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This learning activity aims to provide a comprehensive overview of personality disorders, including the terminology, characteristics, diagnostic criteria, differential diagnoses, and treatment modalities.
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Personality Disorders
This learning activity aims to provide a comprehensive overview of personality disorders, including the terminology, characteristics, diagnostic criteria, differential diagnoses, and treatment modalities.
Upon completion of this module, learners will be able to:
- differentiate between the cluster types of personality disorders
- describe the various personality disorders and their distinguishing features
- summarize the clinical manifestations and diagnostic criteria for each personality disorder
- explain the diagnostic tools available for personality disorder screening
- recognize the differential diagnoses for each personality disorder
- understand the various treatment modalities for personality disorders
Personality disorders are a group of psychiatric conditions characterized by rigid, pervasive, and persistent patterns of thinking, perceiving, functioning, and behaving. Individuals diagnosed with a personality disorder experience difficulty relating to everyday situations and the individuals around them. Personality disorders can create significant difficulty with maintaining relationships, engaging in social activities, and succeeding at school or work. Individuals with a personality disorder are likely unaware of their condition, as their behavior seems natural; blaming others for all issues is a common theme. Most personality disorders manifest during late adolescence or early adulthood, but some individuals may exhibit signs during childhood. Personality disorders vary in persistence as the patient ages, with some, such as antisocial and borderline personality disorders, becoming less severe and even resolving as the patient ages (American Psychiatric Association [APA], 2022a; Zimmerman, 2022). There are 10 distinct personality disorders, which are characterized by long-term patterns of behavior differing significantly from expected behavior, including:
- antisocial personality disorder
- avoidant personality disorder
- borderline personality disorder
- dependent personality disorder
- histrionic personality disorder
- narcissistic personality disorder
- obsessive-compulsive personality disorder
- paranoid personality disorder
- schizoid personality disorder
- schizotypal personality disorder (APA, 2022a)
Commonly, when an individual meets the criteria for one personality disorder, they also meet the criteria for one or more other personality disorders (APA, 2022a; Zimmerman, 2022).
Personality disorders are grouped into three clusters based on similar clinical features. These clusters are labeled A, B, or C. Cluster A personality disorders are characterized by odd or eccentric thinking or behavior. This category includes paranoid, schizoid, and schizotypal personality disorders. Cluster B personality disorders are characterized by unpredictable thinking or behaviors, extreme emotions, and behaving in ways that are considered overly dramatic, emotional, or erratic compared to expected behaviors. This category includes narcissistic, histrionic, borderline, and antisocial personality disorders. Cluster C personality disorders are characterized by fearful or anxious thinking or behaviors. This category comprises dependent, avoidant, and obsessive-compulsive personality disorders (APA, 2022a; Zimmerman, 2022). Table 1 outlines the different personality disorders within each cluster.
Table 1
Personality Disorder Definitions
Personality Disorder | Definition |
Cluster A | |
Paranoid personality disorder |
|
Schizoid personality disorder |
|
Schizotypal personality disorder |
|
Cluster B | |
Antisocial personality disorder |
|
Borderline personality disorder |
|
Histrionic personality disorder |
|
Narcissistic personality disorder |
|
Cluster C | |
Avoidant personality disorder |
|
Dependent personality disorder |
|
Obsessive-compulsive personality disorder |
|
(APA, 2022a, 2022b)
Impact of Personality Disorders
Personality disorders are considered a global mental health priority. Personality disorders are the most common disorders treated by psychiatrists and psychotherapists in the US. The prevalence of personality disorders in the US is approximately 10%, and the median prevalence varies between the three clusters. The median prevalence of cluster B disorders is highest at 4.5%, followed by cluster A (3.6%) and cluster C (2.8%). Personality disorders account for approximately 50% of all inpatient psychiatric admissions (APA, 2022a; Zimmerman, 2022).
