Chapter 18: Disorders of Personality

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Chapter 18 Disorders of Personality

• Psy 260
• Katherine Aumer-Ryan

Slides created by Leslie G. Eaton State
University of New York College at Cortland
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People are Different
Every individual thinks, feels and acts in
distinctive ways. The entire field of
personality psychology is an effort to specify
how and explain why. It is good that people are
different. Life would certainly be boring and
lose much of its meaning if everyone thought,
felt, and acted the same way.
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Personality Disorders
But it is also true that the variations in
individual personality that we celebrate
sometimes go too far. For some people, aspects
of their personality become so extreme as to
cause problems for them or for others who must
deal with them.
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The Diagnostic and Statistical Manual
(DSM)Development

• In 1952 the American Psychiatric Association
  imposed some order on psychological disorders by
  publishing the first edition of the Diagnostic
  and Statistical Manual (DSM), which included a
  list and description of what were seen as the
  major disorders of personality.
• The most recent edition, the DSM-IV-TR was
  published in 2000.
• It is considered the standard reference on
  psychological disorder for medical professionals.
• Disorders are classified and described based on
  behavioral symptoms the DSM specifies how many
  problematic behaviors are required to make a
  diagnosis, and in some cases how long the
  behavioral symptom needs to be present.

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Purposes of the DSM

• The DSM serves two major purposes.
• It represents an effort to make psychological
  diagnosis more objective.
• It provides a common vocabulary for behaviors and
  disorders to be used by medical professionals and
  researchers so that they may communicate with one
  another to make progress toward better
  understanding and treatment of psychological
  disorders.
• It allows multiple medical professionals, all
  working with the same patient, the ability to
  reach a mutual understanding so that a treatment
  regime can be developed.
• The DSM is used for insurance billing purposes.
• Each disorder has a code which is written on
  insurance billing forms when a patient receives
  some kind of treatment.
• So if psychological treatment is going to be paid
  forwhich is the same as saying, if it is to be
  offered at allcategories of psychological
  disorders must be specified.

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Organization of the DSM

• The DSM is criticized on many grounds, but lack
  of comprehensiveness is not among them
• It contains 943 pages of labels and numerical
  codes for just about everything that could
  conceivably go wrong with a person,
  psychologically speaking.
• The book is organized around five basic groups or
  axes.
• Axis I includes severe psychopathologies (e.g.,
  schizophrenia)illnesses that can, in some cases,
  require hospitalization.
• The personality disorders are included as Axis
  II.
• Axis III lists physical conditions that might be
  related to the patients mental health, which can
  range from injuries and poisoning to brain
  diseases that impair mental functioning such as
  Alzheimers.
• Axis IV includes stressors in the patients
  social life such as unemployment, bereavement, or
  a recent divorce.
• Axis V is used to assess the patients current
  ability to function self-sufficiently, including
  whether he or she can hold a job or maintain a
  relationship.
• A complete evaluation of a psychiatric patient
  includes a consideration of behaviors and other
  pertinent conditions (physiological and
  environmental) that are included on all five
  axes.
• Taken as a whole, the DSM-IV describes an amazing
  variety of patterns of thought, feeling, and
  behavior.
• The DSM can be found in the reference section of
  most college libraries, and it is fascinating to
  thumb through it.

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Defining Personality Disorders

• Personality disorders have five general
  characteristics that will be discussed, one at a
  time.
• Unusually Extreme
• Problematic
• Social
• Stable
• Ego-Syntonic

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Unusually Extreme

• A personality disorder, by definition, is the
  expression of an unusually extreme degree of one
  or more attributes of personality.
• It is important that the variation not only be
  extreme, but also unusual, especially considering
  the individuals cultural context.

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Problematic Behavioral Patterns

• The unusually extreme behavioral pattern causes
  major problems for the person or for others.
• A personality disorder typically causes some
  degree of suffering for the person who has it,
  which may include anxiety, depression, and
  confusion.
• In the case of several disorders, many and
  perhaps most of the associated problems are
  suffered by the people who must deal with the
  results (e.g., spouses, employers, friends, and
  sometimes even former friends).

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Personality Disorders Social Aspects

• These next three characteristics are not as
  fundamental as the first two discussed, however,
  they are often part of general patterns of
  behavior found in those diagnosed with a
  personality disorder.
• Social
• The symptoms manifest in interactions with other
  people other people must be present for the full
  expression of many psychological symptoms.

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Stability of Symptoms

• Stable
• The cluster of behavioral symptoms associated
  with personality disorders are, by the usual
  definition, stable they may first become visible
  in adolescence or even childhood and persist
  throughout life.

