Personality Disorders William P. Wattles, Ph.D. Francis Marion University

1. Personality Disorders William P. Wattles, Ph.D. Francis Marion University

2. Personality Disorders are generalized, inflexible patterns of inner experience and behavior of long-standing.

3. Personality Disorders are long-term, maladaptive patterns of perception, emotional regulation, anxiety, and impulse control.

4. Personality • 1.The enduring pattern of inner experiences and outward behavior that is unique to each individual.

5. Personality Disorders • Enduring pattern of inner experience • Deviates markedly from the expectations of the person’s society • Pervasive and inflexible • Onset in adolescence or early adulthood • Is stable over time • Leads to distress or impairment.

6. Personality Traits • Enduring patterns of perceiving, relating to and thinking about the environment and oneself exhibited over a wide range of social and personal contexts. Stable across: • Time • Place • Situation • Only disorders if maladaptive

7. Personality disorder • Involves long-term functioning • difficult to assess in one interview • not organic, substance-induced or situational • must go back at least to early adulthood • may be ego-syntonic

8. PD’s frequently overlooked • Client may express more concern with Axis I Problems • Personality styles often hidden and must be inferred • Can be difficult to distinguish between state (clinical) elevations and trait (personality) scales.

9. Cluster A • Individuals appear odd or eccentric • Paranoid • Schizoid • Schizotypal

10. Cluster B • Individuals appear dramatic, emotional or erratic • Antisocial • Borderline • Histrionic • Narcissistic

11. Cluster C • Individuals appear anxious or fearful • Avoidant • Dependent • Obsessive-Compulsive

12. Paranoid Personality Disorder • Pervasive distrust and suspiciousness of others such that their motives are interpreted as malevolent.

13. Four of: Suspects others exploiting, harming or deceiving preoccupied with unjustified doubts of loyalty of friends and associates Reluctant to confide in others Reads hidden demeaning of threatening meanings into benign events persistently bears grudges perceives attacks not apparent to others recurrent suspicions w/o cause regarding fidelity of partner Paranoid Personality Disorder

14. Overreact to minor slights Hold grudges Constantly vigilant Quick to counterattack Paranoid P.D.

15. Dichotomy Normal Paranoid

16. Points on Continuum Paranoid Traits Paranoid P. D. Delusional Disorder Normal Paranoid Schizophrenic Gullible

17. Delusional Disorder • Persecutory Type • Central theme of being conspired against, cheated, spied on, followed, poisoned Maligned, harassed, or obstructed. May engage in repeated attempts to get satisfaction by appeal to courts and government agencies

18. Delusions • Erroneous beliefs that usually involve misinterpretation of perceptions or experiences. • Vapor trails • Delusions are deemed bizarre is they are clearly implausible. • Thought broadcasting

19. Delusional Disorder vs Schizophrenia • Bizarre versus nonbizarre delusions • Bizarre if clearly implausible, not understandable, not derived from ordinary life experience. • Nonbizarre involves thing that can occur in real life: being followed, poisoned loved at a distance, deceived by one’s spouse.

20. Schizophrenia • Paranoid type • Preoccupation with prominent delusions or hallucinations

21. Schizoid Personality Disorder • Pervasive pattern of detachment from social relationships and a restricted range of expression of emotions.

22. Four of: neither desires nor enjoys close relationships Usually chooses solitary activities Has little interest in sex with another person Take pleasure in few if any activities. Lacks close friend or confidants appears indifferent to praise or criticism shows emotional coldness and flat affect Schizoid Personality Disorder

23. Schizotypal Personality Disorder • Pervasive pattern of social and interpersonal deficits marked by acute discomfort with close relationships as well as by cognitive or perceptual distortions and eccentricities of behavior.

24. Five of: Ideas of reference odd beliefs unusual perceptual experiences odd thinking and speech suspiciousness or paranoid ideation Inappropriate or constricted affect odd behavior or appearance lack of close friends or confidants excessive social anxiety based on paranoid ideation Schizotypal Personality Disorder

25. Antisocial Personality Disorder • The essential feature is a pervasive pattern of disregard for the violation of the rights of others. • Since age 15 • Sociopathy, psychopathy

26. Failure to conform to social norms deceitfulness, lying aliases conning. Impulsivity and failure to plan ahead irritability and aggressiveness reckless disregard for the safety of self and others consistent irresponsibility lack of remorse Antisocial Personality Disorder