Individuals with personality disorders frequently utilize healthcare services, likely due to the severity of impairment experienced by these patients. The number of comorbidities experienced by these patients also increases their need for healthcare services outside of psychiatric care. These disorders also affect the individual's ability to function in a workplace setting, leading to decreased productivity. Due to the need for healthcare services and the inability to maintain employment, a personal financial burden is associated with a personality disorder diagnosis (Bertsch & Herpertz, 2018; Zimmerman, 2022).
Being diagnosed with a personality disorder makes it three times more likely that the individual will commit a crime than the general population. The most common being crimes involving property and violence. Of all the personality disorders, borderline personality disorder and antisocial personality disorder have the highest imprisonment rate. It is estimated that borderline personality disorder affects 25% to 55% of incarcerated individuals. These individuals also have an increased rate of infractions, disciplinary action, and violence while incarcerated (Mundt & Baranyi, 2020; Yasmeen et al., 2022).
Risk Factors
The etiology of personality disorders is often debated (nature versus nurture). It has been shown that there is a genetic influence on the development of personality disorders which contradicts the common belief that the characteristics of personality disorders result from negative environmental influences. The heritability of personality disorders is approximately 50%, similar to other psychiatric disorders. Psychosocial studies have shown that experiencing a lack of socialization, childhood trauma or abuse, or community violence is likely related to the development of personality disorders. Family issues such as erratic, neglectful, or abusive parenting; substance abuse; divorce; instability; or poverty seem to influence the development of personality disorders. Individuals likely have a genetic predisposition to a personality disorder influenced by environmental factors. As an example, those with a first-degree relative diagnosed with borderline personality disorder are five times more likely to be diagnosed themselves when compared to the general population; however, there are also environmental risk factors such as experiencing sexual abuse as a child, childhood emotional or physical abuse, or substance abuse (Perugula et al., 2017; Solmi et al., 2021; Zimmerman, 2022).
Overall, there is no increased risk of developing a personality disorder due to gender, socioeconomic class, or race; however, certain personality disorders are more prevalent in men than women or vice versa. Among individuals diagnosed with a personality disorder, the number of men diagnosed with antisocial personality disorder is six times higher than women, and women are three times more likely to be diagnosed with borderline personality disorder (Zimmerman, 2022).
Diagnosing Personality Disorders
A diagnosis can be determined by combining a physical examination, psychiatric evaluation, and applying diagnostic criteria found in the DSM-5-TR. The healthcare provider (HCP) should ask in-depth questions about the patient's health during the physical examination. Symptoms are often linked to underlying physical health issues rather than mental health issues, which must be ruled out first. The physical examination may also include lab tests and screenings for substance abuse. The psychiatric evaluation should consist of questions about thoughts, feelings, and behaviors and may include a questionnaire or screening tool to help pinpoint a specific diagnosis. The information from the physical and psychiatric evaluation is compared with the diagnostic criteria in the DSM-5-TR to formulate a diagnosis. Diagnosing personality disorders can be challenging as many overlap each other (APA, 2022a). Specifically, of the 10 disorders, four themes recur in them all:
- rigid, distorted, and extreme thinking patterns (thoughts)
- problematic patterns of emotional response (feelings)
- difficulty with impulse control (behaviors)
- substantial interpersonal relationship problems (behaviors; APA, 2022a)
The DSM-5-TR criteria for a personality disorder is an "enduring" pattern of inner experience and behaviors that manifests in two or more areas (thoughts, feelings, impulse control, and interpersonal relationships). This pattern of behavior deviates markedly from cultural norms or expectations, is pervasive and inflexible, is stable over time, or leads to distress or impairment for the individual (APA, 2022a). See Table 2 for disorders and their primary characteristics.
