Ch. 13 Personality Disorders

Question 1

Personality Disorder

Answer 1

PERSONALITY DISORDER – display an enduring, rigid pattern of inner experience and outward behavior that impairs their sense of self, emotional experiences, goals, capacity for empathy, and/or capacity for intimacy.

• Among the most difficult psychological disorders to treat.
• COMORBIDITY – suffering from more than one disorder simultaneously.
• DSM-5 identifies 10 personality disorders in 3 groups:
  
  • ODD or ECCENTRIC – paranoid, schizoid, and schizotypal personality disorders.
  • DRAMATIC – antisocial, borderline, histrionic, and narcissistic personality disorders.
  • ANXIOUS – avoidant, dependent, and obsessive-compulsive personality disorders.
  • Suspiciousness, self-absorption, anxiety, and depression are prominent features in almost all 10 personality disorders.
• DSM’s listing of 10 distinct personality disorders is called a CATEGORICAL APPROACH. Like a light switch that is either on or off, this kind of approach assumes that:
  
  • (1) problematic personality traits are either present or absent
  • (2) a personality disorder is either displayed or not displayed
  • (3) a person who suffers from a personality disorder is not markedly troubled by personality traits outside of that disorder.
• These assumptions are frequently contradicted in clinical practice with so much overlap that clinicians often find it difficult to distinguish one disorder from another,
• As a result, clinicians prefer a DIMENSIONAL APPROACH – They believe that personality disorders differ more in degree than in type of dysfunction and should instead be classified by the severity of personality traits rather than by the presence or absence of specific traits – where each trait is seen as varying along a continuum extending from non-problematic to extremely problematic.

Question 2

“ODD” Personality Disorders

Answer 2

“ODD” PERSONALITY DISORDERS – paranoid, schizoid, schizotypal personality

• These disorders typically have odd or eccentric behaviors similar to but not as extensive as those seen in schizophrenia, suspiciousness, withdrawal, peculiar ways of thinking. related to schizophrenia.
• People with an odd-cluster personality disorder often qualify for an additional diagnosis of schizophrenia or have close relatives with schizophrenia.
  
  • People with these disorders rarely seek treatment.
• PARANOID PERSONALITY DISORDER – A personality disorder marked by a pattern of deep distrust of other people and are suspicious of others’ motives.
  
  • Because they believe that everyone intends them harm, they shun close relationships. Their trust in their own ideas and abilities can be excessive.
  • Quick to challenge the loyalty or trustworthiness of acquaintances, people with paranoid personality disorder remain cold and distant.
  • Although inaccurate and inappropriate, their suspicions are not usually delusional; the ideas are not so bizarre or so firmly held as to clearly remove the individuals from reality.
  • 4.4% of adults experience this disorder, which is apparently more common in men than in women.
  • People with paranoid personality disorder do not typically see themselves as needing help.
  • EXPLANATIONS:
    
    • Psychodynamic theories, the oldest of these explanations, trace the pattern to early interactions with demanding parents, particularly distant, rigid fathers and over-controlling, rejecting mothers. (You will see that psychodynamic explanations for almost all the personality disorders begin the same way – with repeated mistreatment during childhood and lack of love.)
    • Cognitive-behavioral theorists – people with paranoid personality disorder generally hold broad maladaptive assumptions, such as “People are evil” and “People will attack you if given the chance”.
    • Biological theorists – paranoid personality disorder has genetic causes. if one twin was excessively suspicious, the other had an increased likelihood of also being suspicious; might also be the result of common environmental experiences.
  • TREATMENT:
    
    • Cognitive- behavioral therapy:
      
      • Behavioral side – therapists help clients to master anxiety-reduction techniques and to improve their skills at solving interpersonal problems.
      • Cognitive side – guide the clients to develop more realistic interpretations of other people’s words and actions and to become more aware of other people’s points of view.
  • Antipsychotic drug therapy seems to be of limited help.
• SCHIZOID PERSONALITY DISORDER – A personality disorder featuring persistent avoidance of social relationships and little expression of emotion. They genuinely prefer to be alone (as opposed to fearing social interaction while longing for contact with others).
  
