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13 - Cluster C Anxious-Fearful Personality Pathology and Avoidance

from Part III - Individual Disorders and Clusters

Published online by Cambridge University Press:  24 February 2020

By
Charles A. Sanislow  and
Anna Darre Hector
Edited by
Carl W. Lejuez  and
Kim L. Gratz
Carl W. Lejuez
Affiliation:
University of Kansas
Kim L. Gratz
Affiliation:
University of Toledo, Ohio
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Summary

In the DSM-5 main section for clinical diagnoses, psychopathology in Cluster C (Anxious-Fearful) is represented by three personality disorders: Avoidant, Dependent, and Obsessive-Compulsive. However, characterization of persistent anxious-fearful psychopathology has varied historically, and it appears that the cluster formation may not be retained with the next iteration of personality disorder diagnoses. This chapter examines the historical development of anxious-fearful personality disorders, and examines the different ways that associated symptoms and problems have been characterized and grouped to elucidate core features in order to clarify visions looking forward. There is an emphasis on avoidant behaviors, when describing the clinical manifestation of these personality disorders, and it is suggested that focusing on mechanisms for this kind of personality pathology, as well as explicitly addressing the issue of grain size, would enhance continuing efforts to improve diagnostic conceptualizations of personality pathology involving anxiety, fear, and avoidance.

Keywords

avoidantdependentobsessive-compulsivepassive-aggressivenegativisticCluster Canxious-fearfulmechanismsinterpersonalRDoC
Type
Chapter
Information
The Cambridge Handbook of Personality Disorders , pp. 302 - 316
Publisher: Cambridge University Press
Print publication year: 2020

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References

Abraham, K. (1924). The influence of oral eroticism on character formation. In Selected Papers on Psychoanalysis (English translation, 1927). London: Hogarth Press.Google Scholar
Alpert, J. E., Uebelacker, L. A., McLean, N. E., Nierenberg, J. A., Pava, J. J., Worthington, J. R. III, … Fava, M. (1997). Social phobia, avoidant personality disorder, and atypical depression: Co-occurrence and clinical implications. Psychological Medicine, 27, 627–633.CrossRefGoogle ScholarPubMed
American Psychiatric Association. (1952). Diagnostic and Statistical Manual of Mental Disorders. Washington, DC: American Psychiatric Association.Google Scholar
American Psychiatric Association. (1968). Diagnostic and Statistical Manual of Mental Disorders (2nd ed.). Washington, DC: American Psychiatric Association.Google Scholar
American Psychiatric Association. (1980). Diagnostic and Statistical Manual of Mental Disorders (3rd ed.). Washington, DC: American Psychiatric Association.Google Scholar
American Psychiatric Association. (1987). Diagnostic and Statistical Manual of Mental Disorders (revised 3rd ed.). Washington, DC: American Psychiatric Association.Google Scholar
American Psychiatric Association. (1994). Diagnostic and Statistical Manual of Mental Disorders (4th ed.). Washington, DC: American Psychiatric Association.Google Scholar
American Psychiatric Association. (2000). Diagnostic and Statistical Manual of Mental Disorders (4th ed., Text Revision). Washington, DC: American Psychiatric Association.Google Scholar
American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.Google Scholar
Ayduk, O., Gyurak, A., & Luerssen, A. (2008). Individual differences in the rejection–aggression link in the hot sauce paradigm: The case of rejection sensitivity. Journal of Experimental Social Psychology, 44, 775–782.CrossRefGoogle ScholarPubMed
