Psychology
Chapter 16
Mental Disorders

Mental disorders

Before clinicians can diagnose a psychological disorder, the must evaluate the behavior in terms of four themes, the four D’s.

• Deviance
  The degree to which the behaviors a person engages in or their ideas are considered unacceptable or uncommon in society.
• Distress
  The negative feelings a person has because of his or her disorder.
• Dysfunction
   The maladaptive behavior that interferes with a person being able to successfully carry out everyday functions.
• Danger
  Dangerous or violent behavior directed at other people or oneself.

The diagnostic and statistical manual of mental disorders (DSM)
Specifies criteria for deciding what is officially a ‘disorder’ and what is not.
It is a work in process.

What is a mental disorder?

Mental disorder has no really satisfying definition.

Categorizing and diagnosing metal disorders

Diagnosis: the process of assigning a label to a person’s mental disorder.
To be of value, any system of diagnosis must be reliable and valid.

The quest for reliability

The reliability of a diagnostic system: the extent to which different diagnosticians, all trained in the use of the system, reach the same conclusion when they independently diagnose the same individual.

To test alternative ways of diagnosing each disorder, they conducted field studies in which people who might have a particular disorder were diagnosed independently by a number of clinicians or researchers using each of several alternative diagnostic systems.
The systems that produced the greatest reliability were retained.

All the criteria are based on observable characteristics or self-descriptions by the person being diagnosed.

The Question of validity

The validity of a diagnostic system is an index of the extent to which the categories it identifies are clinically meaningful.
This is based on extensive research. To conduct the research needed to determine whether or not a diagnosis is valid, one must fists form a tentative, reliable diagnostic system.
The results of such studies may lead to new means of defining and diagnosing the disorder or to new subcategories of the disorder, leading to increased diagnostic validity.

Systems for classifying mental disorders:
The DSM
The Word Health Organization (WHO) has developed the International Classification of Diseases (ICD-10)

Possible dangers in Labeling

Diagnosing and labeling may be essential for the scientific study of metal disorders, but labels can be harmful.
To reduce the likelihood of such effects, the American Psychiatric Association recommends that clinicians apply diagnostic labels only to people’s disorders, not to people themselves.

Diagnostic systems are never completely reliable.

Medical students’ disease

The power of suggestion, which underlies the ability of labels to cause psychological harm, underlies the medical students’ disease.
This disease (also called the introductory psychology students disease) is a strong tendency to relate personality to, and to fund in oneself, the symptoms of any disease or disorder described in the textbook.

Cultural variations in disorders and diagnoses

Mental disorder is, to a considerable degree, a cultural product.
The kinds of distress that people experience, the ways in which they express that distress, and the ways in which other people respond to the distressed person vary from culture to culture and over time of any given
culture.
Cultural beliefs and values help determine whether syndromes are considered to be disorders or variations of normal behavior.

Culture-bound syndromes

Culture-bound syndromes: expressions of mental distress that are almost completely limited to specific cultural groups.
In some cases, such syndromes represent exaggerated from of behaviors that, in more moderate forms, are admired by the culture.

Role of cultural values in determining what is a disorders

Culture does not affect just the types of behaviors and syndromes that people manifest, it also affects clinicians’ decisions about what to label as disorders.

Cultural values and the diagnosis of ADHD

The American Psychiatric Association has added many more disorders to DSM over the past three or four decades than it has subtracted.
These additions have come partly from increased scientific understanding of mental disorders and partly from a general cultural shift toward seeing mental disorder where people previously saw a normal human variation. 

Causes of mental disorders

The brain is involved in all mental disorders

All the factors that contribute to the causation of mental disorders do so by acting, in one way or another, on the brain.