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Personality Disorders Can Be Ego-Syntonic

• Ego-syntonic means that the people who have the
  symptoms of a personality disorder do not think
  anything is wrong they have little to no
  awareness of their unusual and problematic
  behavior.
• Their symptoms may feel like normal and even
  valued aspects of their personalities.
• They are more likely to see a disorder in the
  people who have problems with them.
• Personality disorders that involve ego-syntonic
  ideas are difficult cases for therapists.
• It is difficult to get the individual into
  therapy (they do not believe they need therapy
  the people trying to get them into therapy are
  the ones who need therapy).
• Once at the therapists office, without an
  awareness of their symptoms, ego-syntonic people
  probably cannot self-report their symptoms
  accurately or completely, making it very
  difficult for a therapist to make a correct
  diagnosis.
• This can be compared to people who suffer from
  Axis I disorders. These individuals generally
  experience their symptoms of confusion,
  depression, or anxiety as ego-dystonic
  afflictions of which they would like to be cured.

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The Major Personality Disorders

• The DSM-IV lists ten major disorders that
  describe patterns of personality so extreme that
  they can cause serious problems.
• These problems can be placed roughly into three
  categories.
• Personality disorders that are marked by
  emotional upset, fear, and anxiety
• These include dependent, avoidant, and
  obsessive-compulsive personality disorders.
• Personality disorders that are associated with
  patterns of behavior that interfere with social
  relationships, and can make a person difficult to
  be around and in some cases even dangerous.
• These include paranoid, histrionic, antisocial,
  and narcissistic personality disorders.
• Personality disorders that are serious mental
  problems characterized by severely confused
  thinking and lack of contact with reality.
• These include schizotypal, schizoid, and
  borderline personality disorders.

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Disorders of Unhappiness and Anxiety
Dependent Personality Disorder
Avoidant Personality Disorder
Obsessive-Compulsive Personality Disorder

• Dependent Personality Disorder (among the most
  frequently reported personality disorders more
  common in women)
• People with this disorder typically rely
  heavilytoo heavilyon a parent, sibling, or
  spouse to take care of everything for them, and
  this reliance goes beyond anything that might be
  reasonable due to age, illness, or physical
  handicap.
• Because of their utter dependence, they may
  exhibit a submissive interpersonal style.
• They are afraid to disagree with anybody about
  anything, because they fear having to think or
  even exist on their own. At the same time, you
  may detect a bitter, resentful edge to their
  behavior just under the surface. They dont
  really agree with you, after all they are just
  afraid to tell you that they dont, because then
  you might not take care of them.
• This conflict resembles the neurotic push and
  pull between love and hate described by Melanie
  Klein and the object relations theorists, taken
  to an extreme.

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Disorders of Unhappiness and Anxiety
Dependent Personality Disorder
Avoidant Personality Disorder
Obsessive-Compulsive Personality Disorder

• Avoidant Personality Disorder (½ to 1 of the
  population)
• The fundamental problem experienced by
  individuals with this disorder is that their fear
  of failure, criticism, or rejection may lead them
  to avoid normal activities of school, work, and
  interactions with others.
• They expect the absolute worst from others
  criticism, contempt, and rejection.
• They cannot join a group activity or have a
  relationship without constant reassurance that
  they will be uncritically accepted, and they may
  actively inhibit any emotional expression toward
  others because they fear being mocked and
  rejected.
• As a result, others cannot get close to them, and
  their interpersonal world is constricted it is
  safer to stay at home with the blinds pulled and
  the phone off the hook.
• This is very sad because, according to clinical
  psychologists who have studied people with this
  disorder, they really have deep cravings for
  affection and social acceptance, and they may
  spend much of their solitary time fantasizing
  about how much fun it would be to have friends or
  a lover.
• They may have trouble in their careers as well,
  because they seek to avoid the meetings and
  social functions central to the business world.

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Disorders of Unhappiness and Anxiety
Dependent Personality Disorder
Avoidant Personality Disorder
Obsessive-Compulsive Personality Disorder

• Obsessive-Compulsive Personality Disorder (OCD
  1 of the population) (DSM-IV lists eight
  characteristics any combination of four are
  required for diagnosis)
• Overconcern with rules and details
• The obsessive-compulsive has a deep reverence for
  rules, organization, and details, to the point of
  absurdity.
• Perfectionism
• There is nothing wrong with wanting to do things
  as well as possible, but people with OCD take
  this inclination to the degree that it causes
  severe problems, because they think nothing is
  ever good enough.
• Workaholic
• People with OCD are often stereotypical
  workaholics they cannot take a weekend or even
  an evening off because they have so much to do.
  And yet, strangely, they never seem to get much
  done.

