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Individuals are socially isolated and uncomfortable with others. Unlike Schizoid PD, they have peculiar patterns of thinking, including ideas of reference and persecution, odd preoccupa-tions, and odd speech and affect. A 30-year-old man is completely preoccupied with the study and the brewing of herbal teas. He associates many peculiar powers with such infusions and says that plants sometimes whisper to him. He spends all of his time alone, often taking solitary walks in the wilderness for days at a time, collecting plants for teas. He has no history of disorganized behavior. Cluster B Histrionic PD. Usually characterized by colorful, exaggerated behavior and excitable, shallow expression of emotions; uses physical appearance to draw attention to self; sexually seductive; and is uncomfortable in situations where he or she is not the center of attention. A 30-year-old woman presents to the doctor's office dressed in a sexually seductive manner and insists that the doctor comment on her appearance. When the doctor refuses to do so, she becomes upset. Borderline PD. Usually characterized by an unstable affect, mood swings, marked impulsivity, unstable relationships, recurrent suicidal behaviors, chronic feelings of emptiness or boredom, identity disturbance, and inappropriate anger. If stressed, may become psychotic. Main defense mechanism is splitting. A 20-year-old nurse was recently admitted after reporting auditory hallucinations, which have occurred during the last few days. She reports marriage difficulties and believes her husband is to blame for the problem. She has several scars on her wrists and has a history of substance abuse. --\ -,
Antisocial PD. Usually characterized by continuous antisocial or criminal acts, inability to conform to social rules, impulsivity, disregard for the rights of others, aggressiveness, lack of remorse, and deceitfulness. These have occurred since the age of 15, and the individual is at least 18 years of age. A 22-year-old man was recently arrested after he set his mother's house on fire. He has had numerous problems with the law, which started at an early age when he was sent to a juvenile detention center for his behavior at both home and school. He lacks remorse for setting the fire and expresses a desire that his mother would have died in the fire. Narcissistic PD. Usually characterized by a sense of self-importance, grandiosity, and preoc-cupation with fantasies of success. This person believes s/he is special, requires excessive admira-tion, reacts with rage when criticized, lacks empathy, is envious of others, and is interpersonally exploitative. A famous actor is outraged when a director questions his acting abilities during rehearsal for a play. The actor responds by walking off the stage and not returning to the stage unless the director apologizes publicly for her behavior.