution.)
4. Has difficulty initiating projects or doing things on his or her own (because of a lack of self-confidence in judgment or abilities rather than a lack of motivation or energy).
5. Goes to excessive lengths to obtain nurturance and support from others, to the point of volunteering to do things that are unpleasant.
6. Feels uncomfortable or helpless when alone because of exaggerated fears of being unable to care for himself or herself.
7. Urgently seeks another relationship as a source of care and support when a close relationship ends.
8. Is unrealistically preoccupied with fears of being left to take care of himself or herself.

ICD-10

Characterized by pervasive passive reliance on other people to make one's major and minor life decisions, great fear of abandonment, feelings of helplessness and incompetence, passive compliance with the wishes of elders and others, and a weak response to the demands of daily life.
Lack of vigour may show itself in the intellectual or emotional spheres;
there is often a tendency to transfer responsibility to others.

Includes: asthenic; inadequate; passive; self-defeating

VARIANTS

Accommodating dependent

+ Self-defeating

Gracious, neighborly, eager, benevolent, compliant, obliging, agreeable; denies disturbing feelings; adopts submissive and inferior role well.

Disquieted dependent

Restlessly perturbed; disconcerted and fretful; feels dread and foreboding; apprehensively vulnerable to abandonment; lonely unless near supportive figures.

Immature dependent

Unsophisticated, half-grown, unversed, childlike; undeveloped, inexperienced, gullible, and unformed; incapable of assuming adult responsibilities.

Ineffectual dependent

+ Schizoid

Unproductive, gainless, incompetent, useless, meritless; seeks untroubled life; refuses to deal with difficulties; untroubled by shortcomings.

Selfless dependent

Merges with and immersed into another; is engulfed, enshrouded, absorbed, incorporated, willingly giving up own identity; becomes one with or an extension of another.

OBSESSIVE-COMPULSIVE (ANANKASTIC) PERSONALITY DISORDER

DSM-V

A pervasive pattern of preoccupation with orderliness, perfectionism, and mental and interpersonal control, at the expense of flexibility, openness, and efficiency, beginning by early adulthood and present in a variety of contexts, as indicated by four (or more) of the following: -
1. Is preoccupied with details, rules, lists, order, organization, or schedules to the extent that the major point of the activity is lost.
2. Shows perfectionism that interferes with task completion (e.g., is unable to complete a project because his or her own overly strict standards are not met).
3. Is excessively devoted to work and productivity to the exclusion of leisure activities and friendships (not accounted for by obvious economic necessity).
4. Is overconscientious, scrupulous, and inflexible about matters of morality, ethics, or values (not accounted for by cultural or religious identification).
5. Is unable to discard worn-out or worthless objects even when they have no sentimental value.
6. Is reluctant to delegate tasks or to work with others unless they submit to exactly his or her way of doing things.
7. Adopts a miserly spending style toward both self and others; money is viewed as something to be hoarded for future catastrophes.
8. Shows rigidity and stubbornness.

ICD-10

Characterized by feelings of doubt, perfectionism, excessive conscientiousness, checking and preoccupation with details, stubbornness, caution, and rigidity.
There may be insistent and unwelcome thoughts or impulses that do not attain the severity of an obsessive-compulsive disorder.

Includes: compulsive; obsessional

VARIANTS

Bedeviled compulsive

Ambivalences unresolved; feels tormented, muddled, indecisive, befuddled; beset by intrapsychic conflicts, confusions, frustrations; obsessions and compulsions condense and control contradictory emotions.

Bureaucratic compulsive

+ Narcissistic

Empowered in formal organizations; rules of group provide identity and security; officious, high-handed, unimaginative, intrusive, nosy, petty-minded, meddlesome, trifling, closed-minded.

Conscientious compulsive

+ Dependent

Rule-bound and duty-bound; earnest, hardworking, meticulous, painstaking; indecisive, inflexible; marked self-doubts; dreads errors and mistakes.

Parsimonious compulsive

+ Schizoid

Miserly, niggardly, tight-fisted, ungiving, hoarding, unsharing; protects self against loss; fears intrusions into vacant inner world; dreads exposure of personal improprietries and contrary impulses.

Puritanical compulsive

+ Paranoid

Austere, self-righteous, bigoted, dogmatic, zealous, uncompromising, indignant, and judgmental; grim and prudish morality; must control and counteract own repugnant impulses and fantasies.