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Disorders of Unhappiness and Anxiety
Dependent Personality Disorder
Avoidant Personality Disorder
Obsessive-Compulsive Personality Disorder

• Obsessive-Compulsive Personality Disorder (OCD)
• Inflexibility
• People with OCD have set ways of thinking and
  behaving and are not open to change. They apply
  values, ethics, and principles mindlessly rather
  than with an appreciation for context, and even
  considering bending the rules can make them
  anxious and even more rigid.
• Packrat
• People with OCD may be compulsively unable to
  throw anything away, even things with no possible
  use or sentimental value. They become very
  anxious about discarding anything because they
  cannot escape feeling that they just might need
  it someday.
• Inability to delegate
• The obsessive-compulsive has to do everything for
  himself or herself, because nobody else can
  possibly do things right. There is one and only
  one way to wash a dish, mow a lawn, paint a wall,
  or even make a decision.

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Disorders of Unhappiness and Anxiety
Dependent Personality Disorder
Avoidant Personality Disorder
Obsessive-Compulsive Personality Disorder

• Obsessive-Compulsive Personality Disorder (OCD)
• Miserly
• People with OCD hoard pennies against unlikely
  future catastrophes, and they may live way below
  their means.
• Rigid and stubborn
• People with OCD like to do things the same way
  time after time, day after day even the
  contemplation of a change upsets them.

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Disorders in Relating with Others
Antisocial Personality Disorder
Histrionic Personality Disorder
Paranoid Personality Disorder
Narcissistic Personality Disorder

• Paranoid Personality Disorder (½ to 2½ of the
  population)
• People with this disorder characteristically
  assume the worst, and may be quite skilled in
  identifying patterns of events and behaviors of
  others that prove they are being plotted
  against.
• Not surprisingly, they are reluctant to trust or
  confide in anyone.
• While they may at first appear calm, rational,
  and analytic, more often they eventually come off
  as angry, stubborn and bitter.
• They frequently become embroiled in lawsuits.

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Disorders in Relating with Others
Antisocial Personality Disorder
Histrionic Personality Disorder
Paranoid Personality Disorder
Narcissistic Personality Disorder

• Histrionic Personality Disorder (2-3 of the
  population more frequently diagnosed in women)
• Along with making themselves the center of
  attention through dress, behavior, or physical
  appearance, such individuals may vehemently
  express strong opinions that turn out not to have
  much basis. When asked to defend their views,
  they may lack the slightest idea what they really
  think and give the impression of having expressed
  the opinion just for effect..
• Similarly, they may express strong emotions of
  happiness, sadness, liking, or disliking that
  suddenly change or disappear.
• They may describe even casual acquaintances as
  dear, dear friends, and in general consider
  their relationships closer than they really are.
• Not surprisingly, the people who know them may
  have trouble taking them seriously they are
  difficult to get along with, and they experience
  serious difficulties in their personal
  relationships and occupational life without
  understanding why.

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Disorders in Relating with Others
Antisocial Personality Disorder
Histrionic Personality Disorder
Paranoid Personality Disorder
Narcissistic Personality Disorder

• Antisocial Personality Disorder (diagnosed in
  about 3 of males and 1 of females)
• This dangerous pattern includes behaviors such as
  vandalism, harassment, theft, and a wide variety
  of illegal activities such burglary and drug
  dealing.
• People with this disorder are impulsive, and
  engage in risky behaviors such as reckless
  driving, drug abuse, and dangerous sexual
  practices.
• They typically are irritable, aggressive, and
  irresponsible.
• The damage they do to others bothers them not one
  whit. They have rationalizations easily available
  that include beliefs that life is unfair. The
  world is full of suckers, and if you dont take
  what you want whenever you can, then you are a
  sucker, too.
• Upon first impression they may appear articulate
  and charming, but watch out.
• Children unlucky enough to come under the care of
  someone with this disorder are at high risk for
  neglect or abuse.
• A wide variety of negative outcomes may accompany
  this disorder including unemployment, divorce,
  drug addiction, imprisonment, murder, and suicide.

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Disorders in Relating with Others
Antisocial Personality Disorder
Histrionic Personality Disorder
Paranoid Personality Disorder
Narcissistic Personality Disorder

• Narcissistic Personality Disorder (less than 1
  of the general population are diagnosed)
• While full-fledged diagnoses of narcissistic
  personality disorder are relatively rare, the
  related trait of narcissism is quite common and
  has important implications as we saw in the
  discussion of excessive self-esteem.
• Each of its characteristics will most likely
  describe familiar tendencies that are present to
  some degree in more than a few people you know.