The brain’s role in irreversible mental disorders

The role of the brain is most obvious in chronic mental disorders.
In this cases, the brain deficits are irreversible.
Like:

• Down syndrome. A congenial (present at birth) disorder. It is caused by an error in meiosis, which results in an extra chromosome 21. The chromosome causes damage to many regions of the developing brain.
• Alzheimer’s disease. Characterized by a progressive deterioration in all cognitive abilities, followed by deterioration in the brain’s control of bodily functions.
  Also characterized by certain physical disruptions in the brain, including the presence of amyloid plaques (deposits of a particular protein, called beta amyloid, which forms in the spaces between neurons and may disrupt neural communication).
  The disorder appears to be caused by a combination of genetic predisposition and the general debilitating effects of old age.

Role of the brain in episodic mental disorders

Many disorders are episodic, they are reversible.
Most mental disorders, including those that are episodic, are to some degree heritable.
In most cases it is not known just which genes are involved or how they influence the likelihood of developing the disorder, but it is reasonable to assume that such effects occur primarily through the genes’ roles in altering the biology of the brain.

A framework for thinking about multiple causes of mental disorders

Most mental disorders derive from the joint effects of more than one cause.
Most disorders are not present at birth, but first appear at some later point in life, often in early childhood.
The subsequent course of a disorder is influenced by experiences that one has after the disorder first appears.
Three categories of causes of mental disorders:

• Predisposing causes
  Those that were in place well before the onset of the disorder and make the person susceptible to the disorder.
  Genetically inherited characteristics that affect the brain. It can also arise from damaging environmental effects on the brain, including effects that occur before or during birth.
  Prolonged psychologically distressing situations can also predispose a person for one or another mental disorder.
  Other predisposing causes include certain styles of learned beliefs and maladaptive patterns of reacting to or thinking about stressful situations. (Like highly pessimistic thoughts if something goes wrong.)
• Precipitating causes
  The immediate events in a person’s life that bring on the disorder. (Like a death of a loved one).
  Precipitating causes are often talked about under the rubric of stress. When the predisposition is high, an event that seems trivial to others can be sufficient stressful to bring on a mental disorder.
  Positive environments produce ‘good’ developmental outcomes.
  The negative effects of an adverse environment are proposed to be especially harmful if an individual has biological predisposition to respond especially strong to stress.
  Early negative experience disturbs the typical course of development, leading to maladaptive behavior and poor mental health. The more risk factors an individual experiences, the greater the deficits in functional behavior.
• Perpetuating causes
  Those consequences of a disorder that help keep it going on once it begins.

Possible causes of sex differences in the prevalence of specific disorders

Women are more diagnosed with anxiety disorders and depression.
Men are more diagnosed with intermittent explosive disorder and antisocial personality disorder and substance-use disorders.
Causes:

• Differences in responding or suppressing psychological distress
• Clinicians’ expectations
• Differences in stressful experiences
• Differences in ways of responding to stressful situations

Anxiety disorders

Anxiety disorders: disorders in with fear or anxiety is the most prominent disturbance.
Genetic differences play a considerable role in the predisposition of all anxiety disorders. About 30 -50 percent of the individual variability in risk to develop any given anxiety disorder derives from genetic variability.

Generalized anxiety disorder

Generalized anxiety is called generalized because it is not focused on any one specific trait. It attached itself to various threats, real or imagined.
It manifests itself primarily as worry. 

Sufferers of generalized anxiety disorder worry more or less continuously about multiple issues, and they experience muscle tension, irritability and difficulty sleeping.

To receive a DSM-5 diagnosis of generalized anxiety disorder, such life-disrupting worry must occur on more days that not for at least 6 months and occur independently of other diagnosable mental disorders.

People that diagnosed with generalized anxiety disorder are particularly attuned to threatening stimuli.
Such automatic attention to potential threat is referred to as hypervigilance. Such vigilance begins early in life and precedes the development of generalized anxiety disorder.
Hypervigilance may result, in part, from genetic influences on brain development. Inhibitory connections are less effective in people who are predisposed for generalized anxiety.
A lifelong tendency toward hypervigilance is also found in many individuals who experienced unpredictable traumatic experiences in early childhood.