  • Clients often described as “loners,” make no effort to start or keep friendships, take little interest in having sexual relationships, and even seem indifferent to their families.
  • Focus mainly on themselves and are generally unaffected by praise or criticism.
  • They rarely show any feelings, expressing neither joy nor anger.
  • They seem to have no need for attention or acceptance; are typically viewed as cold, humorless, or dull; and generally succeed in being ignored.
  • Men are slightly more than women.
  • EXPLANATIONS:
    
    • psychodynamic theorists, object relations theorists – Has its roots in an unsatisfied need for human contact. parents have been unaccepting or even abusive of their children.
      
      • Whereas people with paranoid symptoms react to such parenting chiefly with distrust, those with schizoid personality disorder are left unable to give or receive love. They cope by avoiding all relationships
    • Cognitive-behavioral – people with schizoid personality disorder suffer from deficiencies in their thinking. Unable to pick up emotional cues from others, they simply cannot respond to emotions.
  • TREATMENT:
    
    • Remain emotionally distant from the therapist, seem not to care about their treatment, and make limited progress at best.
    • Cognitive-behavioral:
      
      • Cognitive side, presenting clients with lists of emotions to think about or having them write down and remember pleasurable experiences.
      • Behavioral side, therapists have sometimes had success teaching social skills to such clients, using role-playing, exposure techniques.
    • Group therapy – somewhat useful for social contact.
    • Drug therapy seems to offer limited help.
• SCHIZOTYPAL PERSONALITY DISORDER – A personality disorder characterized by extreme discomfort in close relationships, very odd patterns of thinking and perceiving, and behavioral eccentricities.
  
  • Anxious around others, they seek isolation Some feel intensely lonely. The disorder is more severe than the paranoid and schizoid.
  • SYMPTOMS:
    
    • ideas of reference – beliefs that unrelated events pertain to them in some important way
    • bodily illusions – such as sensing an external “force” or presence, having extrasensory abilities.
  • EXPLANATIONS:
    
    • Schizotypal and Schizophrenia – similar factors may be at work in both disorders.
    • Psychodynamic theorists – Schizotypal symptoms, are often linked to family conflicts and to psychological disorders in parents.
    • Biological theorists – Researchers have linked schizotypal personality disorder to some of the same biological factors found in schizophrenia.
      
      • However, Around 2/3 of people with schizotypal personality disorder also suffer from major depressive disorder or bipolar disorder so the disorder is NOT exclusively tied to schizophrenia.
      • May have a genetic basis.
  • TREATMENTS:
    
    • Primary approach is focusing on the need to help these clients “reconnect” with the world and recognize the limits of their thinking and their powers.
    • Increase positive social contacts, ease loneliness, reduce overstimulation, and help the individuals become more aware of their personal feelings.
    • Cognitive-behavioral: – Teach clients to evaluate their unusual thoughts or perceptions objectively and to ignore the inappropriate ones
      
      • Ask them to sum up what it is they are trying to say. Specific behavioral methods, such as speech lessons, social skills training, and tips on appropriate dress and manners, have sometimes helped clients learn to blend in better with and be more comfortable around other people
    • Antipsychotic drugs have helped some people, usually by reducing certain of their thought problems.

Question 3

“Dramatic” Personality Disorders

Answer 3

DRAMATIC PERSONALITY DISORDERS – antisocial, borderline, histrionic, narcissistic

• Behaviors of people with these problems are so dramatic, emotional, or erratic that it is almost impossible for them to have relationships that are truly giving and satisfying.
• ANTISOCIAL PERSONALITY DISORDER – A personality disorder marked by a general pattern of disregard for and violation of other people’s rights.
  
  • Aside from substance use disorders, this is the disorder most closely linked to adult criminal behavior.
  • Onset prior to 15, including truancy, running away, cruelty to animals or people, and destroying property.
  • Lack a moral conscience
  • Lie repeatedly.
  • Recklessness is another common trait: little regard for their own safety or for that of others, even their children.
  • Self-centered, trouble maintaining close relationships; gaining personal profit at the expense of others; pain or damage they cause seldom concerns them
  • 35% of people in prison.
  • Disorder declines after age of 40.
  • Higher rates of alcoholism and other substance use disorders than the rest of the population.
  • antisocial personality disorder and substance use disorders both have the same cause, such as a deep-seated need to take risks.
  • EXPLANATIONS:
    
    • Psychodynamic theorists – begins with an absence of parental love during infancy, leading to a lack of basic trust; children – the ones who develop antisocial personality disorder – respond to the early inadequacies by becoming emotionally distant, and they bond with others through the use of power and destructiveness.
      