Table 2
Personality Disorders Diagnostic Criteria
Disorder | Criteria |
Antisocial personality disorder | A consistent ignorance and abuse of surrounding people’s rights that began at age 15 (or earlier) as evidenced by at least three of the following:
The symptoms must be present outside of and notwithstanding a diagnosis of bipolar disorder, schizophrenia, or some other psychotic disorder. A prior history of conduct disorder must have been diagnosed or retrospectively evident before age 15. Antisocial personality disorder is not to be confirmed in an individual under 18. |
Avoidant personality disorder | A consistent finding of feelings of deficiency, highly touchy when presented with constructive feedback, and shyness or self-consciousness This personality disorder typically presents by the patient’s '20s and is evidenced by at least four of the following:
|
Borderline personality disorder | A consistent fluctuation in self-regard, social connections, and displays of emotion, along with quick decision-making without consideration of consequences or preparation This personality disorder typically presents by the patient's '20s and is evidenced by at least five of the following:
|
Dependent personality disorder | A consistent and extreme desire to be cared for, resulting in actions that are passive, docile, and insecure and concerns of estrangement This personality disorder typically presents by the patient's '20s and is evidenced by at least five of the following:
|
Histrionic personality disorder | A consistent finding of emotional lability and pursuing notice and attention from others This personality disorder typically presents by the patient's '20s and is evidenced by at least five of the following:
|
Narcissistic personality disorder | A consistent desire for veneration or respect from others, grandness, and lack of understanding and compassion for the feelings of others This personality disorder typically presents by the patient's '20s and is evidenced by at least five of the following:
|
Obsessive-compulsive personality disorder | A consistent finding of a fascination with control, flawlessness, and organization This personality disorder typically presents by the patient's '20s and is evidenced by at least five of the following:
|
Paranoid personality disorder | A ubiquitous wariness, doubt, and lack of trust regarding people's underlying motivation (i.e., malicious intent) that starts no later than the patient's '20s in various environments, as evidenced by at least four of the following:
The symptoms must be present outside of and notwithstanding a diagnosis of bipolar disorder, schizophrenia, or some other psychotic disorder or medical condition. |
Schizoid personality disorder | A consistent lack of attachment to others and a limited display of emotions when interacting with others This personality disorder typically presents by the patient's '20s and is evidenced by at least four of the following:
The symptoms must be present outside of and notwithstanding a diagnosis of bipolar disorder, schizophrenia, some other psychotic disorder, autism spectrum disorder, or other medical condition. |
Schizotypal personality disorders | A consistent lack of close connections with people due to a lack of desire and decreased capability to foster these relationships, as well as mental misrepresentations and oddities of conduct This personality disorder typically presents by the patient's '20s and is evidenced by at least five of the following:
The symptoms must be present outside of and notwithstanding a diagnosis of bipolar disorder, schizophrenia, some other psychotic disorder, autism spectrum disorder, or other medical condition. |
(APA, 2022a)
Other disorders, including depression, anxiety, or substance abuse, can present simultaneously with a personality disorder and complicate the diagnostic process. When individuals seek treatment for their symptoms, they often report feelings of depression or anxiety rather than the symptoms related to the personality disorder. It is essential to distinguish whether the secondary symptoms indicate the presence of a separate mental health condition or developed as a maladaptive response to the personality disorder. There is also an overlap of symptoms between personality disorders are other mental health disorders. A personality disorder should only be diagnosed when the above criteria are met, and the characteristics appear before early adulthood and affect the individual's long-term functioning. The symptoms must also be present outside of an acute episode caused by another mental health disorder and do not emerge in response to a particular situation. Personality disorders must also be differentiated from personality traits, and the patient's symptoms should be evaluated over time to make a diagnosis. Diagnosing personality disorders is also complicated when the individual does not believe their symptoms or behaviors are problematic or has no insight into their condition. In these circumstances, gathering supplemental information from friends or family members may be necessary as characteristics are more difficult to decipher (APA, 2022a; Zimmerman, 2022).
Screening Tools
Section 3 of the DSM-5-TR includes the DSM-5 model for personality disorders developed by the APA Board of Trustees, which attempts to address the shortcomings of the traditional diagnostic criteria. They created the personality trait model, which addresses five broad domains of personality trait changes. These domains include negative affectivity, detachment, antagonism, disinhibition, and psychoticism. These domains are then subdivided into 25 personality facets. An instrument known as the Personality Inventory for DSM-5 (PID-5) is composed of 220 items that address all 25 personality facets. The PID-5 can be completed by the patient or by an individual that knows them well, but it can be time-consuming, taking on average 20-30 minutes to complete. Although the PID-5 does not require a lot of provider time, it is still considered too long, and many patients become frustrated and do not fill it out as accurately or entirely as desired due to fatigue. However, if completed and appropriately reviewed by the HCP, this tool is the most accurate in diagnosing personality disorders (APA, 2022a).
