By K. M. Asano

S E R I E S C O N S U L T A N T Anne S. Walters, Ph.D. Emma Pendleton Bradley Hospital Warren Alpert Medical School of Brown University

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Foreword: Dr. Anne S. Walters, Ph.D.. ......................................... 6 Chapter 1: What Are Personality Disorders?............................... 11 Chapter 2: Cluster A – Eccentric Personality Disorders................ 23 Chapter 3: Cluster B – Dramatic Personality Disorders................ 43 Chapter 4: Cluster C – Fear-Based Personality Disorders............. 69 Chapter 5: Unique Personality Disorders................................... 85 Chapter 6: Learning to Live with a Personality Disorder. ............ 93 Chapter Notes. ..................................................................... 102 Series Glossary of Key Terms. ................................................ 104 Further Reading. .................................................................. 106 Internet Resources................................................................ 107 Organizations to Contact....................................................... 108 Index................................................................................... 109 Author’s Biography / Credits................................................. 112 CONTENTS KEY ICONS TO LOOK FOR: Words to Understand: These words with their easy-to-understand definitions will increase the reader’s understanding of the text while building vocabulary skills. Sidebars: This boxed material within the main text allows readers to build knowledge, gain insights, explore possibilities, and broaden their perspectives by weaving together additional information to provide realistic and holistic perspectives. Educational videos: Readers can view videos by scanning our QR codes, providing them with additional educational content to supplement the text. Examples include news coverage, moments in history, speeches, iconic sports moments, and much more! Text-Dependent Questions: These questions send the reader back to the text for more careful attention to the evidence presented there. Research Projects: Readers are pointed toward areas of further inquiry connected to each chapter. Suggestions are provided for projects that encourage deeper research and analysis. Series Glossary of Key Terms: This back-of-the-book glossary contains terminology used throughout this series. Words found here increase the reader’s ability to read and comprehend higher-level books and articles in this field.


Dr. Anne S. Walters, Ph.D.

Almost one in seven children and adolescents in the United States has a diagnosable mental illness, according to the National Institute of Mental Health (NIMH), the leading federal agency for research on mental disorders. That’s more than the number of children and adolescents suffering from cancer, AIDS, and diabetes combined. NIMH

research has found that almost 50 percent of these young people will experience an episode of mental illness before the age of eighteen. The rate of mental illness is even higher among young adults between the ages of eighteen and twenty-five. This is not a uniquely American problem, however. The World Health Organization (WHO) reports that mental disorders are the leading cause of disability among young people in all regions of the world.


The most common behavioral health diagnoses in children include attention deficit hyperactivity disorder (ADHD), behavior problems, anxiety, and depression. Some of these conditions commonly occur together. For example, about three in four children (73.8 percent) between the ages of three and seventeen who have been diagnosed with depression also suffer from anxiety, and almost one in two (47.2 percent) exhibit behavioral problems, according to the Centers for Disease Control and Prevention. What do these numbers mean? To start, it means that mental illness is very common. Most of you reading this will have at least one friend or family member who either is currently struggling or has struggled in the past with a psychiatric illness. That number may even include you and may mean that you have symptoms of both anxiety and depression. In addition, mental illness is becoming more common. Suicide rates have increased in children and adolescents over the past ten years, and this is a major concern at present for professionals in the behavioral health field. No one is sure what has caused these increases, though some speculate it is related to “cultural trends.” A combination of factors such as social media and technology advances or the opioid crisis may all play contributing roles. Other professionals have wondered about how violence in our schools might impact youth


mental health, and still others have pointed to the potential effects of decreased sleep on these illnesses. Despite there being more widespread information about the prevalence of mental health issues for children and adolescents, only slightly more than half of these children receive treatment. What gets in the way? One of the barriers to seeking treatment is the fear that others will find out. Children, adolescents, and even parents fear the stigma of being identified as having a mental illness. Despite progress in the diagnosis and treatment of these illnesses, the stigma that surrounds mental illness is still very profound, even today. Parents fear that their children will experience shame. As long as this stigma exists, it affects the likelihood that children or their families will seek help. Other barriers include doctor and hospital wait lists, concern about medical expense, a shortage of available mental health providers, and lack of knowledge about treatment options. Some of the movements toward reducing stigma have been helpful in this regard. Notable examples are actress Glenn Close and her foundation aimed at reducing the stigma for those with bipolar disorder, or Olympic athlete Michael Phelps speaking out about his own depression. The good news in all of this is that in recent years, evidence-based treatment has become available. The term “evidence based” refers to treatment that has been tested via research and


