Personality disorder

Classification according to ICD-10
F21	Schizotypic disorder
F60.0	Paranoid personality disorder
F60.1	Schizoid personality disorder
F60.2	Dissocial Personality Disorder
F60.30	Emotionally unstable personality disorder, impulsive type
F60.31	Emotionally unstable personality disorder, borderline type
F60.4	Histrionic Personality Disorder
F60.5	Anankastic [compulsive] personality disorder
F60.6	Anxious (avoidant) personality disorder
F60.7	Dependent (asthenic) personality disorder
F60.8	Other Specific Personality Disorders Narcissistic Personality Disorder Passive Aggressive Personality Disorder
F60.9	Personality disorder, unspecified
F61	Combined and other personality disorders
ICD-10 online (WHO version 2019)

Personality disorders (PS) represent a class of mental disorders . With them, certain characteristics of the personality structure and behavior are particularly pronounced, inflexible or poorly adapted. They are among the most common diagnoses in psychiatry.

Personality disorders describe long-lasting patterns of experience and behavior with a variety of causes (e.g. developmental conditions in childhood or later stages of life, genetic factors or acquired brain damage). These behavioral patterns differ in characteristic ways from a flexible, situation-appropriate experience and behavior. Personal performance in social, professional and private life is usually significantly impaired (see quality of life for PS ).

Personality disorders are divided according to characteristic features, but there is often an overlap. Various typologies or classifications have been developed for this purpose in psychiatry and clinical psychology, for example in the ICD-10 and DSM-5 . The term personality disorder used to be referred to as character neurosis and is closely related, but not identical in content with the terms neurosis structure and neurosis disposition .

In children and adolescents, there are rare cases of preliminary stages or risk constellations of personality disorders. But since the development of the personality is not yet complete, it is more of a personality development disorder .

History

In the past, the general term “ psychopathy ” was used for those personality disorders that are now summarized under the term “personality disorder”. This broad term was only replaced by "personality disorder" in 1980 with the introduction of the DSM-III . In today's forensic-psychiatric usage, however, the meaning of psychopathy is very narrowly limited and exclusively describes an extremely severe form of antisocial personality disorder .

Already Philippe Pinel (1809) distinguished between psychotics and psychopaths and used while the term mania sans delire , where he defined psychopathy as interfering with the affective functions in undisturbed mind forces. Bénédict Morel (1857) believed in the theory of degeneration: According to this, habitual dissociality would arise through the environment, but could then be passed on genetically in a kind of Lamarckism .

The first diathesis-stress model of personality disorders was presented by Valentin Magnan and Lagrain (1895), who ascribed inherited neurophysiological factors a decisive role in the susceptibility to developing a personality disorder. However, these could only become effective through psychosocial stressors.

The term psychopathy was mainly coined by Julius Koch's monograph on psychopathic inferiority (1891) . Koch was also a supporter of a genetic theory of degeneration and described various types of disorders such as the faint-hearted or the do-gooder of the city and the world .

At the turn of the 20th century, there was a paradigm shift away from the theory of degeneration towards the theory of constitution . The German psychiatrists Kraepelin and Kretschmer in particular linked constitutional factors such as drive strength or body structure with various disorders. Ernst Kretschmer examined typical body shapes and the associated risks for mental illness. With Kurt Schneider's The Psychopathic Personalities (1923), the judgmental terminology disappeared and its ten different types already contained most of the known personality disorders.

Diagnosis

Both diagnostic systems describe exactly six criteria for general personality disorder . These criteria describe basic conditions that must be met in each individual case in order to be able to speak of a personality disorder. Only then can a more precise diagnosis of a specific PS be issued.

DSM-5

In the DSM these are the following:

An enduring pattern of inner experience and behavior that deviates noticeably from the expectations of the socio-cultural environment. This pattern manifests itself in at least two of the following areas:

Cognition (i.e. the way you perceive and interpret yourself, other people and events),
Affectivity (i.e. the range, intensity, lability, and appropriateness of emotional responses),
Shaping interpersonal relationships.
Impulse control.

The persistent pattern leads in a clinically meaningful way to suffering or impairment in social, professional or other important functional areas.
The pattern is stable and long-lasting, and its onset can be traced back to at least adolescence or early adulthood.
The persistent pattern cannot be better explained as a manifestation or consequence of another mental disorder.
The persistent pattern is not a result of the physiological effect of a substance or a medical disease factor (e.g. brain injury).
The enduring pattern is inflexible and profound in a wide range of personal and social situations.

