What is Paranoid Personality Disorder?

Introduction

Paranoid personality disorder (PPD) is a mental illness characterised by paranoid delusions, and a pervasive, long-standing suspiciousness and generalised mistrust of others.

People with this personality disorder may be hypersensitive, easily insulted, and habitually relate to the world by vigilant scanning of the environment for clues or suggestions that may validate their fears or biases. They are eager observers. They think they are in danger and look for signs and threats of that danger, potentially not appreciating other interpretations or evidence.

They tend to be guarded and suspicious and have quite constricted emotional lives. Their reduced capacity for meaningful emotional involvement and the general pattern of isolated withdrawal often lend a quality of schizoid isolation to their life experience. People with PPD may have a tendency to bear grudges, suspiciousness, tendency to interpret others’ actions as hostile, persistent tendency to self-reference, or a tenacious sense of personal right. Patients with this disorder can also have significant comorbidity with other personality disorders (such as schizotypal, schizoid, narcissistic, avoidant and borderline).

Epidemiology

PPD occurs in about 0.5-2.5% of the general population. It is seen in 2-10% of psychiatric outpatients. It is more common in males.

Brief History

Paranoid personality disorder is listed in DSM-V and was included in all previous versions of the DSM. One of the earliest descriptions of the paranoid personality comes from the French psychiatrist Valentin Magnan who described a “fragile personality” that showed idiosyncratic thinking, hypochondriasis, undue sensitivity, referential thinking and suspiciousness.

Closely related to this description is Emil Kraepelin’s description from 1905 of a pseudo-querulous personality who is “always on the alert to find grievance, but without delusions”, vain, self-absorbed, sensitive, irritable, litigious, obstinate, and living at strife with the world. In 1921, he renamed the condition paranoid personality and described these people as distrustful, feeling unjustly treated and feeling subjected to hostility, interference and oppression. He also observed a contradiction in these personalities: on the one hand, they stubbornly hold on to their unusual ideas, on the other hand, they often accept every piece of gossip as the truth. Kraepelin also noted that paranoid personalities were often present in people who later developed paranoid psychosis. Subsequent writers also considered traits like suspiciousness and hostility to predispose people to developing delusional illnesses, particularly “late paraphrenias” of old age.

Following Kraepelin, Eugen Bleuler described “contentious psychopathy” or “paranoid constitution” as displaying the characteristic triad of suspiciousness, grandiosity and feelings of persecution. He also emphasized that these people’s false assumptions do not attain the form of real delusion.

Ernst Kretschmer emphasized the sensitive inner core of the paranoia-prone personality: they feel shy and inadequate but at the same time they have an attitude of entitlement. They attribute their failures to the machinations of others but secretly to their own inadequacy. They experience constant tension between feelings of self-importance and experiencing the environment as unappreciative and humiliating.

Karl Jaspers, a German phenomenologist, described “self-insecure” personalities who resemble the paranoid personality. According to Jaspers, such people experience inner humiliation, brought about by outside experiences and their interpretations of them. They have an urge to get external confirmation to their self-deprecation and that makes them see insults in the behaviour of other people. They suffer from every slight because they seek the real reason for them in themselves. This kind of insecurity leads to overcompensation: compulsive formality, strict social observances and exaggerated displays of assurance.

In 1950, Kurt Schneider described the “fanatic psychopaths” and divided them into two categories: the combative type that is very insistent about his false notions and actively quarrelsome, and the eccentric type that is passive, secretive, vulnerable to esoteric sects but nonetheless suspicious about others.

The descriptions of Leonhard and Sheperd from the sixties describe paranoid people as overvaluing their abilities and attributing their failure to the ill-will of others; they also mention that their interpersonal relations are disturbed and they are in constant conflict with others.

In 1975, Polatin described the paranoid personality as rigid, suspicious, watchful, self-centred and selfish, inwardly hypersensitive but emotionally undemonstrative. However, when there is a difference of opinion, the underlying mistrust, authoritarianism and rage burst through.

In the 1980s, paranoid personality disorder received little attention, and when it did receive it, the focus was on its potential relationship to paranoid schizophrenia. The most significant contribution of this decade comes from Theodore Millon who divided the features of paranoid personality disorder to four categories:

  1. Behavioural characteristics of vigilance, abrasive irritability and counterattack.
  2. Complaints indicating oversensitivity, social isolation and mistrust.
  3. The dynamics of denying personal insecurities, attributing these to others and self-inflation through grandiose fantasies.
  4. Coping style of detesting dependence and hostile distancing of oneself from others.

