Personality Disorders

 

   Statistical infrequency (0.5 - 3%)

 

   Violation of norms (of the DSM authors)

 

   Personal distress (not all PDs)

 

   Disability/dysfunction (not all PDs)

 

   Unexpected/inappropriate (not all PDs)

 

o  Controversial disorder


Personality Disorders

DSM

 

A pattern of behavior that is:

 

    Long-standing (Axis II)

    Pervasive and inflexible

    Onset in adolescence or early adulthood

    Stable *

    Departs from cultural expectations

    Impairs social/occupational functioning or leads to distress

 

 

* Zimmerman (1994: low stability for PD's (.11-.57) except antisocial (.84)


Personality Disorders

DSM

Controversial:

 

-all people have some assets;  arrogant; derogatory

 

-data do not support stability criterion

 

-not all involve distress or dysfunction

 

-very subjectively and vaguely defined:  psychological fascism

 

-social skill deficits more specific and treatable

 

10 Personality Disorders

Prevalence

 

       1.  Paranoid (0.5 - 2.5%)

       2.  Schizoid (< 1%)

       3.  Schizotypal (3%)

       4.  Antisocial (3% males; 1% females)

       5.  Borderline (2%)

       6.  Histrionic (2 - 3%)

       7.  Narcissistic (<1%)

       8.  Avoidant (1%)

       9.  Dependent

       10.  Obsessive-compulsive


10 Personality Disorders

3 DSM Clusters

 

Cluster A: Odd or eccentric 

 

   Paranoid

 

   Schizoid

 

   Schizotypal (may involve distress)

 

 

 


10 Personality Disorders

3 DSM Clusters cond

 

Cluster B: dramatic, emotional or erratic

 

    Antisocial 

 

    Borderline (may involve distress)

 

    Histrionic

 

    Narcissistic

 


10 Personality Disorders

3 DSM Clusters cond

 

Cluster C: anxious or fearful

 

    Avoidant (may involve distress)

 

    Dependent

 

    Obsessive-compulsive

     


Personality Disorders

DSM

 

Cluster A: Odd or eccentric

 

1 Paranoid Personality Disorder

 

   Distrust of others

 

   Suspiciousness of others

 

   View that the motives of others are malevolent


Personality Disorders

DSM

 

1 Paranoid Personality Disorder contd

 

4+ of the following 7:

 

    Suspects others are exploiting, harming, or deceiving him/her w/out sufficient basis.

    Preoccupied with unjustified doubts about the loyalty or trustworthiness of acquaintances.

    Reluctant to confide in others due to unwarranted fear the information will be used maliciously against him/her.


Personality Disorders

DSM

1 Paranoid Personality Disorder contd

 

4+ of the following 7 cont'd:

 

   Reads hidden meaning or threatening meanings into benign remarks or events

   Persistently bears grudges

   Perceives attacks on character/reputation that are not apparent to others. Is quick to react angrily or to counterattack

   Has recurrent suspicions, w/out justification, regarding fidelity of spouse or sexual partner


Personality Disorders

DSM

 

Cluster A: Odd or eccentric cont'd

 

2 Schizoid Personality Disorder

 

   Detachment from social relationships

 

   Restricted range of emotions in interpersonal settings

 


Personality Disorders

DSM

 

2 Schizoid Personality Disorder contd

 

4+ of the following 7:

 

   Does not desire or enjoy close relationships

 

   Almost always chooses solitary activities

 

   Little interest in sex with another person


Personality Disorders

 

2 Schizoid Personality Disorder contd

4+ of the following 7 cond:

 

   Finds pleasure in few activities

 

   Lacks confidants other than first-degree relatives

 

   Appears to be indifferent to praise or criticism of others

 

   Shows emotional coldness, detachment, or flattened affect


Personality Disorders

 

3 Schizotypal Personality Disorder

 

    Acute discomfort with & reduced capacity for close relationships

 (may be an attenuated form of schizophrenia)

 

5+ of the following 9:

 

 

    Ideas of reference

 

    Odd beliefs inconsistent with cultural norms

 

    Unusual perceptual experiences


Personality Disorders

 

 

3 Schizotypal Personality Disorder contd

 

5+ of the following con'd:

 