ICD-10

In the guidelines of the International Classification of Mental Disorders , the following general criteria for personality disorders apply:

Clinically important, mostly long-lasting conditions and behavior patterns.
Expression of the characteristic, individual lifestyle, the relationship to oneself and to other people.
Deeply rooted, persistent behavior patterns that show up in rigid reactions to different personal and social situations.
Clear deviations in perception, thinking, feeling and in relationships with others.
Behavioral patterns mostly stable and refer to diverse areas of behavior and psychological functions.
Mostly personal suffering and impaired social functioning.

Demarcation

Personality disorders must be distinguished from the following neurological and psychological disorders ( differential diagnosis ):

Organic changes in personality: These include, above all, brain damage after traumatic brain injury ( frontal brain syndrome ), dementia (such as Pick's disease ) or long-term severe alcohol abuse . All of these disorders can lead to major personality changes.

Affective disorders: Diseases such as depression or bipolar disorder , which relate solely to dealing with moods , must also be considered . People with an affective disorder only behave conspicuously during acute phases of illness; but otherwise like all other people for the rest of the time. People with personality disorders, on the other hand, consistently and consistently show a different behavior than the majority of people. Especially with regard to how they experience feelings and deal with them, how they deal with other people, how they think about problems and how they interpret situations.

autism: When clarifying disorders of the autistic spectrum , personality disorders are one of the most important differential diagnoses and comorbidities . In studies with patients with Asperger's Syndrome (AS) met this

19–32% the formal criteria of compulsive PS,
21–26% that of schizoid PS,
13–25% that of anxious-avoidant PS
and 3–13% of cases that of schizotypic PS.

Conversely, it is not known how many people with PS also have an autistic disorder. In contrast to Asperger's Syndrome, however, PS usually only shows up after puberty and until then, an adapted and inconspicuous social behavior can often be determined initially. In addition, in contrast to autistic people, people with PS usually have a normally developed ability to develop the theory of mind . While autistic people have difficulty recognizing and understanding social signals ("hypo-mentalizing"), communication problems in people with PS arise from over-interpreting social signals in a certain way ("hyper-mentalizing"). People with cluster A-PS tend to "read" hostile messages into neutral signals, while people with anxious-avoiding PS, on the other hand, pay too much attention to critical and negative signals.

Other disorders

Cluster classification of the PS

In the DSM-5 , personality disorders are grouped into clusters :


	DSM-5	description
Cluster A weird, eccentric	paranoid PS schizoid PS schizotypic PS	Cluster A comprises the schizophrenia-related PS . People with these personality disorders are suspicious, strange and eccentric and appear low-affect to cold-hearted. In the event of alleged insults and threats, the mood can quickly turn into anger. They live in isolation and have little personal contact.
Cluster B dramatic, emotional	Borderline PS histrionic PS antisocial PS narcissistic PS	Cluster B personality disorders are characterized by moodiness, impulsiveness, intense anger, and an inability to control them. Behavior in relationships tends to be characterized by idealization and devaluation as well as difficulties in dealing with closeness and distance. Self-damaging and suicidal behaviors occur more frequently with certain manifestations of these personality disorders, sometimes also external aggressiveness. All personality disorders in this cluster are based on a low self-esteem, so that when criticized, feelings such as anger, shame or humiliation arise.
Cluster C fearful, avoidant	avoidant PS dependent PS compulsive PS (passive-aggressive PS)	People with Cluster C personality disorder can be described as anxious and fearful. Central feelings in these people are, besides tension and concern, feelings of helplessness and dependency. They are easily vulnerable to criticism or rejection and suffer from massive separation fears. If they are overly conscientious, they are not flexible and tend to be passive aggressive.

In the ICD-10, the schizotypic personality disorder is listed under the code F21 as a schizotypal disorder . Although it is assigned to the group of schizophrenia and delusional disorders , it also says: "Development and course usually correspond to a personality disorder."

Classification according to ICD-10

Chapter V of the ICD-10 has a section on personality and behavioral disorders .

Paranoid personality disorder

The paranoid personality disorder (F60.0) is characterized by excessive distrust (up to frequent assumption of plots to explain events) quarrelsomeness, Groll lasting and strong self-absorption. Actions, statements and communicative signals of other people are often misinterpreted as hostile.

