Personality disorders
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Personality Disorders. Personality features versus Disorder Categorical versus Dimensional Approaches Overview of major disorders. Cato Grønnerød PSY2600. Definitions. Personality “The enduring patterns of thinking, feeling and reacting that define a person” Personality Disorder

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Personality Disorders

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Personality disorders


Personality features versus Disorder

Categorical versus Dimensional Approaches

Overview of major disorders

Cato Grønnerød




  • Personality

    • “The enduring patterns of thinking, feeling and reacting that define a person”

  • Personality Disorder

    • “An enduring pattern of inner experience and behavior that deviates markedly from the expectations of the individual’s culture” (APA, 2000)

    • Must fit both the general and the specific criteria for DSM diagnosis



  • Personality Disorder

    • Pattern of deviation must be evident in two or more of the following domains

      • Cognition

      • Emotional responses

      • Interpersonal functioning

      • Impulse control

    • Pattern must be inflexible and pervasive across a broad range of personal and social situations



  • Personality Disorder

    • Must be a source of clinically significant distress or impairment in social, occupational or other important areas of functioning

    • Must be stable and of long duration, with an onset that can be traced back to at least adolescence or early adulthood

  • Clinical constructs used to

    • understand, describe and communicate about

    • the complex phenomena that result when

    • the personality system is not functioning optimally

Ways of understanding

Ways of Understanding

  • Categorical Classification

    • DSM-IV – Axis II Disorders

    • Cluster A: odd or eccentric behaviour

      • Paranoid, schizoid, schizotypal personalities

    • Cluster B: erratic, emotional and dramatic

      • Antisocial, borderline (unstable), histrionic and narcissistic personalities

    • Cluster C: anxiety and fearfulness

      • Avoidant, dependent and obsessive-compulsive personalities

Ways of understanding1

Ways of Understanding

  • Categorical Classification

    • ICD-10 – F60: Specific Personality Disorders

    • PDM, MCMI-III: Sadistic, Masochistic, Depressive, Passive-Aggressive

  • Dimensional Classification

    • Personality disorders are normal traits amplified to the extreme

    • E.g. Five-Factor Model of Personality: neuroticism, extraversion, openness to experience, agreeableness and conscientiousness

    • Psychodynamic Diagnostic Manual (PDM)

Ways of understanding2

Ways of Understanding


Very Low

Very High


Very Introverted

Very Extraverted


Very Low

Very High


Very Low

Very High


Very Low

Very High



  • Genetic predisposition

    • Varies among PDs

  • Childhood experience

    • Attachment experience

    • Traumatic events

    • Family factors and dysfunction

  • Sociocultural and political forces

    • Variations between nations

    • More Antisocial PD in the US

    • Presentation of symptoms may vary



  • Varies according to gender, social factors and type

  • Approx. 10-14% overall

  • Most prevalent

    • Obsessive Compulsive, Avoidant, Paranoid

  • Least prevalent

    • Narcissistic, Borderline, Dependent

  • Most visible

    • Borderline, Antisocial

  • Assumption of stability over time, but some more than others

    • e.g. schizotypal > borderline

Cluster a paranoid

Cluster A: Paranoid

  • Pervasive distrust and suspicion of others

  • Argumentative, tense and humourless

  • Become preoccupied with their distrust in others, causing relational problems

  • Attributional style: blames other for everything that is wrong

Cluster a paranoid1

Cluster A: Paranoid

  • Normal trait: Suspicious,sceptical

  • Comorbid: anxiety, psychosis, mood disorder

Cluster a schizoid

Cluster A: Schizoid

  • Social detachment/indifference

  • Limited emotional experience and expression

  • Strong fantasy life

  • Takes pleasure in few activities

  • Appears indifferent to praise or criticism

  • Modest genetic link to autism

Cluster a schizoid1

Cluster A: Schizoid

  • Normal trait: Retiring, introvert

  • Subclinical: asocial

Cluster a schizotypal

Cluster A: Schizotypal

  • Cognitive and perceptual distortions

    • Derealisation and depersonalization

    • Suspicion, magical thinking, illusions

  • Eccentric behaviour

  • Discomfort with close relationships

  • Not serious enough to warrant a schizophrenia diagnosis

  • Genetically related to schizophrenia

Cluster a schizotypal1

Cluster A: Schizotypal

  • Normal trait: Eccentric

  • Extreme: Schizophrenia?

Cluster b narcissistic

Cluster B: Narcissistic

  • Grandiosity, inflated sense of self-importance

  • Need for attention, lack of empathy

  • Fragile, unstable self image

Cluster b narcissistic1

Cluster B: Narcissistic

  • Normal trait: Confident

  • Subclinical: Egoistic

  • Examples: Capote, American Beauty

Cluster b antisocial

Cluster B: Antisocial

  • Disregard for and violation of (the rights of) others

  • Includes sociopaths and psychopaths

  • Emotional detachment

  • Antisocial life style

  • Charming and even charismatic

Cluster b antisocial1

Cluster B: Antisocial

  • Normal trait: Nonconforming

  • Subclinical: Grandiose, conning

  • Examples:Reservoir Dogs, Silence of the Lamb, Wall Street

Cluster b borderline

Cluster B: Borderline

  • Instability of interpersonal relationships, self-image, emotions, and control over impulses

  • Frantic efforts to avoid real or imagined abandonment

  • “Borrowing” identity from others

  • High comorbidity with other disorders

Cluster b borderline1

Cluster B: Borderline

  • Normal trait: Capricious (NO: lunefull)

  • Extreme: biploar?