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Disorders in Relating with Others
Antisocial Personality Disorder
Histrionic Personality Disorder
Paranoid Personality Disorder
Narcissistic Personality Disorder

• Narcissistic Personality Disorder (DSM-IV lists
  nine characteristics any combination of five are
  required for diagnosis.)
• Grandiose sense of self-importance
• The narcissist believes, against all evidence,
  that he is a superior being, and expects
  recognition. This belief in superiority is
  independent of any real basis.
• The narcissist expects recognition with or
  without a specific reason for it. He/she is
  genuinely surprised, even a bit bewildered,
  whenever this recognition is not forthcoming.
• From the lack of recognition received from
  others, the narcissist is forced to conclude that
  other people are terribly unperceptive,
  unappreciative, or just plain jealous.

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Disorders in Relating with Others
Antisocial Personality Disorder
Histrionic Personality Disorder
Paranoid Personality Disorder
Narcissistic Personality Disorder

• Narcissistic Personality Disorder
• Preoccupation with fantasies of ultimate
  attainment
• The narcissist walks around much of the day with
  a head full of visions of unlimited wealth,
  absolute power, flawless beauty, or perfect love.
• These fantasies may lead the narcissist to become
  detached from what is really going on, and
  unrealistic about achievement of goals.
• Belief that he or she should associate only with
  others who are special
• The narcissist seems to see his or her self-image
  reflected in those they associate with thus, the
  narcissist may feel that it is important to hang
  out only with people who are wealthy, famous,
  brilliant, or physically attractive.
• Similarly, narcissists may be inordinately
  attracted to elite institutions such as famous
  universities, exclusive neighborhoods, and
  similar social circles mostly having to do with
  appearance, wealth, and fame.
• In each case, the basis of the institutions
  appeal is not quality, pleasantness of the
  lifestyle, or excitement of the entertainment
  rather, the attraction is that most people cant
  get in, which is irresistible to the narcissist.

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Disorders in Relating with Others
Antisocial Personality Disorder
Histrionic Personality Disorder
Paranoid Personality Disorder
Narcissistic Personality Disorder

• Narcissistic Personality Disorder
• Requirement for excessive admiration
• Narcissists need to be admired by others. They
  may maneuver to evoke praise and the tactics are
  not necessarily subtle (e.g., How about my great
  new car?) or simply brag about accomplishments,
  wealth, friends, or appearance.
• Tell a narcissist that their clothes, car,
  accomplishments, or haircut are the greatest you
  have ever seen. They will agree, and you will not
  be suspected of any insincerity.
• This need for constant praise suggests that the
  narcissists seemingly high self-esteem is
  actually very fragile, even brittle.
• Since it is not based on real accomplishment, the
  narcissists grandiose self-image is always in
  danger of destruction, which they appear to sense.

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Disorders in Relating with Others
Antisocial Personality Disorder
Histrionic Personality Disorder
Paranoid Personality Disorder
Narcissistic Personality Disorder

• Narcissistic Personality Disorder
• Sense of entitlement
• The narcissist expects special treatment.
• Rules apply to other people (e.g., I should not
  have to wait in line!).
• The narcissist is shocked when he isnt treated
  as exceptional.
• There appears to be no upper limit to the sense
  of entitlement the narcissist never gets enough
  to conclude that they have received what they
  truly deserve.
• Exploits others
• The narcissist feels justified in taking
  advantage of others whenever possible the
  purpose is merely to get what he/she deserves
  anyway.
• The narcissist may blithely lie, cheat, or simply
  leave the dirty work to be done by other people
  he or she has much more important things to do,
  and you do not.

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Disorders in Relating with Others
Antisocial Personality Disorder
Histrionic Personality Disorder
Paranoid Personality Disorder
Narcissistic Personality Disorder

• Narcissistic Personality Disorder
• Lack of empathy
• This exploitation is accompanied by a lack of
  empathy for others.
• Empathy is not called for, from the narcissists
  point of view, because he is the only person on
  earth who really matters.
• The narcissist assumes that everything about him
  or her must be of great interest, and may offer
  lengthy and inappropriately detailed monologues
  about his activities or feelings.
• At the same time, the narcissist can be
  shockingly inconsiderate of the feelings of
  others, for example, happily bragging about how
  healthy he or she is, in front of someone who is
  ill.

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Disorders in Relating with Others
Antisocial Personality Disorder
Histrionic Personality Disorder
Paranoid Personality Disorder
Narcissistic Personality Disorder

• Narcissistic Personality Disorder
• Enviousness
• A further clue to the brittleness of the
  narcissists self-esteem is his or her proneness
  to envy.
• The narcissist is acutely aware of small
  differences in prestige, wealth, or
  attractiveness, and simultaneously gloats over
  those he or she views as lower in these
  attributeswhile seething with envy over those
  perceived as superior.
• Just about everybody would like to be better
  looking, have a bigger office, and make more
  money. The clue to narcissism is the peculiar
  structure of these desires the true narcissist
  would actually be perfectly happy with a small
  office as long as everyone elses were smaller.
• Similarly, the narcissists obsession with wealth
  has much less to do with how much money she needs
  or wants to spend than with a need to feel
  superior to others.