Causes

A genetic contribution to paranoid traits and a possible genetic link between this personality disorder and schizophrenia exist. A large long-term Norwegian twin study found paranoid personality disorder to be modestly heritable and to share a portion of its genetic and environmental risk factors with the other cluster A personality disorders, schizoid and schizotypal.

Psychosocial theories implicate projection of negative internal feelings and parental modelling. Cognitive theorists believe the disorder to be a result of an underlying belief that other people are unfriendly in combination with a lack of self-awareness.

Diagnosis

ICD-10

The World Health Organisation’s ICD-10 lists paranoid personality disorder under (F60.0). It is a requirement of ICD-10 that a diagnosis of any specific personality disorder also satisfies a set of general personality disorder criteria. It is also pointed out that for different cultures it may be necessary to develop specific sets of criteria with regard to social norms, rules and other obligations.

PPD is characterised by at least three of the following symptoms:

  1. Excessive sensitivity to setbacks and rebuffs;
  2. Tendency to bear grudges persistently (i.e. refusal to forgive insults and injuries or slights);
  3. Suspiciousness and a pervasive tendency to distort experience by misconstruing the neutral or friendly actions of others as hostile or contemptuous;
  4. A combative and tenacious sense of self-righteousness out of keeping with the actual situation;
  5. Recurrent suspicions, without justification, regarding sexual fidelity of spouse or sexual partner;
  6. Tendency to experience excessive self-aggrandising, manifest in a persistent self-referential attitude;
  7. Preoccupation with unsubstantiated “conspiratorial” explanations of events both immediate to the patient and in the world at large.

Includes: expansive paranoid, fanatic, querulant and sensitive paranoid personality disorder.

Excludes: delusional disorder and schizophrenia.

DSM-5

The American Psychiatric Association’s DSM-5 has similar criteria for paranoid personality disorder. They require in general the presence of lasting distrust and suspicion of others, interpreting their motives as malevolent, from an early adult age, occurring in a range of situations. Four of seven specific issues must be present, which include different types of suspicions or doubt (such as of being exploited, or that remarks have a subtle threatening meaning), in some cases regarding others in general or specifically friends or partners, and in some cases referring to a response of holding grudges or reacting angrily.

PPD is characterised by 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. To qualify for a diagnosis, the patient must meet at least four out of the following criteria:

  1. Suspects, without sufficient basis, that others are exploiting, harming, or deceiving them.
  2. Is preoccupied with unjustified doubts about the loyalty or trustworthiness of friends or associates.
  3. Is reluctant to confide in others because of unwarranted fear that the information will be used maliciously against them.
  4. Reads hidden demeaning or threatening meanings into benign remarks or events.
  5. Persistently bears grudges (i.e., is unforgiving of insults, injuries, or slights).
  6. Perceives attacks on their character or reputation that are not apparent to others and is quick to react angrily or to counterattack.
  7. Has recurrent suspicions, without justification, regarding fidelity of spouse or sexual partner.

The DSM-5 lists paranoid personality disorder essentially unchanged from the DSM-IV-TR version and lists associated features that describe it in a more quotidian way. These features include suspiciousness, intimacy avoidance, hostility and unusual beliefs/experiences.

Other

Various researchers and clinicians may propose varieties and subsets or dimensions of personality related to the official diagnoses. Psychologist Theodore Millon has proposed five subtypes of paranoid personality (table below).

SubtypeFeatures
Obdurate paranoid (including compulsive features)Self-assertive, unyielding, stubborn, steely, implacable, unrelenting, dyspeptic, peevish, and cranky stance; legalistic and self-righteous; discharges previously restrained hostility; renounces self-other conflict.
Fanatic paranoid (including narcissistic features)Grandiose delusions are irrational and flimsy; pretentious, expensive supercilious contempt and arrogance toward others; lost pride re-established with extravagant claims and fantasies.
Querulous paranoid (including negativistic features)Contentious, cavilling, fractious, argumentative, fault-finding, unaccommodating, resentful, choleric, jealous, peevish, sullen, endless wrangles, whiny, waspish, snappish.
Insular paranoid (including avoidant features)Reclusive, self-sequestered, hermitical; self-protectively secluded from omnipresent threats and destructive forces; hypervigilant and defensive against imagined dangers.
Malignant paranoid (including sadistic features)Belligerent, cantankerous, intimidating, vengeful, callous, and tyrannical; hostility vented primarily in fantasy; projects own venomous outlook onto others; persecutory delusions.

