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Personality Disorders

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Title: Personality Disorders


1
  • Personality Disorders
  • William P. Wattles, Ph.D.
  • Francis Marion University

2
Personality Disorders are generalized, inflexible
patterns of inner experience and behavior of
long-standing.
3
Personality Disorders are long-term, maladaptive
patterns of perception, emotional regulation,
anxiety, and impulse control.
4
Personality
  • 1.The enduring pattern of inner experiences and
    outward behavior that is unique to each
    individual.

5
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.

6
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

7
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

8
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.

9
Cluster A
  • Individuals appear odd or eccentric
  • Paranoid
  • Schizoid
  • Schizotypal

10
Cluster B
  • Individuals appear dramatic, emotional or erratic
  • Antisocial
  • Borderline
  • Histrionic
  • Narcissistic

11
Cluster C
  • Individuals appear anxious or fearful
  • Avoidant
  • Dependent
  • Obsessive-Compulsive

12
Paranoid Personality Disorder
  • Pervasive distrust and suspiciousness of others
    such that their motives are interpreted as
    malevolent.

13
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

14
Paranoid P.D.
  • Overreact to minor slights
  • Hold grudges
  • Constantly vigilant
  • Quick to counterattack

15
Dichotomy
Normal
Paranoid
16
Points on Continuum
Paranoid Traits
Paranoid P. D.
Delusional Disorder
Normal
Paranoid Schizophrenic
Gullible
17
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

18
Delusions
  • Erroneous beliefs that usually involve
    misinterpretation of perceptions or experiences.
  • Vapor trails
  • Delusions are deemed bizarre is they are clearly
    implausible.
  • Thought broadcasting

19
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.

20
Schizophrenia
  • Paranoid type
  • Preoccupation with prominent delusions or
    hallucinations

21
Schizoid Personality Disorder
  • Pervasive pattern of detachment from social
    relationships and a restricted range of
    expression of emotions.

22
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

23
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.

24
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

25
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

26
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

27
Borderline Personality Disorder
  • Pervasive pattern of instability of interpersonal
    relationships, self-image, and affects. Marked
    impulsivity
  • KM

28
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

29
Histrionic Personality Disorder
  • Pervasive Pattern of excessive emotionality and
    attention-seeking behavior.

30
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

31
Narcissistic Personality Disorder
  • Pervasive pattern of grandiosity, need for
    admiration and lack of empathy that begins by
    early adulthood

32
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

33
Narcissistic Personality Disorder
  • Baughman article
  • Sense of entitlement
  • Lack of empathy or conscience
  • No lack of intelligence
  • No lack of social skills

34
Avoidant Personality Disorder
  • Pervasive pattern of social inhibition, feelings
    of inadequacy and hypersensitivity to negative
    evaluation.

35
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

36
Dependent Personality Disorder
  • Pervasive need to be taken care of that leads to
    submissive and clinging behavior and fears of
    separation.

37
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

38
Obsessive-Compulsive Personality Disorder
  • Preoccupation with orderliness, perfectionism and
    mental and interpersonal control.

39
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40
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

41
Millon Clinical Multiaxial Inventory MCMI-III
  • Standardized
  • Self-report
  • Adults
  • 8th grade reading level
  • Focus on Personality Disorders

42
Millon Clinical Multiaxial Inventory MCMI-III
  • 175 items
  • 28 Scales
  • Closely aligned with Millons theory and DSM-IV

43
MCMI-III
  • Can be used instead of or in addition to MMPI.

44
Theoretical Considerations
  • Millons Theory
  • Core Principle Polarities of
  • Pleasure-pain
  • Active-passive
  • Self-other

45
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

46
BR scores
  • For clinical scales
  • BR 75 indicates presence of a trait
  • BR 85 indicates presence of a disorder

47
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.

48
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.

49
3. Interpret Clinical Syndrome Scales
  • Precedence given to elevations on Severe Clinical
    Syndrome scales
  • All can be elevated

50
Schizoid Scale 1
  • Little or no interest in other people

51
Avoidant Scale 2A
  • A desire to be with other people that is blocked
    by an intense fear of being rejected or
    humiliated.

52
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.

53
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.

54
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.

55
Narcissistic Scale 5
  • Exaggerated sense of self-importance and
    competence.

56
Antisocial Scale 6A
  • Competitiveness along with impulsive acting-out
    of anti-social feelings. Provocative, violent,
    vicious, self-centered, dominant, dishonest,
    brutal an devious.

57
Aggressive Scale 6B
  • Competitive, energetic, hard-headed,
    authoritarian and socially intolerant.
    Predisposed toward aggressive outburst with
    little sensitivity.

58
Compulsive Scale 7
  • Conformity, discipline, self-restraint,
    formality. Strictly adhere to social norms.
    Conscientious, well prepared, reghteous, and
    meticulous.

59
Passive-Aggressive Scale 8A
  • Passive compliance combined with resentment and
    opposition.

60
Self-defeating 8B
  • Present themselves as inferior, nonindulgent,
    self-effacing, insecure. They do not deserve
    pleasure.

61
Schizotypal Scale S
  • Eccentricity, disorganization and social
    isolation.

62
Bordeline Scale C
  • Instability and unpredictability of mood and
    behavior.

63
Paranoid Scale P
  • Suspicious and defensive

64
Anxiety Scale A
  • Tension, difficulty relaxing, indecisiveness, and
    apprehension.

65
Somatoform Scale H
  • Somatic complaints in the for of generalized
    pain, fatigue, multiple vague complaints,
    preoccupation with health problems.

66
Bipolar Manic Scale N
  • Moods swings that range from elation to
    depression.

67
Dysthymia Scale D
  • Sadness, pessimism
  • hopelessness, apathy, low self-esteem, guilt

68
Alcohol Dependence Scale B
  • A history of problem drinking.

69
Drug Dependence Scale T
  • Recurring difficulties with drug abuse

70
Posttraumatic Distress Disorder Scale R
  • Extreme experience leading to fear, helplessness
    and arousal.

71
Thought Disorder SS
  • Inconsistent, bizarre, fragmented and
    disorganized thoughts.

72
Major Depression Scale CC
  • Severe depression-difficulty with effective daily
    living.

73
Delusional Disorder PP
  • Irrational but interconnected delusions,
    persecutory thoughts and grandiosity

74
MCMI
  • Commendable and innovative
  • Generally a well-constructed psychometric
    instrument
  • Test-retest reliabilities moderate to high
  • Factor analysis generally supports organization
    of scales.

75
MCMI problems
  • No gold standard or benchmark to validate
    scale.
  • Low interdiagnostician agreement
  • May over diagnose and over pathologize

76
MCMI problems
  • Our ability to describe different personality
    disorders has outstripped out ability to diagnose
    them accurately in real-world clinical settings.

77
MCMI
  • Axis 1 State
  • Axis 2 Trait
  • MCMI frequently revised to keep it consistent
    with the DSM
  • Should be used only with clinical populations

78
The End
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