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©2013 UpToDate ® Print Email Aspects of personality disorder styles relevant to the therapeutic relationship Personality disorder/traits Alliance challenges Points of possible engagement in treatment Schizotypal Suspiciousness/paranoia Profound interpersonal discomfort Bizarre thinking Possible motivation for human connection Schizoid Social detachment Emotional aloofness Underlying neediness and sensitivity Paranoid Expectations of harm or exploitation Hypersensitivity to perceived criticism Inclination to withdraw or attack Underlying need for affirmation Borderline Unstable emotional and cognitive states Extremely demanding Proneness to acting-out Relationship-seeking Responds to warmth and support Narcissistic Need for constant positive regard Contempt for others Grandiose sense of entitlement Responds over time to empathy and affirmation Histrionic Attempts to charm and entertain Emotionally labile Unfocused cognitive style Relationship-seeking Responds to warmth and support Antisocial Controlling Tendency to lie and manipulate No empathy or regard for others Use of pseudoalliance to gain some advantage May engage in treatment if in self-interest or if Axis I symptoms cause sufficient distress Avoidant Expectations of criticism or rejection Proneness to shame and humiliation Reluctance to disclose information Responds to warmth/empathy Desire for relationships in spite of vulnerabilities Dependent No value placed on independence/taking initiative Submission leading to pseudoalliance Friendly and compliant Likely to stay in treatment Obsessive-compulsive Need for control Perfectionistic toward self and others Fear of criticism from therapist Restricted affect Stubbornness Conscientious Use of intellectualization may be helpful at times Will try to be a "good patient" Reprinted with permission from the American Psychiatric Textbook of Personality Disorders, (Copyright © 2005). American Psychiatric Association.