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Disorders in Relating with Others
Antisocial Personality Disorder
Histrionic Personality Disorder
Paranoid Personality Disorder
Narcissistic Personality Disorder

• Narcissistic Personality Disorder
• Arrogant behavior and attitudes
• Narcissists are not generally difficult to spot
  their arrogance gives them away.
• They belittle others and brag about themselves.
• They are rude to service people, seeming to revel
  in their small (and temporary) degree of social
  superiority over waiters and cashiers.
• They are boastful about small (or nonexistent)
  accomplishments, and sarcastic and condescending
  about the virtues or accomplishments of anybody
  else.

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Narcissism is a Trait

• Within the normal range, those who score
  relatively high on measures of narcissism
• may appear superficially charming and make a good
  first impression, however, over time their
  characteristic arrogance typically becomes
  self-defeating
• tend to defend their unrealistically inflated
  self-concept through means such as bragging, or
  making themselves look good at someone elses
  expense defenses that are likely to lead to
  social isolation or poor social relationships.
• desperately crave feelings of power, prestige,
  success, and glory.
• Rather than earning these feelings through hard
  work or being courageous they act impulsively and
  have difficulty delaying gratification,
  consequently, they express feelings of
  superiority whenever they experience the need,
  regardless of whether these feelings have any
  basis.
• They feel better at the moment, but they alienate
  others and ultimately prevent the very success
  and admiration they so desperately crave.

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Disorders of Thinking and Lack of Contact with
Reality
Schizotypal Personality Disorder
Schizoid Personality Disorder
Borderline Personality Disorder

• Schizotypal Personality Disorder (3 prevalence
  rate in the populationmay be slightly more
  common in males)
• Some people are idiosyncratic they experience
  odd thoughts, have seemingly strange ideas, and
  behave unconventionally.
• They may wear odd and unkempt clothing, and
  espouse unique ideologies or theories of
  everything.
• They possess an interpersonal awkwardness to the
  point of strangeness, and a discomfort with
  social interaction that only gets worse as
  interactions progress therefore, they have
  particular difficulty in close relationships.
• None of these characteristics is especially rare,
  and taken one at a time they may not pose serious
  problems when they appear in combination and
  become extreme, a diagnosis of schizotypal
  personality disorder can be made.
• At its extreme this disorder can dangerously
  approach schizophrenia, a serious Axis I
  condition characterized by major distortions of
  reality, jumbled thinking, and even
  hallucinations.

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Disorders of Thinking and Lack of Contact with
Reality
Schizotypal Personality Disorder
Schizoid Personality Disorder
Borderline Personality Disorder

• Schizoid Personality Disorder (extremely rare
  may be more common and more severe in males)
• An inability to take pleasure from any kind of
  social interaction, ranging from interesting
  conversation to sexual activity.
• Indifference to others opinions, rarely
  experiences strong feelings, and generally
  presents a bland facade to the world.
• An important life event (e.g., loss of a job) may
  leave the individual literally at a loss as for
  how to react, and he or she may seem not to react
  at all.
• People with this disorder live solitary lives
  (e.g., they are unlikely to marry), though they
  can sometimes perform adequately in jobs that do
  not require much interaction with others.
• The disorder is reportedly rare, but such people
  seem unlikely to seek professional help.

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Disorders of Thinking and Lack of Contact with
Reality
Schizotypal Personality Disorder
Schizoid Personality Disorder
Borderline Personality Disorder

• Borderline Personality Disorder (BPD)
• The hallmark of this disorder is emotional
  instability the persons mood can change rapidly
  from one moment to the next. The foundation of
  the disorder, according to some writers, is a
  sort of emotional hemophilia, in which a
  reaction, once stimulated, cannot be
  staunchedthe individual emotionally bleeds to
  death.
• It is probably the most severe one on the list.
  Patterns of self-harm are often present that may
  range from self-defeating behaviors to
  self-mutilation to suicide.

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Disorders of Thinking and Lack of Contact with
Reality
Schizotypal Personality Disorder
Schizoid Personality Disorder
Borderline Personality Disorder

• Borderline Personality Disorder (DSM-IV lists
  nine characteristics, any combination of five are
  required for diagnosis)
• Rapid mood shifts
• Emotional vulnerability characteristically
  experience frequent shifts in mood, as often as
  every few hours or even less.
• They can swing from happiness to sadness and from
  anger to affection quickly with little or no
  apparent cause shortly thereafter, the feelings
  will pass as if nothing ever happened.
• Uncontrollable anger
• They may frequently experience anger that is
  inappropriate, intense, or out of control, with
  very little impetus or none (that anybody else
  can see) at all like their other moods, anger
  will also pass quickly.