Bach, B., & First, M. B. (2018). Application of the ICD-II classification of personality disorders. BMC Psychiatry. https://doi.org/10.1186/s12888–01801908-3CrossRefGoogle Scholar
Bell, R. C., & Jackson, H. J. (1992). The structure of personality disorders in DSM-III. Acta Psychiatrica Scandinavica, 85, 279–287.CrossRefGoogle ScholarPubMed
Benjamin, L. S. (1993). Interpersonal Diagnosis and Treatment of Personality Disorders (2nd ed.). New York: Guilford Press.Google Scholar
Blashfield, R. K., & Intoccia, V. (2000). Growth of the literature on the topic of personality disorders. American Journal of Psychiatry, 167, 472–473.CrossRefGoogle Scholar
Blashfield, R. K., McElroy, R. A., Pfohl, B., & Blum, N. (1994). Comorbidity and the prototype model. Clinical Psychology: Science and Practice, 1, 96–99.Google Scholar
Blatt, S. J., D’Afflitti, J. P., & Quinlan, D. M. (1976). Experiences of depression in normal young adults. Journal of Abnormal Psychology, 85, 383–389.CrossRefGoogle ScholarPubMed
Bleuler, E. (1911/1950). Dementia Praecox or the Group of Schizophrenias (Trans. Zinkin, J.). New York: International Universities Press.Google Scholar
Boone, M. L., McNeil, D. W., Masia, C. L., Turk, C. L., Carter, L. E., Ries, B. J., & Lewin, M. R. (1999). Multimodal comparisons of social phobia subtypes and avoidant personality disorder. Journal of Anxiety Disorders, 13, 271–292.CrossRefGoogle ScholarPubMed
Campbell, D. W., Sareen, J., Paulus, M. P., Goldin, P. R., Stein, M. B., & Reiss, J. P. (2007). Time-varying amygdala response to emotional faces in generalized social phobia. Biological Psychiatry, 62, 455–463.CrossRefGoogle ScholarPubMed
Carson, R. C. (1989). Personality. Annual Review of Psychology, 40, 227–248.CrossRefGoogle ScholarPubMed
Chambless, D. L., Fydrich, T., & Rodebaugh, T. L. (2008). Generalized social phobia and avoidant personality disorder: Meaningful distinction or useless duplication? Depression and Anxiety, 25, 8–19.CrossRefGoogle ScholarPubMed
Cloninger, C. R., Svrakic, D. R., & Przybeck, T. R. (1993). A psychobiological model of temperament and character. Archives of General Psychiatry, 50, 975–990.CrossRefGoogle ScholarPubMed
Coles, M. E., Pinto, A., Mancebo, M. C., Rasmussen, S. A., & Eisen, J. L. (2008). OCD with comorbid OCPD: A subtype of OCD? Journal of Psychiatric Research, 42, 289–296.CrossRefGoogle ScholarPubMed
Crome, E., Baillie, A., Slade, T., & Ruscio, A. M. (2010). Social phobia: Further evidence of dimensional structure. Australian and New Zealand Journal of Psychiatry, 44, 1012–1020.Google ScholarPubMed
Cuthbert, B. N. (2005). Dimensional models of psychopathology: Research agenda and clinical utility. Journal of Abnormal Psychology, 14, 565–569.Google Scholar
Denny, B. T., Fan, J, Liu, X., Ochsner, K. N., Guerreri, S., Mayson, S. J., … Koenigsberg, H. W. (2015). Elevated amygdala activity during reappraisal anticipation predicts anxiety in avoidant personality disorder. Journal of Affective Disorders, 172, 1–7.CrossRefGoogle ScholarPubMed
Devanand, D. P. (2002). Comorbid psychiatric disorders in late life depression. Biological Psychiatry, 52, 236–242.CrossRefGoogle ScholarPubMed
DeYoung, C. G., Hirsh, J. B., Shane, M. S., Papademetris, X., Rajeevan, N., & Gray, J. R. (2010). Testing predictions from personality neuroscience: Brain structure and the Big Five. Psychological Science, 21, 820–828.CrossRefGoogle ScholarPubMed
Donegan, N. H., Sanislow, C. A., Blumberg, H. P., Fulbright, R. K., Lacadie, C., Skudlarski, P., … Wexler, B. E. (2003). Amygdala hyperreactivity in borderline personality disorder: Implications for emotional dysregulation. Biological Psychiatry, 54, 1284–1293.Google Scholar
Downey, G., & Feldman, S. I. (1996). Implications of rejection sensitivity for intimate relationships. Journal of Personality and Social Psychology, 70, 1327–1343.Google Scholar