Schizoid personality disorder

The ICD-10 describes schizoid personality disorder (F60.1) as follows: “A personality disorder characterized by a withdrawal from affective, social and other contacts with an excessive predilection for fantasy, solitary behavior and withdrawn reticence. There is only a limited ability to express feelings and experience joy. "

Dissocial Personality Disorder

Typical of dissocial personality disorder (F60.2) are irresponsibility and disregard for social norms, rules and obligations, a lack of a sense of guilt and a lack of empathy for others. Often there is a low threshold for aggressive or violent behavior, a low tolerance for frustration, and a lack of learning ability due to experience. Relationships with other people are formed, but are not stable.

People with dissocial personality disorder come into conflict with the law more often than the population average. The older term psychopathy for this disorder is no longer used in current German-language literature.

Emotionally unstable personality disorder

The ICD-10 distinguishes between two subtypes of emotionally unstable personality disorder : the impulsive type (F60.30, mainly characterized by emotional instability and lack of impulse control) and the borderline type (F60.31) . The DSM-5 , on the other hand, speaks of a borderline personality disorder (diagnosis no. 301.83) and does not differentiate between these two sub-forms.

According to ICD-10, the essential characteristics of borderline personality disorder are impulsive actions without consideration of the consequences for the person concerned or for third parties in connection with frequent, unpredictable and capricious mood swings. In addition, there is a tendency towards intensive and unstable relationships, often with the result of emotional crises, disturbances and insecurities with regard to self-image, one's own goals and inner preferences. There is a persistent feeling of emptiness and outbursts of anger. When violent behavior occurs against others or against oneself, one speaks in this case of autoaggressive behavior and a lack of impulse control as a persistent experience and behavior pattern. There is also a tendency towards contentious behavior and conflicts with other people, especially when impulsive actions are prevented or censured. An important characteristic of this disorder is the great fear of being alone. People with this disease occasionally have pronounced separation fears, fear of loss or fear of isolation, even if there is no specific reason to do so.

Histrionic Personality Disorder

Characteristic of histrionic personality disorder (F60.4) are exaggeration, theatrical behavior, tendency to dramatization, superficiality, unstable mood, increased susceptibility to influence, constant desire for recognition and the desire to be the center of attention, increased vulnerability and an excessive interest in physical attractiveness.

People with this structure often have a high level of acting talent, they assign themselves roles for many situations, which they stage perfectly. If they do not get the attention they want in situations that they attach importance to, it can create a threatening situation in which they feel helpless and excluded. This can cause devastating reactions, especially in larger society, because these personalities often resort to drastic, shocking means that can sometimes be dangerous. People with histrionic personality disorder have a tendency to lie, make up particularly extreme stories, or "personal adventures" in order to gain attention. These personalities are often rated as untrustworthy by those around them.

Obsessive Compulsive Personality Disorder

The anankastic (compulsive) personality disorder (F60.5) is characterized by feelings of doubt, perfectionism , excessive conscientiousness, constant checks generally great caution and rigidity in thought and action, posing as inflexibility, pedantry shows and stiffness.

Furthermore, excessive preoccupation with details and rules is typical, so that the actual activity often takes a back seat. Persistent and unwanted thoughts or impulses may arise that do not reach the severity of OCD .

The ability to express feelings is often reduced. In interpersonal relationships, those affected appear correspondingly cool and rational. The ability to adapt to the habits and peculiarities of other people is limited. Rather, others are expected to adhere to their own principles and standards.

People with obsessive-compulsive personality disorder tend to be overly performance-oriented and perfectionist. Therefore, they prove to be hard-working, overly conscientious and overly precise in their working life, whereby the overly strict perfectionism sometimes prevents the fulfillment of tasks. Their fear of making mistakes hinders the decision-making ability of those affected. Anankastic personality disorder affects around one percent of the total population.

Anxious Avoidant Personality Disorder

The personality disorder anxious avoided or avoidant personality disorder (F60.6) is to be characterized by excessive anxiety up to the belief refused to be unattractive or inferior. The consequences of this are constant tension and anxiety, and the lifestyle is subject to severe restrictions because of the strong need for security. In some cases, those affected are over-sensitive to rejection or criticism.