The APA (2023) website offers three versions of this form in their DSM-5-TR online assessment measures. Included is their brief form (PID-5-BF), the original PID-5, and an informant form (PID-5-IRF) specifically designed to be completed by the affected individual's family and friends. The PID-5-BF only has 25 questions, so it is less time-consuming to complete but offers much less insight into the patient's condition and should only be used as a follow-up screening tool to monitor the severity of symptoms and improvement in functioning over time rather than as an initial assessment (APA, 2023). The following are the 25 statements included in the PID-5-BF (APA, 2013):
1. People would describe me as reckless.
2. I feel like I act totally on impulse.
3. Even though I know better, I can't stop making rash decisions.
4. I often feel like nothing I do really matters.
5. Others see me as irresponsible.
6. I'm not good at planning ahead.
7. My thoughts often don't make sense to others.
8. I worry about almost everything.
9. I get emotional easily, often for very little reason.
10. I fear being alone in life more than anything else.
11. I get stuck on one way of doing things, even when it's clear it won't work.
12. I have seen things that weren't really there.
13. I steer clear of romantic relationships.
14. I'm not interested in making friends.
15. I get irritated easily by all sorts of things.
16. I don't like to get too close to people.
17. It's no big deal if I hurt other people's feelings.
18. I rarely get enthusiastic about anything.
19. I crave attention.
20. I often have to deal with people who are less important than me.
21. I often have thoughts that make sense to me, but that other people say are strange.
22. I use people to get what I want.
23. I often "zone out" and then suddenly come to and realize that a lot of time has passed.
24. Things around me often feel unreal or more real than usual.
25. It is easy for me to take advantage of others.
Scoring is based on a 4-point scale associated with the individual's responses to the statement. A response of very false or often false is scored a 0; sometimes or somewhat false is scored a 1; sometimes or somewhat true is scored a 2; and very true or often true is scored a 3. Each statement is associated with a particular personality trait domain; negative affect (8, 9, 10, 11, and 15); detachment (4, 13, 14, 16, and 18); antagonism (17, 19, 20, 22, 25); disinhibition (1, 2, 3, 5, 6); and psychoticism (7, 12, 21, 23, and 24). The individual statement scores are added for a total/partial raw domain score, and an average is applied based on how many questions were answered. If the individual leaves seven or more questions on the entire assessment unanswered, scoring should not be completed; if two or more questions in each domain are left unanswered, scoring for that domain should not be completed. Each domain can have a score between 0 and 15. A higher score indicates a higher level of dysfunction in a particular domain. Scoring criteria are based on the patient selections and overall score. The score does not indicate which personality disorder is present but simply the presence of one (APA, 2013).
Another tool developed to reduce the length of assessment for personality disorders is the Standardized Assessment of Personality-Abbreviated Scale (SAPAS). The SAPAS was initially created in 2003 using eight items taken from the opening section of the Standardized Assessment of Personality (SAP), an informant-based interview tool used to diagnose a personality disorder (Moran et al., 2003). The SAPAS asks the following yes/no questions (Moran et al., 2003):
- In general, do you have difficulty making and keeping friends?
- Would you normally describe yourself as a loner?
- In general, do you trust other people?
- Do you normally lose your temper easily?
- Are you normally an impulsive sort of person?
- Are you normally a worrier?
- In general, do you depend on others a lot?
- In general, are you a perfectionist?
A response of yes to three or more of the eight questions indicates the presence of a personality disorder; however, this screening tool can not differentiate between different personality disorders (Moran et al., 2003).
