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Personality disorders
A personality disorder is a fixed, rigid pattern of thinking, feeling and behaviour that starts in early adulthood and impairs function; they are grouped into three clusters — A odd, B dramatic, C anxious — and the main treatment is psychotherapy, in borderline disorder mainly DBT.
Why it matters in the exam
Exam questions describe a person in a few sentences and ask you to choose the personality disorder. Know the three clusters: A — paranoid (suspicion), schizoid (isolation without a wish for relationships) and schizotypal (magical thinking and odd behaviour); B — antisocial (violating others' rights, from age 18 with conduct disorder before age 15), borderline, histrionic (need to be the centre of attention) and narcissistic (grandiosity and lack of empathy); C — avoidant (wants relationships but fears rejection), dependent and obsessive-compulsive (perfectionism and rigidity).
The confusing pairs are the heart of the questions: schizoid versus avoidant (no wish for relationships versus wish and fear), obsessive-compulsive personality disorder versus OCD (the pattern feels right and consistent with the self, versus intrusive thoughts that feel alien), schizotypal versus schizophrenia (no sustained psychosis). In borderline disorder there is instability of relationships, self-image and affect, impulsivity, recurrent suicidal behaviour or self-harm, emptiness, intense anger and transient paranoid thoughts under stress; the typical defence mechanism is splitting. The proven treatment is DBT; drugs are not the main treatment and are given only for comorbid disorders, and benzodiazepines are avoided.
Key points
- Three clusters: A odd, B dramatic, C anxious.
- Borderline: instability, recurrent self-harm, splitting; DBT.
- Antisocial: from age 18, conduct disorder before age 15.
- Schizoid versus avoidant: the wish for relationships.
- Obsessive-compulsive personality versus OCD: whether the pattern feels alien.
Summary table
| Cluster | Disorders | Core feature | Exam notes |
|---|---|---|---|
| A — odd | Paranoid, schizoid, schizotypal | Suspicion, emotional detachment, magical thinking | Schizotypal is close to the schizophrenia spectrum |
| B — dramatic | Antisocial, borderline, histrionic, narcissistic | Emotionality, impulsivity, crossing boundaries | Antisocial only from age 18, with conduct disorder before age 15 |
| C — anxious | Avoidant, dependent, obsessive-compulsive | Anxiety, need for reassurance, control | Avoidant wants relationships; schizoid does not |
| Borderline | Unstable relationships, self-image and affect; recurrent self-harm; emptiness | Splitting; transient paranoid thoughts under stress | DBT first line; avoid benzodiazepines |
| Obsessive-compulsive (personality) | Perfectionism, rigidity, preoccupation with detail | The pattern feels right and consistent with the self | Differs from OCD, where the thoughts feel alien |
Free exam questions
איזו מהפרעות האישיות לא מופיעה ב- DSM 5 ? (the question as examined, in Hebrew)
- א. פסיבית-אגרסיבית
- ב. מאנית
- ג. דיכאונית
- ד. סדיסטית עמוד 15 יש לבחור בתשובה אחת בלבד עבור כל שאלה
בן 25 מתקבל להסתכלות פסיכיאטרית, לאחר שהפסיד 10000 ₪ בערב בקזינו וסירב להפסיק הימורים, תוך תקיפת צוות הקזינו. הוא לא מתחרט על התנהגותו. איזו אבחנה פחות ?סבירה עבורו (the question as examined, in Hebrew)
- א. Gambling disorder
- ב. Manic episode
- ג. Intermittent explosive disorder
- ד. Dissocial personality disorder
Example question from the licensing exam (IMLE)
A 33-year-old single male lives alone, and works as a programmer in a tech company. He asked his employer to work from home as he prefers to be alone. He has never been in a relationship and says he never thought he would enjoy one. He has no friends and does not miss company. When he is with people he seems apathetic to compliments and prefers not to have small talk. During feedback meetings with his superior seems apathetic to criticism. Which of the following is the most likely diagnosis?
- A. Obsessive compulsive personality disorder
- B. Schizoid personality disorder
- C. Narcissistic personality disorder
- D. Histrionic personality disorder
In the full version for subscribers
- A simple algorithm
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- 5 review cards
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Sources
- DSM-5-TR, American Psychiatric Association, 2022 — Personality Disorders
- NICE guideline CG78, 2009 — Borderline personality disorder: recognition and management
- APA Practice Guideline for the Treatment of Patients With Borderline Personality Disorder, 2024 — Psychotherapy and pharmacotherapy
- Kaplan and Sadock's Synopsis of Psychiatry, 12th edition (2021) — Personality Disorders
Sources are given for further reading; the text is written afresh and not copied from them.
Reviewed by the Examqo AI Professor · 2026-11-02. The text may contain errors; when in doubt, check the source.