Category Archives: Personality Disorder

Schizoid Personality Disorder Symptoms and DSM-V Diagnosis




F60.1 (301.20) Schizoid Personality Disorder: Overview

Individuals with schizoid personality disorder are indifferent to social experiences and interpersonal relationships. There is usually a lifelong history of very restricted emotional expression and feeling, unsociability, reclusiveness and emotional coldness.

Persons with schizoid personality disorder have little interest in relationships, even family relationships. They usually prefer isolated experiences which rarely involve other people. They typically have few to no friends, take no pleasure in activities with others and most often have no interest in intimate relationships and sex with others. Emotional reactions to others are usually cold, elusive and they have difficulty experiencing emotions in general. Usually they are uninterested in and not responsive to the assessments of others or even to encouragement or criticism.




The symptoms of schizoid personality disorder cannot occur only during a psychotic episode such as with schizophrenia and cannot be attributed to antisocial personality disorder. The symptoms must significantly impair the individuals functioning to warrant a diagnosis of this personality disorder.

Although this disorder may affect as many as 3.1% of the population in the United States, these individuals will usually not seek treatment. The impairment in social and occupational functioning is very significant.

Treatment of Schizoid Personality Disorder

Treatment for this disorder may be conducted using cognitive behavioral therapy along with a psychodynamic theoretical perspective when conceptualized within the perspective of attachment theory. Several psychological theorists and clinicians have concluded that the role of the counselor may be crucial in that this individual seems to need a model for interpersonal relationships. Also, it is important to recognize that people with this disorder may experience brief psychotic episodes when experiencing significant levels of stress.

Additional Considerations: Schizoid Personality Disorder:

Schizoid personality disorder seems to occur more often among men than women. It is important for the therapist to consider the cultural context when working with and diagnosing individuals with schizoid personality disorder as some cultures seem to emphasize defensive behaviors and detachment more than others. Also, additional consideration needs to be given to individuals who have changed cultures such as immigrants who experience issues related to acculturation.

Differential Diagnosis of Schizoid Personality Disorder
:
When considering whether an individual has schizoid personality disorder, the clinician needs to be careful that the symptoms are not related to substance use, another medical condition such as those that affect the central nervous system and medication use. It is also important to understand that this diagnosis should not be given if the symptoms only occur within the context of psychosis.

F60.1 (301.20) Schizoid Personality Disorder Diagnostic Criteria:

A. A pervasive pattern of detachment from social relationships and a very restricted range of expression of emotions in interpersonal experiences, usually beginning in early adulthood and manifested in a variety of contexts, as well as indicated by four or more of the following symptoms:

1. Neither enjoys nor desires close interpersonal relationships, including being part of a family experience.
2. Almost always chooses solitary activities.
3. Has little to no interest in having sexual relationships with others.
4. Takes pleasure in a very limited number of activities.
5. Has no close friends or confidants besides first-degree relatives.
6. Is indifferent to the praise or criticism of others.
7. Seems cold emotionally, detached or has a very flattened affect.

B. The symptoms do not occur exclusively during the course of schizophrenia, bipolar disorder or a depressive disorder with psychotic features, another psychotic disorder, an autism spectrum disorder and is not attributable to the physiological effects of another medical condition

Note: If the above symptoms and criteria are met prior to the onset of schizophrenia, add “premorbid” such as “schizoid personality disorder (premorbid).”

Adapted from the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM-V) American Psychiatric Association by Paul Susic Ph.D. Licensed Psychologist


Personality Disorders Symptoms and DSM-V Diagnosis




Personality Disorders Symptoms and Diagnosis: An overview

Personality disorders symptoms are not always easy to distinguish from relatively normal behaviors, although the consequences can be tremendously different. Personality disorders are groups of traits and characteristics that have become very rigid and dysfunctional, severely limiting functioning and most often resulting in severe distress and impairment. These thinking and behavioral patterns have usually been identified in these individual for a long time and in most cases since late adolescence or early adulthood.

The characteristics associated with personality disorders should probably be considered dimensional rather than categorical in that they are also seen in normal individuals to a significantly lesser degree. The DSM-V however has continued the traditional structure of categories that has been used over the last 30 years.

Common Characteristics of the Personality Disorders:

In order to receive a diagnosis of a personality disorder there needs to be an enduring pattern of negative behaviors, thoughts, feelings and sensations that are substantially different from the individual’s culture. This pattern includes an individual’s affect, cognition, control of impulses, and interpersonal relationships. This pattern of behaving and thinking has to apply in a broad-based manner over the individual’s personal and social life.




Personality disorders usually begin in adolescence (sometimes childhood) or early adulthood and manifest themselves in many social and personal contexts and cause a high level of distress and disability in an individual’s working and educational experience, as well as social and personal functioning. These characteristics cannot be associated with substance abuse, other mental disorders, physical illness, other personality disorders or personality changes associated with other medical conditions. The hallmark of personality disorders is their level of early onset (most commonly late teens), intensity of characteristics and pervasive nature in that it affects multiple aspects of an individual’s life including work, personal and social life.