Another screening tool is the Iowa Personality Disorder Screener (IPDS), which Langbehn and colleagues developed in 1999. This 11-item screening tool asks the patient to consider their thoughts and feelings in recent weeks or months and how they differed from when they felt like their usual self. It can be used in the outpatient psychiatric setting to determine if a personality disorder is present (PsychTools, 2018). The following yes/no questions are included (Langbehn et al., 1999):
- a. Some people find their mood frequently changes - as if they spend every day on an emotional roller coaster. For example, they might switch from feeling angry to depressed to anxious many times a day. Does this sound like you?
b. If YES, have you been this way most of your life? - a. Some people prefer to be the center of attention, while others are content to remain on the edge of things. Would you describe yourself as preferring to be the center of attention?
b. If YES, does it bother you when someone else is in the spotlight? - a. Do you frequently insist on having what you want right now, even when waiting a little longer would get you something much better?
b. Do you often get in trouble at work or with friends because you act excited at first but then lose interest in projects and don't follow through? - Do you find that most people will take advantage of you if you let them know too much about you?
- a. Do you generally feel nervous or anxious around people?
b. Do you avoid situations where you have to meet new people? - a. Do you avoid getting to know people because you're worried they may not like you?
b. If YES, has this affected the number of friends that you have? - a. Do you keep changing how you present yourself to people because you don't know who you really are?
b. Do you often feel like your beliefs change so much that you don't know what you really believe anymore? - Do you often get angry or irritated because people don't recognize your special talents or achievements as much as they should?
- a. Do you often suspect that people you know may be trying to cheat or take advantage of you?
b. If YES, do you worry about this a lot? - Do you tend to hold grudges or give people the silent treatment for days at a time?
- a. Do you get annoyed when friends or family complain about their problems?
b. Do people complain that you're not very sympathetic to their problems?
Differential Diagnoses
As previously noted, there are often overlapping features among mental health disorders, and this can make a differential diagnosis even more complex. A developmental history, pre-condition history, and informant observations and perceptions can help identify differential diagnoses. Personality disorders can also mimic many of the signs and symptoms associated with other psychiatric disorders. Examples are the dependency features of major depression, the antisocial behaviors in substance abuse, or the narcissistic behaviors of mania within the bipolar spectrum (APA, 2022a; Brudey, 2021). The following conditions should be considered in the differential diagnosis of a personality disorder:
- social phobia (intense anxiety or fear of being judged negatively or rejected in a social situation)
- psychotic disorders, including schizophrenia (reality is interpreted abnormally) or schizoaffective disorder (a chronic condition characterized by hallucinations or delusions and symptoms of a mood disorder)
- anxiety disorders
- bipolar disorder
- substance abuse disorders
- pathological gambling
- developmental disorders
- attention deficit hyperactivity disorder (ADHD)
- post-traumatic stress disorder (PTSD; a mental health condition that is triggered by a terrifying event causing nightmares, extreme anxiety, or causing flashbacks)
- paraphilias (intense sexual arousal to atypical objects, fantasies, or situations; APA, 2022a; Brudey, 2021)
Management of Personality Disorders
Psychotherapy is the gold standard treatment of personality disorders. Individual and group therapy are beneficial, but the patient must be willing and motivated to participate in treatment and change their behavior (Zimmerman, 2022). The commonly used psychotherapy types include (APA, 2022b; Johnson et al., 2018):
- Cognitive-behavioral therapy (CBT) focuses on changing dysfunctional emotions, thoughts, or behaviors through interrogation and discovery of negative or irrational thoughts and beliefs; these dysfunctional thoughts are then replaced with reality or solutions to the dysfunctional thoughts.
- Dialectical behavior therapy (DBT) helps the individual learn to communicate in ways that are assertive but maintain self-respect and strengthen relationships. It focuses on the therapeutic skills of mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness. It provides patients with the skills to manage unhealthy emotions and decrease conflict in relationships. This is the most researched therapy method for the treatment of borderline personality disorder.
- Psychoanalytic therapy is a form of talk therapy aimed at bringing unconscious or deeply buried thoughts to the surface so the repressed memories can be examined for how they affect current behavior, thinking, or relationships.