Eaton, N. R., Krueger, R. F., South, S., Simms, L., & Clark, L. A. (2011). Contrasting prototypes and dimensions in the classification of personality pathology: Evidence that dimensions, but not prototypes, are robust. Psychological Medicine, 41, 1151–1163.CrossRefGoogle Scholar
Eikenæs, I., Pedersen, G., & Wilberg, T. (2016). Attachment styles in patients with avoidant personality disorder compared with social phobia. Psychology and Psychotherapy: Theory, Research and Practice, 89, 245–260.CrossRefGoogle ScholarPubMed
Eisen, J. L., Coles, M. E., Shea, M. T., Pagano, M. E., Stout, R. L.., Yen, S. … Rasmussen, S. A. (2006). Clarifying the convergence between obsessive compulsive personality disorder criteria and obsessive compulsive disorder. Journal of Personality Disorders, 20, 294–305.Google Scholar
Etkin, A., Prater, K. E., Hoeft, F., Menon, V., & Schatzberg, A. F. (2010). Failure of anterior cingulate activation and connectivity with the amygdala during implicit regulation of emotional processing in generalized anxiety disorder. American Journal of Psychiatry, 167, 545–554.CrossRefGoogle ScholarPubMed
Fenichel, O. (1945). The Psychoanalytical Theory of the Neurosis. New York: W. W. Norton.Google Scholar
Fossati, A., Maffei, C., Bagnato, M., Battaglia, M., Donati, D., Donini, M., … Prolo, F. (2000). Patterns of covariation of DSM-IV personality disorders in a mixed psychiatric sample. Comprehensive Psychiatry, 41, 206–215.CrossRefGoogle Scholar
Frances, A., & Widiger, T. (1987). A critical review of four DSM-III personality disorders. In Tischer, G. (Ed.), Diagnosis and Classification in Psychiatry. New York: Cambridge University Press.Google Scholar
Gangestad, S., & Snyder, M. (1985). “To carve nature at its joints”: On the existence of discrete classes in personality. Psychological Review, 92, 317–349.Google Scholar
Garyfallos, G., Katsigiannopoulos, K., Adamopoulou, A., Papazisis, G., Karastergiou, A., & Bozikas, V. P. (2010). Comorbidity of obsessive-compulsive disorder with obsessive-compulsive personality disorder: Does it imply a specific subtype of obsessive-compulsive disorder? Psychiatry Research, 177, 156–160.Google Scholar
Gordon, O. M., Salkovskis, P. M., Oldfield, V. B., & Carter, N. (2013). The association between obsessive compulsive disorder and obsessive compulsive personality disorder: Prevalence and clinical presentation. British Journal of Clinical Psychology, 52, 300–315.CrossRefGoogle ScholarPubMed
Grazioplene, R. G., Chavez, R. S., Rustichini, A., & DeYoung, C. G. (2016). White matter correlates of psychosis-linked traits support continuity between personality and psychopathology. Journal of Abnormal Psychology, 125, 1135–1145.Google Scholar
Gyurak, A., & Ayduk, O. (2007). Defensive physiological reactions to rejection: The effect of self-esteem and attentional control on startle responses. Psychological Science, 18, 886–892.CrossRefGoogle ScholarPubMed
Harkness, A. R., & McNulty, J. L. (1994). The Personality Psychopathology Five (PSY-5): Issue from the pages of a diagnostic manual instead of a dictionary. In Strack, S. & Lorr, M. (Eds.), Differentiating Normal and Abnormal Personality (pp. 291–315). New York: Springer.Google Scholar
Herpertz, S. C., Schwenger, U. B., Kunert, H. J., Lukas, G., Gretzer, U., Nutzmann, L., … Sass, H. (2000). Emotional responses in patients with borderline as compared with avoidant personality disorder. Journal of Personality Disorders, 14, 339–351.CrossRefGoogle ScholarPubMed
Hewitt, P. L., & Flett, G. L. (1991). Perfectionism in the self and social contexts: Conceptualization, assessment, and association with psychopathology. Journal of Personality and Social Psychology, 60, 456–470.CrossRefGoogle ScholarPubMed
Hoch, A. (1910). Constitutional factors in the dementia praecox group. Review of Neurology and Psychiatry, 8, 463–474.Google Scholar