Dependent personality disorder

The dependent (asthenic) personality disorder (F60.7) is characterized by a lack of the ability to make personal decisions, constant appeals for help from others, dependence on and disproportionate indulgence towards others. In addition, there are fears of not being able to take care of themselves and of being abandoned by a loved one and of being helpless.

Schizotypic personality disorder

The schizotypic personality disorder or schizotypal disorder is characterized by a profound behavioral deficit in the interpersonal or psychosocial area. This is expressed in behavioral peculiarities that are sometimes perceived as inappropriate, the inability to enter into close relationships and distortions in thinking and perception. The appearance is often quirky and eccentric. In the ICD-10, this disorder is classified as “schizophrenic and delusional disorders” (F2x).

Narcissistic Personality Disorder

The narcissistic personality disorder is characterized by a lack of empathy, overestimation of their own abilities and increased desire for appreciation. The exaggerated demands of those affected do not compensate for a deep inner insecurity, as previously assumed, but are rather an integral part of a life conception that is stubbornly geared towards success. They are constantly looking for new reassurance to further increase their self-esteem. People with narcissistic personality disorder are often described as arrogant, arrogant, snobbish, or condescending.

However, they can be productive (at school, at work, in their hobby) and sometimes have well-groomed and status-conscious manners. Affected people are always on the lookout for admiration and recognition, while paying little real attention to other people. They find it difficult to respond to the needs of other people and they have an unrealistic self-image , which makes them unable to accept themselves. You have an exaggerated feeling of importance, hope to occupy a special position and to deserve it. Affected people are often very proud and have high expectations of themselves. Affected people usually show exploitative behavior and a lack of empathy . Delusional disorders with ideas of size can arise.

People with narcissistic PS overestimate their own abilities and destroy from envy what others have built. In addition, those affected show a noticeable sensitivity to negative criticism, which they often understand globally, which causes feelings of anger, shame or humiliation in them. This is why a network of intrigues is often spun, especially in the family area, in order to put yourself in the right light. This usually happens out of self-protection and fear of further criticism. Here, people who are perceived as threatening are downgraded by partly invented or exaggerated stories.

Narcissistic personality disorder is listed in the ICD-10 under the heading “Other specific personality disorders (F 60.8)”. However, it is only described in more detail in Appendix I of the "Research Criteria" issue, although it is often used as a diagnosis in practice. In the DSM-5 of the American Psychiatric Association , on the other hand, the NPS is included as an independent disorder and belongs there to cluster B , which includes the “moody, dramatic, emotional” personality disorders. In either case, it must be distinguished from normal narcissism as an actual or ascribed trait .

Passive-aggressive personality disorder

The passive-aggressive personality disorder is characterized by a deep pattern of negativistic attitudes and passive resistance to suggestions and performance requirements, which come from other people. It is particularly noticeable through passive resistance to demands in the social and professional area and through the often unjustified assumption of being misunderstood, treated unfairly or overly accountable.

A code of its own only existed until DSMIV and was in DSM-5 painted. In the ICD-10 and its predecessors, the disorder is only listed in F60.8, but only described in more detail by criteria in the "Research criteria" output in Appendix I.

Combined personality disorder

Combined personality disorders often lead to impairments, but do not show the specific symptom patterns of the disorders described in F60.-. As a result, they are often more difficult to diagnose.

Examples:

Combined personality disorders with different characteristics from the disorders listed under F60.-, but without a predominant symptom pattern that would enable a more precise diagnosis.

Disruptive personality changes that cannot be classified under F60.- or F62.- or secondary diagnoses of previously existing anxiety or affect disorders .

life quality

Mostly it is assumed that all personality disorders make it difficult to lead a normal life and contribute to a poor quality of life , since recognizable suffering and impairments are a fundamental condition for the diagnosis. But that doesn't seem to be the case for all types of horsepower alike.

Various studies have shown that anxious, dependent, schizoid, paranoid, schizotypal and antisocial personality disorder are associated with reduced functionality and quality of life. Compulsive and histrionic PS, on the other hand, had hardly any negative influence on quality of life and performance in everyday life. In a long-term study , almost all PS were still associated with psychosocial restrictions after 15 years; except for compulsive and narcissistic personality disorder.

On the contrary, these two PSs seem to have positive effects, according to a study of certain aspects of “life success” (i.e. social status, wealth and successful intimate relationships). Because they reached the highest level here and showed rather good values; the schizotypic, antisocial, borderline and dependent PS, on the other hand, have rather bad values. The paranoid, histrionic and anxious personality disorders were in the middle, the schizoid PS was associated with poor values and thus brought up the rear.