Phobias

A phobia is an intense, irrational fear that is very clearly related to a particular category of object or event.
The fear is of some specific, nonsocial category of object or situation.

For a diagnosis to be given, the fear must be long-standing and sufficiently strong to disrupt everyday life in some way.

Usually a phobia sufferer is aware that his or her fear is irrational but still cannot control it.
People with phobias are hypervigilant specifically for the category of object that they fear.
They also suffer from the knowledge of the irrationality of their fear.

The relation of phobias to normal fears

The difference between normal fear and the disorder is one of degree.
Phobias are much more often diagnosed in women than in men.

Phobias explained in terms of evolution and learning

Learning plays some role in many, if not most, cases.
For example a traumatic event.
Such experiences may be understood in terms of classical conditioning.

People often develop phobias of objects that they have never inflicted damage or been a true threat to them.
People are genetically prepared to be wary of, and to learn easily fear, objects and situations that would have posed realistic dangers during most of our evolutionary history.
People can acquire strong fears of such evolutionarily significant objects and situations more easily than they can acquire fear of other sorts of objects.
Simply observing others respond fearfully to them, or reading or hearing fearful stories about them, can initiate or contribute to a phobia.
Children aren’t born with this fear, but rather they seem to possess perceptual biases to attend to certain types of stimuli and to associate them with fearful voices or reactions. In some people, such fears can develop into phobias.

The fact that some people acquire phobias and others don’t in the face of similar experiences probably stems from variety of predisposing factors, including genetic temperament and prior experiences.

People with phobias have a strong tendency to avoid looking at or being anywhere near the object they fear, and this behavior pattern tends to perpetuate the disorder.

Panic disorder and agoraphobia

Panic is a feeling of helpless terror.
In some people, this sense of terror comes at unpredictable times, unprovoked by any specific threat in the environment.
Because the panic is unrelated to any specific thought or situation, the panic victim cannot avoid it by avoiding certain situations or relieve it by engaging in certain rituals.
Panic attacks usually last several minutes and are accompanied by high physiological arousal and a fear of losing control and behaving in some frantic, desperate way.

To be diagnosed with panic disorder, by DSM-5 criteria, a person must have experienced recurrent unexpected attacks, at least one of which is followed by at least 1 month of debilitating worry about having another attack or by life-constraining changes in behavior motivated by fear of another attack.

Panic disorder often manifest itself shortly after some stressful event or life change.
Panic victims seem to be particularly attuned to, and afraid of, physiological changes that are similar to those involved in fearful arousal.

A perpetuating cause, and possibly also a predisposing cause, of the disorder is a learned tendency to interpret physiological arousal as catastrophic.

Agoraphobia: a fear of public places.
Develops at least partly because of the embarrassment and humiliation that might follow loss of control in front of others.

Posttraumatic Stress disorder

PTSD is necessarily brought on by stressful experiences. The symptoms of PTSD must be linked to one or more emotionally traumatic incidents that the affected person has experienced.

PTSD is characterized by three major symptoms:

• Uncontrollable re-experiencing
• Heightened arousal (sleeplessness, irritability, exaggerated startle responses and difficulty concentrating)
• Avoidance of trauma-related stimuli.

People who are exposed repeatedly, or over long period of time, to distressing conditions are much more likely to develop PTSD than are those exposed to a single short-term, highly traumatic incident.
Most people can rebound reasonably well from a single horrific event, but the repeated experience of such events seems to wear that resilience down, perhaps partly through long-term debilitating effects of stress hormones on the brain.

Not everyone exposed to repeated highly stressful conditions develops PTSD. Social support, both before and after the stressful experiences, seems to play a role in reducing the likelihood of the disorder.
Genes also play a role.

