Cluster A includes paranoid, schizoid, and schizotypal personality disorders. Individuals with these disorders often appear odd or eccentric. Cluster B includes antisocial, borderline, histri- onic, and narcissistic personality disorders. Individuals with these disorders often appear dra- matic, emotional, or erratic. Cluster C includes avoidant, dependent, and obsessive— compulsive personality disorders. Individuals with these disorders often appear anxious or fearful. It should be noted that this clustering system, although useful in some research and ed- ucational situations, has serious limitations and has not been consistently validated.
Moreover, individuals frequently present with co-occurring personality disorders from different clusters. Prevalence estimates for the different clusters suggest 5.7% for dis- orders in Cluster A, 1.5% for disorders in Cluster B, 6.0% for disorders in Cluster C, and 9.1% for any personality disorder, indicating frequent co-occurrence of disorders from dif- ferent clusters. Data from the 2001—2002 National Epidemiologic Survey on Alcohol and
Related Conditions suggest that approximately 15% of US. adults have at least one per- sonality disorder.
The diagnostic approach used in this manual represents the categorical perspective that personality disorders are qualitatively distinct clinical syndromes. An alternative to the categorical approach is the dimensional perspective that personality disorders represent maladaptive variants of personality traits that merge imperceptibly into normality and into one another. See Section III for a full description of a dimensional model for person- ality disorders. The DSM—IV personality disorder clusters (i.e., odd-eccentric, dramatic- emotional, and anxious-fearful) may also be viewed as dimensions representing spectra of personality dysfunction on a continuum with other mental disorders. The alternative di- mensional models have much in common and together appear to cover the important ar- eas of personality dysfunction. Their integration, clinical utility, and relationship with the personality disorder diagnostic categories and various aspects of personality dysfunction are under active investigation.
A. An enduring pattern of inner experience and behavior that deviates markedly from the expectations of the individual’s culture. This pattern is manifested in two (or more) of the following areas: 1. Cognition (i.e., ways of perceiving and interpreting self, other people, and events).
2. Affectivity (i.e., the range, intensity, lability, and appropriateness of emotional re- sponse).
3. Interpersonalfunctioning.
4. Impulse control.
B. The enduring pattern is inflexible and pervasive across a broad range of personal and social situations.
C. The enduring pattern leads to clinically significant distress or impairment in social, oc- cupational, or other important areas of functioning.
D. The pattern is stable and of long duration, and its onset can be traced back at least to adolescence-pr early adulthood.
E. The enduring pattern is not better explained as a manifestation or consequence of an- other mental disorder.
F. The enduring pattern is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition (e.g., head trauma).
Personality traits are enduring patterns of perceiving, relating to, and thinking about the en- vironment and oneself that are exhibited in a wide range of social and personal contexts.