Overall, there is a direct negative correlation between the number of diagnostic criteria met and quality of life. This means that the more personality disorders and the more individual criteria (of all PS) are present, the lower the quality of life of a person. Some findings also suggest that most PSs have an unfavorable influence on the level of education, economic problems (unemployment, etc.) and socio-economic status .

Depending on the type of PS, the risk of attempting suicide may also be increased. This is especially true for antisocial, narcissistic and borderline personality disorder; but to a lesser extent also for others like the schizoid PS.

frequency

The frequency of personality disorders has only been researched to a limited extent, which is why it is uncertain and the information on this subject varies greatly. So far, only one study has been carried out in Germany, according to which around 9.4 percent of the total population suffers from a personality disorder. However, 40 to 60 percent of psychiatric patients have PS, so that the proportion there is significantly higher. Within this population group, anxious personality disorder is the most common diagnosis, while paranoid and schizoid personality disorder is the rarest.

Frequently personality disorders among homeless people , particularly those from cluster A . The same applies to male prisoners , although PS from cluster B predominate here. The paranoid, anxious, and dependent personality disorder seems to be more common among people with less education, while the obsessive-compulsive disorder appears to be more common in higher social classes. People who live in the center of a city are also more likely to have personality disorders; however, the reasons for this are still unclear.

The question of the gender distribution of personality disorders has also not been adequately clarified. However, there is evidence that it differs significantly for certain disorders. Around 80 percent of people with dissocial personality disorder are male. Schizotypic and paranoid PS are also likely to be more common in men. Histrionic, dependent, and borderline personality disorders, on the other hand, seem to be more common in women.

causes

There is no uniform understanding of the causes or the development of personality disorders. Personality development is generally seen as the result of complex interactions between environmental factors (parents, social environment) and genetic predisposition .

The various explanatory approaches in psychology weight individual aspects more than others, but on the whole complement one another. From the point of view of depth psychology , disorders in child development are assumed to be the cause or aiding factor in the development of personality disorders. For example, an unfavorable social environment and possible traumatic experiences are viewed as stressful factors. Classical psychoanalysis evaluates the processes of identity development more strongly. Learning theory approaches emphasize that personality disorders are essentially a learned behavior. Principles of operant conditioning (influencing by positive or negative reinforcement) and model learning (learning by example) lead to the fact that already established behavioral tendencies can be strengthened or weakened. These assumptions are the starting point for modern behavior therapy, which, for example, has empirically proven treatment success in the treatment of borderline symptoms.

therapy

The treatment of personality disorders is primarily based on psychotherapeutic methods . Usually psychoanalytic or depth psychological therapy (according to Peter Fonagy or Otto F. Kernberg ) and cognitive behavioral therapy (according to Aaron T. Beck or Marsha M. Linehan ) are used.

In some cases, drugs are also prescribed. However, these only reduce symptoms: for example, some antidepressants and antipsychotics can reduce impulsive or self-harming actions. Other psychiatric illnesses that exist at the same time, such as depression , should also be treated; antidepressant drugs are definitely indicated here.

Depending on the initial situation, therapies can drag on for years and place great demands on therapists as well as patients. In some cases, they experience suicidality or self-harm, while others have a tendency towards substance abuse, delinquency or violence. Depression is very common as part of a personality disorder, and psychotic symptoms are less common . All these factors make therapeutic work difficult.

It is questionable whether personality disorders can be treated with psychiatric-psychotherapeutic interventions in such a way that a complete cure occurs. It is often pointed out that the aim of the treatment is to improve the mental disorder or to solve specific everyday problems that existed at the time of treatment. In various studies on the success of treatment for personality disorders, therapeutic effects could be demonstrated, according to which the diagnosis of a personality disorder was no longer justified. But even here one cannot speak of a complete recovery, only of a strong improvement.