Obsessive-compulsive disorder

An obsession: a disturbing thought that intrudes repeatedly on a person’s consciousness even though the person recognizes it as irrational.
A compulsion: a repetitive action that is usually performed in response to the obsession.

Characteristics of the disorder

People diagnosed with OCD are those for whom such thoughts and actions are serve, prolonged and disruptive of normal life.
DSM-5: the obsessions and compulsions must consume more than an hour per day of the person’s time and seriously interfere with work or social relationships.

OCD involves a specific irrational fear.
The fear is of something that exists only as a thought and can be reduced only by performing some ritual.
People with OCD suffer also form their knowledge of the irrationality of their actions and often go to great lengths to hide them from other people.

The obsessions experiences by people with OCD are similar to, but stronger and more persistent than, the kinds of obsessions experiences by most people in the general population.

Brian abnormalities related to the disorder

In some cases, the disorder first appears after known brain damage.
Brian damage resulting from a difficult birth has also been known to be a predisposing cause.
The brain areas that seem to be particularly involved include portions of the frontal lobes of the cortex and parts of the underlying limbic system and basal ganglia. These normally work together in a circuit to control voluntary actions, controlled by thought.
One theory: damage in these areas may produce OCD by interfering with the brain’s ability to produce the psychological sense of closure or safety that normally occurs when a protective action is completed.

Mood disorders

Depressive disorders

Depression is characterized primarily by prolonged sadness, self-blame, a sense of worthlessness and absence of pleasure. Other symptoms include decreased or increased sleep and appetite. And either retarded or agitated motor symptoms.
To warrant diagnosis of a depressive disorder, the symptoms must be either very severe or very prolonged and not attributable just to a specific life experience, though they may be triggered or exacerbated by such an experience.

Two main classes:

• Major depression
  Very serve symptoms that last essentially without remission for at least two weeks
• Dysthymia
  Or persistent depressive disorder. Less-serve symptoms that last for at least two years.

Comparisons between depression and generalized anxiety

The two are predisposed by the same genes.
The two often occur in the same individuals. Typically, generalized anxiety occurs before the onset of major depression.
Cognitively, anxious individuals worry about what might happen in the future, while depressed individuals feel that all is already lost.

Negative thought pattern as a cause of depression

Negative thoughts are characteristic of people who are depressed, and they may also characterize people who are not depressed but are vulnerable to becoming so.

Depression results from a pattern of thinking about negative events that has the following 3 characteristics:

• The person assumes that the negative event will have disastrous consequences
• The person assumes that the negative event reflects something negative about him-or herself.
• The person attributes the cause of the negative event to something that is stable and global.

This hopeless manner of thinking can also occur, to varying degrees, in people who by other measures are not depressed, and in those people it is predictive of future depression.

Stressful experiences plus genetic predisposition as cause of depression

People who have recently suffered a severely stressful experience are much more likely to become depressed than are those who have not.
The kinds of stressful events most strongly associated with depression are losses that alter the nature of one’s life. They can promote the kind of hopeless thinking that corresponds with and predicts depression.

Not everyone becomes depressed in response of such occurrences. The difference appears to reside largely in genes.

There is an interaction between genetic disposition and childhood experience in depression.

Possible brain mechanisms of depression

Depression is a product of the brain.
All the drugs that are used regularly to treat depression have the effect of increasing the amount of activity of one or both of two neurotransmitters in the brain: norepinephrine and serotonin.

Stress and worry are often associated with an increased release of cortisol, a hormone produced by the adrenal glands.
Cortisol can act on the brain to shut of certain grow-promoting processes.
Over period of weeks or months, a high level of cortisol can result in a small but measurable shrinkage in some portions of the brain, including portions of the prefrontal cortex and the hippocampus. These brain changes are reversible. During periods of reduced stress, the shrunken brain areas may regain their former size. Increases in norepinephrine and serotonin over periods of weeks can stimulate growth in these brain areas. This may explain the delayed effects of drug treatments in relieving depression.