  • Example: Fatal Attraction

Cluster b histrionic dramatizing

Cluster B: Histrionic/Dramatizing

  • Excessive emotionality and attention-seeking

  • Superficial charm, viewed as shallow

  • Demanding, inconsiderate and egocentric in relationships

  • Some overlap with Antisocial PD

  • Less severe form of Borderline PD?

Cluster b histrionic dramatizing1

Cluster B: Histrionic/Dramatizing

  • Normal trait: Sociable

  • Subclinical: affect ridden (NO: affektert)

  • Example: Being Julia

Cluster c avoidant

Cluster C: Avoidant

  • Social withdrawal

  • Feelings of inadequacy, low self-esteem

  • Hypersensitive to criticism, disapproval or rejection

  • Overlap with social phobia

  • Normal trait: shy

  • Subclinical: withdrawn

Cluster c dependent

Cluster C: Dependent

  • Excessive need to be taken care of

  • Clinging and submissive behaviour

  • Relies on others for important decisions

  • Will often tolerate abuse

  • Subtypes

    • Attachment/abandonment

    • Dependency/incompetence

  • Normal trait: cooperative

  • Subclinical: attached

Cluster c obsessive compulsive

Cluster C: Obsessive compulsive

  • Preoccupation with orderliness, perfection and control at the expense of flexibility

  • Sticks to plans and rules to an extent that the original purpose of the activity is lost

  • Demands perfection from themselves and others

  • Very little overlap with OCD

  • Normal trait: conscientious

  • Subclinical: restricted



  • Traditionally PDs considered very difficult to treat because of their pervasive, entrenched nature

  • Psychoanalysis/psychodynamic therapy

    • Esp. Borderline, Histrionic, Dependent, Narcissistic, etc.

  • Cognitive Behavioural Therapy

  • Medication

Antisocial personality disorder apd

Antisocial Personality Disorder (APD)

  • More studied than any other personality disorder

  • Origins usually traced back to earlier periods in development (Conduct Disorder),

    • Can not be diagnosed until late adolescence (DSM criteria)

  • Has the distinction between ASPD and criminality been blurred?

    • Not all psychopaths are criminals, and not all serious offenders are psychopaths

Antisocial personality disorder apd1

Antisocial Personality Disorder (APD)

  • Psychopathy includes

    • ”Shallow, deceitful, unreliable and incapable of learning from emotional experience”

    • Seemingly lacking in basic emotions: shame, guilt, anxiety, remorse (conscience).

  • Increasing age can bring a change (lessening) in overt antisocial behaviors

    • Less obvious impulsivity, recklessness, social deviance

    • Some argue that the behaviors merely go ”underground”

Apd causes

APD: Causes

  • Biological Factors

    • Seems to be a genetic loading, esp. father-son, but outcome strongly determined by environment (adoption studies)

  • Temperament and family environment interaction

    • Parenting (punitive, inconsistent, low warmth), peers, school

  • Behavioral and social reinforcers

    • Learned behavior resistant to change, modeling, consequence ”trap”, peer support

Apd born bad

APD: Born bad?

  • Psychological factors

    • Inability to anticipate punishment

    • Lack of anxiety regarding punishment/negative consequences

  • Consequent participation in risk-taking, self-promoting behaviour with reduced ability to interpret (or pay attention to) nonverbal cues

    • Esp. fear, distress, anger, anxiety

  • Some people ”born bad”?

    • GSR, emotional responsiveness, empathy studies

Apd treatment

APD: Treatment

  • Seldom seek treatment

  • Often coerced into treatment by the legal system

    • Participation does not always equate with success

  • Difficulty building a therapeutic relationship

  • Very high recurrance of behaviour

  • Limited success with behavioural techniques

Borderline personality disorder bpd

Borderline Personality Disorder (BPD)

  • Often present due to other complaints

    • E.g. somatic, self-harm, anxiety, depression, abuse history; large degree of comorbidity

  • Initially conceptualized as the ”borderline” between neurosis and schizophrenia

  • Very poor sense of/integration of self leads to uncertainty about personal values, identity, worth and choices

    • = erratic, impulsive and self-damaging behavior

Bpd cognitive behavioural features

BPD: Cognitive/behavioural features

  • Fear abandonment and crave relationships

  • Incapable of maintaining these due to unrealistic expectations and lack of self-cohesion

  • Subject to chronic feelings of depression, worthlessness, ’emptiness’ leading to self-harm and self-deprecating behavior

    • E.g. sexual activity, substance abuse, eating

  • Demonstrate dissociation during intense distress

  • Splitting

    • Tend to see people and events as either all good or all bad, and can shift rapidly between these.

Bpd causes

BPD: Causes

  • Biological/genetic

    • Seems to run in families and may be associated with genes that contribute to anxiety, frontal lobe dysfunction

  • Object Relations

    • The internalisation of early caregiving relationships

      • E.g. inconsistency = insecurity & ego confusion leads to ego defence such as splitting

  • Diathesis-stress

    • Vulnerability thresholds overwhelmed e.g. by abuse and trauma

Bpd treatment

BPD: Treatment

  • Perceived as very difficult clients

  • Therapeutic relationship is key but threatening to person with BPD

    • Attrition is high, and therapy is made very challenging

  • Psychoanalysis uses the transference relationship to interpret and integrate

    • Ego-supportive therapy

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