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Personality Disorders . Assessment & Diagnosis SW 593. Introduction . These disorders are listed on Axis II. Refers to a pervasive, persistent, relatively inflexible personality trait that leads to functional impairment or subjective distress.
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Personality Disorders Assessment & Diagnosis SW 593
Introduction • These disorders are listed on Axis II. • Refers to a pervasive, persistent, relatively inflexible personality trait that leads to functional impairment or subjective distress. • The pattern in question should be stable across a broad range of situations, be established by early adulthood, and not be due to another Axis I disorder, general medical condition, or substance usage.
Introduction • Clinicians are encouraged to be extremely circumspect in applying these labels with young people. • Problematic personality traits exhibited in early years will often not persist into adulthood. • In any event, for these diagnoses to be applied to persons under the age of 18, the behaviors need to have been present for at least one year.
Introduction • Diagnoses are divided into three “clusters” based on similarities in symptom presentation. • Cluster A: odd and eccentric • Cluster B: dramatic and emotional • Cluster C: fearful and anxious • An individual warranting a diagnosis of a particular personality disorder will exhibit traits related to other diagnoses within the same cluster.
Introduction • An individual may exhibit a grouping of traits related to a particular cluster of personality disorders without fully meeting any specific diagnosis. • Clinicians may simply list such personality traits on Axis II, particularly if their presence is deemed to have relevance to treating a coexisting Axis I disorder.
Cluster A • Refers to a pattern of behavior that is generally viewed as odd or eccentric. • Tend to isolate themselves and/or be suspicious. • Pattern of social isolation can be traced into childhood. • Seldom seek treatment.
Paranoid • Pervasive mistrust and/or suspiciousness of others. • They may suspect others of having malevolent motives; • Be preoccupied with concerns about others; • Be reluctant to confide in others; • Be extremely sensitive to perceived criticisms and/or bear grudges against others.
Schizoid • Characterized by a general detachment from social relationships. • Restricted range of emotional expressions. • Consistently prefer isolation to social relationships, generally have few interests. • Seldom engage in intimate relationships. • Described as cold or emotionless.
Schizotypal • Restricted interpersonal relationships • Marked peculiarities in thinking and perception. • Similar but not as severe as one diagnosed with schizophrenia. • Ideas of reference vs. delusions of reference.
Cluster B • A pattern of behavior that is viewed as dramatic or emotional. • Often display erratic or impulsive behaviors. • There is generally a marked self-absorption that results in a diminished capacity for empathy.
Antisocial • This diagnosis is not given to clients under the age of 18. • Usually engage in illegal activities; • Routinely practice deceit; • Often aggressive and violent; • Typically irresponsible • Generally ignore the rights and feelings of others. • Rarely show remorse
Borderline • Typically demonstrate erratic interpersonal relationships; • Fluctuating self-image and/or affect; • Marked impulsivity. • Frequently engage in suicidal or self-mutilating behaviors. • Noted for extremes in affect and in judgment.
Borderline • They rarely see themselves or others in a balanced way. • These clients are the most likely of people with personality disorders to seek treatment.
Histrionic • Characterized by emotionality and attention seeking. • Are only comfortable when they are the “center of attention”. • Will use physical appearance, speech, and emotions to command others’ attention.
Narcissistic • A grandiose sense of self-importance; • A need for attention • A reduced capacity for empathy • Often seem to have an exaggerated sense of entitlement; • Expect to be admired and obeyed by others. • Usually seeks treatment when frustrated by others.
Cluster C • Includes patterns of behaviors that are essentially fearful and/or anxious. • Tend to be perfectionistic or rigid in standards or expectations for themselves or others. • Relatively unlikely to seek treatment.
Avoidant • Demonstrate marked feelings of inadequacy that are associated with hypersensitivity to negative feedback and/or social inhibition. • Seldom put themselves in “risky” or even new situations in which they may perform poorly. • Seldom develop intimate interpersonal relationships. • May constrain occupational choices based on fear of negative judgments.
Dependent • Seek someone to take care of them, even to the extent of being submissive, clinging, and fearful of separation. • Avoid decisive action and encourage others to make decisions for them. • Subservience makes it quite difficult to express disagreement, even when asked to undertake unpleasant activities.
Dependent • Fear being alone and quickly substitute a new relationship if an old one is lost. • They systematically underestimate themselves and their ability to function independently.
Obsessive-Compulsive • Have well-controlled perfectionistic patterns of behavior at the expense of spontaneity, flexibility, and even efficiency. • There is often such preoccupation with planning and details that tasks are not completed. • Difficulty delegating responsibilities and tend to work long hours in order to meet their own standards regarding productivity.
Obsessive-Compulsive • Tend to collect and hoard things even when those things have little value. • Unlike obsessive-compulsive disorder, individuals with OCPD do not necessarily have obsessions or compulsions. • Tendency is to be rigid in their actions and thinking, adhering to strict and controlled patterns of thought and behaviors.
Assessment • Detailed and thorough histories are necessary for the diagnosis of a Personality Disorder. • Often the level of detail needed to substantiate a pattern of persistent and pervasive personality traits is not obtained when the clinical focus is on an Axis I mental disorder. • A number of psychometric tools are available: • MMPI-2 • Millon Clinical Multiaxial Inventory • Coolidge Axis II Inventory
Cultural Considerations • Judgments about persistent and pervasive personality traits cannot be made without consideration of a person’s cultural background. • Always use caution!!!!!!!!!! • Particular care should be exercised in diagnosing members of a minority group with Paranoid Personality Disorder.
Cultural Considerations • Men are much more likely to be diagnosed with Antisocial PD. • Women are much more likely to be diagnosed with Borderline, Histrionic, and Dependent PD.
