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Risk Factors:  History of Abuse Physical (Antisocial, borderline, dependent, schizoid) Sexual (Borderline) Childhood neglect: (antisocial, avoidant

, borderline, dependent, narcissistic, paranoid, schizotypal  Negative parenting interactions (harsh punishment, lack of affection)  Family Hx of schizophrenia  Emotional disorder in childhood Cluster Type Diagnostic Criteria (DSM-IV-TR) Paranoia Hidden meaning in neutral actions, suspects harm/deception by clinician, suspects infidelity in partner Appears angry Anxiety/Tension Appears tense, hypervigilant Restricted range of emotion Delay seeking medical care because of unwanted contact and may appear cold/indifferent Anxiety/Tension Discomfort w/ social communication and physical exam Magical thinking Anxiety/Tension Discomfort w/ social communication and physical exam Paranoia Paranoid thinking can emerge in response to stress Episodic, intense anger states Unstable and intense mood states Occur in concert w/ idealization and devaluation of others Chronic dysphoria Impulsive behavior Impulsive, recurrent self-destructive behaviors (cutting, substance abuse and drug overdose, sexual promiscuity) Irritable Impulsive behavior May appear cooperative and charming at first in an effort to obtain desired outcome from clinician, but repeatedly acts w/ disregard for safety and rights of others w/ irresponsibility and lack of remorse Violence and substance abuse common Grandiosity Need for admiration Projection Coping mechanism Projection (attribution of person s unacknowledged feelings to other people



Distrust and suspiciousness of others, whose motives are viewed as malevolent Suspicious and bears grudges Perceives threats in neutral events

A: Odd/eccenteric 

Detached and distrustful



Pattern of detachment in social relationships (loner) Restricted emotional expression in interpersonal interactions Solitary, indifferent toward others Affectively detached Social and interpersonal deficits marked by discomfort w/ and capacity for close relationships




Instability of interpersonal relationships, self-image, and affects, and impulsivity Intense anger and affective instability Recurrent suicidal behavior/gestures Impulsive behavior w/ potential for self-harm

Splitting (black-or-white, all-ornothing perceptions or thinking, in which people are divided into all-good idealized saviors or all-bad evildoers)

B: Dramatic/erratic 

Emotionally unstable, impulsive, and intense



Disregard for and violation of rights of others beginning at age 15 Impulsivity Deceitfulness Lack of remorse Engages in acts that are illegal or show disrespect for social norms Grandiosity (in fantasy and behavior), need for admiration, lack of empathy Views self as special and needs to be admired Unwilling to recognize feelings of others Arrogant and interpersonally exploitative Excessive emotionality and attention-seeking Discomfort when not center of attention Shifting and shallow expression of emotions Draws attention to self through physical appearance Superficial Excessive need to be taken care of leading to submissive and clinging behavior Difficulty w/ decision making in absence of advice Fears solitude due to fear of inability to take care for self Social inhibition, feelings of inadequacy, hypersensitivity to negative evaluation Interpersonally inhibited and extremely reluctant to take personal risks, even in occupation activities, due to fear of rejection Desires relationships w/ others (vs. schizoid) Preoccupation w/ orderliness, perfectionism, and mental/interpersonal control (lack of flexibility, openness, and efficiency) Overconscientious, stubborn, and excessively devoted to work



Superficial and excessive emotionality Anxiety/Tension Becomes anxious w/ discussion of serious health issues or difficult feelings Anxiety/Tension Experiences significant difficulty when asked to engage in decision making Tries to enlist other to take responsibility for health issues Anxiety/Tension Fearful of rejection, unlikely to disagree w/ physician, socially anxious

Dependent C: Anxious/fearful  

Nervous and passive OR Rigid and preoccupied



Restricted range of emotion (rational) Anxiety/Tension Extreme concern about providing the right answers to questions