A couple of the problems associated with the recognition and diagnosis of personality disorders is that they are frequently overlooked and at other times may be over-diagnosed. Two of the more notorious over diagnosed personality disorders are probably the narcissistic and borderline personality disorders. In DSM-V Made Easy, James Morrissey identified several things for a clinician keep in mind when making a diagnosis of personality disorder.

1. Verify the duration of the symptoms. Make sure that your patient’s symptoms have been present at least since early adulthood (before age 15 for antisocial personality disorder).
2. Verify that the symptoms affect several areas of the patient’s life.
3. Make sure that the patient fully qualifies for the particular diagnosis in question.
4. If the patient is under age 18, make sure that the symptoms have been present for at least the past 12 months.
5. Rule out other mental pathology that may be more accurate and have greater potential for doing harm.
6. Search for other personality disorders. Evaluate the entire history to learn whether any additional personality disorders are present.
7. Record all personality and non-personality mental diagnosis.

The following are the most commonly diagnosed personality disorders:


Cluster A Personality Disorders:

The Cluster A personality disorders usually involve behaviors described as suspicious, cold, withdrawn and/or irrational.

F60.0 (301.0) Paranoid Personality Disorder
F60.1 (301.20) Schizoid Personality Disorder
F21 (301.22) Schizotypal Personality Disorder

Cluster B Personality Disorders:

People who experience Cluster B Personality Disorders usually tend to be dramatic, very emotional and attention seeking with shallow, fluctuating moods. They often have intense interpersonal problems.

F60.2 (301.7) Antisocial Personality Disorder
F60,3 (301.83) Borderline Personality Disorder
F60.4 (301.50) Histrionic Personality Disorder
F60.81 (301.81) Narcissistic Personality Disorder

Cluster C Personality Disorders:

The Cluster C Personality Disorders usually feature characteristics of being typically tense, anxious and being over controlled.

F60.6 (301.82) Avoidant Personality Disorder
F60.7 (301.6) Dependent Personality Disorder
F60.5 (301.4) Obsessive-Compulsive Personality Disorder

Other Personality Conditions:

F07.0 (301.1) Personality Change Due to Another Medical Condition
F60.89 (301.89) Other Specified Personality Disorder
F60.9 (301.9) Unspecified Personality Disorder

By Paul Susic Ph.D. Licensed Psychologist



Paranoid Personality Disorder Symptoms and DSM-V Criteria




301.0 (F 60.0) Paranoid Personality Disorder: Overview

The key features of paranoid personality disorder involve suspicion of others and mistrust in their motivations. This disorder begins in early adulthood and persists for life and may affect multiple areas of functioning in their daily experience. The signs of mistrust must be manifested in at least four areas of their life including an inability to trust or rely upon friends and difficulty confiding in others because of fear that what is shared will be used against them, constant suspicion that others are trying to harm, trick or exploit them. They may have a pervasive pattern of not forgiving others and may misperceive insults and threats in normal conversation. They often believe that others are trying to assault their character. They obviously then feel a need to respond to the attack and frequently have a chronic suspicion that their spouse or partner is unfaithful to them.





Additional Aspects of Paranoid Personality Disorder:

This personality disorder occurs more often in men than women and is estimated to affect about 4.4% of the population in the United States. The sentiment and perspective of individuals with this disorder should not be confused with the feelings of oppression or disenfranchisement experienced by some minority, immigrant and refugee groups in the United States of America. Individuals who experience or have a family history of psychotic disorders such as schizophrenia or have other unique experiences such as being incarcerated are more often diagnosed with paranoid personality disorder.

Diagnosing Paranoid Personality Disorder:

As mentioned above, it is very important not to confuse the symptoms of psychotic disorders such as schizophrenia with paranoid personality disorder. This diagnosis would be given if the symptoms of paranoid personality disorder also persist before and after the psychotic symptoms of schizophrenia. It is important to understand that there is a significant overlap or comorbidity among personality disorders. Psychologists, psychiatrists and other mental health clinicians need to screen for whether another personality disorder may be even more appropriate such as schizotypal personality disorder.

301.0 (F 60.0) Paranoid Personality Disorder Diagnostic Criteria

A. Suspiciousness and pervasive mistrust of others in their motivations that are interpreted as malevolent, which began in early adulthood and is manifested in a variety of contexts as indicated by four (or more) of the following:

1. Suspects without a sufficient basis that others are harming, exploiting or deceiving them.
2. Has a preoccupation without justification about the trustworthiness or loyalty of friends, family or associates.
3. A reluctance to confide in others because of an unwarranted fear that the information will be used negatively against them.
4. Reads threatening meanings and demeaning motivations behind benign remarks or events.
5. Unforgiving of other’s insults, slights and perceived injuries and persistently bearing grudges
6. Perceives attacks on their character and reputation that is not apparent to others and reacts quickly and angrily in counterattack.
7. Has recurrent suspicions although unjustified about the fidelity of their spouse or sexual partner.

B. The symptoms do not occur exclusively during the course of schizophrenia, bipolar disorder or depressive disorder with psychotic features, or other psychotic disorders that are not attributable to the physiological effects of another medical condition.

Note: If the criteria are met before the onset of schizophrenia, add “premorbid,” such as “paranoid personality disorder (premorbid).”

Adapted from the Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) American Psychiatric Association By Paul Susic Ph.D. Licensed Psychologist