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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.

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personality disorders

Personality Disorders

Chapter 9

November 18, 2005

definition of personality
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
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
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
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
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
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
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
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
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
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
a ntisocial personality disorder
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
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

Psychopathy Checklist-Revised (Hare, 1991) – 2 Factors
quote of the day
Quote of the day

“I’m the most cold-hearted son of a b---- you will ever meet”

  • Ted Bundy
borderline personality disorder
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
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
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
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
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
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
Dependent Personality Disorder
  • submissive, clingy behaviour
  • fear of separation
  • easily hurt by criticism
obsessive compulsive personality disorder
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
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
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
DSM – Categorical Approach
  • Based on the medical model
  • Disorder is present or absent
assumptions of the dsm
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
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
John Livesley - UBC
  • Dimensional Assessment of Personality Pathology Basic Questionnaire (DAPP)
  • 4 Dimensions: Emotional Dysregulation; Dissocail Behaviour; Inhibitedness; Compulsivity
slide30
“ …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
The “Big 5” Personality Traits
  • Openness to experience
  • Conscientiousness
  • Extraversion
  • Agreeableness
  • Neuroticism

 personality disorders represent extreme variations of OCEAN

advantages of categorical system
Advantages of Categorical System
  • Ease in conceptualization and communication
  • Familiarity
  • Consistency with clinical decision making
disadvantages of the categorical approach
Disadvantages of the Categorical Approach
  • Complex and cumbersome
  • Arbitrary cut-off points
  • Loss of important information
advantages of the dimensional model
Advantages of the Dimensional Model
  • Resolution of a variety of classification dilemmas
  • Retention of Information
  • Flexibility
disadvantages of the dimensional approach
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