Personality Disorders

Chapter 9 November 18, 2005

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 persons 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 others 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

Quote of the day

Im the most cold-hearted son of a b---- you will ever meet Ted Bundy

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, selfcentred 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)

DSM Categorical Approach

Based on the medical model Disorder is present or absent

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 doesnt 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 fields 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

Disadvantages of the Dimensional Approach

Lack of clinical utility? Lack of familiarity?

Bottom line: not too many disadvantages and most researchers favor it likely to be adopted in DSM-V