Differential Diagnosis

Paranoid personality disorder can involve, in response to stress, very brief psychotic episodes (lasting minutes to hours). The paranoid may also be at greater than average risk of experiencing major depressive disorder, agoraphobia, social anxiety disorder, obsessive-compulsive disorder or alcohol and substance-related disorders. Criteria for other personality disorder diagnoses are commonly also met, such as:

Treatment

Because of reduced levels of trust, there can be challenges in treating PPD. However, psychotherapy, antidepressants, antipsychotics and anti-anxiety medications can play a role when a person is receptive to intervention.

What is the Negativistic Personality Disorder?

Introduction

Negativistic personality disorder is characterised by procrastination, covert obstructionism, inefficiency and stubbornness.

The current version of the Diagnostic and Statistical Manual of Mental Disorders no longer uses this phrase or label, and it is not one of the ten listed specific personality disorders. The previous edition, the revision IV (DSM-IV) describes passive-aggressive personality disorder as a proposed disorder involving a “pervasive pattern of negativistic attitudes and passive resistance to demands for adequate performance” in a variety of contexts.

Passive-aggressive behaviour is the obligatory symptom of the passive-aggressive personality disorder. Persons with passive-aggressive personality disorder are characterised by procrastination, covert obstructionism, inefficiency and stubbornness.

Brief History

In the first version of the Diagnostic and Statistical Manual of Mental Disorders, DSM-I, in 1952, the Passive-aggressive was defined in a narrow way, grouped together with the passive-dependent.

The DSM-III-R stated in 1987 that Passive-aggressive disorder is typified by, among other things, “fail[ing] to do the laundry or to stock the kitchen with food because of procrastination and dawdling.”

Causes

Passive-aggressive disorder may stem from a specific childhood stimulus (e.g. alcohol/drug addicted parents, bullying, abuse) in an environment where it was not safe to express frustration or anger. Families in which the honest expression of feelings is forbidden tend to teach children to repress and deny their feelings and to use other channels to express their frustration. For example, if physical and psychological punishment were to be dealt to children who express anger, they would be inclined to be passive aggressive.

Children who sugarcoat hostility may have difficulties being assertive, never developing better coping strategies or skills for self-expression. They can become adults who, beneath a “seductive veneer,” harbour “vindictive intent,” in the words of Timothy F. Murphy and Loriann Oberlin. Alternatively individuals may simply have difficulty being as directly aggressive or assertive as others. Martin Kantor suggests three areas that contribute to passive-aggressive anger in individuals: conflicts about dependency, control, and competition, and that a person may be termed passive-aggressive if they behave so to few people on most occasions.

Murphy and Oberlin also see passive aggression as part of a larger umbrella of hidden anger stemming from ten traits of the angry child or adult. These traits include making one’s own misery, the inability to analyse problems, blaming others, turning bad feelings into angry ones, attacking people, lacking empathy, using anger to gain power, confusing anger with self-esteem, and indulging in negative self-talk. Lastly, the authors point out that those who hide their anger can be nice when they wish to be.

Diagnosis

Diagnostic and Statistical Manual

With the publication of the DSM-5, this label has been largely disregarded. The equivalent DSM-5 diagnostic label would be “Other specified personality and unspecified personality disorder,” as the individual may meet general criteria for a personality disorder, but does not meet the trait-based diagnostic criteria for any specific personality disorder (p.645).

Passive-aggressive [personality disorder] was listed as an Axis II personality disorder in the DSM-III-R, but was moved in the DSM-IV to Appendix B (“Criteria Sets and Axes Provided for Further Study”) because of controversy and the need for further research on how to also categorise the behaviours in a future edition. According to DSM-IV, people with passive-aggressive personality disorder are “often overtly ambivalent, wavering indecisively from one course of action to its opposite. They may follow an erratic path that causes endless wrangles with others and disappointment for themselves.” Characteristic of these persons is an “intense conflict between dependence on others and the desire for self-assertion.” Although exhibiting superficial bravado, their self-confidence is often very poor, and others react to them with hostility and negativity. This diagnosis is not made if the behaviour is exhibited during a major depressive episode or can be attributed to dysthymic disorder.

ICD-10

The 10th revision of the International Classification of Diseases (ICD-10) of the World Health Organisation (WHO) includes passive-aggressive personality disorder in the “other specific personality disorders” rubric (description: “a personality disorder that fits none of the specific rubrics: F60.0-F60.7”). ICD-10 code for “other specific personality disorders” is F60.8. For this psychiatric diagnosis a condition must meet the general criteria for personality disorder listed under F60 in the clinical descriptions and diagnostic guidelines.

The general criteria for personality disorder includes markedly disharmonious behaviour and attitudes (involving such areas of functioning as affectivity – ability to experience affects: emotions or feelings, involving ways of perceiving and thinking, impulse control, arousal, style of relating to others), the abnormal behaviour pattern (enduring, of long standing), personal distress and the abnormal behaviour pattern must be clearly maladaptive and pervasive. Personality disorder must appear during childhood or adolescence and continue into adulthood.