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Disorders of Thinking and Lack of Contact with
Reality
Schizotypal Personality Disorder
Schizoid Personality Disorder
Borderline Personality Disorder

• Borderline Personality Disorder
• Self-destructive acts
• A wide and dangerous range of self-destructive
  acts are possible, including suicide and
  self-mutilation.
• Suicide attempts are common, and eventually 810
  percent are successful in their suicidal
  attempts this is a dangerous affliction, with
  death rates comparable to the most threatening
  physical diseases.
• Even among the non-suicidal, self-mutilation is
  common and may include compulsively cutting
  (e.g., with fingernails or knives) parts of the
  body including the hands, arms, and even
  genitals.
• The reason for cutting is not clear. Possible
  explanations include feeling guilty, indulging in
  self-punishment, and the possibility that these
  individuals are so emotionally disconnected that
  they must hurt themselves to know they are alive.

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Disorders of Thinking and Lack of Contact with
Reality
Schizotypal Personality Disorder
Schizoid Personality Disorder
Borderline Personality Disorder

• Borderline Personality Disorder
• Self-damaging behaviors
• Self-damaging behaviors are less directly
  physical than self-destructive acts, but they are
  still harmful acts may include drug abuse,
  compulsive gambling, eating disorders,
  shoplifting, reckless driving, etc.
• A particular characteristic pattern appears to
  involve undermining oneself at (or just before)
  the moment of success (e.g., they may drop out of
  school just before graduation, break up a
  relationship when it starts to succeed, or quit
  working on and even destroy a major project when
  it is about to be finished.
• Some cases of runaway brides (and grooms) may
  fit this pattern everything seems great until
  the moment just before completion then they
  appear to panic.

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Disorders of Thinking and Lack of Contact with
Reality
Schizotypal Personality Disorder
Schizoid Personality Disorder
Borderline Personality Disorder

• Borderline Personality Disorder
• Identity disturbance
• Many people with BPD literally do not know who
  they are.
• They may have great difficulty understanding how
  they appear to others, and be confused about
  their values, career goals, and even sexual
  identities.
• They do not understand their own actionscutters,
  for example, can say almost nothing meaningful
  about why they do itand BPD sufferers may try to
  be social chameleons, avoiding behavioral choices
  and fading into the background by doing what
  everybody else seems to be doing.
• Chronic emptiness
• They may complain of feeling empty and bored
  all the time they might indicate that they
  desperately need to get a life.
• They seem unable to find activities that are
  satisfying and enjoyable, or to establish
  personal relationships that might give their
  lives purpose and meaning.

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Disorders of Thinking and Lack of Contact with
Reality
Schizotypal Personality Disorder
Schizoid Personality Disorder
Borderline Personality Disorder

• Borderline Personality Disorder
• Unstable relationships
• Their interpersonal relationships are confusing,
  chaotic, noisy, unpredictable, and unstable.
• May be attributed to being prone to splitting it
  may be that the person is unable to handle the
  complex reality that people all have a mix of
  good and bad characteristics.
• Fear of abandonment
• Many people with BPD put a great deal of effort
  into frantically trying to fend off being
  abandoned by others sometimes fear of
  abandonment is realistic, often it is not.
• In any case, they find it difficult to be
  separated from significant others for any length
  of time e.g., they might panic when someone is a
  few minutes late, because at the time they are
  certain that the person has left for good.
• Self-destructive behaviors might, in some cases,
  be attempts to seek attention and/or to
  manipulate people into staying (e.g., If you
  leave me, Ill kill myself!).

39
Disorders of Thinking and Lack of Contact with
Reality
Schizotypal Personality Disorder
Schizoid Personality Disorder
Borderline Personality Disorder

• Borderline Personality Disorder
• Confusion and feelings of unreality
• The fear of abandonment sometimes leads to
  confused thinking and feelings of being
  disconnected from reality.
• This might include sudden, unrealistic, and
  paranoid fears, or even the inability to remember
  ones own name.
• In general, the person becomes so upset that he
  or she literally cannot think straight.
• These symptoms may come and go when the
  significant other returns, the sufferer may
  return to reality (relatively speaking) for a
  while.

40
Criteria for a DSM Diagnosis and the Prototype
Model

• The DSM criteria for diagnosis involve
  manifesting a certain minimum number of
  behavioral characteristics for each disorder.
• That means there are no clear-cut requirements
  for diagnosing a personality disordera fact that
  has a couple of important implications.
• There are many different ways to exhibit each of
  the disorders.
• For example, five out of nine characteristics are
  required to be present for BPD, which means 256
  different patterns (of five or more
  characteristics) are consistent with a diagnosis.
  Consequently, people with the same official
  diagnosis may be quite different from each other,
  creating some vagueness and confusion in clinical
  work and for research.
• It is highly possible for a given individual to
  exhibit characteristics of several different
  disorders at once.
• For example, it is not difficult to imagine
  someone who has rapidly shifting moods, a
  preference for solitary activities, and a view of
  him or herself as inferior, yet these are
  characteristics of three different disorders.