Hopwood, C. J., Morey, L. C., Markowitz, J. C., Pinto, A., Skodol, A. E., Gunderson, J. G., … Sanislow, C. A. (2009). The construct validity of passive-aggressive personality disorder. Psychiatry, 72, 256–268.CrossRefGoogle ScholarPubMed
Horney, K. (1945). Our Inner Conflicts. New York: W. W. Norton.Google Scholar
Horney, K. (1950). Neurosis and Human Growth. New York: W. W. Norton.Google Scholar
Kernberg, O. F. (1976). Object Relations Theory and Clinical Psychoanalysis. New York: Jason Aronson.Google Scholar
Kretschmer, E. (1925). Physique and Character: An Investigation of the Nature of Constitution and Temperament. London: Kegan Paul.Google Scholar
Kross, E., Egner, T., Ochsner, K., Hirsh, J., & Downey, G. (2007). Neural dynamics of rejection sensitivity. Journal of Cognitive Neuroscience, 19, 945–956.CrossRefGoogle ScholarPubMed
Lampe, L., & Sunderland, M. (2015). Social phobia and avoidant personality disorder: Similar but different? Journal of Personality Disorders, 29, 115–130.CrossRefGoogle Scholar
Lenzenweger, M. F., Lane, M. C., Loranger, A. W., & Kessler, R. C. (2007). DSM-IV personality disorders in the National Comorbidity Survey Replication. Biological Psychiatry, 62, 553–564.CrossRefGoogle ScholarPubMed
Livesley, W. J., & West, M. (1986). The DSM-III distinction between schizoid and avoidant personality disorders. Canadian Journal of Psychiatry, 31, 59–61.Google Scholar
Livesley, W. J., West, M., & Tanney, A. (1985). Historical comment on DSM-III schizoid and avoidant personality disorders. American Journal of Psychiatry, 142, 1344–1347.Google Scholar
Lochner, C., Serebro, P., van der Merwe, L., Hemmings, S., Kinnear, C., Seedat, S., & Stein, D. J. (2011). Comorbid obsessive-compulsive personality disorder in obsessive-compulsive disorder (OCD): A marker of severity. Progress in Neuro-Psychopharmacology & Biological Psychiatry, 35, 1087–1092.Google Scholar
Lynam, D. R., & Widiger, T. A. (2001). Using the five factor model to represent the DSM-IV personality disorders: An expert consensus approach. Journal of Abnormal Psychology, 110, 401–412.CrossRefGoogle ScholarPubMed
Lynum, L. I., Wilberg, T., & Karterud, S. (2008). Self-esteem in patients with borderline and avoidant personality disorders. Scandinavian Journal of Psychology, 49, 469–477.Google Scholar
McGlashan, T. H., Grilo, C. M., Skodol, A. E., Gunderson, J. G., Shea, M. T., Morey, L. C., … Stout, R. L. (2000). The Collaborative Longitudinal Personality Disorders Study: baseline Axis I/II and II/II diagnostic co-occurrence. Acta Psychiatrica Scandinavica, 102, 256–264.CrossRefGoogle Scholar
Millon, T. (1969). Modern Psychopathology: A Biosocial Approach to Maladaptive Learning and Functioning. Philadelphia: W. B. Saunders.Google Scholar
Millon, T. (1973). Theories of Psychopathology and Personality (2nd ed.). Philadelphia: W. B. Saunders.Google Scholar
Millon, T. (1977). Millon Clinical Multiaxial Inventory Manual (2nd ed.). Minneapolis: National Computer Systems.Google Scholar
Millon, T. (1993). Negativistic (passive-aggressive) personality disorder. Journal of Personality Disorders, 7, 78–85.CrossRefGoogle Scholar
Morey, L. C. (1988). Personality disorders in DSM-III and DSM-III-R: Convergence, coverage, and internal consistency. American Journal of Psychiatry, 145, 573–577.Google Scholar
Morey, L. C., & Benson, K. T. (2016). An investigation of adherence to diagnostic criteria, revisited: Clinical diagnosis of the DSM-IV/DSM-5 Section II personality disorders. Journal of Personality Disorders, 30, 130–144.CrossRefGoogle ScholarPubMed
Morey, L. C., Hopwood, C. J., & Klein, D. (2007). Depressive, passive-aggressive, and sadistic personality disorders. In O’Donohue, W., Fowler, K. A., & Lilienfeld, S. O. (Eds.), Personality Disorders: Toward the DSM-V (pp. 353–374). Thousand Oaks, CA: Sage Publications.Google Scholar
