Personality Disorders Chapter 9 November 18, 2005.
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Definition of Personality
“Enduring patterns of perceiving, relating to, and thinking about the environment and oneself, which are exhibited in a wide range of important social and personal contexts”
Definition of Personality Disorders
Personality disorders are “enduring patterns of perceiving, relating to, and thinking about the environment and oneself” that “are exhibited in a wide range of important social and personal contexts,” and “are inflexible and maladaptive, and cause either significant functional impairment or subjective distress” (DSM-IV, p. 630)
Main Features of PDs
Extreme patterns of thinking, feeling, and behaving that deviate from a person’s culture
Listed on Axis II of the DSM-IV-TR Begin early in life and remain stable
- not contextual or transient Inflexible and maladaptive Cause significant functional impairment and
subjective distress - ego-syntonic vs. ego-dystonic
Problems with the PDs
Low levels of inter-rater reliability Comorbidity with both Axis I and Axis II Problems with classification system
- Categorical vs. Dimensional System
DSM-IV-TR Personality Disorders Paranoid Personality Disorder Schizoid Personality Disorder Schizotypal Personality Disorder
Antisocial Personality Disorder Borderline Personality Disorder Histrionic Personality Disorder Narcissistic Personality Disorder
Avoidant Personality Disorder Dependent Personality Disorder Obsessive-Compulsive Personality Disorder
Cluster A: Odd or Eccentric
Paranoid PD – is a pattern of distrust and suspiciousness such that others’ motives are interpreted as malevolent
Schizoid PD – is a pattern of detachment from social relationships and restricted range of emotional expression
Schizotypal PD – is a pattern of acute discomfort in close relationships, cognitive or perceptual distortions, and eccentricities of behaviour
Paranoid Personality Disorder
suspicious of other’s motives interprets actions of others as deliberately
demeaning/threatening expectation of being exploited see hidden messages in benign comments easily insulted/ bears grudges appear cold and serious
Schizoid Personality Disorder
indifferent to relationships limited social range (some are hermits) aloof, detached, called loners no apparent need of friends, sex solitary activities seem to be missing the “human part”
Schizotypal Personality Disorder
peculiar patterns of thinking and behaviour
perceptual and cognitive disturbances magical thinking not psychotic
perhaps a distant “cousin” of schizophrenia
Cluster B: Dramatic, Emotional, or Erratic
Antisocial PD – is a pattern of disregard for, and violation of, the rights of others
Borderline PD – is a pattern of instability in interpersonal relationships, self-image, and affects, and marked impulsivity
Histrionic PD – is a pattern of excessive emotionality and attention seeking
Narcissistic PD – is a pattern of grandiosity, need for admiration, and lack of empathy
Antisocial Personality Disorder
pattern of irresponsibility, recklessness, impulsivity beginning in childhood or adolescence (e.g., lying, truancy)
adulthood: criminal behaviour little adherence to societal norms, little anxiety conflicts with others callous/exploitive
Psychopathy
Egocentric, deceitful, shallow, impulsive individuals who use and manipulate others
Callous, lack of empathy Little remorse Thrill-seeking “human predators” (Hare, 1993) No “conscience”
Psychopathy Checklist-Revised (Hare, 1991) – 2 Factors
Glib and superficial Egocentric and
grandiose Lack of remorse or
guilt Lack of empathy Deceitful and
manipulative Shallow emotions
Impulsive Poor behavior
controls Need for excitement Lack of responsibility Early behavior
problems Adult antisocial
behavior
Borderline Personality Disorder
marked instability of mood, relationships, self-image
intense, unstable relationships uncertainty about sexuality everything is “good” or “bad” chronic feeling of “emptiness” recurrent threats of self-harm/
“slashers”
Borderline and comorbidity
High degree of overlap with both Axis I and Axis II disorders
24%-74% also diagnosed with major depression; 4% to 20% bipolar
25% of bulimics also diagnosed with BPD 67% also diagnosed with substance use
disorder
Histrionic Personality Disorder
excessive emotional displays/ dramatic behaviour
attention-seeking, victim stance seek re-assurance, praise shallow emotions, flamboyant, self-
centred very seductive, “life of the party”
Narcissistic Personality Disorder
grandiose, sense of self-importance lack of empathy hyper-sensitive to criticism exaggerate accomplishments/ abilities special and unique
entitlement below surface is fragile self-esteem
Cluster C: Anxious or Fearful
Avoidant PD – is a pattern of social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation
Dependent PD – is a pattern of submissive and clinging behaviour related to an excessive need to be taken care of
Obsessive-Compulsive PD – is a pattern of preoccupation with orderliness, perfectionism, and control at the expense of flexibility
Avoidant Personality Disorder
over-riding sense of social discomfort easily hurt by criticism always need emotional support occasionally try to socialize
so distressing they retreat into loneliness
Dependent Personality Disorder
submissive, clingy behaviour fear of separation easily hurt by criticism
Obsessive-Compulsive Personality Disorder
excessive control and perfectionism inflexible preoccupied with trivial details judgmental/moralistic workaholic/ignore family members often humourless
Personality Disorder Not Otherwise Specified
Meets general criteria for a PD but no specific criteria for a specific PD.
Exhibit at least 10 symptoms of PDs across all subtypes
Comorbidity
Average number of PD diagnoses per patient:
- 4.6 (Skodal et al., 1988)
- 2.8 (Zanaarini et al., 1987)- 3.75 (Widiger et al., 1986)
Assumptions of the DSM
Personality pathology is suited to be classified into discrete types or disorders
These disorders group themselves into three clusters
The diagnostic criteria naturally fall into the particular personality disorders to which they have been assigned
Empirical Evidence doesn’t support these assumptions!!!
David Klonsky – University of Virgina
“the DSM practice of putting expert opinions into writing and only then conducting tests of reliability and validity cannot lead to an acceptable classification system. Rather it directs scientists to conduct research on, and practitioners to put their trust in, diagnostic labels that may or may not map onto valid constructs that exist in nature. Instead, researchers must turn to objective, empirical methodologies to discover the dimensions or personality pathology, letting the data fall where they may and letting the data determine how personality disorder is best classified”
John Livesley - UBC
Dimensional Assessment of Personality Pathology Basic Questionnaire (DAPP)
4 Dimensions: Emotional Dysregulation; Dissocail Behaviour; Inhibitedness; Compulsivity
“ …the evidence on this point is so unequivocal that the only issue to explain is the field’s reluctance to accept empirical evidence”
~ W. John Livesley, (2000) Journal of Personality Disorders, 14, 2, p. 139-140.
The “Big 5” Personality Traits
Openness to experience Conscientiousness Extraversion Agreeableness Neuroticism
personality disorders represent extreme variations of OCEAN
Advantages of Categorical System
Ease in conceptualization and communication
Familiarity Consistency with clinical decision
making
Disadvantages of the Categorical Approach
Complex and cumbersome Arbitrary cut-off points Loss of important information
Advantages of the Dimensional Model
Resolution of a variety of classification dilemmas
Retention of Information Flexibility
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