Personality Disorders . EPC 695B. All humans have personality traits . These are well-ingrained ways in which individuals experience, interact with, and think about everything that goes on around them.
These are well-ingrained ways in which individuals experience, interact with, and think about everything that goes on around them.
Personality Disorders are collections of traits that have become rigid, and work to individual’s disadvantage, to the point that their personality disorders impair functioning or cause distress.
All of the DSM-IV-TR personality disorders are patterns of behavior and thinking that have been present since early adult life and have been recognizable in the client for a long time.
dimensional, not categorical
This means that their components (the traits) are present in normal people, but are accentuated in those with the disorders in question.
A lasting pattern of inner experience and behavior that markedly deviates from norms of the client's culture.
a.Cognition (how the client perceives and interprets self, others, and events)
b.Affect (appropriateness, intensity, lability, and range of emotions)
and social situations.
orimpairs work, social, or personal functioning
These general criteria are extremely important. They identify vital points that are central to the diagnosis of any personality disorder.
To summarize, a personality disorder is:
Quick Guide to the Personality Disorders
See additional handouts:
a. Semi-structured interviews guide the therapist
through a series of questions that assess all of the
potential personality disorders.
Example: SCIS-II by Spitzer, Williams & Giffon
(Helps to avoid impressions that rely on only
one or two symptoms rather than the full criteria set.)
b. Millon Clinical Multiaxial Inventory II (MCMI-I) is a self-
report measure. Self report inventories tend to
indicate more personality disorder pathology than
reported by clinical interviews. Thus, the inventories are
only suggestiveof possible diagnoses and alternatives.
Personality disorders are more vulnerable to error of diagnosis than Axis I disorders.
Diagnostic errors occur most often when the therapist fails to adhere to the diagnostic criteria or when the therapist has a gender or cultural bias.
For example: The counselor may only
see one key symptom and make or rule
out a diagnosis without carefully looking for the entire cluster of symptoms required to meet DSM criteria.
A study by Morey and Ochoa (1989) found that, when a client with a borderline personality disorder had a symptom of little sexual interest, the client was not diagnosed correctly because clinicians believe that clients with borderline personality disorder are sexually promiscuous.
1. If a client has an Axis I diagnosis, but a personality disorder is the main reason the client has come for evaluation, (Principal Diagnosis) should be attached to the Axis II diagnosis.
Axis I312.32 Kleptomania
Axis II 301.6 Dependent Personality Disorder (Principal Diagnosis)
2. A frequently used defense mechanism can be indicated on the Axis II line:
Axis II 301.0 Paranoid Personality Disorder; frequent use of projection
See DSM-IV-TR, p. 811: Defense Mechanism and Coping Styles
3. If your client's personality disorder preceded a psychotic disorder (most
often Schizophrenia), the diagnosis
Axis I 295.10 Schizophrenia, Disorganized Type, Continuous, With Prominent
Axis II 301.22 Schizoid Personality Disorder
Correlation between Axis II Personality Disorders
and Axis I Mental Disorders
Profile of Characteristics
of Personality Disordersin your packet
a. Central characteristic: unjustified distrust and
suspicion of others.
c.Client reads unintended meaning into benign
comments and actions.
d.Client will interpret specious occurrences as
the result of deliberate intent and will harbor resentment for a long time, perhaps forever.
e. These clients are rigid, often litigious, and
have an especially urgent need to be self-sufficient.
f. To others, these clients appear to be cold, calculating, and guarded people who avoid both blame and intimacy.
g. When interviewed, they may appear tense and have trouble
h. This disorder is especially likely to create occupational
difficulties; these clients are so aware of rank and power that they frequently have trouble dealing with superiors
i. Although it is far from rare (about 1% of the general population), it rarely comes to clinical attention. Usually diagnosed in men.
Its relationship (if any) to the development
of Schizophrenia, Paranoid Type, remains unclear.
Case: Useful Work (DSM-IV-TR Casebook, p. 211)
Countertransference: As watch film, see what feelings he engenders in you.
Film: Jerry - Schizoid Personality Disorder
that severely reduce capacity for closeness with others.
and behaviors that can make these clients seem odd.
no close friends.
d. May be suspicious and superstitious
belief in telepathy or other unusual modes of communication.
speech characterized by vagueness, digressions, excessive abstractions, impoverished vocabulary, or unusual use of words.
g. May eventually develop Schizophrenia.
h. Many are depressed when first come to clinical
Axis I: Paranoid Schizophrenia; Mood Disorder;
Axis II: Borderline; Schizoid
Case: Wash Before Wearing (DSM-IV Casebook, p. 289)
Axis I Major Depression; Substance abuse
Axis II Borderline; Narcissistic
Countertransference: Watch your feelings when you see the film.
Film: Antisocial Personality Disorder (Tape 3) George #8
Axis I Major depression; Dysthymic Disorder; Adjustment Disorder
Axis II Histrionic; Narcissistic; Schizotypal; Antisocial
In therapy, it is important to:
seeking that seeps into all areas of lives.
their interests and topics of conversation focus on their own desires and activities; and (b) their behavior, including speech, continually calls attention to themselves.
parody of normal emotionality.
Axis I: Mood Disorders; Somatization Disorder
Axis II: Borderline; Narcissistic
Case: My Fan Club (DSM-IV-TR Casebook, p. 84). Case encompasses both Histrionic and Narcissistic Personality Disorders.
(These traits are true only of adults. Children and teenagers are naturally self-centered; this doesn't imply ultimate personality disorder)
e. Despite grandiosity, have fragile self-esteem and often feel unworthy.
Axis I Major depression; Adjustment disorder with depressed mood
Psychodynamic Object Relations
Brief Supportive Therapy Client-centered
In therapy, it is important to:
Countertransference: Please the client, Anger, Retaliation
overly sensitive to criticism.
traits are common in children and do not necessarily imply eventual personality disorder.
c. Self-effacing and eager to please others.
information about sex distribution and family pattern.
i. This disorder may be associated with a
disfiguring illness or condition.
Axis I: Anxiety disorder; Dysthymia; Major depression;
Adjustment Disorder with Depressed Mood.
Axis II: Dependent; Passive-aggressive
Case: The Jerk (DSM-IV-TR Case Book. p. 124)
Axis I: Anxiety disorders; Mood disorder
Axis II: Histrionic; Narcissistic; Avoidant; Schizotypal
Case: Blood is Thicker Than Water (DSM-IV Case book, p. 179)
a. Perfectionistic and preoccupied with orderliness; needs to exert
interpersonal and mental control.
b. Many with this personality disorder have no actual obsessions
or compulsions at all, though some eventually develop OCD.
c. Rigid perfectionism often results in indecisiveness, preoccupation with detail, and insistence that others do things their way.
d. Sometimes savers, refusing to throw away even worthless objects they no longer need.
e. List makers who allocate their own time poorly, workaholics who
must meticulously plan even their own pleasure.
f. May resist authority of others, but insist on their own.
g. May be perceived as stilted, stiff, or moralistic.
h. Condition is fairly common. Diagnosed more often in males than females.
i. Probably runs in families
Axis I Mood Disorders; Anxiety Disorders
Axis II Avoidant; Dependent
Case: The Workaholic (DSM-IV Case book, p. 147)
Case: Stubborn Psychiatrist (DSM-IV Case book, p. 166)