Specific diagnostic criteria of the passive-aggressive personality disorder in the “Diagnostic criteria for research” by WHO is not presented.

Millon’s Subtypes

The psychologist Theodore Millon has proposed four subtypes of ‘negativist’ (‘Passive-aggressive’). Any individual negativist may exhibit none or one of the following:

SubtypeDescriptionPersonality Traits
Vacillating negativistIncluding borderline featuresEmotions 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.
Discontented negativistIncluding depressive featuresGrumbling, petty, testy, cranky, embittered, complaining, fretful, vexed, and moody; gripes behind pretence; avoids confrontation; uses legitimate but trivial complaints.
Circuitous negativistIncluding antisocial and dependent featuresOpposition displayed in a roundabout, labyrinthine, and ambiguous manner, e.g. procrastination, dawdling, forgetfulness, inefficiency, neglect, stubbornness, indirect and devious in venting resentment and resistant behaviours.
Abrasive negativistIncluding sadistic featuresContentious, intransigent, fractious, and quarrelsome; irritable, caustic, debasing, corrosive, and acrimonious, contradicts and derogates; few qualms and little conscience or remorse (no longer a valid diagnosis in DSM).

Treatment

Psychiatrist Kantor suggests a treatment approach using psychodynamic, supportive, cognitive, behavioural and interpersonal therapeutic methods. These methods apply to both the passive-aggressive person and their target victim.

What is Avoidant Personality Disorder?

Introduction

Avoidant personality disorder (AvPD) is a Cluster C personality disorder in which the main coping mechanism of those affected is avoidance of feared stimuli.

Those affected display a pattern of severe social anxiety, social inhibition, feelings of inadequacy and inferiority, extreme sensitivity to negative evaluation and rejection, and avoidance of social interaction despite a strong desire for intimacy.

People with AvPD often consider themselves to be socially inept or personally unappealing and avoid social interaction for fear of being ridiculed, humiliated, rejected, or disliked. They often avoid becoming involved with others unless they are certain they will be liked.

Childhood emotional neglect (in particular, the rejection of a child by one or both parents) and peer group rejection are associated with an increased risk for its development; however, it is possible for AvPD to occur without any notable history of abuse or neglect.

Brief History

The avoidant personality has been described in several sources as far back as the early 1900s, although it was not so named for some time. Swiss psychiatrist Eugen Bleuler described patients who exhibited signs of avoidant personality disorder in his 1911 work Dementia Praecox: Or the Group of Schizophrenias. Avoidant and schizoid patterns were frequently confused or referred to synonymously until Kretschmer (1921), in providing the first relatively complete description, developed a distinction.

Signs and Symptoms

Avoidant individuals are preoccupied with their own shortcomings and form relationships with others only if they believe they will not be rejected. They often view themselves with contempt, while showing a decreased ability to identify traits within themselves that are generally considered as positive within their societies. Loss and social rejection are so painful that these individuals will choose to be alone rather than risk trying to connect with others.

Some with this disorder fantasize about idealized, accepting and affectionate relationships because of their desire to belong. They often feel themselves unworthy of the relationships they desire, and shame themselves from ever attempting to begin them. If they do manage to form relationships, it is also common for them to pre-emptively abandon them out of fear of the relationship failing.

Individuals with the disorder tend to describe themselves as uneasy, anxious, lonely, unwanted and isolated from others. They often choose jobs of isolation in which they do not have to interact with others regularly. Avoidant individuals also avoid performing activities in public spaces for fear of embarrassing themselves in front of others.

Symptoms include:

  • Extreme shyness or anxiety in social situations, though the person feels a strong desire for close relationships;
  • Heightened attachment-related anxiety, which may include a fear of abandonment; and
  • Substance abuse and/or dependence.

Comorbidity

AvPD is reported to be especially prevalent in people with anxiety disorders, although estimates of comorbidity vary widely due to differences in (among others) diagnostic instruments. Research suggests that approximately 10-50% of people who have panic disorder with agoraphobia have avoidant personality disorder, as well as about 20-40% of people who have social anxiety disorder. In addition to this, AvPD is more prevalent in people who have comorbid social anxiety disorder and generalised anxiety disorder (GAD) than in those who have only one of the aforementioned conditions.

Some studies report prevalence rates of up to 45% among people with GAD and up to 56% of those with obsessive-compulsive disorder. Posttraumatic stress disorder is also commonly comorbid with AvPD.