Stigma

The public has less knowledge about personality disorders than about other mental illnesses. There is some evidence that personality disorders may be stigmatized even more than other psychiatric diagnoses . In fact, the public is less compassionate about those who are described as having a personality disorder. It is often assumed that those affected tend to need less professional help than people with other psychiatric disorders. Both fear and frustration are the general public reactions to personality disorders. Ignorance in public can lead to individuals with personality disorders being marginalized rather than treated. The belief that people with personality disorders should be able to have control over their behavior leads to symptoms of the disease being interpreted as manipulative behavior or a refusal to help. This can also lead to people being seen as difficult to deal with rather than sick.

criticism

Peter Fiedler criticizes the concept of personality disorders from a behavioral therapy-oriented clinical-psychological perspective.

With the help of a quote from the philosopher and psychiatrist Karl Jaspers , he describes the problem of stigmatization: "In human terms, however, establishing the nature of a person means doing something that is offensive on closer inspection and breaks off communication". The definition of an entire personality as "disturbed" is ethically questionable. In particular, Fiedler states that people with personality disorders behave in characteristically disturbed ways in interpersonal interactions. Only at this level does the disorder come to light; the person affected often does not feel that they are disturbed ( ego syntony ).

Thus, through the "diagnosis" of a personality disorder, the "healthy" interaction partner reinterprets what is happening in such a way that the deviating interaction partner is made solely responsible for the disorder by means of a "character diagnosis". This reinterpretation of the event is ultimately a pseudo-explanation: the person as a whole is disturbed and the person is the disturbing factor, the cause of the disturbance. Possible disturbances of the social system, of interaction, of society got out of sight.

Clinical psychologists oriented towards behavior therapy (in the German-speaking area including Rainer Sachse ) view personality disorders primarily as “interaction disorders”. In the English-speaking world, z. B. Beck and Freeman personality disorders as a combination of fundamental thoughts about oneself (eg: "I am helpless.") And corresponding interactional behavioral strategies (eg attachment) that determine social interaction in a characteristic and inflexible way and thus can lead to subsequent problems.

literature

Reference books

Sven Barnow: Personality Disorders: Causes and Treatment. With five case studies . Huber, Bern 2007, ISBN 978-3-456-84406-0 .
Thomas Bronisch, Martin Bohus, Matthias Dose: Crisis intervention for personality disorders . Klett-Cotta-Verlag, Stuttgart 2005, ISBN 3-608-89007-6 .
Peter Fiedler , Sabine Herpertz: Personality Disorders. 7th edition, Beltz Verlag 2016. ISBN 3-621-28013-8 .
H. Halthof, G. Schmid-Ott, U. Schneider (Ed.): Personality disorders in everyday therapeutic life . Pabst, Lengerich 2009, ISBN 978-3-89967-517-7 .
Otto F. Kernberg : Severe personality disorders . 2000, ISBN 3-608-95369-8 .
Rudi Merod (Ed.): Treatment of personality disorders. A cross-school manual . Dgvt-Verlag, Tübingen 2005, ISBN 3-87159-054-1 .
Andreas Remmel, Otto F. Kernberg, Wolfgang Vollmoeller: Handbook body and personality. Schattauer, Stuttgart 2006, ISBN 3-7945-2411-X .
Rainer Sachse: Understanding personality disorders. For dealing with difficult patients. 10th edition. Psychiatrie-Verlag, Bonn 2014, ISBN 978-3-88414-508-1 .
B. Schmitz, P. Schuhler, A. Handke-Raubach, A. Jung: Cognitive behavioral therapy for personality disorders and inflexible personality styles . Pabst, Lengerich 2002, ISBN 3-935357-38-9 .

Guidelines

Old S2 guideline on personality disorders (valid from 2008 to 2013) ( Memento from January 23, 2013 in the Internet Archive ) . AWMF register number 038/015.
S3 guideline for psychosocial therapies for severe mental illnesses In: AWMF online (as of October 25, 2012)

Web links

Individual evidence

↑ ^a ^b Henning Saß (2001): Personality Disorders . In: International Encyclopedia of the Social & Behavioral Sciences . S. 11301–11308 , doi : 10.1016 / b0-08-043076-7 / 03763-3 ( elsevier.com [accessed November 30, 2017]).

↑ Keyword psychopathy In: Uwe Henrik Peters : Dictionary of Psychiatry and Medical Psychology. 1999, ISBN 3-86047-864-8 , p. 420.

^ Philippe Pinel: Traité Medico-Philosophique sur l'aliénation mental . Brosson, Paris 1809.

↑ Julius A. Koch: The psychopathic inferiorities . Maier, Ravensburg 1891-1893.

↑ Ernst Kretschmer: Physique and Character. Springer, Berlin 1921.