27. Borderline Personality Disorder • Pervasive pattern of instability of interpersonal relationships, self-image, and affects. Marked impulsivity • KM

28. Frantic efforts to avoid abandonment unstable and intense relationships identity disturbance impulsivity: sex, substance abuse, reckless driving, binge eating. Recent suicidal behavior or threats affective instability chronic feelings of emptiness Borderline Personality Disorder

29. Histrionic Personality Disorder • Pervasive Pattern of excessive emotionality and attention-seeking behavior.

30. Uncomfortable if not the center of attention. Inappropriate sexually seductive or provocative behavior. Rapidly shifting and shallow emotions Uses physical appearance to draw attention. Speech is excessively impressionistic and lacking in detail Self-dramatization, theatricality and exaggerated expression of emotion Suggestible Considers shallow relationships intimate Histrionic Personality Disorder

31. Narcissistic Personality Disorder • Pervasive pattern of grandiosity, need for admiration and lack of empathy that begins by early adulthood

32. Grandiose sense of self-importance Preoccupied with fantasies of unlimited success Believes he or she is special requires excessive admiration Sense of entitlement interpersonally exploitative lacks empathy envious arrogant behavior and attitudes Narcissistic Personality Disorder

33. Baughman article Sense of entitlement Lack of empathy or conscience No lack of intelligence No lack of social skills Narcissistic Personality Disorder

34. Uconn President • …spending in hard times. There was the $170,000 inauguration with regal fireworks, the half-million-dollar office renovation, the decision to have the state pay $49,000 in rent on a house near campus rather than live in the recently restored presidential mansion (the reason cited was health issues related to mold), and the $3,500 for six life-size cutouts of him around campus.”

35. Avoidant Personality Disorder • Pervasive pattern of social inhibition, feelings of inadequacy and hypersensitivity to negative evaluation.

36. Avoids jobs with social contact or evaluation Unwilling to get involved unless sure of being liked Restraint in intimate relationships Preoccupied with being criticized or rejected Inhibited in new situations due to inadequacy view self as socially inept reluctant to take risks Avoidant Personality Disorder

37. Dependent Personality Disorder • Pervasive need to be taken care of that leads to submissive and clinging behavior and fears of separation.

38. Difficulty making decisions Needs other to take responsibility for life Difficulty expressing disagreement Problems with initiative Excessive need for nurturing Feels uncomfortable or helpless alone Urgently seeks new relationship when one ends. Fears of being left to care for self Dependent Personality Disorder

39. Obsessive-Compulsive Personality Disorder • Preoccupation with orderliness, perfectionism and mental and interpersonal control.

41. Preoccupied with details, rules, lists, order. Perfectionism that interferes with task Excessively devoted to work and productivity Rigid and stubborn Overconscientious about matters of morality, ethics or values. Unable to discard worthless objects Reluctant to delegate Miserly Obsessive-Compulsive Personality Disorder

42. Millon Clinical Multiaxial Inventory MCMI-III • Standardized • Self-report • Adults • 8th grade reading level • Focus on Personality Disorders

43. Millon Clinical Multiaxial Inventory MCMI-III • 175 items • 28 Scales • Closely aligned with Millon’s theory and DSM-IV

44. MCMI-III • Can be used instead of or in addition to MMPI.

45. Theoretical Considerations • Millon’s Theory • Core Principle Polarities of: • Pleasure-pain • Active-passive • Self-other

46. Interpretation • BR base rate scores • Used instead of T scores and norm-referencing. • Distribution of scores varies from one personality scale to the next. • MCMI uses criterion referencing rather than norm referencing. • Base rate or prevalence of disorder in the psychiatric population

47. BR scores • For clinical scales: • BR 75 indicates presence of a trait • BR 85 indicates presence of a disorder

48. 1. Interpret Profile Validity • Validity Scale-3 items, 1 is sign of absurd answer • Disclosure Index- below 34 indicates defensive unwillingness to disclose. • Desirability Index –measure of defensive responding. Scores above BR 75 suggest claims of unusual moral, attractive stable organized. • Debasement index-the extent to which a client describes themselves in negative terms. Above BR 85 bad profile and/or cry for help.

49. 2. Interpret Personality Disorder scales • The primary focus for diagnosis is on the Severe Personality Disorders. • Unless elevations on others were high compared to SPD • Other personality pattern scales used to elaborate on Severe Personality Disorder Scale.

50. 3. Interpret Clinical Syndrome Scales • Precedence given to elevations on Severe Clinical Syndrome scales • All can be elevated