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PERSONALITY�DISORDERS

CHAPTER 14

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PERSONALITY DISORDERS

Personality trait: An enduring pattern of perceiving, relating to, and thinking about the environment and others.

Personality disorders: Ingrained patterns of relating to other people, situations, and events with a rigid and maladaptive pattern of inner experience and behavior.

Dating back to adolescence or early adulthood

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THE NATURE OF PERSONALITY DISORDERS

Behavior patterns must manifest themselves in at least two of the following four areas:

Cognition
Affectivity
Interpersonal functioning
Impulse control

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DSM-5 PERSONALITY DISORDER CLUSTERS

The DSM-5 groups the 11 diagnoses into three clusters based on shared characteristics:

Cluster A - The odd and eccentric behaviors Weird
Cluster B - The dramatic and emotional behaviors Wild
Cluster C - The anxious and fearful behaviors Worried

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GENERAL CRITERIA FOR A PERSONALITY DISORDER IN SECTION 3

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ALTERNATIVE PERSONALITY DISORDER DIAGNOSTIC SYSTEM IN �SECTION 3 OF THE DSM-5

Personality disorders are included in both Section II and Section III of the DSM- 5 due to the complexity of the disorder and various points of view on the disorder.

Section II includes the updated diagnostic criteria.

Section III includes the proposed research model for personality disorder diagnosis where it will receive further study and be revisited in the future.

Within this framework, clinicians would have evaluated all clients on a consistent set of five personality traits.

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PERSONALITY DOMAINS IN THE DSM-5 SECTION 3 RATING SYSTEM

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DSM-5 SECTION 3 PERSONALITY DISORDER FRAMEWORK

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DSM-5 SECTION 3 PERSONALITY DISORDER FRAMEWORK

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CLUSTER A PERSONALITY DISORDERS

Cluster A of the personality disorders in DSM-5 include those disorders characterized by eccentric behavior.

In other words, individuals with these disorders show characteristics that might lead others to view them as slightly odd, unusual, or peculiar.

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PARANOID PERSONALITY�DISORDER

A personality disorder whose outstanding feature is that the individual is unduly suspicious of others and is always on guard against potential danger or harm.

Impossible to trust people
Project blame onto others
Refuse to seek professional help

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SCHIZOID PERSONALITY DISORDER

Indifference to social and sexual relationships
Prefer to be alone
No desire to love or be loved
Cold, reserved, withdrawn
Insensitive to feelings of others

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SCHIZOTYPAL PERSONALITY DISORDER

A personality disorder that primarily involves odd beliefs, behavior, appearance, and interpersonal style.

Such individuals lack a clear sense of direction or motivation, and do not have a clear set of standards against which to measure their behavior

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SCHIZOTYPAL PERSONALITY DISORDER

Social isolation
Eccentricity
Peculiar communication
Poor social adaptation

Treatment

Parallels interventions commonly used in treating schizophrenia

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CLUSTER B PERSONALITY DISORDERS

THESE BEHAVIORS INCLUDE IMPULSIVITY, AN INFLATED�SENSE OF SELF, AND A TENDENCY TO SEEK STIMULATION.

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ANTISOCIAL PERSONALITY DISORDER

A personality disorder characterized by a lack of regard for society’s moral or legal standards and an impulsive and risky lifestyle.

History

Hervey Cleckley (1941)

Psychopathy

Robert Hare (1997)

Psychopathy Checklist

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ANTISOCIAL PERSONALITY DISORDER

The diagnostic criteria in the DSM-5 require that an individual show a pervasive pattern of three out of seven possible behaviors:

Failure to conform to social norms
Deceitfulness
Impulsivity
Aggressiveness
Disregard for safety of self or others
Irresponsibility
Lack of remorse

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IMPORTANT DISTINCTIONS

There is a difference between antisocial personality disorder and antisocial behavior.