Morey, L. C., & Ochoa, E. S. (1989). An investigation of adherence to diagnostic criteria: Clinical diagnosis of the DSM-III personality disorders. Journal of Personality Disorders, 3, 180–192.Google Scholar
Nestadt, G., Addington, A., Samuels, J., Liang, K., Bienvenu, O. J., Riddle, M., … Cullen, B. (2003). The identification of OCD-related subgroups based on comorbidity. Biological Psychiatry, 53, 914–920.Google Scholar
Oldham, J. M., Skodol, A. E., Kellman, H. D., Hyler, S. E., Doidge, N., Rosnick, L., & Gallaher, P. E. (1995). Comorbidity of axis I and axis II disorders. American Journal of Psychiatry, 152, 571–578.Google ScholarPubMed
Pinto, A., Steinglass, J. E., Greene, A. L., Weber, E. U., & Simpson, H. B. (2014). Capacity to delay reward differentiates obsessive-compulsive disorder and obsessive-compulsive personality disorder. Biological Psychiatry, 75, 653–659.Google Scholar
Pretzer, J. L., & Beck, A. T. (1996). A cognitive theory of personality disorders. In Clarkin, J. F. and Lenzenweger, M. F. (Eds.), Major Theories of Personality Disorder (pp. 36–105). New York: Guilford Press.Google Scholar
Ralevski, E., Sanislow, C. A., Grilo, C. M., Skodol, A. E., Gunderson, J. G., Shea, M. T., … McGlashan, T. H. (2005). Avoidant personality disorder and social phobia: Distinct enough to be separate disorders? Acta Psychiatrica Scandinavica, 112, 208–214.CrossRefGoogle ScholarPubMed
Reed, G. M. (2018). Progress in developing classification of personality disorders for ICD-11. World Psychiatry, 17, 227–229.CrossRefGoogle ScholarPubMed
Sanislow, C. A., Bartolini, E., & Zoloth, E. C. (2012). Avoidant personality disorder. In Ramachandran, V. S. (Ed.), Encyclopedia of Human Behavior (2nd ed., pp. 257–266). San Diego, CA: Academic Press.Google Scholar
Sanislow, C. A., da Cruz, K., Gianoli, M. O., & Reagan, E. R. (2012). Avoidant personality disorder, traits, and type. In Widiger, T. A. (Ed.), The Oxford Handbook of Personality Disorders (pp. 549–565). New York: Oxford University Press.Google Scholar
Sanislow, C. A., Little, T. D., Ansell, E. B., Grilo, C. M., Daversa, M., Markowitz, J. C., … McGlashan, T. H. (2009). Ten-year stability and latent structure of the DSM-IV schizotypal, borderline, avoidant, and obsessive-compulsive personality disorders. Journal of Abnormal Psychology, 118, 507–519.Google Scholar
Sanislow, C. A., & McGlashan, T. H. (1998). Treatment outcome of personality disorders. Canadian Journal of Psychiatry, 43, 237–250.CrossRefGoogle ScholarPubMed
Sanislow, C. A., Morey, L. C., Grilo, C. M., Gunderson, J. G., Shea, M. T., Skodol, A. E., … McGlashan, T. H. (2002). Confirmatory factor analysis of DSM-IV schizotypal, borderline, avoidant, and obsessive-compulsive personality disorders: Findings from the Collaborative Longitudinal Study of Personality Disorders. Acta Psychiatrica Scandinavica, 105, 28–36.Google Scholar
Sanislow, C. A., Pine, D. S., Quinn, K. J., Kozak, M. J., Garvey, M. A., Heinssen, R. K. … Cuthbert, B. N. (2010). Developing constructs for psychopathology research: Research Domain Criteria. Journal of Abnormal Psychology, 119, 631–639.CrossRefGoogle ScholarPubMed
Schmidt, L. A., & Jetha, M. K. (2009). Temperament and affect vulnerability: Behavioral, electrocortical, and neuroimaging perspectives. In de Haan, M. & Gunnar, M. R. (Eds.), Handbook of Developmental Social Neuroscience (pp. 305–323). New York: Guilford Press.Google Scholar
Serpella, L., Livingstone, A., Neidermanb, M., & Laska, B. (2002). Anorexia nervosa: Obsessive-compulsive disorder, obsessive-compulsive personality disorder, or neither? Clinical Psychology Review, 22, 647–669.Google Scholar
