6. Personality disorders Flashcards
Personalities
Personality refers to enduring patterns of thinking and behaviour that define the person and distinguish him/her from others. A person’s characteristic manner of thinking, feeling, behaving and
relating to others that has been evident since young adulthood and
is evident throughout almost everyday of adult life
What are personalities patterns of?
– expressing emotion
– thinking about ourselves and other people – i.e. our representations
What does personality facilitate?
Personality usually facilitates interactions with others – but patterns of behavior and emotion can bring the person into conflict with others
Abnormal/dysfunctional personality
• Dysfunctional personality marked by rigidity/inflexibility, narrow range of responses
• Impacting on identity and self direction and interpersonal relationships (empathy and intimacy)
– May bring a person into conflict with others; exacerbate conflict
– Impede connectedness
– Undermine problem resolution
Healthy or adaptive personality
Healthy or adaptive personality marked by flexibility, variety in responses & capacity to adapt
Reliability of personality disorders
The personality disorders as diagnostic categories tend to lack reliability
– Limited evidence that they are discrete conditions
– Substantial overlap/comorbidity
– Gender bias
Descriptive categories of personality disorders
Categories are descriptive – they do not provide any insight into the aetiology of disorder
Criticisms of personality disorders
- categories are descriptive• Considerable heterogeneity within categories
- Many are ego-syntonic
General criteria for PD
• An enduring pattern of inner experience and behavior that deviates markedly from the expectations of the individual’s culture.
• Manifested in two (or more) of the following areas:
1. Cognition (i.e., ways of perceiving and interpreting self, other people, and events).
2. Affectivity (i.e., the range, intensity, lability, and appropriateness of emotional response).
3. Interpersonal functioning.
4. Impulse control.
Three clsuters of personality disorders
– Cluster A – social detachment, eccentric/odd
– Cluster B – emotional, erratic, dramatic
– Cluster C – anxious, fearful
Also included are:
– Personality change due to another medical condition
– Other specified personality disorder
– Unspecified personality disorder
The 10 PDS organised by cluster
• Cluster A – Schizoid Personality Disorder – Schizotypal Personality Disorder – Paranoid Personality Disorder • Cluster B – Borderline Personality Disorder – Histrionic Personality Disorder – Narcissistic Personality Disorder – Antisocial Personality Disorder • Cluster C – Avoidant Personality Disorder – Obsessive Compulsive Personality Disorder – Dependent Personality Disorder
Paranoid Personality Disorder: Diagnostic Criteria
A A pervasive distrust and suspiciousness of others such that their motives are interpreted as
malevolent
- Suspects, without sufficient basis, that others are exploiting, harming, or deceiving him or
her. - Is preoccupied with unjustified doubts about the loyalty or trustworthiness of friends or
associates. - Is reluctant to confide in others because of unwarranted fear that the information will be
used maliciously against him or her. - Reads hidden demeaning or threatening meanings into benign remarks or events.
- Persistently bears grudges (i.e., is unforgiving of insults, injuries, or slights).
- Perceives attacks on his or her character or reputation that are not apparent to others and
is quick to react angrily or to counterattack. - Has recurrent suspicions, without justification, regarding fidelity of spouse or sexual
partner.
B Does not occur exclusively during the course of schizophrenia, a bipolar disorder or
depressive disorder with psychotic features, or another psychotic disorder and is not
attributable to the physiological effects of another medical condition.
Schizoid Personality Disorder: Diagnostic Criteria
A A pervasive pattern of detachment from social relationships and a restricted range of expression of emotions in interpersonal settings
- Neither desires nor enjoys close relationships, including being part of a
family. - Almost always chooses solitary activities.
- Has little, if any, interest in having sexual experiences with another
person. - Takes pleasure in few, if any, activities.
- Lacks close friends or confidants other than first-degree relatives.
- Appears indifferent to the praise or criticism of others.
- Shows emotional coldness, detachment, or flattened affectivity.
B Does not occur exclusively during the course of schizophrenia, a bipolar
disorder or depressive disorder with psychotic features, another psychotic
disorder, or autism spectrum disorder and is not attributable to the physiological
effects of another medical condition.