Antisocial behavior

Illegal or immoral behavior such as stealing, lying, or cheating

Criminal

A legal term, not a psychological concept

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PERSPECTIVES ON�ANTISOCIAL PERSONALITY

Biological

Possible genetic causes
Various brain abnormalities

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PERSPECTIVES ON�ANTISOCIAL PERSONALITY

Psychological

Neuropsychological deficits
Passive avoidance
Response modulation hypothesis

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TREATMENT OF ANTISOCIAL PERSONALITY DISORDER

Problems of working with these individuals

Seeming lack of motivation to change
Tendency toward deception and manipulation
Lack of deep or lasting emotion

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BORDERLINE PERSONALITY DISORDER

Pervasive pattern of poor impulse control and instability in mood, interpersonal relationships, and self-image

BPD’s central feature is that of instability

The way that people with BPD relate to others is termed “splitting”

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PERSPECTIVES ON BORDERLINE PERSONALITY

Biological

High heritability
Abnormalities in:

Amygdala and prefrontal cortex
Neurotransmitters and hormones

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PERSPECTIVES ON BORDERLINE PERSONALITY

Psychological

Emotional dysregulation
Distress tolerance
Experiential avoidance
Childhood neglect or traumatic experiences
Marital or psychiatric difficulties

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TREATMENT OF BORDERLINE PERSONALITY

Dialectical behavioral therapy
Core mindfulness
Transference-focused psychotherapy

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NEEDS INVOLVED IN BASIC PRINCIPLES OF EFFECTIVE TREATMENT FOR CLIENTS WITH BPD

Need for clinicians to:

Take over a primary role in treatment
Provide a therapeutic structure
Support the client
Involve the client in the therapeutic process
Take an active role in treatment
Deal with the client’s suicidal threats or self-harming acts
Be self-aware and ready to consult with colleagues

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HISTRIONIC PERSONALITY DISORDER

Exaggerated emotional reactions, approaching theatricality, in everyday behavior.

Show extreme pleasure as the center of attention and who behave in whatever way necessary to ensure that this happens.

They are excessively concerned with their physical appearance, often trying to draw attention to themselves in such extreme ways that their behavior seems ludicrous.

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HISTRIONIC PERSONALITY DISORDER

Flirtatious and seductive
Demand reassurance, praise, approval of others
Need for immediate gratification
Easily influenced by others
Lack analytical ability

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NARCISSISTIC PERSONALITY DISORDER

Unrealistic, inflated sense of self-importance and lack of sensitivity to other people’s needs

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THEORIES OF NARCISSISTIC PERSONALITY

Freudian

Stuck in early psychosexual stages

Psychodynamic

Empathy

Cognitive behavioral

Maladaptive ideas
Grandiose ideas clash with their experiences of failure

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TREATMENT OF NARCISSISTIC PERSONALITY

Most effective approach

Provide reassurance and develop a more realistic view of themselves and other people

People with NPD are difficult to treat

Tend not to have insight into their disorder
Extreme perfectionism can obstruct treatment

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CLUSTER C �PERSONALITY DISORDERS

DISORDERS THAT INVOLVE

PEOPLE WHO APPEAR ANXIOUS OR FEARFUL AND MAY SEEM HIGHLY RESTRICTED

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AVOIDANT PERSONALITY DISORDER

The individual desires, but is fearful of, any involvement with other people and is terrified at the prospect of being publicly embarrassed

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AVOIDANT - THEORIES

Cognitive-behavioral

Hypersensitive due to parental criticism
Feel unworthy of other people’s regard
Expect not to be liked
Avoid getting close to avoid expected rejection
Distorted perceptions of experiences with others

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TREATMENT OF AVOIDANT PERSONALITY

Cognitive-behavioral

Break negative cycle of avoidance
Confront and correct dysfunctional attitudes and thoughts
Graduated exposure to social situations
Learn skills to improve chance of intimacy

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DEPENDENT PERSONALITY DISORDER

The individual is extremely passive

Tends to cling to other people to the point of being unable to make any decisions

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OBSESSIVE-COMPULSIVE �PERSONALITY DISORDER

A personality disorder involving intense perfectionism and inflexibility manifested in worrying, indecisiveness, and behavioral rigidity.

OCPD is a disturbance of personality, not a disturbance involving anxiety or even out-of-control behaviors

OCPD do not experience obsessions and compulsions. OCPD refers to this rigidly compulsive personality tendency and also obsessive concern with perfectionism.

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OBSESSIVE-COMPULSIVE DISORDER

Sense of self and self-worth in terms of work productivity

Pathological personality trait - Rigid perfectionism

Quality of perseveration

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THEORIES OF�OBSESSIVE-COMPULSIVE

Freudian

Fixation at anal psychosexual stage

Cognitive-behavioral

Unrealistic standard of perfection
Ruminative tendency

Metacognitive interpersonal therapy

Think about their thinking

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BIOPSYCHOSOCIAL PERSPECTIVE

Disorders represent:

Mix of long-standing personal dispositions and behavior patterns

Disturbances in identity and interpersonal relationships

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