      • People with this disorder are more likely than others to have had significant stress in their childhoods, particularly in such forms as family poverty, family violence, child abuse, and parental conflict or divorce.
    • Cognitive-behavioral:
      
      • Behavioral side – suggest that antisocial symptoms may be learned through principles of conditioning, particularly modeling.
        
        • Evidence shows a high rate of antisocial personality disorder found among the parents and close relatives of people with this disorder.
        • Also point to operant conditioning to help explain this disorder – parents may give (reward) in to restore peace. Without meaning to, they may be teaching the child to be stubborn and perhaps even violent.
      • Cognitive side – People with antisocial personality disorder often hold attitudes that trivialize the importance of other people’s needs, likely because they don’t have the capacity to recognize other people’s points of view.
    • Biological factors – Genetic research suggests that the disorder may be linked to particular genes.
    • Lower activity of serotonin – impulsivity and aggression have been linked to low serotonin.
    • Underarousal may enable people with the disorder to readily tune out threatening or emotional situations and so be unaffected by them.
      
      • This takes away an important skill needed to learn from negative life experiences.
      • This underarousal may explain why they take more risks and seek more thrills.
    • Connecting the biological factors** – antisocial personality disorder is ultimately related to poor functioning by a brain circuit, which may produce chronic low reactions to stress by the two brain-body stress pathways – the **sympathetic nervous system pathway** and the **hypothalamic-pituitary-adrenal – leading, in turn, to a state of low arousal, weak stress reactions, poor empathy for the pain of others, and other features of antisocial personality disorder.
  • TREATMENT:
    
    • Typically ineffective – Most of those in therapy have been forced to participate.
• BORDERLINE PERSONALITY DISORDER – A personality disorder characterized by repeated instability in interpersonal relationships, self-image, and mood and by impulsive behavior.
  
  • People with borderline personality disorder swing in and out of very depressive, anxious, and irritable states that last anywhere from a few hours to a few days or more.
  • Their emotions seem to be always in conflict with the world around them. They are prone to bouts of anger, which sometimes result in physical aggression and violence.
  • Becoming one of the more common conditions seen in clinical practice.
  • 85% with this also experience COMORBIDITY, such as major depressive disorder or an eating disorder.
  • Many try to hurt themselves as a way of dealing with their chronic feelings of emptiness, boredom, and identity confusion.
  • 75% attempt suicide.
  • 10% actually die of suicide
  • Form intense, conflict-ridden relationships.
  • May come to idealize another person’s qualities after just a brief first encounter.
  • Violate the boundaries of relationships.
  • Quickly feel rejected and become furious when their expectations are not met; recurrent fears of impending abandonment.
  • Cut themselves or carry out other self-destructive acts to prevent partners from leaving.
  • Dramatic identity shifts. Because of this unstable sense of self, their goals, aspirations, friends, and even sexual orientation may shift.
  • May also occasionally have a sense of dissociation, or detachment.
  • 5.9% of the adult population.
  • 75% women.
  • EXPLANATION:
    
    • Psychodynamic View – Fear of abandonment tortures so many people with borderline personality disorder.
      
      • Object relations theorists, for example, propose that an early lack of acceptance by parents may lead to a loss of self-esteem, increased dependence, and an inability to cope with separation.
      • Parents of many people with borderline personality disorder did indeed neglect or reject them during their childhood, verbally abuse them, or otherwise behave inappropriately. The childhoods were often marked by multiple parent substitutes, divorce, death, or traumas such as physical or sexual abuse.
    • Biological view – People may inherit a biological predisposition.
      
      • Close relatives of those with the disorder are five times more likely than the general population to have the same disorder.
      • Those who are most impulsive – individuals who attempt suicide or are very aggressive toward others – have lower brain serotonin activity, which is linked repeatedly to depression, suicide, aggression, and impulsivity.
      • Abnormal brain structure activity reflect dysfunction (that is, poor interconnectivity) throughout that entire brain circuit.
    • Sociocultural view – Cultures that change rapidly. leaves many of its members with problems of identity.
    • Integrative View: Made up of the Biosocial and Developmental Psychopathological views.
      
      • Biosocial explanation – the disorder results from a combination of internal forces (for example, difficulty identifying and controlling one’s emotions, social skill deficits, abnormal neurotransmitter activity) and external forces (for example, an environment in which a child’s emotions are punished, ignored, trivialized, or disregarded)
      • Developmental Psychopathology view – adds details to the biosocial view, noting that the internal and external factors ALSO may intersect over the course of a person’s life.
        