↑ Kurt Schneider: The psychopathic personalities. In: Gustav Aschaffenburg (Hrsg.): Handbuch der Psychiatrie. Deuticke, Leipzig 1923.

↑ Peter Falkai, Hans-Ulrich Wittchen (ed.): Diagnostic and statistical manual of mental disorders DSM-5 . Hogrefe, Göttingen 2015, ISBN 978-3-8017-2599-0 , pp. 885 .

↑ ICD code: F60-F69 personality and behavioral disorders. Retrieved March 15, 2018 .

↑ Mark T. Gastpar, Siegfried Kasper, Michael Linden (2013): Mental Health Professional. ISBN 978-3-7091-6068-8 . P. 227

^ What's the Difference Between a Personality Disorder and a Mood Disorder? Retrieved September 15, 2015 .

↑ ^a ^b Fritz-Georg Lehnhardt et al. (2013): Diagnostics and differential diagnosis of Asperger's syndrome in adulthood . Ärzteblatt, doi: 10.3238 / arztebl.2013.0755 .

↑ ^a ^b ^c ^d ^e AWMF : Old S2 guidelines for personality disorders (valid from 2008 to 2013) ( Memento of January 23, 2013 in the Internet Archive ). See chapter: 1.2.2. Gender distribution, 1.2.3. Mortality, 2.2. Definition of personality disorders (ICD-10 research criteria) and 4.5. Treatment principles for emotionally unstable or borderline personality disorder.

↑ ICD-10-WHO: Personality and behavioral disorders. ( Memento from April 6, 2016 in the Internet Archive )

^ Rainer Sachse: Personality disorders. 2nd revised and expanded edition. Hogrefe, Göttingen. 2013. ISBN 978-3-8017-2542-6 .

^ JK Bosson et al.: Untangling the links between narcissism and self-esteem: A theoretical and empirical review. In: Journal of Personality and Social Psychology Compass. Volume 2, Issue 3, 2008, pp. 1415-1439.

↑ ^a ^b ^c Thomas A. Widiger (2012): Chap. 9 (Epidemiology) and Chap. 10 (Gender and Personality Disorders) . In: The Oxford Handbook of Personality Disorders . ISBN 978-0-19-999601-8 , pp. 203 f., 201 ( limited preview in Google Book search).

^ Paul Emmelkamp (2013): Personality Disorders . P. 54ff, ISBN 978-1-317-83477-9 .

^ Simone Ullrich (2007): Dimensions of DSM-IV Personality Disorders and Life-Success (full text). doi: 10.1521 / pedi.2007.21.6.657.

^ ^A ^b Svenn Torgersen (2014): Prevalence, Sociodemographics and Functional Impairment . In: The American Psychiatric Publishing textbook of personality disorders . 2nd Edition. 2014, ISBN 978-1-58562-456-0 , pp. 122, 126 ( limited preview in Google Book search).

↑ Y. Levi-Belz, Y. Gvion, U. Levi, A. Apter (2019): Beyond the mental pain: A case-control study on the contribution of schizoid personality disorder symptoms to medically serious suicide attempts . In: Comprehensive Psychiatry . tape 90 , p. 102-109 , doi : 10.1016 / j.comppsych.2019.02.005 ( elsevier.com ).

^ Adrian J. Connolly (2008): Personality Disorders in Homeless Drop-In Center Clients . ( Memento of the original from June 17, 2009 in the Internet Archive ) Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice. doi: 10.1521 / pedi.2008.22.6.573 : "Cluster A personality disorders (paranoid, schizoid, schizotypal) were found in almost all participants (92% had at least one diagnosis), and Cluster B (83% had at least one of antisocial , borderline, histrionic, or narcissistic) and C (68% had at least one of avoidant, dependent, obsessive-compulsive) disorders also were highly prevalent. " @1@ 2

↑ Tina Schröder: Mental illnesses in male prisoners in closed prison . Dissertation (2005), from p. 49. (PDF; 447 kB), accessed on May 20, 2017.

↑ Lindsay Sheehan, Katherine Nieweglowski, Patrick Corrigan: The stigma of Personality Disorders . In: Current Psychiatry Reports . tape 18 , no. 1 , 2016, ISSN 1523-3812 , p. 11 , doi : 10.1007 / s11920-015-0654-1 ( springer.com [accessed November 10, 2019]).

