PERSONALITY DISORDERS

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PERSONALITY DISORDERS

• JACK L. BODDEN, PH.D.

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What do we mean by personality?
Personality involves characteristic patterns of
coping and interacting with the social
environment. It is the traits and behavior
patterns that constitute what we think of as a
persons identity, what makes us uniquely the
persons we are.
Today there is general agreement as to the core
personality trait dimensions, and they have
become known as the Big Five.
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THE BIG FIVE PERSONALITY TRAITS

• NEUROTICISM
• EXTRAVERSION-INTROVERSION
• OPENNESS TO EXPERIENCE
• AGREEABLENESS-ANTAGONISM
• CONSCIENTIOUSNESS

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The Big Five factors and their constituent traits
can be summarized as follows Openness -
appreciation for art, emotion, adventure, unusual
ideas, imagination, curiosity, and variety of
experience. Conscientiousness - a tendency to
show self-discipline, act dutifully, and aim for
achievement planned rather than spontaneous
behavior. Extraversion - energy, positive
emotions, surgency, and the tendency to seek
stimulation and the company of others.
Agreeableness - a tendency to be compassionate
and cooperative rather than suspicious and
antagonistic towards others. Neuroticism - a
tendency to experience unpleasant emotions
easily, such as anger, anxiety, depression, or
vulnerability sometimes called emotional
instability. Some scholarly works refer to the
Big Five as the Five-Factor Model. These factors
are also referred to as the OCEAN or CANOE models
of personality. When scored for individual
feedback, they are frequently presented as
percentile scores, with the median at 50. For
example, a Conscientiousness rating in the 80th
percentile indicates a relatively strong sense of
responsibility and orderliness, whereas an
Extraversion rating in the 5th percentile
indicates an exceptional need for solitude and
quiet. On average, people high in Openness (for
example) are intellectually curious, open to
emotion, interested in art, and willing to try
new things. A particular individual, however, may
have a high overall Openness score and be
interested in learning and exploring new
cultures. Yet he might have no great interest in
art or poetry. Situational influences also exist,
as even extroverts may occasionally need time
away from people.
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WHAT IS A PERSONALITY DISORDER?
Generally speaking, people with a personality
disorder have difficulty getting along with
others. The nature of their interpersonal
difficulty tends to define which personality
disorder they may have.
The general DSM criteria for diagnosing a
personality disorder are as follows an enduring
pattern of pervasive, inflexible behavior which
causes either distress or dysfunction. The
dysfunction must be manifest in at least two of
the followings areas cognition, affectivity,
interpersonal relations, or impulse control.
Often, personality disorders cause as much or
more distress in the lives of others as they do
in their own lives. Personality disorders seldom
see the problem as being with themselves.
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Personality Disorders are coded on AXIS II
WHY ?
Personality disorders, unlike most of the Axis I
disorders we have studied thus far, do NOT stem
from debilitating reactions to stress or loss or
trauma. Rather, they stem largely from the
gradual development of inflexible and distorted
behavior patterns that result in persistently
maladaptive ways of perceiving, thinking about
and relating to the world. Personality disorders
are seen as different enough from the other Axis
I disorders so that they are coded separately.
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Little is known about prevalence rates and causal
factors associated with personality disorders.
WHY?
Misdiagnosis is more likely than with other
disorders because criteria are not mutually
exclusive.
High levels of comorbidity
They are less amenable to study
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CAUSAL FACTORS
TEMPRAMENT an inborn disposition to react a
certain way to environmental stimuli- predisposes
certain individuals to develop certain traits
disorders.
PARENTAL PSYCHOPATHOLOGY ineffective, poor
parenting as a predisposing factor.
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THREE CLUSTERS OF DISORDERS

• CLUSTER A characterized by odd, eccentric,
  unusual behavior (Paranoid, Schizoid
  Schizotypal)
• CLUSTER B characterized by dramatic, emotional,
  dramatic, and erratic behavior (Borderline,
  Histrionic, Narcissistic, Antisocial)
• CLUSTER C Anxious, fearful, constricted
  behavior (Obsessive compulsive, Avoidant,
  Dependent)

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SEE TABLE 11.1 ON PAGE 378 IN TEXT. IT IS AN
EXCELLENT SUMMARY OF ALL PERSONALITY DISORDERS.
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CLUSTER A PERSONALITY DISORDERS
Paranoid Personality Disorder characterized by
suspiciousness and general mistrust of others and
their motives. They tend to be rather angry and
hold grudges and they do not forgive insults or
wrongs which they perceive as having been done
to them. They have few close friends because they
never confide in others or let others get to know
them. They are generally not liked by others.
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Schizoid Personality Disorder characterized by
a pervasive pattern of detachment and withdrawal
from social relations and an inhibited or
constricted range of affect. They tend to be
loners or hermits, who seem to not only lack
friends but also any need for friendships.
Schizotypal Personality Disorder characterized
by oddness and social discomfort. They are
extremely introverted and also exhibit
distortions in their thinking and perceptual
experiences (similar to but less than
schizophrenics).
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CLUSTER B DISORDERS
Histrionic Personality Disorder characterized
by dramatic, colorful, seductive, attention
seeking behavior. Generally more likeable
superficially but also irritable and stormy in
relationships. Text says equally common in men
women but that is not my experience.
Narcissistic Personality Disorder -
characterized by grandiosity and exaggerated self
importance. Preoccupied with self promotion
attention seeking lack capacity for empathy.
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Antisocial Personality Disorder characterized
by lack of moral or ethical standards inability
to follow rules shameless manipulation of
others and history of conduct problems as a
child. Often end up in prison or in trouble with
legal system.
Borderline Personality Disorder A therapist's
nightmare. Good example in movie Fatal
Attraction. Impulsiveness, stormy anger, chronic
feelings of boredom. Given to self mutilation
(cutting). Frequent suicide attempts or
gestures.
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CLUSTER C DISORDERS
Avoidant Personality Disorders - characterized
by extreme sensitivity to rejections, very
anxious and insecure in relationships. Hangs
around the fringes of groups. Desires
relationships but too fearful to join in.
Dependent Personality Disorders characterized
by difficulty in becoming autonomous afraid to
be alone overly reliant on others in
relationships. Very indecisive. Sometimes never
seem to leave parents home.
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Obsessive-Compulsive Personality Disorder not
to be confused with OCD (the Anxiety Disorder)-
characterized by excessive concern with rules or
orderliness perfectionistic, rigid and cant
relax. Indecisive, cant have enough information
to act quickly or with spontaneity.
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Be sure to look at Table 11.2 on page 383 as it
gives a nice summary of how each disorder looks
with regard to the Big Five Personality factors.
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TREATMENT OF PERSONALITY DISORDERS

• Generally very difficult to treat, partly because
  they dont see themselves as having a problem
  (problem perceived to be others) and they dont
  seek treatment.
• Medications sometimes used for comorbid
  conditions (e.g. depression in borderlines).
• Dialectic Behavior Therapy developed by M.
  Linehan has shown promise with borderlines. This
  approach combines CBT, group rx, and
  interpersonal skill training.
• CBT is of some limited value.
• Empathy training for antisocials and drug rx used
  antisocials in prison settings.

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THE END