        • Early parent−child relationships are particularly influential – children who experience early trauma and abuse and whose parents are markedly inattentive, uncaring, confusing, threatening, and dismissive are likely to enter adulthood with a disorganized attachment style – a severely flawed capacity for healthy relationships
        • Studies have found clear ties between poor parent−child attachments and the development of disorganized attachment styles and between disorganized attachment styles and borderline personality disorders.
        • Believe that central psychological deficit in borderline personality disorder is the person’s inability to MENTALIZE (people’s capacity to understand their own mental states and those of other people—that is, to recognize needs, desires, feelings, beliefs, and goals), meaning they can’t predict other people’s behavior or react to others in appropriate, trusting ways (i.e. they lack EMPATHY).
  • TREATMENTS:
    
    • Psychodynamic View – Traditional psychoanalytic therapy has not been effective. However, relational psychoanalytic therapy, in which therapists take a more supportive posture and focus primarily on the therapist−patient relationship (humanistic), have had some success.
    • Cognitive Behavioral View** – new-wave therapy called **DIALECTIC BEHAVIOR THERAPY (DBT)** is now considered the **treatment of choice with the most research support – A comprehensive treatment approach, which includes both individual therapy sessions and group sessions.
      
      • Also borrow heavily from the contemporary psychodynamic and humanistic approaches, placing the client–therapist relationship itself at the center of treatment interactions.
• HISTRIONIC PERSONALITY DISORDER (once called hysterical) – A personality disorder characterized by a pattern of excessive emotionality and attention seeking.
  
  • Always “on stage,” using theatrical gestures and mannerisms and grandiose language to describe ordinary everyday events.
  • Speech is actually scanty in detail and substance.
  • Constantly seeking approval and praise.
  • draw attention to themselves by exaggerating their physical illnesses or fatigue, behave very provocatively.
  • Obsess over how they look.
  • Exaggerate the depth of their relationships.
  • 1.8% of adults
  • males and females equally affected
  • EXPLANATION:
    
    • Psychodynamic View – Originally developed to help explain cases of hysteria
      
      • As children, people with this disorder had cold and controlling parents who left them feeling unloved and afraid of abandonment. To defend against deep-seated fears of loss, the children learned to behave dramatically, inventing crises that would require other people to act protectively.
    • Cognitive-behavioral – look at the lack of substance and extreme suggestibility that people with histrionic personality disorder have. They see these individuals as becoming less and less interested in knowing about the world at large because they are so self-focused and emotional.
      
      • Patients believe they are helpless to care for themselves, and so they constantly seek out others who will meet their needs.
    • Sociocultural – society encouraged women to hold on to childlike dependency throughout their development. The vain, dramatic, and selfish behavior of the histrionic personality may actually be an exaggeration of femininity as our culture once defined it.
  • TREATMENT:
    
    • In all of these approaches, therapists ultimately aim to help the clients recognize their excessive dependency, find inner satisfaction, and become more self-reliant.
• NARCISSISTIC PERSONALITY DISORDER – A personality disorder marked by a broad pattern of grandiosity, need for admiration, and lack of empathy.
  
  • Convinced of their own great success, power, or beauty, they expect constant attention and admiration from those around them, expecting others to recognize them as superior.
  • Often make favorable first impressions, yet they can rarely maintain long-term relationships.
  • Seldom interested in the feelings of others. They may not even be able to empathize. Many take advantage of other people to achieve their own ends,
  • React to criticism or frustration with rage. Others may react with cold indifference. And still others experience a sense of inadequacy, pessimism, or depression.
  • 6.2% of adults
  • 75% men
  • EXPLANATION:
    
    • Psychodynamic View – Again propose that the problem begins with cold, rejecting parents.
      
      • Object relations theorists – the psychodynamic theorists who emphasize relationships – interpret the grandiose self-image as a way for these people to convince themselves that they are totally self-sufficient and without need of warm relationships with their parents or anyone else.
      • Research has found that children who are neglected and/or abused or who lose parents through adoption, divorce, or death are at particular risk for the later development of narcissistic personality disorder.
    • Cognitive-behavioral – theorists propose that narcissistic personality disorder may develop when people are treated too positively rather than too negatively in early life.
    • Sociocultural – theorists see a link between narcissistic personality disorder and “eras of narcissism” in society. They suggest that family values and social ideals in certain societies periodically break down, producing generations of young people who are self-centered and materialistic and have short attention spans.
      
