Personality Disorders on the LCSW Exam: A Study Guide

Personality Disorders on the LCSW Exam

Personality disorders are a commonly tested topic on the ASWB Clinical exam. Questions may ask you to identify specific personality disorders based on clinical vignettes, differentiate between similar diagnoses, understand the therapeutic challenges these clients present, and select appropriate treatment approaches. A thorough understanding of the DSM-5-TR personality disorder criteria and related clinical concepts is essential.

General Diagnostic Features

Before studying the individual personality disorders, understand the general criteria that apply to all personality disorders. According to the DSM-5-TR, a personality disorder is an enduring pattern of inner experience and behavior that deviates markedly from the expectations of the individual's culture. This pattern is manifested in two or more of the following areas:

• Cognition: ways of perceiving and interpreting self, others, and events
• Affectivity: the range, intensity, lability, and appropriateness of emotional response
• Interpersonal functioning: patterns of relating to others
• Impulse control: the ability to manage impulses and urges

The pattern must be inflexible, pervasive across a broad range of personal and social situations, stable and of long duration (with onset in adolescence or early adulthood), and not better explained by another mental disorder, substance use, or a medical condition.

Cluster A: Odd or Eccentric

Paranoid Personality Disorder

Characterized by a pervasive distrust and suspiciousness of others. Individuals interpret others' motives as malevolent, suspect exploitation or harm without sufficient basis, and are reluctant to confide in others. They may bear grudges and perceive attacks on their character that are not apparent to others.

Schizoid Personality Disorder

Marked by a pervasive pattern of detachment from social relationships and a restricted range of emotional expression. Individuals prefer solitary activities, have little interest in close relationships including family, appear indifferent to praise or criticism, and show emotional coldness or flattened affect.

Schizotypal Personality Disorder

Characterized by acute discomfort with close relationships, cognitive or perceptual distortions, and eccentric behavior. Individuals may have ideas of reference, odd beliefs or magical thinking, unusual perceptual experiences, odd speech patterns, suspiciousness, inappropriate or constricted affect, and few close friends.

Cluster B: Dramatic, Emotional, or Erratic

Antisocial Personality Disorder

A pervasive pattern of disregard for and violation of the rights of others, beginning by age 15. Features include deceitfulness, impulsivity, irritability and aggressiveness, reckless disregard for safety, consistent irresponsibility, and lack of remorse. The individual must be at least 18 years old and have evidence of conduct disorder before age 15.

Borderline Personality Disorder

Characterized by a pervasive pattern of instability in interpersonal relationships, self-image, and emotions, along with marked impulsivity. Features include frantic efforts to avoid real or imagined abandonment, unstable and intense relationships, identity disturbance, impulsive behavior, recurrent suicidal behavior or self-harm, emotional instability, chronic feelings of emptiness, intense and inappropriate anger, and transient stress-related paranoid ideation or dissociative symptoms.

Histrionic Personality Disorder

A pervasive pattern of excessive emotionality and attention-seeking. Individuals are uncomfortable when not the center of attention, display inappropriate sexually seductive behavior, show rapidly shifting and shallow expression of emotions, use physical appearance to draw attention, speak in an impressionistic and vague style, are suggestible, and consider relationships more intimate than they are.

Narcissistic Personality Disorder

A pervasive pattern of grandiosity, need for admiration, and lack of empathy. Features include a grandiose sense of self-importance, preoccupation with fantasies of success and power, belief in being special, need for excessive admiration, sense of entitlement, interpersonally exploitative behavior, lack of empathy, envy of others, and arrogant behavior.

Cluster C: Anxious or Fearful

Avoidant Personality Disorder

A pervasive pattern of social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation. Individuals avoid occupational activities involving interpersonal contact due to fear of criticism, are unwilling to get involved with people unless certain of being liked, show restraint in intimate relationships due to fear of shame, and view themselves as socially inept or inferior.

Dependent Personality Disorder

A pervasive and excessive need to be taken care of, leading to submissive and clinging behavior and fears of separation. Individuals have difficulty making everyday decisions without excessive advice, need others to assume responsibility for major areas of their life, have difficulty expressing disagreement, go to excessive lengths to obtain support, and feel uncomfortable or helpless when alone.

Obsessive-Compulsive Personality Disorder

A pervasive pattern of preoccupation with orderliness, perfectionism, and control. Note that this is distinct from Obsessive-Compulsive Disorder (OCD), which involves obsessions and compulsions. OCPD features include preoccupation with details and rules, perfectionism that interferes with task completion, excessive devotion to work, inflexibility about morality, inability to discard worn-out objects, reluctance to delegate, miserliness, and rigidity.

Treatment Approaches

Dialectical Behavior Therapy

DBT is the gold standard treatment for Borderline Personality Disorder and has the strongest evidence base of any personality disorder treatment. It combines individual therapy, skills training groups, phone coaching, and a therapist consultation team.

Schema Therapy

Schema therapy integrates elements of CBT, psychodynamic therapy, and experiential therapy to address early maladaptive schemas (deeply held patterns of thinking and feeling) that underlie personality disorders.

Mentalization-Based Treatment

MBT focuses on improving the capacity to understand one's own and others' mental states. It was developed for Borderline Personality Disorder and helps clients develop more stable and coherent representations of self and others.