41
Criteria for a DSM Diagnosis and the Prototype
Model

• The prototype model may be a better system for
  clinical diagnosis and for research purposes.
• Most (perhaps all) natural categories are best
  thought of in terms of ideal exemplars, or
  prototypes.
• Real objects may match a prototype more or less
  well, even while differing from each other.
• Real objects may also fit more than one prototype
  category because fit is not absolute, it is a
  matter of degree.

42
Criteria for a DSM Diagnosis and the Prototype
Model

• The prototype model may be a better system for
  clinical diagnosis and for research purposes.
• Each of the personality disorders can be thought
  of as a prototype.
• It is possible and meaningful to assess the
  degree to which an individual matches a single
  prototype, or more than one prototype .
• No individual is likely to match any prototype
  perfectly, which acknowledges the complexity of
  diagnosis, the behavioral overlap among the
  categories, and the heterogeneity within
  categories.
• This view goes a long way toward rescuing the
  system of categorizing and diagnosing personality
  disorders.
• On the other hand, the psychiatrist or clinical
  psychologist probably needs to fill out the
  insurance form with just one billing code
  (although this potential obstacle to the
  prototype model could be overcome).

43
Bases for Diagnosis

• The diagnosis of a personality disorder may be
  based upon several kinds of information each of
  which have advantages and disadvantages.
• Clinical Impression
• Self-Report Scales
• Structured Interviews
• Informant Report
• The most information, from the widest possible
  number of sources, will lead to the most accurate
  diagnosis.

44
Organizing the Personality Disorders

• The list of ten personality disorders in the
  DSM-IV does not exhaust the ways that individual
  differences can become extreme and problematic.
• The DSM-IV also includes a catch-all category for
  personality disorder not otherwise specified.
• Psychologists have proposed many other disorders.
• The list of disorders is continuously being
  reorganized and rethought.
• For example, passive-aggressive personality
  disorder has gone on and off the list over
  succeeding editions (at the moment it is off,
  pending further study, and has been tentatively
  renamed negativistic personality disorder).
• A major project for the next revision of the DSM
  is a reconsideration of the organization of the
  personality disorders.
• Organization is an important issue, because some
  kind of structure is necessary for comparing the
  disorders with each other and for seeking
  psychological processes, causes, or cures that
  apply to more than one disorder.

45
Organizing the Personality DisordersThe DSM-IV
Clusters

• The DSM-IV organizes the ten personality
  disorders into three clusters that are different
  from the three groups presented earlier if you
  look at the research literature, you will find
  that the DSM-IVs A, B, and C labels are used
  frequently, and clinical psychologists often
  discuss and write about personality disorders in
  these terms
• Cluster A contains disorders characterized by odd
  or eccentric patterns of thinking, including the
  schizotypal, schizoid, and paranoid personality
  disorders these are disorders that fundamentally
  involve dysfunctional thinking.
• Cluster B includes disorders characterized by
  impulsive and erratic patterns of behavior,
  including the histrionic, narcissistic,
  antisocial, and borderline personality disorders
  for these disorders, behavior is the central area
  of concern.
• Cluster C comprises disorders characterized by
  anxious and avoidant emotional styles, including
  the dependent, avoidant, and obsessive-compulsive
  personality disorders these disorders involve,
  most importantly, dysfunctional emotional
  processes.
• Organizing the personality disorders into
  thinking, behavioral, and emotional groups
  oversimplifies the relations among the disorders,
  because all of them include dysfunctions in all
  three areas (thinking, emotion, and behavior).

46
Organizing the Personality DisordersDr.
Funders Groups

• Dr. Funders organizing themes are similar, but
  not identical to the DSM-IV recall Dr. Funders
  groups from earlier
• Those associated with unhappiness and anxiety
  (dependent, avoidance, and obsessive-compulsive
  the same as the DSMs Cluster C).
• Disorders that primarily cause problems for other
  people (paranoid, histrionic, antisocial, and
  narcissistic).
• Disorders associated with seriously distorted
  thinking (schizotypal, schizoid, and borderline).
• Dr. Funders list has a similar problem of
  category overlap, which may be an inevitable
  problem of any system of organization.

