Title: Personality Disorders
1- Personality Disorders
- William P. Wattles, Ph.D.
- Francis Marion University
2Personality Disorders are generalized, inflexible
patterns of inner experience and behavior of
long-standing.
3Personality Disorders are long-term, maladaptive
patterns of perception, emotional regulation,
anxiety, and impulse control.
4Personality
- 1.The enduring pattern of inner experiences and
outward behavior that is unique to each
individual.
5Personality 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.
6Personality 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
7Personality 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
8PDs 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.
9Cluster A
- Individuals appear odd or eccentric
- Paranoid
- Schizoid
- Schizotypal
10Cluster B
- Individuals appear dramatic, emotional or erratic
- Antisocial
- Borderline
- Histrionic
- Narcissistic
11Cluster C
- Individuals appear anxious or fearful
- Avoidant
- Dependent
- Obsessive-Compulsive
12Paranoid Personality Disorder
- Pervasive distrust and suspiciousness of others
such that their motives are interpreted as
malevolent.
13Paranoid 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
14Paranoid P.D.
- Overreact to minor slights
- Hold grudges
- Constantly vigilant
- Quick to counterattack
15Dichotomy
Normal
Paranoid
16Points on Continuum
Paranoid Traits
Paranoid P. D.
Delusional Disorder
Normal
Paranoid Schizophrenic
Gullible
17Delusional 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
18Delusions
- Erroneous beliefs that usually involve
misinterpretation of perceptions or experiences. - Vapor trails
- Delusions are deemed bizarre is they are clearly
implausible. - Thought broadcasting
19Delusional 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.
20Schizophrenia
- Paranoid type
- Preoccupation with prominent delusions or
hallucinations
21Schizoid Personality Disorder
- Pervasive pattern of detachment from social
relationships and a restricted range of
expression of emotions.
22Schizoid 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
23Schizotypal 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.
24Schizotypal 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
25Antisocial Personality Disorder
- The essential feature is a pervasive pattern of
disregard for the violation of the rights of
others. - Since age 15
- Sociopathy, psychopathy
26Antisocial 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
27Borderline Personality Disorder
- Pervasive pattern of instability of interpersonal
relationships, self-image, and affects. Marked
impulsivity - KM
28Borderline 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
29Histrionic Personality Disorder
- Pervasive Pattern of excessive emotionality and
attention-seeking behavior.
30Histrionic 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
31Narcissistic Personality Disorder
- Pervasive pattern of grandiosity, need for
admiration and lack of empathy that begins by
early adulthood
32Narcissistic 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
33Narcissistic Personality Disorder
- Baughman article
- Sense of entitlement
- Lack of empathy or conscience
- No lack of intelligence
- No lack of social skills
34Avoidant Personality Disorder
- Pervasive pattern of social inhibition, feelings
of inadequacy and hypersensitivity to negative
evaluation.
35Avoidant 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
36Dependent Personality Disorder
- Pervasive need to be taken care of that leads to
submissive and clinging behavior and fears of
separation.
37Dependent 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
38Obsessive-Compulsive Personality Disorder
- Preoccupation with orderliness, perfectionism and
mental and interpersonal control.
39(No Transcript)
40Obsessive-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
41Millon Clinical Multiaxial Inventory MCMI-III
- Standardized
- Self-report
- Adults
- 8th grade reading level
- Focus on Personality Disorders
42Millon Clinical Multiaxial Inventory MCMI-III
- 175 items
- 28 Scales
- Closely aligned with Millons theory and DSM-IV
43MCMI-III
- Can be used instead of or in addition to MMPI.
44Theoretical Considerations
- Millons Theory
- Core Principle Polarities of
- Pleasure-pain
- Active-passive
- Self-other
45Interpretation
- 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
46BR scores
- For clinical scales
- BR 75 indicates presence of a trait
- BR 85 indicates presence of a disorder
471. 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.
482. 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.
493. Interpret Clinical Syndrome Scales
- Precedence given to elevations on Severe Clinical
Syndrome scales - All can be elevated
50Schizoid Scale 1
- Little or no interest in other people
51Avoidant Scale 2A
- A desire to be with other people that is blocked
by an intense fear of being rejected or
humiliated.
52Depressive 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.
53Dependent 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.
54Histrionic 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.
55Narcissistic Scale 5
- Exaggerated sense of self-importance and
competence.
56Antisocial Scale 6A
- Competitiveness along with impulsive acting-out
of anti-social feelings. Provocative, violent,
vicious, self-centered, dominant, dishonest,
brutal an devious.
57Aggressive Scale 6B
- Competitive, energetic, hard-headed,
authoritarian and socially intolerant.
Predisposed toward aggressive outburst with
little sensitivity.
58Compulsive Scale 7
- Conformity, discipline, self-restraint,
formality. Strictly adhere to social norms.
Conscientious, well prepared, reghteous, and
meticulous.
59Passive-Aggressive Scale 8A
- Passive compliance combined with resentment and
opposition.
60Self-defeating 8B
- Present themselves as inferior, nonindulgent,
self-effacing, insecure. They do not deserve
pleasure.
61Schizotypal Scale S
- Eccentricity, disorganization and social
isolation.
62Bordeline Scale C
- Instability and unpredictability of mood and
behavior.
63Paranoid Scale P
64Anxiety Scale A
- Tension, difficulty relaxing, indecisiveness, and
apprehension.
65Somatoform Scale H
- Somatic complaints in the for of generalized
pain, fatigue, multiple vague complaints,
preoccupation with health problems.
66Bipolar Manic Scale N
- Moods swings that range from elation to
depression.
67Dysthymia Scale D
- Sadness, pessimism
- hopelessness, apathy, low self-esteem, guilt
68Alcohol Dependence Scale B
- A history of problem drinking.
69Drug Dependence Scale T
- Recurring difficulties with drug abuse
70Posttraumatic Distress Disorder Scale R
- Extreme experience leading to fear, helplessness
and arousal.
71Thought Disorder SS
- Inconsistent, bizarre, fragmented and
disorganized thoughts.
72Major Depression Scale CC
- Severe depression-difficulty with effective daily
living.
73Delusional Disorder PP
- Irrational but interconnected delusions,
persecutory thoughts and grandiosity
74MCMI
- Commendable and innovative
- Generally a well-constructed psychometric
instrument - Test-retest reliabilities moderate to high
- Factor analysis generally supports organization
of scales.
75MCMI problems
- No gold standard or benchmark to validate
scale. - Low interdiagnostician agreement
- May over diagnose and over pathologize
76MCMI problems
- Our ability to describe different personality
disorders has outstripped out ability to diagnose
them accurately in real-world clinical settings.
77MCMI
- Axis 1 State
- Axis 2 Trait
- MCMI frequently revised to keep it consistent
with the DSM - Should be used only with clinical populations
78The End