The theory is:
Depression in humans results at least partly from a stress-induced loss of neurons or neural connections in certain parts of the brain. Recovery from depression results from regrowth in those brain areas.

Possible evolutionary bases for depression

From an evolutionary perspective, depression may be an exaggerated form of a response to loss that in less extreme form is maladaptive.
A depressed mood slows us down, makes us think realistically rather than optimistically, leads us to turn away from goals that we can no longer hoop to achieve, and signals to others than we are no threat to them and need their help.
A depressed mood can also lead to a kind of soul-searching, the end result of which may be the establishment of new, more realistic goals and a new approach to life.

Depressed moods may come in a variety of different forms, each adapted for different survival purposes.

Bipolar disorders

Characterized by mood swings in both directions. Downward in depressive episodes and upward in manic episodes. Such episodes may last anywhere from a few days to several months, often separated by months or years of relatively normal mood.

DSM-5 identifies two main varieties:

• Bipolar I disorder
  The classic type, characterized by at least one manic episode, which may or may not be followed by a depressive episode.
• Bipolar II disorder
  Similar to bipolar I, except that its high phase is less extreme and is referred to as hypomania. In some cases, episodes of mania may occur without intervening of episodes of depression.

The predisposition for bipolar disorder is strongly heritable.
Stressful life events may help bring on manic and depressive episodes in people who are predisposed.
Bipolar disorder can usually be controlled with regular doses of the element lithium, used as a drug.

The manic condition

Manic episodes are typically characterized by expansive, euphoric feelings.
During hypomania and the early stages of a manic episode, the high energy and confidence may lead to an increase in productive work, but, as manic episode progresses, judgment becomes increasingly poor and behavior increasingly maladaptive.
Full-blown mania may be accompanied by bizarre thoughts and dangerous behaviors.

Not all people with bipolar disorders experience the manic state as euphoric.

Possible relation of hypomania to enhanced creativity

There is a correlation between hypomania and creativity.

Schizophrenia

Diagnostic characteristics of schizophrenia

No two sufferers of schizophrenia have quite the same symptoms.

DSM-5 diagnosis: the person must manifest a serious decline in ability to work, care for him-or herself, and connect socially with others.
The person must also manifest, for at least one month, two or more of the following five categories of symptoms.
The symptoms are usually not continuously present.

Disorganized thought and speech

Many people with schizophrenia show speech patterns that reflect an underlying deficit in the ability to think in a logical, coherent manner.
In some cases, thought and speech are guided by loose word associations.
In all sorts of formal test of logic, people with schizophrenia do poorly when in an active phase of their disorder. They often encode the problem information incorrectly, fail to see meaningful connections, or base their reasoning on superficial connections having more to do with the sounds of words than with the meaning.
People may show disorganized speech or thoughts long before symptoms of schizophrenia are apparent.

Delusions

A delusion is a false belief held in the face of compelling evidence to the contrary.
Delusions may result, in part, form a fundamental difficulty in identifying and remembering the original source of ideas or actions.

Hallucinations

Hallucinations are false sensory perceptions.
The most common hallucinations in schizophrenia are auditory.
Hallucinations and delusions typically work together to support one another.
Auditory hallucinations derive from the person’s own intrusive verbal thoughts.

Grossly disorganized or catatonic behaviors

People with schizophrenia often behave in much disorganized ways.
The inability to keep context in mind and to coordinate actions with it seems to among the basic deficits in schizophrenia.
Catatonic behavior: behavior that is unresponsive to the environment.

Negative symptoms.

Symptoms of schizophrenia that involve a lack of, or reduction in expected behaviors, thoughts, feelings and drives.
They include a general slowing down of bodily movements, poverty of speech, flattened affect, loss of basic drives such as hunger, loss of the pleasure that normally comes from fulfilling drives and social withdrawal.