Avoidants are prone to self-loathing and, in certain cases, self-harm. In particular, avoidants who have comorbid PTSD have the highest rates of engagement in self-harming behaviour, outweighing even those with borderline personality disorder (with or without PTSD). Substance use disorders are also common in individuals with AvPD – particularly in regard to alcohol, benzodiazepines and heroin – and may significantly affect a patient’s prognosis.

Earlier theorists proposed a personality disorder with a combination of features from borderline personality disorder and avoidant personality disorder, called “avoidant-borderline mixed personality” (AvPD/BPD).

Causes

Causes of AvPD are not clearly defined, but appear to be influenced by a combination of social, genetic and psychological factors. The disorder may be related to temperamental factors that are inherited.

Specifically, various anxiety disorders in childhood and adolescence have been associated with a temperament characterised by behavioural inhibition, including features of being shy, fearful and withdrawn in new situations. These inherited characteristics may give an individual a genetic predisposition towards AvPD.

Childhood emotional neglect and peer group rejection are both associated with an increased risk for the development of AvPD. Some researchers believe a combination of high-sensory-processing sensitivity coupled with adverse childhood experiences may heighten the risk of an individual developing AvPD.

Subtypes

Millon

Psychologist Theodore Millon notes that because most patients present a mixed picture of symptoms, their personality disorder tends to be a blend of a major personality disorder type with one or

more secondary personality disorder types. He identified four adult subtypes of AvPD as outlined below.

SubtypePersonality Traits/Features
Phobic Avoidant (including dependent features)General apprehensiveness displaced with avoidable tangible precipitant; qualms and disquietude symbolised by a repugnant and specific dreadful object or circumstances.
Conflicted Avoidant (including negativistic features)Internal discord and dissension; fears dependence; unsettled; unreconciled within self; hesitating, confused, tormented, paroxysmic, embittered; and unresolvable angst.
Hypersensitive Avoidant (including paranoid features)Intensely wary and suspicious; alternatively panicky, terrified, edgy, and timorous, then thin-skinned, high-strung, petulant, and prickly.
Self-Deserting Avoidant (including depressive features)Blocks or fragments self-awareness; discards painful images and memories; casts away untenable thoughts and impulses; ultimately jettisons self (suicidal).

Others

In 1993, Lynn E. Alden and Martha J. Capreol proposed two other subtypes of avoidant personality disorder, as outlined below.

SubtypePersonality Traits/Features
Cold-AvoidantCharacterised by an inability to experience and express positive emotion towards others.
Exploitable-AvoidantCharacterised by an inability to express anger towards others or to resist coercion from others. May be at risk for abuse by others.

Diagnosis

ICD

The World Health Organisation’s ICD-10 lists avoidant personality disorder as anxious (avoidant) personality disorder (F60.6).

It is characterised by the presence of at least four of the following:

  1. Persistent and pervasive feelings of tension and apprehension.
  2. Belief that one is socially inept, personally unappealing, or inferior to others.
  3. Excessive preoccupation with being criticised or rejected in social situations.
  4. Unwillingness to become involved with people unless certain of being liked.
  5. Restrictions in lifestyle because of need to have physical security.
  6. Avoidance of social or occupational activities that involve significant interpersonal contact because of fear of criticism, disapproval, or rejection.

Associated features may include hypersensitivity to rejection and criticism.

It is a requirement of ICD-10 that all personality disorder diagnoses also satisfy a set of general personality disorder criteria.

DSM

The Diagnostic and Statistical Manual of Mental Disorders (DSM) of the APA also has an avoidant personality disorder diagnosis (301.82). It refers to a widespread pattern of inhibition around people, feeling inadequate and being very sensitive to negative evaluation. Symptoms begin by early adulthood and occur in a range of situations.

Four of the following seven specific symptoms should be present:

  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 criticised 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 risk or to engage in any new activities because they may prove embarrassing.

Differential Diagnosis

In contrast to social anxiety disorder, a diagnosis of AvPD also requires that the general criteria for a personality disorder are met.

According to the DSM-5, avoidant personality disorder must be differentiated from similar personality disorders such as dependent, paranoid, schizoid, and schizotypal. But these can also occur together; this is particularly likely for AvPD and dependent personality disorder. Thus, if criteria for more than one personality disorder are met, all can be diagnosed.

There is also an overlap between avoidant and schizoid personality traits and AvPD may have a relationship to the schizophrenia spectrum.

Epidemiology

Data from the 2001-2002 National Epidemiologic Survey on Alcohol and Related Conditions indicates a prevalence of 2.36% in the US general population. It appears to occur with equal frequency in males and females. In one study, it was seen in 14.7% of psychiatric outpatients.