Schizotypal Personality Disorder: Diagnostic Criteria
A. A pervasive pattern of social and interpersonal deficits marked by acute discomfort with, and reduced capacity for, close relationships as well as by cognitive or perceptual distortions and eccentricities of behavior
- ideas of reference (excluding delusions of reference)
- odd beliefs or magical thinking that influences behavior and is inconsistent with subcultural norms
(e.g., superstitiousness, belief in clairvoyance, telepathy, or “sixth sense“ - unusual perceptual experiences, including bodily illusions
- odd thinking and speech (e.g., vague, circumstantial, metaphorical, overelaborate, or
stereotyped) - suspiciousness or paranoid ideation
- inappropriate or constricted affect
- behavior or appearance that is odd, eccentric, or peculiar
- lack of close friends or confidants other than first-degree relatives
- excessive social anxiety that does not diminish with familiarity and tends to be associated with
paranoid fears rather than negative judgments about self
B. Does not occur exclusively during the course of schizophrenia, a bipolar disorder or
depressive disorder with psychotic features, another psychotic disorder, or autism spectrum
disorder.
PD distinguished from psychosis
Psychosis (i.e. Schizophrenia) is characterised by a number of other symptoms which may include paranoia, ideas of reference, social withdrawal
– Positive symptoms: hallucinations and delusions
– Negative symptoms of reduced affectivity, poverty of thought, avolition, amotivation, anhedonia
– Disorganised thinking, speech and behaviour
Antisocial Personality Disorder:
Diagnostic Criteria
A. There is a pervasive pattern of disregard for and violation of the rights of others occurring since age 15 years
- failure to conform to social norms with respect to lawful behaviors as indicated by
repeatedly performing acts that are grounds for arrest - deceitfulness, as indicated by repeated lying, use of aliases, or conning others for personal
profit or pleasure - impulsivity or failure to plan ahead
- irritability and aggressiveness, as indicated by repeated physical fights or assaults
- reckless disregard for safety of self or others
- consistent irresponsibility, as indicated by repeated failure to sustain consistent work
behavior or honor financial obligations - lack of remorse, as indicated by being indifferent to or rationalizing having hurt, mistreated,
or stolen from another
B. The individual is at least age 18 years.
C. There is evidence of Conduct Disorder with onset before age 15 years.
D. The occurrence of antisocial behavior is not exclusively during the course of
Schizophrenia or a Manic Episode.
Psychopathy distinguished from antisocial behaviour
• Cleckley (1976) distinguished between 2 groups of symptoms, which Hare (1998) argues differentiate between psychopathy and
antisocial behaviour
• Psychopathy is argued to consist of both emotional/interpersonal traits and social deviance – see below
• The diagnostic criteria for ASPD capture mainly the “Social Deviance” factor
Borderline Personality Disorder
A. A pervasive pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsivity beginning by early adulthood and present in a variety of contexts
- frantic efforts to avoid real or imagined abandonment. Note: Do not include suicidal or selfmutilating
behavior covered in Criterion 5. - a pattern of unstable and intense interpersonal relationships characterized by alternating
between extremes of idealization and devaluation - identity disturbance: markedly and persistently unstable self-image or sense of self
- impulsivity in at least two areas that are potentially self-damaging (e.g., spending, sex,
substance abuse, reckless driving, binge eating). Note: Do not include suicidal or selfmutilating
behavior covered in Criterion 5. - recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior
- affective instability due to a marked reactivity of mood (e.g., intense episodic dysphoria,
irritability, or anxiety usually lasting a few hours and only rarely more than a few days) - chronic feelings of emptiness
- inappropriate, intense anger or difficulty controlling anger (e.g., frequent displays of
temper, constant anger, recurrent physical fights) - transient, stress-related paranoid ideation or severe dissociative symptoms
Histrionic Personality Disorder
A. A pervasive pattern of excessive emotionality and attention seeking, beginning by early adulthood and present in a variety of contexts,
- is uncomfortable in situations in which he or she is not the center of
attention - interaction with others is often characterized by inappropriate sexually
seductive or provocative behavior - displays rapidly shifting and shallow expression of emotions
- consistently uses physical appearance to draw attention to self
- has a style of speech that is excessively impressionistic and lacking in
detail - shows self-dramatization, theatricality, and exaggerated expression of
emotion - is suggestible, i.e., easily influenced by others or circumstances
- considers relationships to be more intimate than they actually are
Narcissistic Personality Disorder
