Personality
Disorders
á
Statistical
infrequency (0.5 - 3%)
á
Violation
of norms (of the DSM authors)
á
Personal
distress (not all PDs)
á
Disability/dysfunction
(not all PDs)
á
Unexpected/inappropriate
(not all PDs)
o
Controversial disorder
Personality Disorders
DSM
A
pattern of behavior that is:
á
Long-standing (Axis II)
á
Pervasive and inflexible
á
Onset in adolescence or early adulthood
á
Stable *
á
Departs from cultural expectations
á
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
á
Paranoid
á
Schizoid
á
Schizotypal
(may involve distress)
10 Personality
Disorders
3 DSM Clusters conÕd
Cluster
B: dramatic, emotional or erratic
á Antisocial
á Borderline (may involve distress)
á Histrionic
á Narcissistic
10 Personality
Disorders
3 DSM Clusters conÕd
Cluster
C: anxious or fearful
á Avoidant (may involve distress)
á Dependent
á Obsessive-compulsive
Personality
Disorders
DSM
Cluster A: Odd or eccentric
1
Paranoid Personality Disorder
á Distrust of others
á Suspiciousness of
others
á View that the motives
of others are malevolent
Personality
Disorders
DSM
1
Paranoid Personality Disorder contÕd
4+
of the following 7:
á Suspects others are exploiting, harming,
or deceiving him/her w/out sufficient basis.
á Preoccupied with unjustified doubts
about the loyalty or trustworthiness of acquaintances.
á 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 contÕd
4+
of the following 7 cont'd:
á Reads hidden meaning
or threatening meanings into benign remarks or events
á Persistently bears
grudges
á Perceives attacks on
character/reputation that are not apparent to others. Is quick to react angrily
or to counterattack
á 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
á Detachment from
social relationships
á Restricted range of
emotions in interpersonal settings
Personality
Disorders
DSM
2
Schizoid Personality Disorder contÕd
4+
of the following 7:
á Does not desire or
enjoy close relationships
á Almost always chooses
solitary activities
á Little interest in
sex with another person
Personality
Disorders
2
Schizoid Personality Disorder contÕd
4+
of the following 7 conÕd:
á Finds pleasure in few
activities
á Lacks confidants
other than first-degree relatives
á Appears to be
indifferent to praise or criticism of others
á Shows emotional
coldness, detachment, or flattened affect
Personality
Disorders
3
Schizotypal Personality Disorder
á Acute discomfort with & reduced
capacity for close relationships
(may be an attenuated form of
schizophrenia)
5+
of the following 9:
á Ideas of reference
á Odd beliefs inconsistent with cultural
norms
á Unusual perceptual experiences
Personality
Disorders
3
Schizotypal Personality Disorder contÕd
5+
of the following con'd:
á
Odd
thinking & speech
á
Suspiciousness
or paranoid ideation
á
Inappropriate
or constricted affect
á
Odd
or eccentric behavioral appearance
á
Lack
of close friends or confidants other than first-degree relatives
á
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:
á Failure to conform to
lawful behavior
á Deceitfulness
(i.e., repeated lying, use of aliases,
or conning)
á Impulsivity or
failure to plan ahead
Personality
Disorders
4
Antisocial Personality Disorder cont'd
3+
of the following 7 contÕd:
á Irritability &
aggressiveness
á Reckless disregard
for safety of self or others
á Consistent
irresponsibility
á Lack of remorse
Personality
Disorders
Cluster
B: dramatic, emotional or erratic cont'd
5
Borderline Personality Disorder
Instability
of
á Interpersonal relationships
á Self-image
á Emotions
á Impulse control
Personality
Disorders
5
Borderline Personality Disorder conÕd
4+
of the following 10:
á Frantic efforts to avoid real or
imagined abandonment
á Unstable & intense interpersonal
relationships, alternating between extremes of idealization & devaluation
á Identity disturbance; markedly &
persistently unstable self-image
Personality
Disorders
5
Borderline Personality Disorder conÕd
4+
of the following 10 conÕd:
á
Impulsive
in 2+ potentially self-damaging areas
á
Recurrent
suicidal behavior, gestures, or threats
á
Self-mutilation
á
Affective
instability
Personality
Disorders
5
Borderline Personality Disorder conÕd
4+
of the following 10 conÕd:
á Chronic feelings of emptiness
á Inappropriate, intense anger or
difficulty controlling anger
(may include physical aggression)
á Transient, stress-related paranoid
ideation or dissociative symptoms
Personality Disorders
Cluster
B: dramatic, emotional or erratic
6
Histrionic Personality Disorder
á Excessive emotionality and attention
seeking
5+
of following 7:
á Uncomfortable where he/she not the
center of attn
á Inappropriate sexually provocative or
seductive behavior
á Rapid shifting & shallow expression
of emotions
Personality
Disorders
6
Histrionic Personality Disorder conÕd
5+
of following 7 con'd
á Style of speech excessively
impressionistic & lacking detail
á Self-dramatization, theatrical,
exaggerated expression of emotion
á Suggestible (i.e., easily influenced by
others)
á Considers relationships more intimate
that they actually are
Personality
Disorders
Cluster
B: dramatic, emotional or erratic
7
Narcissistic Personality Disorder
á Grandiosity (in fantasy/behavior)
á Need for admiration
á Lack of empathy
Personality
Disorders
7
Narcissistic Personality Disorder conÕd
5+
of following 9:
á Grandiose sense of
self-importance
á Preoccupied with
fantasies of unlimited success, power, brilliance, beauty or ideal love
á Believes he or she is
"special"
Personality
Disorders
DSM
7
Narcissistic Personality Disorder conÕd
5+
of following 9 conÕd
á Requires excessive admiration
á Has a sense of entitlement
á Interpersonally exploitative
á Lacks empathy
á Envious of others or believes others are
envious of him or her
á Arrogant
Personality
Disorders
Cluster
C: anxious or fearful
8
Avoidant Personality Disorder
á Social inhibition
á Feelings of inadequacy, and
hypersensitivity to negative evaluation
Personality Disorders
8
Avoidant Personality Disorder contÕd
4+
of the following 7:
á Avoids occupational
activities involving significant interpersonal contact. Fear of criticism,
disapproval, or rejection.
á Unwilling to get
involved w/ people unless certain of being liked
á Restraint within
intimate relationships for fear of being shamed/ridiculed
Personality
Disorders
8
Avoidant Personality Disorder contÕd
4+
of the following 7 conÕd:
á Preoccupied w/ criticism or rejection in
social situations
á Inhibited in new interpersonal
situations because of feelings of inadequacy
á Views self as socially inept, personally
unappealing, or inferior to others
á 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
á Excessive need to be taken care of ð submissiveness
á Clinging behavior
á Fears of separation
Personality
Disorders
9
Dependent Personality Disorder conÕd
5+
of the following 8:
á Difficulty making everyday decisions
w/out excessive advice & reassurance from others
á Needs others to assume responsibility
for most major areas of his/her life
á Difficulty expressing
disagreement w/ others due to unwarranted fear of loss of support or approval
Personality
Disorders
9
Dependent Personality Disorder conÕd
5+
of the following 8 conÕd:
á Difficulty initiating
projects or doing things on his or her own due to lack of self-confidence
rather than lack of energy
á Goes to excessive
lengths to obtain nurturance & support from others
á 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 conÕd:
á Urgently seeks
another relationship as a source of care and support when a close relationship
ends
á 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
á Flexibility,
á Openness
á Efficiency
á Preoccupation with
á Orderliness
á Perfectionism
á Mental and
interpersonal control
Personality
Disorders
10
Obsessive-compulsive Personality Disorder conÕd
4+
of the following 8 :
á Preoccupied w/
details, rules, lists, order, organization, or schedules to the extent that the
major point of the activity is lost
á Shows perfectionism,
interfering with task completion (unrealistic standards)
á 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 conÕd
4+
of the following 8 conÕd:
á Overconscientious,
scrupulous, and inflexible about matters of morality, ethics, or values (not
due to cultural or religious identification)
á
Cannot
discard worthless objects w/ no sentimental value
á Reluctant to delegate
tasks to others unless they submit to exactly his or her way of doing things
á Adopts a miserly
spending style
á Rigid and stubborn
Personality
Disorders
Cognitive
Behavioral Treatment of PDÕs
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 PDÕs
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 PDÕs
Cluster
B: dramatic, emotional or erratic conÕd
6
Histrionic and
7
Narcissistic
Empathy
training
Social
skills training
Personality
Disorders
Cognitive
Behavioral Treatment of PDÕs
Cluster
C: anxious or fearful
8
Avoidant
Desensitization
Self-efficacy
9
Dependent
Self-esteem
training
Self-control training
Personality
Disorders
Cognitive
Behavioral Treatment of PDÕs
Cluster
C: anxious or fearful conÕd
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%)