Neurological factors associated with schizophrenia

Schizophrenia is characterized primarily as a cognitive disorder, brought on by deleterious changes in the brain.
People with schizophrenia suffer from deficits in essentially all the basic processes of attention and memory.

Disruptions on brain chemistry

Schizophrenia may involve unusual patterns of dopamine activity.
Overactivity of dopamine in some part of the brain, especially in the basal ganglia, may promote the positive symptoms of schizophrenia.
Underactivity of dopamine in the prefrontal cortex may promote the negative symptoms.

The role of glutamate.

Glutamate is the major excitatory neurotransmitter at fast synapses throughout the brain.
One of the major receptor molecules for glutamate is defective in people who have schizophrenia, resulting in a decline in the effectiveness of glutamate neurotransmission.
Such a decline could account for the general cognitive debilitation that characterizes the disorder.

Alterations in brain structure

There are structural differences between the brains of people with schizophrenia and those of other people.

• Enlargement of the cerebral ventricles (fluid filled spaces in the brain) accompanied by a reduction in neural tissue surrounding the ventricles.
• Abnormal blood flow to certain areas of the brain.
• Decreased neural mass, especially in the hippocampus and the prefrontal cortex.

During adolescence, the brain normally undergoes certain structural changes.
Pruning: many neural cell bodies are lost.
An abnormality in pruning, which leads to the loss of too many cell bodies, may underlie at least some cases of schizophrenia.

Genetic and environmental causes of schizophrenia

Predisposing effects of genes

Genetic differences among individuals play a substantial role in the predisposition for schizophrenia.
The genetic similarity, not the environmental similarity, between relatives produces high concordance for schizophrenia.
Many different genes are involved, no single gene or small set of genes can account for most of the genetic influence in large samples of people with schizophrenia.
At least some of the identified genes are known to influence dopamine neurotranssion and some are known to influence glutamate neurotranssion.

Effects of the prenatal environment and early brain traumas

Genes are not the only determinants of the disorder.
There are specific prenatal variables that can contribute to the likelihood of developing schizophrenia.

• Malnutrition
• Prenatal viral infections and birth complications
• Head injury later in childhood before age 10

Effects of life experiences

Stressful life events of many sorts can precipitate schizophrenia and exacerbate its symptoms.
High-risk children whose parents communicated in a relatively disorganized, hard-to-follow, or highly emotional manner were much more likely to develop schizophrenia or a milder disorder akin to schizophrenia than were high-risk children whose parents communicated in a calmer, more organized fashion.
This relationship is not found among low-risk children.

A degree of disordered communication at home that does not harm most children may have damaging effects on those who are genetically predisposed for schizophrenia.

Expressed emotion: criticisms and negative attitudes or feelings expressed about and toward a person with a mental disorder by family members with whom that person lives.
Other things being equal, the greater the expressed emotion, the greater the likelihood that the active symptoms will return or worsen and the person will require hospitalization.

A cross-cultural study of the course of schizophrenia

There is considerable cross-cultural consistency.

A developmental model of schizophrenia

The disorder has no simple, unitary cause.

Personality disorders

A personality disorder: an enduring pattern of behavior, thoughts and emotions that impairs a person’s sense of self, goals, and capacity for empathy and/or intimacy and is associated with significant stress and disability.

Many patients meet criteria for more than one personality disorder, many have personality disorders that do not fall into one of the 10 categories and personality dysfunction may reflect maladaptive extremes of normal personality.

Cluster A: ‘Odd’ personality disorders

Paranoid personality disorder

People with paranoid personality disorder are deeply distrustful of other people and are suspicious of their motives.
Most of these attributions are inaccurate, but not so off base as to be considered delusional.
They frequently blame other for their failures and tend to bear grudges.

Schizoid personality disorder

Display little in the way of emotion, either positive or negative and tend to avoid social relationships.
They avoid others because they genuinely prefer to be alone.
They are self-centered and are not much influenced by either praise of criticism.