Shea, M. T., Stout, R. L., Yen, S., Pagano, M. E., Skodol, A. E., Morey, L. C., … Zanarini, M. C. (2004). Associations in the course of personality disorders and axis I disorders over time. Journal of Abnormal Psychology, 113, 499–508.Google Scholar
Siever, L. J., & Davis, K. L. (1991). A psychobiological perspective on the personality disorders. American Journal of Psychiatry, 148, 1647–1658.Google ScholarPubMed
Skocic, S., Jackson, H., & Hulbert, C. (2015). Beyond DSM-5: An alternative approach to assessing social anxiety disorder. Journal of Anxiety Disorders, 30, 8–15.Google Scholar
Skodol, A. E. (2012). Personality disorders in DSM-5. Annual Review of Clinical Psychology, 8, 317–344.Google Scholar
Skodol, A. E., Gunderson, J. G., Shea, M. T., McGlashan, T. H., Morey, L. C., Sanislow, , … Stout, R. L. (2005). The Collaborative Longitudinal Personality Disorders Study (CLPS): Overview and implications. Journal of Personal Disorders, 19, 487–504.Google Scholar
Skodol, A. E., Morey, L. C., Bender, D. S., & Oldham, J. M. (2015). The alternative model for personality disorders: A clinical application. American Journal of Psychiatry, 172, 606–613.Google Scholar
Skodol, A. E., Oldham, J. M., Hyler, S. E., Stein, D. J., Hollander, E., Gallaher, P. E., & Lopez, A. E. (1995). Patterns of anxiety and personality disorder comorbidity. Journal of Psychiatric Research, 29, 361–367.CrossRefGoogle ScholarPubMed
Stuart, S., Pfohl, B., Battaglia, M., Bellodi, L., Grove, W., & Cadoret, R. (1998). The cooccurrence of DSM-III-R personality disorders. Journal of Personality Disorders, 12, 302–315.Google Scholar
Swendsen, J. D., & Merikangas, K. R. (2000). The comorbidity of depression and substance use disorders. Clinical Psychology Review, 20, 173–189.Google Scholar
Thornton, C., & Russell, J. (1997). Obsessive compulsive comorbidity in the dieting disorders. International Journal of Eating Disorders, 21, 83–87.Google Scholar
Trull, T. J., Widiger, T. A., & Frances, A. (1987). Covariation of criteria sets for avoidant, schizoid, and dependent personality disorders. American Journal of Psychiatry, 144, 767–771.Google Scholar
van Velzen, C. J. M., Emmelkamp, P. M. G., & Scholing, A. (2000). Generalized social phobia versus avoidant personality disorder: Differences in psychopathology, personality traits, and social and occupational functioning. Journal of Anxiety Disorders, 14, 395–411.CrossRefGoogle ScholarPubMed
Wakefield, J. C. (1992). Disorder as harmful dysfunction: A conceptual critique of DSM-III-R’s definition of mental disorder. Psychological Review, 99, 232–247.Google Scholar
War Department. (1946). Nomenclature of psychiatric disorders and reactions: War Department Technical Bulletin, Medical 203. Journal of Clinical Psychology, 2, 289–296.3.0.CO;2-O>CrossRefGoogle Scholar
Warner, M. B., Morey, L. C., Finch, J. F., Gunderson, J. G., Skodol, A. E., Sanislow, C. A., … Grilo, C. M. (2004). The longitudinal relationship of personality traits and disorders. Journal of Abnormal Psychology, 113, 217–227.Google Scholar
Wetzler, S., & Morey, L.C. (1999). Passive-aggressive personality disorder: The demise of a syndrome. Psychiatry, 62, 49–59.Google Scholar
Wheaton, M. G., & Pinto, A. (2017). The role of experiential avoidance in obsessive-compulsive personality disorder traits. Personality Disorders: Theory, Research, and Treatment, 8, 383–388.Google Scholar
Zanarini, M. C., Frankenburg, F. R., Hennen, J., Reich, D. B., & Silk, K. R. (2006). Prediction of the 10-year course of borderline personality disorder. American Journal of Psychiatry, 163, 827–832.Google Scholar
Zimmerman, M., Rothschild, L., & Chelminski, I. (2005). The prevalence of DSM-IV personality disorders in psychiatric outpatients. American Journal of Psychiatry, 162, 1911–1918.CrossRefGoogle ScholarPubMed

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