      • Western cultures in particular, which encourage self-expression, individualism, and competitiveness, are considered likely to produce such generations of narcissism.
      • NOT supported by research despite the large following.
      • SELFIES – no relationship at all between how many selfies people post and how high they score on narcissism personality scales.
        
        • Selfies are an inevitable by-product of “technology-enabled self-expression.” Rutledge contends that selfie behaviors are simply confusing to individuals of a predigital generation.
  • TREATMENT: Narcissistic personality disorder is one of the most difficult personality patterns to treat because the clients are unable to acknowledge weaknesses.
    
    • The clients who consult therapists usually do so because of a related disorder such as depression.

Question 4

“Anxious” Personality Disorders

Answer 4

ANXIOUS PERSONALITY DISORDERS – avoidant, dependent, and obsessive-compulsive

• People with these patterns typically display anxious and fearful behavior.
• AVOIDANT PERSONALITY DISORDER – A personality disorder characterized by consistent discomfort and restraint in social situations, overwhelming feelings of inadequacy, and extreme sensitivity to negative evaluation.
  
  • They are so fearful of being rejected that they give no one an opportunity to reject them – or to accept them either.
  • At the center of this withdrawal lies not so much poor social skills as a dread of criticism, disapproval, or rejection.
  • Believe themselves to be unappealing or inferior to others.
  • Exaggerate the potential difficulties of new situations, so they seldom take risks or try out new activities.
  • They usually have few or no close friends, though they actually yearn for intimate relationships, and frequently feel depressed and lonely.
    
    • Different from SCHIZOID PERSONALITY DISORDER that actually desires to be alone.
  • 40-60% of people in the United States consider themselves to be shy.
  • Avoidant personality disorder is similar to social anxiety disorder, and many people with one of these disorders also experience the other
    
    • social anxiety disorder primarily fear social circumstances.
    • personality disorder tend to fear close social relationships.
  • 2.4 % of adults have avoidant personality disorder
  • Men as frequently as women.
  • Childhood shyness – usually just a normal part of their development.
  • EXPLANATION:
    
    • Psychodynamic View – Focus mainly on the general feelings of shame and insecurity. Some trace the shame to childhood experiences such as early bowel and bladder accidents. If parents repeatedly punish or ridicule a child for having such accidents, the child may develop a negative self-image. This may lead to the child’s feeling unlovable throughout life and distrusting the love of others.
    • Cognitive-behavioral – harsh criticism and rejection in early childhood may lead certain people to assume that others in their environment will always judge them negatively. These people come to expect rejection, misinterpret the reactions of others to fit that expectation, discount positive feedback, and generally fear social involvements.
      
      • Recalling their childhood, patients’ descriptions supported both the psychodynamic and cognitive-behavioral predictions.
      • They fail to develop effective social skills, a failure that helps maintain the disorder.
  • TREATMENTS: Beyond building trust, therapists tend to treat people with avoidant personality disorder much as they treat people with social anxiety disorder and other anxiety disorders
    
    • Psychodynamic View – help clients recognize and resolve the unconscious conflicts.
    • Cognitive-behavioral View:
      
      • Cognitive side – help the individuals change their distressing beliefs and thoughts, carry on in the face of painful emotions, and improve their self-image .
      • Behavioral side – They also provide social skills training and exposure treatments that require people to gradually increase their social contacts.
    • Biological view – Antianxiety and antidepressant drugs are sometimes useful in reducing the social anxiety.
• DEPENDENT PERSONALITY DISORDER – A personality disorder characterized by a pattern of clinging and obedience, fear of separation, and an ongoing pervasive, excessive need to be taken care of.
  
  • Need assistance with even the simplest matters and have extreme feelings of inadequacy and helplessness.
  • Cannot make the smallest decision for themselves.
  • They feel completely helpless and devastated when a close relationship ends, and they quickly seek out another relationship to fill the void.
  • Many cling persistently to relationships with partners who physically or psychologically abuse them.
  • Seldom disagree with others and allow even important decisions to be made for them.
  • 1% of population
  • Equally common in men and women
  • EXPLANATION:
    
    • Psychodynamic View – Similar to those for depression.
      