Criticism

There is controversy as to whether avoidant personality disorder (AvPD) is distinct from generalised social anxiety disorder. Both have similar diagnostic criteria and may share a similar causation, subjective experience, course, treatment and identical underlying personality features, such as shyness.

It is contended by some that they are merely different conceptualisations of the same disorder, where avoidant personality disorder may represent the more severe form. In particular, those with AvPD experience not only more severe social phobia symptoms, but are also more depressed and more functionally impaired than patients with generalised social phobia alone. But they show no differences in social skills or performance on an impromptu speech. Another difference is that social phobia is the fear of social circumstances whereas AvPD is better described as an aversion to intimacy in relationships.

Treatment

Treatment of avoidant personality disorder can employ various techniques, such as social skills training, psychotherapy, cognitive therapy, and exposure treatment to gradually increase social contacts, group therapy for practicing social skills, and sometimes drug therapy.

A key issue in treatment is gaining and keeping the patient’s trust since people with an avoidant personality disorder will often start to avoid treatment sessions if they distrust the therapist or fear rejection. The primary purpose of both individual therapy and social skills group training is for individuals with an avoidant personality disorder to begin challenging their exaggerated negative beliefs about themselves.

Significant improvement in the symptoms of personality disorders is possible, with the help of treatment and individual effort.

Prognosis

Being a personality disorder, which is usually chronic and has long-lasting mental conditions, an avoidant personality disorder is not expected to improve with time without treatment. Given that it is a poorly studied personality disorder and in light of prevalence rates, societal costs, and the current state of research, AvPD qualifies as a neglected disorder.

Can We Link Personality Pathology with Smoking & Traits?

Research Paper Title

Predicting smoking and nicotine dependence from the DSM-5 alternative model for personality pathology.

Background

Individuals with personality disorders (PDs) have higher morbidity and mortality than the general population, which may be due to maladaptive health behaviours such as smoking.

Previous studies have examined the links between categorical PD diagnoses/personality traits and smoking/nicotine dependence, but little is known about how the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition alternative model for personality disorders relates to smoking and nicotine dependence.

Methods

The current study examined this question in a sample of 500 participants using the Levels of Personality Functioning Scale to assess general personality pathology, the Personality Inventory for the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition to measure specific traits, the Fagerström test for Nicotine Dependence to assess nicotine dependence, and questions about current and past smoking to assess smoking status (i.e. current, former, never).

Results

Multinomial logistic regression results demonstrated that general personality pathology (Criterion A) was not related to smoking status, and there were no reliable associations between traits (Criterion B) and smoking status. However, correlations showed that higher negative affectivity and disinhibition were related to higher levels of nicotine dependence within smokers.

Conclusions

Findings are discussed in regard to previous findings linking personality pathology to smoking/nicotine dependence as well as the general validity of this new personality disorder diagnostic system.

Reference

Halberstadt, A.L., Skrzynski, C.J., Wright, A.G.C. & Creswell, K.G. (2021) Predicting smoking and nicotine dependence from the DSM-5 alternative model for personality pathology. Personality Disorders. doi: 10.1037/per0000487. Online ahead of print.

Book: Working Effectively with ‘Personality Disorder’

Book Title:

Working Effectively with ‘Personality Disorder’: Contemporary and Critical Approaches to Clinical and Organisational Practice.

Author(s): Jo Ramsden (Author & Editor), Sharon Prince (Editor), and Julia Blazdell (Editor).

Year: 2020.

Edition: First (1st).

Publisher: Luminate.

Type(s): Paperback and Kindle.

Synopsis:

The history of personality disorder services is problematic to say the least. The very concept is under heavy fire, services are often expensive and ineffective, and many service users report feeling that they have been deceived, stigmatised or excluded. Yet while there are inevitably serious (and often destructive) relational challenges involved in the work, creative networks of learning do exist – professionals who are striving to provide progressive, compassionate services for and with this client group.

Working Effectively with Personality Disorder shares this knowledge, articulating an alternative way of working that acknowledges the contemporary debate around diagnosis, reveals flawed assumptions underlying current approaches, and argues for services that work more positively, more holistically and with a wider and more socially focused agenda.