OTHER PROPOSED PERSONALITY DISORDERS

COMPENSATORY NARCISSISTIC PERSONALITY DISORDER

PTYPES

A pervasive pattern of unstable, "overtly narcissistic behaviors [that] derive from an underlying sense of insecurity and weakness rather than from genuine feelings of self-confidence and high self-esteem," beginning by early adulthood and present in a variety of contexts, as indicated by ten (or more) of the following: -
1. Seeks to create an illusion of superiority and to build up an image of high self-worth.
2. Has disturbances in the capacity for empathy.
3. Strives for recognition and prestige to compensate for the lack of a feeling of self-worth.
4. May acquire a deprecatory attitude in which the achievements of others are ridiculed and degraded.
5. Has persistent aspirations for glory and status.
6. Has a tendency to exaggerate and boast.
7. Is sensitive to how others react to him or her, watches and listens carefully for critical judgment, and feels slighted by disapproval.
8. Is prone to feel shamed and humiliated and especially hyper-anxious and vulnerable to the judgments of others.
9. Covers up a sense of inadequacy and deficiency with pseudo-arrogance and pseudo-grandiosity.
10. Has a tendency to periodic hypochondria.
11. Alternates between feelings of emptiness and deadness and states of excitement and excess energy.
12. Entertains fantasies of greatness, constantly striving for perfection, genius, or stardom.
13. Has a history of searching for an idealized partner and has an intense need for affirmation and confirmation in relationships.
14. Frequently entertains a wishful, exaggerated, and unrealistic concept of himself or herself which he or she can't possibly measure up to.
15. Produces (too quickly) work not up to the level of his or her abilities because of an overwhelmingly strong need for the immediate gratification of success.
16. Is touchy, quick to take offense at the slightest provocation, continually anticipating attack and danger, reacting with anger and fantasies of revenge when he or she feels frustrated in his or her need for constant admiration.
17. Is self-conscious, due to a dependence on approval from others.
18. Suffers regularly from repetitive oscillations of self-esteem.
19. Seeks to undo feelings of inadequacy by forcing everyone's attention and admiration upon himself or herself.
20. May react with self-contempt and depression to the lack of fulfillment of his or her grandiose expectations.

CYCLOTHYMIC (AFFECTIVE) PERSONALITY DISORDER

PTYPES

A pervasive pattern of pronounced periodic changes in mood, behavior, thinking, sleep, and energy levels, beginning by early adulthood and present in a variety of contexts, as indicated by seven (or more) of the following: -
1. Has depressive periods: depressed mood or loss of interest or pleasure in all, or almost all, activities and pastimes alternating with hypomanic periods: elevated, expansive, or irritable mood.
2. Becomes excessively involved in pleasurable activities with lack of concern for the high potential of painful consequences alternating with restriction of involvement in pleasurable activities and guilt over past activities.
3. Alternates between over-optimism or exaggeration of past achievement and a pessimistic attitude toward the future, or brooding about past events.
4. Is more talkative than usual, with inappropriate laughing, joking, and punning: and, then, less talkative, with tearfulness or crying.
5. Has a decreased need for sleep alternating with hypersomnia.
6. Has shaky self-esteem: naive grandiose overconfidence alternating with lack of self-confidence.
7. Has periods of sharpened and creative thinking alternating with periods of mental confusion and apathy.
8. Displays marked unevenness in the quantity and quality of productivity, often associated with unusual working hours.
9. Engages in uninhibited people-seeking (that may lead to hyper-sexuality) alternating with introverted self-absorption.
10. Frequently shifts line of work, study, interest, or future plans.
11. Engages in occasional financial extravagance.
12. Has a tendency toward promiscuity, with repeated conjugal or romantic failure.
13. May use alcohol or drugs to control moods or to augment excitement.
14. Has irritable-angry-explosive outbursts that alienate loved ones.
15. Makes frequent changes in residence or geographical location.

DSM-II

This behavior pattern is manifested by recurring and alternating periods of depression and elation.
Periods of elation may be marked by ambition, warmth, enthusiasm, optimism, and high energy.
Periods of depression may be marked by worry, pessimism, low energy, and a sense of futility.
These mood variations are not readily attributable to external circumstances.
If possible, the diagnosis should specify whether the mood is characteristically depressed, hypomanic, or alternating.

DEPRESSIVE PERSONALITY DISORDER

DSM-IV (APPENDIX B)

A pervasive pattern of depressive cognitions and behaviors beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following: -
1. Usual mood is dominated by dejection, gloominess, cheerlessness, joylessness, unhappiness.
2. Self-concept centers around beliefs of inadequacy, worthlessness, and low self-esteem.
3. Is critical, blaming, and derogatory toward self.
4. Is brooding and given to worry.
5. Is negativistic, critical, and judgmental toward others.
6. Is pessimistic.
7. Is prone to feeling guilty or remorseful.