      • Freudian theorists argue, for example, that unresolved conflicts during the oral stage of development can give rise to a lifelong need for nurturance
      • Object relations theorists say that early parental loss or rejection may prevent normal experiences of attachment and separation, leaving some children with fears of abandonment.
      • Other psychodynamic theorists suggest that, to the contrary, many parents of people with this disorder were over involved and overprotective, thus increasing their children’s dependency, insecurity, and separation anxiety.
    • Cognitive-behavioral:
      
      • Behavioral side – Parents of people with dependent personality disorder unintentionally rewarded their children’s clinging and “loyal” behavior, while at the same time punishing acts of independence.
        
        • Alternatively, some parents’ own dependent behaviors may have served as models for their children.
      • Cognitive side – There are two maladaptive attitudes:
        
        • (1) “I am inadequate and helpless to deal with the world”
        • (2) “I must find a person to provide protection so I can cope.”
        • Dichotomous (black-andwhite) thinking may also play a key role: “If I am to be dependent, I must be completely helpless, ” or “If I am to be independent, I must be alone.” Such thinking prevents sufferers from making efforts to be autonomous.
  • TREATMENT:
    
    • Therapist must help patients accept responsibility for themselves.
    • Because the domineering behaviors of a spouse or parent may help foster a patient’s symptoms, some clinicians suggest couple or family therapy as well, or even separate therapy for the partner or parent.
• OBSESSIVE-COMPULSIVE PERSONALITY DISORDER – A personality disorder marked by such an intense focus on orderliness, perfectionism, and control that the person loses flexibility, openness, and efficiency.
  
  • When faced with a task, may become so focused on organization and details that they fail to grasp the point of the activity.
  • DIFFERENT From OCD (but closely related)
    
    • Those with OCD do NOT want their symptoms
    • Those with OC Personality Disorder embrace their symptoms.
  • Because they are so afraid of making mistakes, they may be reluctant to make decisions.
  • Tend to be rigid and stubborn.
  • Live by a strict personal code and use it as a yardstick for measuring others.
  • Have trouble expressing affection.
  • Stingy with their time or money.
  • 7.9% of the adult population
  • White, educated, married, and employed people receiving the diagnosis most often.
  • Men are twice as likely as women.
  • Oddly, people with the personality disorder are more likely to suffer from either major depressive disorder, an anxiety disorder, or a substance use disorder than from OCD. No specific link to OCD has been found.
  • EXPLANATION:
    
    • Psychodynamic View – Similar to those for depression.
      
      • Freudian theorists – suggest that people with obsessive-compulsive personality disorder are anal retentive. That is, because of overly harsh toilet training during the anal stage, they become filled with anger, and they remain fixated at this stage. To keep their anger under control, they resist both their anger and their instincts to have bowel movements – this is not stupid At All.
    • Cognitive-behavioral – illogical thinking processes help keep it going. They point, for example, to dichotomous thinking, which may produce rigidity and perfectionism. Similarly, they note that people with this disorder tend to misread or exaggerate the potential outcomes of mistakes or errors.
  • TREATMENT – People with obsessive compulsive personality disorder do not usually believe there is anything wrong with them. They therefore are not likely to seek treatment unless they are also suffering from another disorder.
    
    • Psychodynamic View – Help clients recognize, experience, and accept their underlying feelings and insecurities, and perhaps take risks and accept their personal limitations.
    • Cognitive-behavioral therapists focus on helping the clients to change their dichotomous – “all or nothing” – thinking.
    • Biological – respond well to SSRIs, the serotonin enhancing antidepressant drugs

Question 5

Multicultural Factors

Answer 5

MULTICULTURAL FACTORS:

• According to the current criteria of DSM-5, a pattern diagnosed as a personality disorder must “deviate markedly from the expectations of the individual’s culture”.
• Given the importance of culture in this diagnosis, and given the enormous clinical interest in personality disorders, it is striking how little multicultural research has been conducted on these problems.
• The lack of multicultural research is of special concern with regard to BORDERLINE PERSONALITY DISORDER.
  
  • Convinced that gender and other cultural differences may be particularly important in both the development and diagnosis of this disorder.
  • 75% of all people who receive a diagnosis of borderline personality disorder are female.
    