TABLE OF CONTENTS

  • Foreword by John Livesley.
  • Introduction (Jo Ramsden, Sharon Prince and Julia Blazdell).
  • PART 1: CONTEMPORARY AND CRITICAL PERSPECTIVES ON PERSONALITY DISORDER.
    • Chapter 1: Life and Labels: Some Personal Thoughts about Personality Disorder (Sue Sibbald).
    • Chapter 2: Personality Disorder: Breakdown in the Relational Field (Nick Benefield & Rex Haigh).
    • Chapter 3: The Scale of the Problem (Sarah Skett & Kimberley Barlow).
    • Chapter 4: The Politics of Personality Disorder A Critical Realist Account (David Pilgrim).
    • Chapter 5: The Importance of Personal Meaning (Sharon Prince & Sue Ellis).
    • Chapter 6: The Organisation and Its Discontents: In Search of the Fallible and Good Enough Care Enterprise (Jina Barrett).
  • PART 2: GOVERNANCE PRINCIPLES SUPPORTING SERVICES TO ENACT CONTEMPORARY AND CRITICAL PERSPECTIVES.
    • Chapter 7: Access to Services – Moving beyond Specialist Provision while Applying the Learning (Jo Ramsden).
    • Chapter 8: Reimagining Interventions (Alan Hirons & Ruth Sutherland).
    • Chapter 9: Service User Involvement and Co-production in Personality Disorder Services An Invitation to Transcend Re Traumatising Power Politics (Melanie Ann Ball).
    • Chapter 10: Partnership Working (David Harvey & Bernie Tuohy).
    • Chapter 11: Outcomes (Mary McMurran).
    • Chapter 12: Contained and Containing Teams (Jo Ramsden).
    • Chapter 13: Co-Produced Practice Near Learning: Developing Critically Reflective Relational Systems (Neil Gordon).

Book: Personality Disorders and Mental Illnesses: The Truth About Psychopaths, Sociopaths, and Narcissists

Book Title:

Personality Disorders and Mental Illnesses: The Truth About Psychopaths, Sociopaths, and Narcissists.

Author(s): Clarence T. Rivers.

Year: 2014.

Edition: First (1st).

Publisher: Createspace Independent Publishing Platform.

Type(s): Paperback and Kindle.

Synopsis:

From the ~Unleash the Power of the Mind~ collection and the award winning writer, Clarence T. Rivers, comes a masterful explanation of the mind and the various personality disorders and mental illnesses.

Topics of Discussion

  • Personality Disorders and Mental Illnesses.
  • Psychopathy Defined.
  • Crime and Psychopaths.
  • Psychopaths vs. Sociopaths.
  • Sociopath Defined.
  • The Goal of a Sociopath.
  • The Weaknesses of a Sociopath.
  • Dealing with a Sociopath.
  • Narcissism Defined.
  • The Narcissist in You.
  • The Narcissists of Today.
  • How to Deal with a Narcissist.
  • and much more!

Book: Working Effectively with ‘Personality Disorder’

Book Title:

Working Effectively with ‘Personality Disorder’: Contemporary and Critical Approaches to Clinical and Organisational Practice.

Author(s): Joanne Ramsden (Author and Editor), Sharon Prince (Editor), and Julia Blazdell (Editor).

Year: 2020.

Edition: First (1st).

Publisher: Luminate.

Type(s): Paperback and Kindle.

Synopsis:

The history of personality disorder services is problematic to say the least. The very concept is under heavy fire, services are often expensive and ineffective, and many service users report feeling that they have been deceived, stigmatised or excluded. Yet while there are inevitably serious (and often destructive) relational challenges involved in the work, creative networks of learning do exist – professionals who are striving to provide progressive, compassionate services for and with this client group.

Working Effectively with Personality Disorder shares this knowledge, articulating an alternative way of working that acknowledges the contemporary debate around diagnosis, reveals flawed assumptions underlying current approaches, and argues for services that work more positively, more holistically and with a wider and more socially focused agenda.

Table of Contents

  • Foreword by John Livesley.
  • Introduction (Jo Ramsden, Sharon Prince and Julia Blazdell).
  • PART 1: CONTEMPORARY AND CRITICAL PERSPECTIVES ON PERSONALITY DISORDER:
    • Chapter 1: Life and Labels: Some Personal Thoughts about Personality Disorder (Sue Sibbald).
    • Chapter 2: Personality Disorder: Breakdown in the Relational Field (Nick Benefield & Rex Haigh).
    • Chapter 3: The Scale of the Problem (Sarah Skett & Kimberley Barlow).
    • Chapter 4: The Politics of Personality Disorder A Critical Realist Account (David Pilgrim).
    • Chapter 5: The Importance of Personal Meaning (Sharon Prince & Sue Ellis).
    • Chapter 6: The Organisation and Its Discontents: In Search of the Fallible and Good Enough Care Enterprise (Jina Barrett).
  • PART 2: GOVERNANCE PRINCIPLES SUPPORTING SERVICES TO ENACT CONTEMPORARY AND CRITICAL PERSPECTIVES:
    • Chapter 7: Access to Services – Moving beyond Specialist Provision while Applying the Learning (Jo Ramsden).
    • Chapter 8: Reimagining Interventions (Alan Hirons & Ruth Sutherland).
    • Chapter 9: Service User Involvement and Co-production in Personality Disorder Services An Invitation to Transcend Re Traumatising Power Politics (Melanie Ann Ball).
    • Chapter 10: Partnership Working (David Harvey & Bernie Tuohy).
    • Chapter 11: Outcomes (Mary McMurran).
    • Chapter 12: Contained and Containing Teams (Jo Ramsden).
    • Chapter 13: Co-Produced Practice Near Learning: Developing Critically Reflective Relational Systems (Neil Gordon).