VARIANTS

Ill-humored depressive

Sour, distempered, cantankerous, irritable, grumbling discontentment; guilt-ridden and self-condeming; self-pitying; hypochondriacal.

Morbid depressive

+ Self-defeating

Profound dejection and gloom; haggard, morose, lugubrious, macabre, drained, oppressed; intensely self-abnegating.

Restive depressive

Wrought-up despair; agitated, ruffled, perturbed, confused, restless, and unsettled; vacillatory emotions and outlook; suicide avoids inescapable pain.

Self-derogating depressive

+ Dependent

Disparaging self for weaknesses and shortcomings; self-deriding, discrediting, censurable, dishonorable, odious, contemptible.

Voguish depressive

+ Histrionic, narcissistic

Suffering seen as ennobling; unhappiness considered a popular and stylish mode of social disenchantment; personal depression viewed as self-glorifying and dignifying.

**"HALTLOSE" PERSONALITY DISORDER**

C. LANGMAACK

Those with haltlose personality disorder have features of frontal lobe syndrome, sociopathic and histrionic personality traits.
1. He or she lacks concentration and persistence and lives in the present only. His or her immediate affects, moods and interests rule completely; he or she has no interest in the future, and no hold in the past: in this sense he or she is quite at mercy of the environment. He or she is certainly easily persuaded, and is often led astray by the surrounding persons, sometimes criminals.
2. He or she mixes well with sociopaths as he or she also has an inability to learn from experience, and no sincere sense of remorse for his or her actions.
3. In common with the histrionic personality he or she has a number of endearing qualities: charming with an apparent emotional warmth, but also an enhanced suggestibility and a superficiality of affect. He or she is usually overoptimistic and pleasant to be with. This makes him or her quite a likeable character, the ‘lovable rogue' which we sometimes see in our substance misuse clinic.

IMMATURE PERSONALITY DISORDER (EMOTIONAL IMMATURITY)

DEPRESSIONALS.COM

People with immature personalities tend to lack social and emotional skills, as well as have difficulty relating to other adults. You can tell that someone is emotionally immature if they exhibit the following behaviors: -
Impulsive behavior: Children often exhibit this behavior. It is common for them to speak out of turn, for example. They don't consider the effects their words may have on others. People eventually learn not to repeat such mistakes. The emotional immaturity of adults leads them to act on impulses rather than think before acting. Adults make unintentional or antisocial decisions.
Demanding attention: When people aren't paying attention to young children, they become bored. It isn't uncommon for them to act out in negative ways in order to draw attention back to themselves. People who lack emotional maturity often do the same. Even if they don't act out negatively, they may try to get everyone's attention by injecting themselves into discussions or by cracking inappropriate jokes.
Name-calling and bullying: Adults generally avoid schoolyard tactics in their interactions with others. It is rare that two adults use names to insult each other. Behaviorally acting like a mean kid in school shows that the individual is not in control of their emotions. This shows that the individual is acting like a child.
Avoidance: People with emotional immaturity may not be able to plan for the future well. It is an indication of avoiding responsibility when you don't take on significant roles in your life, such as marriage, career, or investment such as homeownership. Individuals like this are likely to let others take care of their needs too far beyond what they should be able to provide for themselves. Sometimes, this condition is referred to as Peter Pan syndrome, named after the fictional character who has no desire to grow up.
Narcissism: Understanding other people's feelings and needs is one of the essentials of maturity. People who are immature seem to only care about themselves. A person does not want to compromise or consider the opinions of others. He or she always wants to do things his or her own way.

NEGATIVISTIC (PASSIVE-AGGRESSIVE) PERSONALITY DISORDER

DSM-IV (APPENDIX B)

A pervasive pattern of negativistic attitudes and passive resistance to demands for adequate performance, beginning by early adulthood and present in a variety of contexts, as indicated by four (or more) of the following: -
1. Passively resists fulfilling routine social and occupational tasks.
2. Complains of being misunderstood and unappreciated by others.
3. Is sullen and argumentative.
4. Unreasonably criticizes and scorns authority.
5. Expresses envy and resentment toward those apparently more fortunate.
6. Voices exaggerated and persistent complaints of personal misfortune.
7. Alternates between hostile defiance and contrition.