    • HOWEVER, it may be that women are biologically more prone to the disorder or that diagnostic bias is at work, this gender difference may instead be a reflection of the extraordinary traumas to which many women are subjected as children.
    • As a result, borderline personality disorder should more properly be viewed and treated as a special form of posttraumatic stress disorder.
    • Given the childhood experiences that typically precede borderline personality disorder**, some multicultural theorists believe that the disorder may actually be a reaction to persistent feelings of marginality, powerlessness, and social failure. That is, the disorder **may be attributable more to social inequalities (including sexism, racism, or homophobia) than to psychological factors.
    • Hispanic American individuals qualified for a diagnosis of borderline personality disorder more often than white American or African American

Question 6

Better Way to Classify (Categorical vs. Dimensional)

Answer 6

BETTER WAY TO CLASSIFY:

• The current DSM-5 classification system defines such disorders by using categories – rather than dimensions – of personality.
• Many of today’s theorists believe that personality disorders differ more in degree than in type of dysfunction.
  
  • Therefore, they propose that the disorders should be classified by the severity of key personality traits (or dimensions) rather than by the presence or absence of specific traits.
  • Thus, People with a personality disorder would be those who display extreme degrees of several of these key traits – degrees not commonly found in the general population.

RANDO

DARK TRIAD – a trio of malicious traits that work together to produce socially offensive behaviors. traits—narcissism, psychopathy, and Machiavellianism.

• Those with all three traits are particularly self-absorbed and create serious problems for others.
• People who score high on Dark Triad rating scales may display a personality disorder, but more often, they experience little distress or impairment and function adequately, sometimes quite effectively, in the personal, social, and occupational realms.

The “Big Five” Theory of Personality and Personality Disorders

BIG 5 PERSONALITY TRAITS – neuroticism, extroversion, openness to experiences, agreeableness, conscientiousness

• Many proponents of the Big Five model have argued further that it would be best to describe all people with personality disorders as being high, low, or in between on the five supertraits and to drop the use of personality disorder categories altogether
  
  • Also, “Big Five ” consists of a number of subfactors. Anxiety and hostility, for example, are subfactors of the neuroticism factor, while optimism and friendliness are subfactors of the extroversion factor.

“Personality Disorder—Trait Specified”: DSM-5’s Proposed Dimensional Approach

• DSM-5’s proposed dimensional approach to personality disorders begins with the notion that people whose traits significantly impair their functioning should receive a diagnosis called PERSONALITY DISORDER – TRAIT SPECIFIED (PDTS).
  
  • Clinicians would also identify and list the problematic traits and rate the severity of impairment caused by them. According to the proposal, five groups of problematic traits would be eligible for a diagnosis of PDTS:
• Negative Affectivity – People who display negative affectivity experience (negative emotions) frequently and intensely.
• Detachment – withdraw from other people and social interactions.
• Antagonism – behave in ways that put them at odds with other people.
• Disinhibition – behave impulsively, without reflecting on potential future consequences.
• Psychotism – have unusual and bizarre sensory experiences.
• If a person is impaired significantly by any of the five trait groups, or even by just 1 of the 25 traits that make up those groups, he or she would qualify for a diagnosis of personality disorder—trait specified.

Alternative dimensional approach presented in DSM-5, a diagnostician would instead observe that Lucas is significantly impaired by several of the traits that characterize the negative affectivity trait group.

• He is, for example, greatly impaired by “separation insecurity.” This trait has prevented him from ever living on his own, marrying his girlfriend, disagreeing with his father, advancing at work, and broadening his social life.
• In addition, Lucas seems to be impaired significantly by the traits of “submissiveness, ” “anxiousness, ” and “depressivity.”
• Given this picture, his therapist might assign him a diagnosis of personality disorder—trait specified, with problematic traits of separation insecurity, submissiveness, anxiousness, and depressivity
• According to this dimensional approach, when clinicians assign a diagnosis of personality disorder—trait specified, they also must rate the degree of dysfunction caused by each of the person’s traits, using a five-point scale ranging from “little or no impairment” (Rating = 0) to “extreme impairment” (Rating = 4).
• Altogether, he would receive the following cumbersome, but informative, diagnosis:
  
  • Diagnosis: Personality Disorder—Trait Specified
    
    • Separation insecurity: Rating 4
    • Submissiveness: Rating 4
    • Anxiousness: Rating 3
    • Depressivity: Rating 3
    • Other traits: Rating 0
• This dimensional approach to personality disorders may indeed prove superior to DSM-5’s current categorical approach