    Odd thinking & speech

    Suspiciousness or paranoid ideation

    Inappropriate or constricted affect

    Odd or eccentric behavioral appearance

    Lack of close friends or confidants other than first-degree relatives

    Excessive social anxiety that does not diminish w/ familiarity. May be associated w/ paranoid fears rather than negative judgments about self


Personality Disorders

 

Cluster B: dramatic, emotional or erratic

 

4 Antisocial Personality Disorder

(psychopathy, sociopathy or dissocial)

 

Pervasive disregard for & violation of the rights of others since age 15

&

Diagnosed w/ conduct disorder before age 15

 

(Conduct Dx: Pervasive disregard for & violation of the rights of others)


Personality Disorders

 

 

4 Antisocial Personality Disorder cont'd

 

3+ of the following 7:

 

   Failure to conform to lawful behavior

 

   Deceitfulness

(i.e., repeated lying, use of aliases, or conning)

 

   Impulsivity or failure to plan ahead


Personality Disorders

 

 

4 Antisocial Personality Disorder cont'd

 

3+ of the following 7 contd:

 

   Irritability & aggressiveness

 

   Reckless disregard for safety of self or others

 

   Consistent irresponsibility

 

   Lack of remorse


Personality Disorders

 

 

Cluster B: dramatic, emotional or erratic cont'd

 

5 Borderline Personality Disorder

 

Instability of

 

    Interpersonal relationships

    Self-image

    Emotions

    Impulse control


Personality Disorders

 

5 Borderline Personality Disorder cond

 

4+ of the following 10:

 

    Frantic efforts to avoid real or imagined abandonment 

    Unstable & intense interpersonal relationships, alternating between extremes of idealization & devaluation

    Identity disturbance; markedly & persistently unstable self-image

 


Personality Disorders

 

5 Borderline Personality Disorder cond

 

4+ of the following 10 cond:

 

    Impulsive in 2+ potentially self-damaging areas

    Recurrent suicidal behavior, gestures, or threats

    Self-mutilation

    Affective instability


Personality Disorders

 

 

5 Borderline Personality Disorder cond

 

4+ of the following 10 cond:

 

    Chronic feelings of emptiness

    Inappropriate, intense anger or difficulty controlling anger
(may include physical aggression)

    Transient, stress-related paranoid ideation or dissociative symptoms

 
Personality Disorders

 

Cluster B: dramatic, emotional or erratic

 

6 Histrionic Personality Disorder

 

    Excessive emotionality and attention seeking

 

5+ of following 7:

 

    Uncomfortable where he/she not the center of attn

    Inappropriate sexually provocative or seductive behavior

    Rapid shifting & shallow expression of emotions


Personality Disorders

 

6 Histrionic Personality Disorder cond

 

5+ of following  7 con'd

 

 

    Style of speech excessively impressionistic & lacking detail

    Self-dramatization, theatrical, exaggerated expression of emotion

    Suggestible (i.e., easily influenced by others)

    Considers relationships more intimate that they actually are


Personality Disorders

 

 

Cluster B: dramatic, emotional or erratic

 

7 Narcissistic Personality Disorder

 

    Grandiosity (in fantasy/behavior)

 

    Need for admiration

 

   Lack of empathy

 


Personality Disorders

 

7 Narcissistic Personality Disorder cond

 

5+ of following 9:

 

 

   Grandiose sense of self-importance

 

   Preoccupied with fantasies of unlimited success, power, brilliance, beauty or ideal love

 

   Believes he or she is "special"


Personality Disorders

DSM

 

7 Narcissistic Personality Disorder cond

 

5+ of following 9 cond

 

    Requires excessive admiration

    Has a sense of entitlement

    Interpersonally exploitative

    Lacks empathy

    Envious of others or believes others are envious of him or her

    Arrogant


Personality Disorders

 

Cluster C: anxious or fearful

 

8 Avoidant Personality Disorder

 

    Social inhibition

 

    Feelings of inadequacy, and hypersensitivity to negative evaluation

 


Personality Disorders

 

 

8 Avoidant Personality Disorder contd

 

4+ of the following 7:

 

   Avoids occupational activities involving significant interpersonal contact. Fear of criticism, disapproval, or rejection.