↑ ^a ^b Peter Fiedler : Personality disorders . 6th edition. Beltz, 2007, ISBN 978-3-621-27622-1 , pp. 3-6 .

↑ Aaron T. Beck , Arthur Freeman: Cognitive Therapy of Personality Disorders . 3rd German edition. Beltz, Weinheim 1995, ISBN 3-621-27155-4 .

[:4-1] Henning Saß (2001): Personality Disorders . In: International Encyclopedia of the Social & Behavioral Sciences . S. 11301–11308 , doi : 10.1016 / b0-08-043076-7 / 03763-3 ( elsevier.com [accessed November 30, 2017]).

[:022-2] Keyword psychopathy In: Uwe Henrik Peters : Dictionary of Psychiatry and Medical Psychology. 1999, ISBN 3-86047-864-8 , p. 420.

[3] Philippe Pinel: Traité Medico-Philosophique sur l'aliénation mental . Brosson, Paris 1809.

[4] Julius A. Koch: The psychopathic inferiorities . Maier, Ravensburg 1891-1893.

[5] Ernst Kretschmer: Physique and Character. Springer, Berlin 1921.

[6] Kurt Schneider: The psychopathic personalities. In: Gustav Aschaffenburg (Hrsg.): Handbuch der Psychiatrie. Deuticke, Leipzig 1923.

[7] Peter Falkai, Hans-Ulrich Wittchen (ed.): Diagnostic and statistical manual of mental disorders DSM-5 . Hogrefe, Göttingen 2015, ISBN 978-3-8017-2599-0 , pp. 885 .

[8] ICD code: F60-F69 personality and behavioral disorders. Retrieved March 15, 2018 .

[9] Mark T. Gastpar, Siegfried Kasper, Michael Linden (2013): Mental Health Professional. ISBN 978-3-7091-6068-8 . P. 227

[10] What's the Difference Between a Personality Disorder and a Mood Disorder? Retrieved September 15, 2015 .

[:12-11] Fritz-Georg Lehnhardt et al. (2013): Diagnostics and differential diagnosis of Asperger's syndrome in adulthood . Ärzteblatt, doi: 10.3238 / arztebl.2013.0755 .

[:1-12] AWMF : Old S2 guidelines for personality disorders (valid from 2008 to 2013) ( Memento of January 23, 2013 in the Internet Archive ). See chapter: 1.2.2. Gender distribution, 1.2.3. Mortality, 2.2. Definition of personality disorders (ICD-10 research criteria) and 4.5. Treatment principles for emotionally unstable or borderline personality disorder.

[13] ICD-10-WHO: Personality and behavioral disorders. ( Memento from April 6, 2016 in the Internet Archive )

[14] Rainer Sachse: Personality disorders. 2nd revised and expanded edition. Hogrefe, Göttingen. 2013. ISBN 978-3-8017-2542-6 .

[15] JK Bosson et al.: Untangling the links between narcissism and self-esteem: A theoretical and empirical review. In: Journal of Personality and Social Psychology Compass. Volume 2, Issue 3, 2008, pp. 1415-1439.

[:2-16] Thomas A. Widiger (2012): Chap. 9 (Epidemiology) and Chap. 10 (Gender and Personality Disorders) . In: The Oxford Handbook of Personality Disorders . ISBN 978-0-19-999601-8 , pp. 203 f., 201 ( limited preview in Google Book search).

[17] Paul Emmelkamp (2013): Personality Disorders . P. 54ff, ISBN 978-1-317-83477-9 .

[18] Simone Ullrich (2007): Dimensions of DSM-IV Personality Disorders and Life-Success (full text). doi: 10.1521 / pedi.2007.21.6.657.

[:3-19] A ^b Svenn Torgersen (2014): Prevalence, Sociodemographics and Functional Impairment . In: The American Psychiatric Publishing textbook of personality disorders . 2nd Edition. 2014, ISBN 978-1-58562-456-0 , pp. 122, 126 ( limited preview in Google Book search).

[20] Y. Levi-Belz, Y. Gvion, U. Levi, A. Apter (2019): Beyond the mental pain: A case-control study on the contribution of schizoid personality disorder symptoms to medically serious suicide attempts . In: Comprehensive Psychiatry . tape 90 , p. 102-109 , doi : 10.1016 / j.comppsych.2019.02.005 ( elsevier.com ).