47
Organizing the Personality DisordersDimensional
Structures and the Big Five

• Several psychologists have attempted to identify
  key dimensions that underlie the personality
  disorders in some cases, their goal is similar
  to that of psychologists seeking to identify the
  essential traits of personality.
• For example, Millon (1996) has offered a
  biosocial learning model that arranges the
  personality disorders according to the ways in
  which people focus on themselves or others, are
  active or passive, and primarily seek reward or
  avoid pain. This model is interesting, but
  empirical research has not consistently supported
  it.
• Other theorists have proposed circumplex models,
  like those for goals and emotions, in which the
  disorders and other attributes of personality are
  arranged around a circle that shows how they are
  related.
• Currently the best supported and most accepted
  way of organizing the personality disorders is
  probably the Big Five set of personality traits
  (extraversion, neuroticism, agreeableness,
  conscientiousness, and openness to experience).
• Researchers studying the Big Five have proposed
  these traits as the foundation of most if not all
  of the variation in personality, with the idea
  that the 17,953 trait terms in the English
  language can be reduced to combinations of two or
  more of these five attributes.

48
Pathologizing

• Pathologizing behaviorsdescribing them as the
  result of mental illness
• There has been increasing amount of insight and
  imagination when formulating descriptions of many
  psychological disorders.
• Personality disorders themselves describe bad
  ways to behave. Does this mean that bad people
  have personality disorders, by definition?
• For example Psychologists have recently proposed
  that pathological bias, such as extreme racism,
  homophobia, or other strong feelings about
  certain groups, should be defined as a
  personality disorder. It has not yet been added
  to the DSM.

49
Too Much Pathologizing?

• The notion that bad people have personality
  disorders is one of the eternal conundrums in
  the foggy area where psychology meets moral
  reasoning. It has been a long-standing dilemma in
  philosophy, religion, and law, and there is no
  resolution in sight.
• Pathologizing is too easyand pathologizing has
  professional consequences.
• Critics of the DSM-IV have enjoyed pointing out
  that it includes a label for everything from
  compulsive gambling to coffee nerves.
• The DSM-IV describes so many behavioral patterns
  as illnesses that it threatens to undermine the
  meaning of the concept altogether.
• Ask yourself this question If everything is a
  mental illness, then is nothing a mental illness?
• A related question If everything is a mental
  illness, then having a mental illness would be
  normal (not abnormal, and not statistically
  unusual). So, if having a mental illness is
  normal, then why would anyone try and seek
  treatment for what is a normal condition?

50
Mental Health

• Pathologizing tells us almost nothing about the
  nature of mental health.
• Mental health certainly means more than not
  having any of the symptoms listed in the DSM-IV,
  even if that were possible, which it is not.
• This is not merely a shortcoming of the DSM.
  Psychology has a history of paying much more
  attention to defining and attempting to cure
  mental illness than to describing the ideal state
  that one might aspire to achieve.
• This omission is precisely what motivates the
  positive psychology movement.
• The positive psychology movement aims to move
  beyond an exclusive focus on fixing whats wrong
  with people, and instead to promote meaningful
  and happy living.
• Improving mental health requires an understanding
  of normal personality, not just mental illness
  and personality disorders.

51
Labeling

• Along with pathologizing, there has been much
  debate (psychological and legal) about the
  virtues of labeling.
• The specific categories in the DSM-IV have come
  in for a lot of criticism, and with good reason.
• Nobody seems to quite fit the criteria for any
  category, many people exhibit characteristics of
  several categories at once.
• Systems like the DSM-IVs list of personality
  disorders are difficult to apply consistently and
  reliably.
• Thus, the labels in the DSM-IV are always a
  little bit misleading, and sometimes seriously
  misleading.
• Using catch-all labels can shut off rather than
  promote further understanding, because once we
  have labeled a person as mentally ill, we may no
  longer feel that we have to take seriously his or
  her feelings, outlook, or even rights, or to
  empathize with his or her point of view.
• A label is not an explanation, and the conclusion
  that someone has a personality disorder raises
  many more questions than it answers.

52
Labeling

• On the other hand, the labels can be useful.
• The syndromes described in the DSM-IV, while not
  as clear-cut as we would like, describe patterns
  that clinicians have noticed over many years. So,
  if you come across someone who exhibits one or
  more of the characteristics of a personality
  disorder, it might be worth your while to
  consider whether he or she might show some of the
  other symptoms as well.
• No matter how uncomfortable we may be about
  labeling people, it is still worthwhile to learn
  the basic characteristics of the major
  personality disorders.
• Finally, it must be acknowledged that labels are
  absolutely necessary there is simply no escaping
  them.
• When a psychiatrist or clinical psychologist
  writes down impressions of a patient, it is
  necessary to write something, and the more
  precise the label, the better.
• Research, or even serious discussion, about
  mental illness would be completely impossible
  without words labelsto refer to the different
  varieties that exist.
• Do you remember that something usually beats
  nothing? (Funders Second Law) No matter how
  flawed they may beand they are flawedthe labels
  in the DSM-IV will persist until something better
  comes along.