A. A pervasive pattern of grandiosity (in fantasy or behavior), need for admiration, and lack of empathy, beginning by early adulthood and present in a variety of contexts
- has a grandiose sense of self-importance (e.g., exaggerates achievements and
talents, expects to be recognized as superior without commensurate achievements) - is preoccupied with fantasies of unlimited success, power, brilliance, beauty, or ideal
love - believes that he or she is “special” and unique and can only be understood by, or
should associate with, other special or high-status people (or institutions) - requires excessive admiration
- has a sense of entitlement, i.e., unreasonable expectations of especially favorable
treatment or automatic compliance with his or her expectations - is interpersonally exploitative, i.e., takes advantage of others to achieve his or her
own ends - lacks empathy: is unwilling to recognize or identify with the feelings and needs of
others - is often envious of others or believes that others are envious of him or her
- shows arrogant, haughty behaviors or attitudes
Avoidant Personality Disorder
A. A pervasive pattern of social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation,
beginning by early adulthood and present in a variety of contexts
- avoids occupational activities that involve significant interpersonal contact,
because of fears of criticism, disapproval, or rejection - is unwilling to get involved with people unless certain of being liked
- shows restraint within intimate relationships because of the fear of being
shamed or ridiculed - is preoccupied with being criticized or rejected in social situations
- is inhibited in new interpersonal situations because of feelings of
inadequacy - views self as socially inept, personally unappealing, or inferior to others
- is unusually reluctant to take personal risks or to engage in any new
activities because they may prove embarrassing
Avoidant personality disorder distinguished from social anxiety
- Some argue there is no difference between Social Anxiety and AvPD
- Others argue that AvPD is characterised by more pervasive and diffuse avoidance
Why is AvPD characterised by more pervasive and diffuse avoidance?
– Persons with SAD tend to avoid particular situations/activities that may involve scrutiny – may have friends/close relationships but avoid ‘performance’ situations
– Tend to be comfortable with persons whom they are close to/familiar
– Persons with AvPD tend to be concerned about intimate/close relationships more generally
– Closeness/intimacy and relationships may be avoided
Dependent Personality Disorder
A. A pervasive and excessive need to be taken care of that leads to submissive and clinging behavior and fears of separation, beginning by early adulthood and present in a variety of contexts
- has difficulty making everyday decisions without an excessive amount of advice and
reassurance from others - needs others to assume responsibility for most major areas of his or her life
- has difficulty expressing disagreement with others because of fear of loss of support
or approval. Note: Do not include realistic fears of retribution. - has difficulty initiating projects or doing things on his or her own (because of a lack
of self-confidence in judgment or abilities rather than a lack of motivation or energy) - goes to excessive lengths to obtain nurturance and support from others, to the point
of volunteering to do things that are unpleasant - feels uncomfortable or helpless when alone because of exaggerated fears of being
unable to care for himself or herself - urgently seeks another relationship as a source of care and support when a close
relationship ends - is unrealistically preoccupied with fears of being left to take care of himself or herself
Obsessive Compulsive PD
A. A pervasive pattern of preoccupation with orderliness, perfectionism, and mental and interpersonal control, at the expense of flexibility, openness, and efficiency
- is preoccupied with details, rules, lists, order, organization, or schedules to the extent that
the major point of the activity is lost - shows perfectionism that interferes with task completion (e.g., is unable to complete a
project because his or her own overly strict standards are not met) - is excessively devoted to work and productivity to the exclusion of leisure activities and
friendships (not accounted for by obvious economic necessity) - is overconscientious, scrupulous, and inflexible about matters of morality, ethics, or values
(not accounted for by cultural or religious identification) - is unable to discard worn-out or worthless objects even when they have no sentimental
value - is reluctant to delegate tasks or to work with others unless they submit to exactly his or her
way of doing things - adopts a miserly spending style toward both self and others; money is viewed as
something to be hoarded for future catastrophes - shows rigidity and stubbornness
Obsessive Compulsive PD comarpred to OCD
- Rigidity/rule bound behaviours are prescribed to because of the belief that they are the best person to control things
- Often do not describe subjective feelings of anxiety
- Having control does not relieve distress/anxiety as in OCD
- OCPD is typically ego-syntonic, whereas OCD is usually ego-dystonic