Schizotypal personality disorder

Show extreme discomfort in social situations, often bizarre patterns of thinking and perceiving, and behavioral eccentricities, such as wearing odd clothing or repeatedly organizing their kitchen shelves.
They tend to be anxious and distrustful.
They often see significance in unrelated events, especially as they relate to themselves, and some people with this disorder believe they have special abilities.
They have poor attentional focus, making conversations vague, often with loose associations.

Cluster B: ‘Dramatic’ personality disorders

Individuals with these disorders display highly emotional, dramatic, or erratic behavior that makes it difficult for them to have a stable, satisfying relationships.

Antisocial personality disorder

Consistently violate or disregard the rights of others and are sometimes referred to as sociopaths or psychopaths.
They frequently lie, seem to lack a moral conscience, and behave impulsively, seemingly disregarding the consequences of their actions.
As result of their reckless behavior and disregard for others, the frequently find themselves in trouble with the law.

Borderline personality disorder

Instability, including in emotions, and self-image, often showing dramatic changes in identity, goals, friends and sexual orientation.
They tend to be impulsive, often engaging reckless behavior, sometimes lashing out at others when things don’t go right, and other times turning their anger inward, engaging in self-injurious behavior.
Attempted suicide is common in people with borderline personality disorder.
The relationships of people with borderline personality disorder tend to be intense and stormy, and they often have fears of abandonment in frantic efforts to head off anticipated separations.

Histrionic personality disorder

People with histrionic personality disorder continually seek to be the center of attention (they behave as if they are always ‘on stage’) and are often described as vain, self-centered, and emotionally charged, displaying exaggerated moods and emotions.
People with this disorder constantly seek attention and approval from others and are concerned with how others will evaluate them, often wearing provocative clothing to attract attention.

Narcissistic personality disorder

People with this disorder are even more self-centered than people with borderline disorder.
They seek admiration from others, tend to lack empathy, and are grandiose and overconfident in their own exceptional talents or characteristics.
They exaggerate their abilities and achievements and expect others to see the same exceptional qualities in them that they see in themselves. So they are frequently perceived as arrogant.
They often make good first impressions, but these are rarely maintained.
This is due in part to their perceived arrogance, but also to their general lack of interest in other people.

Cluster C: ‘Anxious’ personality disorders

The common thread is fear and anxiety. The difference is in degree.

Avoidant personality disorder

People with this disorder are excessively shy. They are uncomfortable and inhibited in social situations.
They feel inadequate and are extremely sensitive to being evaluated, experiencing a dread of criticism.
Their extreme fear of rejection causes them to be timid and fearful in social settings and often results in their avoiding social contact, making it impossible for them to be accepted.
They rarely take risks or try out new activities, exaggerating the difficulty of tasks before them.

Dependent personality disorder

Show an extreme need to be cared for. They are clingy and fear separation from significant people in their lives, believing they cannot care for themselves.
They fear upsetting relationship partners and as a result tend to be obedient, rarely disagreeing with them and permitting them to make important decisions for them.
They often feel lonely, sad and distressed, putting them at high risk for anxiety, depression and eating disorders.
They are prone to suicidal thoughts, especially when a relationship is breaking up.

Obsessive-compulsive personality disorder

Are preoccupied with order and control, and as a result are inflexible and resist change.
They are so highly focused on the details of a task that they often fail to understand to point of an activity.
They tend to set extremely high standards for themselves and others, exceeding any normal degree of conscientiousness.
They often have difficulty expressing affection, and as a result their relations are frequently shallow and superficial.

Origins of personality disorders

There are multiple causes of any single personality disorder. With genes, operating in interaction with the environment at all levels.

DMS-5
A person must be at least 18 years old to be diagnosed with a personality disorder, the roots of such disorders are in development, with features of all of these disorders being apparent to lesser degrees during childhood and adolescence.