- Group therapy involves one or more psychologists leading a group of 5 to 15 patients, typically meeting 1 to 2 hours each week. The groups typically focus on a specific problem, such as a type of personality disorder or a symptom, such as anxiety. Participation in group therapy can help the individual recognize and build camaraderie with others with similar issues and gain perspective.
- Psychoeducation involves teaching the patient or their family about their illness, ways of coping, and available treatment options.
These therapies can aid the patient in gathering insight into their condition and understanding the effects of their behaviors on their life and the others around them. The focus is on learning coping skills for the symptoms, thereby reducing the problematic behaviors to improve daily function and relationships (See the NursingCE course on Psychotherapy for more information). Personality disorders are not typically responsive to pharmaceutical treatment; however, anxiolytics, antidepressants, and mood-stabilizing medications have successfully targeted specific symptoms of various personality disorders, such as anxiety or depression. These medications are also contraindicated in certain personality disorders, as their use can increase the severity of some symptoms. Anxiolytics are not indicated for those with impulsive behaviors, such as patients with antisocial or borderline personality disorders, as the behaviors can increase with use. Antidepressants, especially selective serotonin reuptake inhibitors (SSRIs), are not recommended for patients with narcissistic personality disorder as the grandiose behavior and lack of empathy for others can increase with use. Otherwise, these medication groups can be used when psychotherapy is unsuccessful but require a team approach that may include primary care providers, psychiatrists, or psychologists for medication management (APA, 2022b; Bateman et al., 2015; Zimmerman, 2022). See Table 3 for supportive medications for symptomatic treatment.
Table 3
Supportive Medications for Symptomatic Treatment of Personality Disorders
Medication Category | Targeted Symptoms | Examples |
Benzodiazepines |
|
|
Antidepressants |
|
|
Mood stabilizers |
|
|
(APA, 2022b; Zimmerman, 2022)
Additionally, active participation in the treatment plan by the individual and their family is essential to success. The patient should be educated on additional self-care and coping mechanisms (APA, 2022b). These techniques include:
- learning more about the condition to empower the individual to understand symptoms and how to manage them
- increasing physical activity and participating in an exercise program can help alleviate symptoms of depression, stress, and anxiety
- avoiding alcohol and illicit drugs as these can increase the severity of symptoms and interact with prescribed medications
- getting regular check-ups with an HCP to maintain overall health
- taking medications as prescribed
- joining a support group specific to personality disorders
- engaging in reflective journaling
- utilizing stress management techniques such as yoga or meditation
- staying connected to family and friends and avoiding isolation (APA, 2022b)
Managing and coping with a personality disorder can challenge the patient and their family and friends. Support and education regarding effective coping mechanisms can benefit all individuals involved. It is vital to remember that this is not an isolated event but an ongoing, lifelong treatment process geared toward managing the symptoms, pitfalls, and successes of personality disorders. Personality disorders can cause significant impairment in daily functioning with personal and professional relationships, yet they can also lead to extraordinary achievements. For instance, an individual with narcissistic personality disorder can be confident, highly self-motivated, and ambitious, with leadership skills that allow them to utilize people and situations to maximum advantage. Someone with narcissistic personality disorder is more likely to hold a high-level executive position. An individual with borderline personality disorder can be charming, witty, and the "life of the party." Executives with personality disorders have been called successful psychopaths, and criminals with the same condition unsuccessful psychopaths. The differentiator between the two pathways seems to be that successful psychopaths have a conscience, whereas unsuccessful ones do not. Their success comes from being able to control impulses and act responsibly. Unsuccessful psychopaths cannot restrain their destructive tendencies enough to build relationships (APA, 2022b; Lasko & Chester, 2020).