proven to be effective for various types of mental illness. For example, we know that a form of treatment called “Coping Cat” utilizes a cognitive behavioral form of treatment that is effective for childhood anxiety, and that effectiveness is improved with the use of certain medications as well. Cognitive behavioral therapy (CBT) targets the way that we negatively interpret or perceive situations, and teaches us to “restructure” those thoughts, leading to different feelings and experiences. We know CBT is helpful because researchers have performed studies comparing patients who get this form of treatment with patients that receive other forms of treatment. Our readers will learn more about all these topics in the volumes ahead. We hope that having more information will help you to combat the stigma that surrounds mental illness, and therefore reduce the length of time it takes a child and family to seek treatment. Our hope is that this series will spark conversation and provide important information for children, parents, and school personnel about the various diagnoses that are most common in childhood and adolescence. With this series, we hope you will understand much more about mental illnesses, what is involved, and what to do to help those who might be suffering like family, friends, or even you.



attained: having reached or achieved a goal or a milestone interpersonal: referring to relations between or among people perceive: to attain awareness or understanding of predisposed: having established ideas, beliefs, views, or opinions


1 chapter

What Are Personality Disorders?

When it comes to discussing the intricacies of personality disorders, it is important to first have a clear understanding of what personality is and what it is not. Personality denotes the existence of a very distinctive set of traits, behaviors, and actions that make up the individual nature of a person. How a person perceives the world, their unique attitudes, their individual thoughts, and their personalized feelings are all parts of what constitutes someone’s personality. People with healthy personalities can usually cope with normal stresses. They also typically do not have issues with forming and keeping relationships with family, friends, and co-workers. Individuals with personality disorders have difficulty behaving in a socially accepted manner. They also tend to not easily adjust in conflict situations or when life does not go their way. The American Psychiatric Association (APA) states that mental health professionals


Always becoming incensed when stuck in traffic is the sort of consistent symptom that may indicate a personality disorder.


Behavioral Disorders: Personality Disorders

must diagnose a personality disorder by looking at a person’s long term symptoms and patterns of functioning. The APA estimates that about nine percent of American adults have a personality disorder, and people can have more than one type. People under age eighteen are not likely to be diagnosed with personality disorders. Why? Because their personalities are still developing. 1 In the DSM-5 When discussing something as controversial and personal as personality disorders, it is important to establish a firm and reputable point of reference for what is and is not considered a personality disorder, and the DSM-5 is the resource used by medical professionals for that purpose. It is maintained and regulated by medical experts across many medical fields. The National Institute of Mental Health (NIMH) Director Thomas R. Insel, along with American Psychiatric Association President Jeffrey A. Lieberman, released a statement noting that the DSM-5 “represents the best information currently available for clinical diagnosis of mental disorders.” 2 According to the official Diagnostic and Statistical Manual of Mental Disorders (DSM-5), people have a personality disorder when they are significantly impaired at self-regulation and interpersonal functioning, but they also need to have one or more pathological personality traits: • Consistency of symptoms in a variety of situations. For example, a person is always angry when stuck in traffic, or a person always feels judged when people offer advice. • Symptoms that are not normal parts of an individual’s development and learning process. For example, some young people challenge authority and don’t have a personality disorder, it’s just part of becoming an adult.


What Are Personality Disorders?

• Symptoms are not related to another cause, such as medications or drug or alcohol abuse. For example, some medications can cause aggression or suicidal thoughts in some people, but they do not necessarily have personality disorders. The Diagnostic and Statistical Manual of Mental Disorders is used by clinicians and psychiatrists to diagnose psychiatric illnesses. The American Psychiatric Association publishes the DSM and released its fifth edition in 2013. The DSM-5 covers all categories of mental health disorders for both adults and children and is widely used in the United States for psychiatric diagnosis, treatment recommendations, and insurance coverage purposes. The DSM-5 lists 10 personality disorders (PD) and allocates each to one of three groups or “clusters”: A, B, or C. The following are the classifications for the three major clusters:


A personality disorder is a variation of a mental disorder. People who suffer from personality disorders generally are very unyielding and have an unhealthy pattern of behavior and personality that affects how they think, function, and behave. They tend to have trouble in certain social situations and difficulty picking up on the actions and words of people. That causes significant problems and limitations in relationships, social activities, work, and school.


Behavioral Disorders: Personality Disorders

Personality disorder symptoms often overlap and blend together.


What Are Personality Disorders?

Cluster A (odd, bizarre, eccentric) • Paranoid PD • Schizoid PD • Schizotypal PD Cluster B (dramatic, erratic)

• Antisocial PD • Borderline PD • Histrionic PD • Narcissistic PD

When it starts to impact the way someone relates to the people in their lives, that is when a personality disorder may be diagnosed.


Behavioral Disorders: Personality Disorders

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