Book: Psychopathy: An Introduction to Biological Findings and Their Implications

Book Title:

Psychopathy: An Introduction to Biological Findings and Their Implications.

Author(s): Andrea L. Glenn and Adrian Raine.

Year: 2014.

Edition: First (1st).

Publisher: NYU Press.

Type(s): Hardcover, Paperback, and Kindle.

Synopsis:

The last two decades have seen tremendous growth in biological research on psychopathy, a mental disorder distinguished by traits including a lack of empathy or emotional response, egocentricity, impulsivity, and stimulation seeking. But how does a psychopath’s brain work? What makes a psychopath?

Psychopathy provides a concise, non-technical overview of the research in the areas of genetics, hormones, brain imaging, neuropsychology, environmental influences, and more, focusing on explaining what we currently know about the biological foundations for this disorder and offering insights into prediction, intervention, and prevention. It also offers a nuanced discussion of the ethical and legal implications associated with biological research on psychopathy. How much of this disorder is biologically based? Should offenders with psychopathic traits be punished for their crimes if we can show that biological factors contribute? The text clearly assesses the conclusions that can and cannot be drawn from existing biological research, and highlights the pressing considerations this research demands.

Book: Handbook of Psychopathy

Book Title:

Handbook of Psychopathy.

Author(s): Christopher J. Patrick (Editor).

Year: 2018.

Edition: Second (2nd).

Publisher: Guildford Press.

Type(s): Hardcover, Paperback, and Kindle.

Synopsis:

Widely considered the go-to reference – and now extensively revised with over 65% new material – this authoritative handbook surveys the landscape of current knowledge on psychopathy and addresses essential clinical and applied topics. Leading researchers explore major theoretical models; symptomatology and diagnostic subtypes; assessment methods; developmental pathways; and causal influences, from genes and neurobiology to environmental factors. The volume examines manifestations of psychopathy in specific populations as well as connections to antisocial behaviour and recidivism. It presents contemporary perspectives on prevention and treatment and discusses special considerations in clinical and forensic practice.

New to This Edition

  • Extensively revised with more than a decade’s theoretical, empirical, and clinical advances.
  • Many new authors and topics.
  • Expanded coverage of phenotypic facets, with chapters on behavioural disinhibition, callous–unemotional traits, and boldness.
  • Chapters on DSM-5, clinical interviewing, cognitive and emotional processing, and serial murder.
  • Significantly updated coverage of aetiology, assessment methods, neuroimaging research, and adult and juvenile treatment approaches.

Book: Psychopathy – A Very Short Introduction

Book Title:

Psychopathy – A Very Short Introduction.

Author(s): Essi Viding.

Year: 2019.

Edition: First (1st).

Publisher: OUP Oxford.

Type(s): Paperback, Audiobook, and Kindle.

Synopsis:

Psychopathy is a personality disorder that has long captured the public imagination. Newspaper column inches have been devoted to murderers with psychopathic features, and we also encounter psychopaths in films and books. Individuals with psychopathy are characterised in particular by lack of empathy and guilt, manipulation of other people and, in the case of criminal psychopathy, premeditated violent behaviour. They are dangerous and can incur immeasurable emotional, psychological, physical, and financial costs to their victims and their families. Despite the public fascination with psychopathy, there is often a very limited understanding of the condition, and several myths about psychopathy abound. For example, people commonly assume that all psychopaths are sadistic serial killers or that all violent and antisocial individuals are psychopaths. Yet, research shows that most psychopaths are not serial killers, and, equally, there are plenty of antisocial and violent offenders who are not psychopaths. This Very Short Introduction gives an overview of how we can identify individuals with or at risk of developing psychopathy, and how they differ from other people who display antisocial behaviour. Essi Viding also explores the latest genetic, neuroscience, and psychology evidence in order to illuminate why psychopaths behave and develop the way they do, and considers whether it is possible to prevent or even treat psychopathy.