Personality Disorders

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

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Personality Disorders are generalized, inflexible
patterns of inner experience and behavior of
long-standing.
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Personality Disorders are long-term, maladaptive
patterns of perception, emotional regulation,
anxiety, and impulse control.
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Personality

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

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Personality Disorders

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

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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

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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

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PDs 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.

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Cluster A

• Individuals appear odd or eccentric
• Paranoid
• Schizoid
• Schizotypal

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Cluster B

• Individuals appear dramatic, emotional or erratic
• Antisocial
• Borderline
• Histrionic
• Narcissistic

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Cluster C

• Individuals appear anxious or fearful
• Avoidant
• Dependent
• Obsessive-Compulsive

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Paranoid Personality Disorder

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

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Paranoid Personality Disorder

• 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

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Paranoid P.D.

• Overreact to minor slights
• Hold grudges

• Constantly vigilant
• Quick to counterattack

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

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Delusions

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

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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 ones spouse.

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Schizophrenia

• Paranoid type
• Preoccupation with prominent delusions or
  hallucinations

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Schizoid Personality Disorder

• Pervasive pattern of detachment from social
  relationships and a restricted range of
  expression of emotions.

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Schizoid Personality Disorder

• 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

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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.

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Schizotypal Personality Disorder

• 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

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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

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Antisocial Personality Disorder

• 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

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Borderline Personality Disorder

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

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Borderline Personality Disorder

• 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

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Histrionic Personality Disorder

• Pervasive Pattern of excessive emotionality and
  attention-seeking behavior.

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Histrionic Personality Disorder

• 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

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Narcissistic Personality Disorder

• Pervasive pattern of grandiosity, need for
  admiration and lack of empathy that begins by
  early adulthood

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Narcissistic Personality Disorder

• 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

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Narcissistic Personality Disorder

• Baughman article
• Sense of entitlement
• Lack of empathy or conscience
• No lack of intelligence
• No lack of social skills

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Avoidant Personality Disorder

• Pervasive pattern of social inhibition, feelings
  of inadequacy and hypersensitivity to negative
  evaluation.

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Avoidant Personality Disorder

• 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

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Dependent Personality Disorder

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

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Dependent Personality Disorder

• 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

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Obsessive-Compulsive Personality Disorder

• Preoccupation with orderliness, perfectionism and
  mental and interpersonal control.

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Obsessive-Compulsive Personality Disorder

• 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

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Millon Clinical Multiaxial Inventory MCMI-III

• Standardized
• Self-report
• Adults
• 8th grade reading level
• Focus on Personality Disorders

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Millon Clinical Multiaxial Inventory MCMI-III

• 175 items
• 28 Scales
• Closely aligned with Millons theory and DSM-IV

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MCMI-III

• Can be used instead of or in addition to MMPI.

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Theoretical Considerations

• Millons Theory
• Core Principle Polarities of
• Pleasure-pain
• Active-passive
• Self-other

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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

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BR scores

• For clinical scales
• BR 75 indicates presence of a trait
• BR 85 indicates presence of a disorder

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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.

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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.

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3. Interpret Clinical Syndrome Scales

• Precedence given to elevations on Severe Clinical
  Syndrome scales
• All can be elevated

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Schizoid Scale 1

• Little or no interest in other people

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Avoidant Scale 2A

• A desire to be with other people that is blocked
  by an intense fear of being rejected or
  humiliated.

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Depressive Scale 2B

• Clients perceive themselves as worthless,
  vulnerable, inadequate, unsuccessful, and guilty.
  The frequently engage in self-criticism and frame
  events in a defeatist manner.

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Dependent Scale 3

• They feel incapable and incompetent of
  functioning independently. They quickly form
  alliances and give up responsibility for
  decisions. See themselves as placating, insecure,
  passive and immature.

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Histrionic Scale 4

• Histrionic persons are dramatic, colorful and
  emotional. Tolerance for boredom is low and they
  constantly seek novel situations.
• Elevations of Histrionic are associated with an
  above average number of positive life events, low
  levels of distress and good social adjustment.

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Narcissistic Scale 5

• Exaggerated sense of self-importance and
  competence.

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Antisocial Scale 6A

• Competitiveness along with impulsive acting-out
  of anti-social feelings. Provocative, violent,
  vicious, self-centered, dominant, dishonest,
  brutal an devious.

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Aggressive Scale 6B

• Competitive, energetic, hard-headed,
  authoritarian and socially intolerant.
  Predisposed toward aggressive outburst with
  little sensitivity.

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Compulsive Scale 7

• Conformity, discipline, self-restraint,
  formality. Strictly adhere to social norms.
  Conscientious, well prepared, reghteous, and
  meticulous.

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Passive-Aggressive Scale 8A

• Passive compliance combined with resentment and
  opposition.

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Self-defeating 8B

• Present themselves as inferior, nonindulgent,
  self-effacing, insecure. They do not deserve
  pleasure.

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Schizotypal Scale S

• Eccentricity, disorganization and social
  isolation.

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Bordeline Scale C

• Instability and unpredictability of mood and
  behavior.

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Paranoid Scale P

• Suspicious and defensive

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Anxiety Scale A

• Tension, difficulty relaxing, indecisiveness, and
  apprehension.

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Somatoform Scale H

• Somatic complaints in the for of generalized
  pain, fatigue, multiple vague complaints,
  preoccupation with health problems.

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Bipolar Manic Scale N

• Moods swings that range from elation to
  depression.

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Dysthymia Scale D

• Sadness, pessimism
• hopelessness, apathy, low self-esteem, guilt

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Alcohol Dependence Scale B

• A history of problem drinking.

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Drug Dependence Scale T

• Recurring difficulties with drug abuse

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Posttraumatic Distress Disorder Scale R

• Extreme experience leading to fear, helplessness
  and arousal.

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Thought Disorder SS

• Inconsistent, bizarre, fragmented and
  disorganized thoughts.

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Major Depression Scale CC

• Severe depression-difficulty with effective daily
  living.

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Delusional Disorder PP

• Irrational but interconnected delusions,
  persecutory thoughts and grandiosity

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MCMI

• Commendable and innovative
• Generally a well-constructed psychometric
  instrument
• Test-retest reliabilities moderate to high
• Factor analysis generally supports organization
  of scales.

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MCMI problems

• No gold standard or benchmark to validate
  scale.
• Low interdiagnostician agreement
• May over diagnose and over pathologize

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MCMI problems

• Our ability to describe different personality
  disorders has outstripped out ability to diagnose
  them accurately in real-world clinical settings.

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MCMI

• Axis 1 State
• Axis 2 Trait
• MCMI frequently revised to keep it consistent
  with the DSM
• Should be used only with clinical populations

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The End