   Unwilling to get involved w/ people unless certain of being liked

   Restraint within intimate relationships for fear of being shamed/ridiculed


Personality Disorders

 

 

8 Avoidant Personality Disorder contd

 

4+ of the following 7 cond:

 

    Preoccupied w/ criticism or rejection in social situations

    Inhibited in new interpersonal situations because of feelings of inadequacy

    Views self as socially inept, personally unappealing, or inferior to others

    Unusually reluctant to take personal risks or engage in new activities because of embarrassment


Personality Disorders

 

 

Cluster C: anxious or fearful

 

9 Dependent Personality Disorder

 

    Excessive need to be taken care of ð submissiveness

    Clinging behavior

    Fears of separation

 


Personality Disorders

 

9 Dependent Personality Disorder cond

 

5+ of the following 8:

 

    Difficulty making everyday decisions w/out excessive advice & reassurance from others

    Needs others to assume responsibility for most major areas of his/her life

   Difficulty expressing disagreement w/ others due to unwarranted fear of loss of support or approval


Personality Disorders

 

 

9 Dependent Personality Disorder cond

 

5+ of the following 8 cond:

 

   Difficulty initiating projects or doing things on his or her own due to lack of self-confidence rather than lack of energy

   Goes to excessive lengths to obtain nurturance & support from others

   Uncomfortable or helpless when alone due to exaggerated fears of inability to care for him/herself


Personality Disorders

 

9 Dependent Personality Disorder

 

5+ of the following 8 cond:

 

   Urgently seeks another relationship as a source of care and support when a close relationship ends

 

   Unrealistically preoccupied with fears of being left to take care of him/herself

 

 


Personality Disorders

Cluster C: anxious or fearful

 

10 Obsessive-compulsive Personality Disorder

 

At the expense of

   Flexibility,

   Openness

   Efficiency

 

   Preoccupation with

   Orderliness

   Perfectionism

   Mental and interpersonal control


Personality Disorders

 

10 Obsessive-compulsive Personality Disorder cond

 

4+ of the following 8 :

 

   Preoccupied w/ details, rules, lists, order, organization, or schedules to the extent that the major point of the activity is lost

   Shows perfectionism, interfering with task completion (unrealistic standards)

   Excessively devoted to work and productivity to the exclusion of leisure activities and friendships (not due to economic necessity)


Personality Disorders

 

10 Obsessive-compulsive Personality Disorder cond

 

4+ of the following 8 cond:

 

   Overconscientious, scrupulous, and inflexible about matters of morality, ethics, or values (not due to cultural or religious identification)

    Cannot discard worthless objects w/ no sentimental value

   Reluctant to delegate tasks to others unless they submit to exactly his or her way of doing things

   Adopts a miserly spending style

   Rigid and stubborn


Personality Disorders

Cognitive Behavioral Treatment of PDs

 

Cluster A: Odd or eccentric

 

1 Paranoid:

 Cognitive restructuring attributions of causes

    Problem-solving to discriminate trustworthy people

 

2 Schizoid 

      ?

 

3 Schizotypal

Desensitization

   Social skills training


Personality Disorders

 Cognitive Behavioral Treatment of PDs

 

Cluster B: dramatic, emotional or erratic

 

4. Antisocial

   

    passage of time

 

5 Borderline

 

Dialectical behavior therapy =

 

 Mood acceptance and regulation

 

 

 

Personality Disorders

 Cognitive Behavioral Treatment of PDs

 

Cluster B: dramatic, emotional or erratic cond

 

6 Histrionic and

7 Narcissistic

 

Empathy training

 

Social skills training

 

 

 

Personality Disorders

Cognitive Behavioral Treatment of PDs

Cluster C: anxious or fearful

 

8 Avoidant

 

Desensitization

Self-efficacy

 

9 Dependent

 

Self-esteem training

  Self-control training

Personality Disorders

Cognitive Behavioral Treatment of PDs

 

Cluster C: anxious or fearful cond

 

 

10 Obsessive-compulsive

 

Exposure

Ritual/response prevention


Personality Disorders

Prevalence

 

      1      paranoid (0.5 - 2.5%)

      2      schizoid (< 1%)

      3      schizotypal (3%)

      4      antisocial (3% males; 1% females)

      5      borderline (2%)

      6      histrionic (2 - 3%)

      7      narcissistic (<1%)

      8      avoidant (1%)

      9      dependent (1.5%)

10. obsessive-compulsive (2%)