References
American Psychiatric Association. (2013). The personality inventory for DSM-5 brief form. https://www.psychiatry.org/getmedia/f65c4386-b2bc-44a5-9ace-d6fea2211506/APA-DSM5TR-ThePersonalityInventoryForDSM5BriefFormAdult.pdf
American Psychiatric Association. (2022a). Diagnostic and statistical manual of mental disorders (5th ed., text rev.) (DSM-5-TR). https://doi.org/10.1176/appi.books.9780890425787
American Psychiatric Association. (2022b). What are personality disorders? https://www.psychiatry.org/patients-families/personality-disorders/what-are-personality-disorders
American Psychiatric Association. (2023). DSM-5-TR online assessment measures. https://www.psychiatry.org/psychiatrists/practice/dsm/educational-resources/assessment-measures
Bateman, A. W., Gunderson, J., & Mulder, R. (2015). Treatment of personality disorder. The Lancet, 385(9969), 735-743. https://doi.org/10.1016/S0140-6736(14)61394-5
Bertsch, K., & Herpertz, S. C. (2018). Personality disorders, functioning, and health. Psychopathology, 51(2), 69-70. https://doi.org/10.1159/000487971
Brudey, C. (2021). Personality disorders in older age. Focus, 19(3), 303-307. https://doi.org/10.1176/appi.focus.20210007
Johnson, B. N., Clouthier, T. L., Rosenstein, L. K., & Levy, K. N. (2018). Psychotherapy for personality disorders. In V. Zeigler-Hill & T. K. Shackelford (Eds.), Encyclopedia of personality and individual differences (pp. 54-76). Springer. https://doi.org/10.1007/978-3-319-28099-8_925-1
Langbehn, D. R., Pfohl, B. M., Reynolds, S., Clark, L. A., Battaglia, M., Bellodi, L., Cadoret, R., Grove, W., Pilkonis, P., & Links, P. (1999). The Iowa personality disorder screen: Development and preliminary validation of a brief screening interview. Journal of Personality Disorders, 13(1), 75-89. https://doi.org/10.1521/pedi.1999.13.1.75
Lasko, E. N., & Chester, D. S. (2020). What makes a 'successful' psychopath? Longitudinal trajectories of offenders' antisocial behavior and impulse control as a function of psychopathy. Personality Disorders: Theory, Research, and Treatment, 12(3), 207-215. https://doi.org/10.1037/per0000421
Moran, P., Leese, M., Lee, T., Walters, P., Thornicroft, G., & Mann, A. (2003). Standardised assessment of personality-abbreviated scale (SAPAS): Preliminary validation of a brief screen for personality disorder. The British Journal of Psychiatry, 183(3), 228-232. https://doi.org/10.1192/bjp.183.3.228
Mundt, A. P., & Baranyi, G. (2020). The unhappy mental health triad: Comorbid severe mental illnesses, personality disorders, and substance use disorders in prison populations. Frontiers in Psychiatry, 11. https://doi.org/10.3389/fpsyt.2020.00804
Perugula, M. L., Narang, P. D., & Lippmann, S. B. (2017). The biological basis to personality disorders. The Primary Care Companion for CNS Disorders, 19(2). https://doi.org/10.4088/PCC.16br02076
PsychTools. (2018). Iowa Personality Disorder Screen (IPDS). https://www.psychtools.info/ipds/
Solmi, M., Dragioti, E., Croatto, G., Radua, J., Borgwardt, S., Carvalho, A. F., Demurtas, J., Mosina, A., Kurotschka, P., Thompson, T., Cortese, S., Shin, J. I., & Fusar-Poli, P. (2021). Risk and protective factors for personality disorders: An umbrella review of published meta-analyses of case-control and cohort studies. Frontiers in Psychiatry, 12. https://doi.org/10.3389/fpsyt.2021.679379
Yasmeen, S., Tangney, J. P., Stuewig, J. B., Hocter, C., & Weimer, L. (2022). The implications of borderline personality features for jail inmates' institutional misconduct and treatment-seeking. Personality Disorders: Theory, Research, and Treatment, 13(5), 505-515. https://doi.org/10.1037/per0000518
Zimmerman, M. (2022). Overview of personality disorders. Merck Manual Professional Version. https://www.merckmanuals.com/professional/psychiatric-disorders/personality-disorders/overview-of-personality-disorders