VARIANTS

Abrasive negativist

+ Sadistic

Contentious, intransigent, fractious, and quarrelsome; irritable, caustic, debasing, corrosive, and acrimonious, contradicts and derogates; few qualms and little conscience or remorse.

Circuitous negativist

+ Dependent

Opposition displayed in a roundabout, labyrinthine, and ambiguous manner, e.g., procrastination, dawdling, forgetfulness, inefficiency, neglect, stubbornness, indirect and devious in venting resentment and resistant behaviors.

Discontented negativist

Grumbling, petty, testy, crankly, embittered, complaining, fretful, vexed, and moody; gripes behind pretense; avoids confrontation; uses legitimate but trival complaints.

Vacillating negativist

+ Borderline

Emotions fluctuate in bewildering, perplexing, and enigmatic ways; difficult to fathom or comprehend own capricious and mystifying moods; wavers, in flux, and irresolute both subjectively and intrapsychically.

SADISTIC PERSONALITY DISORDER

DSM-III-R (APPENDIX)

A pervasive pattern of cruel, demeaning, and aggressive behavior, beginning by early adulthood, as indicated by the repeated occurrence of at least four of the following: -
1. Has used physical cruelty or violence for the purpose of establishing dominance in a relationship (not merely to achieve some non-interpersonal goal, such as striking someone in order to rob him or her).
2. Humiliates or demeans people in the presence of others.
3. Has treated or disciplined someone under his or her control unusually harshly, e.g., a child, student, prisoner, or patient.
4. Is amused by, or takes pleasure in, the psychological or physical suffering of others (including animals).
5. Has lied for the purpose of harming or inflicting pain on others (not merely to achieve some other goal).
6. Gets other people to do what he or she wants by frightening them (through intimidation or even terror).
7. Restricts the autonomy of people with whom he or she has a close relationship, e.g., will not let spouse leave the house unaccompanied or permit teen-age daughter to attend social functions.
8. Is fascinated by violence, weapons, martial arts, injury, or torture.

VARIANTS

Enforcing sadist

+ Obsessive-compulsive

Hostility sublimated in the "public interest," cops, "bossy" supervisors, deans, judges; possessess the "right" to be pitiless, merciless, coarse, and barbarous; task is to control and punish, to search out rule breakers.

Explosive sadist

+ Borderline

Unpredictably precipitous outbursts and fury; uncontrollable rage and fearsome attacks; feelings of humiliation are pent-up and discharged; subsequently contrite.

Spineless sadist

Basically insecure, bogus, and cowardly; venomous dominance and cruelty is counterphobic; weakness counteracted by group support; public swaggering; selects powerless scapegoats.

Tyrannical sadist

Relishes menacing and brutalizing others, forcing them to cower and submit; verbally cutting and scathing, accusatory and destructive; intentially surly, abusive, inhumane, unmerciful.

SELF-DEFEATING (MASOCHISTIC) PERSONALITY DISORDER

DSM-III-R (APPENDIX)

A pervasive pattern of self-defeating behavior, beginning by early adulthood and present in a variety of contexts. The person may often avoid or undermine pleasurable experiences, be drawn to situations or relationships in which he or she will suffer, and prevent others from helping him or her, as indicated by at least five of the following: -
1. Chooses people and situations that lead to disappointment, failure, or mistreatment even when better options are clearly available.
2. Rejects or renders ineffective the attempts of others to help him or her.
3. Following positive personal events (e.g., new achievement), responds with depression, guilt, or a behavior that produces pain (e.g., an accident).
4. Incites angry or rejecting responses from others and then feels hurt, defeated, or humiliated (e.g., makes fun of spouse in public, provoking an angry retort, then feels devastated).
5. Rejects opportunities for pleasure, or is reluctant to acknowledge enjoying himself or herself (despite having adequate social skills and the capacity for pleasure).
6. Fails to accomplish tasks crucial to his or her personal objectives despite demonstrated ability to do so, e.g., helps fellow students write papers, but is unable to write his or her own.
7. Is uninterested in or rejects people who consistently treat him or her well, e.g., is unattracted to caring sexual partners.
8. Engages in excessive self-sacrifice that is unsolicited by the intended recipients of the sacrifice.

VARIANTS

Oppressed masochist

Experiences genuine misery, despair, hardship, anguish, torment, illness; grievances used to create guilt in others; resentments vented by exempting from responsibilities and burdening "oppressors."

Possessive masochist

Bewitches and ensnares by becoming jealous, overprotective, and indispensable; entraps, takes control, conquers, enslaves, and dominates others by being sacrificial to a fault; control by obligatory dependence.

Self-undoing masochist