Personality Disorders, 4A Flashcards
Personality Disorders and DSM-IV Axis II
Personality disorders are a category of mental disorders characterized by enduring patterns of inner experience and behavior that deviate from cultural expectations.
In the DSM-IV (1994) and its text revision in 2000, personality disorders were classified on Axis II along with intellectual disabilities.
The purpose of separating Axis II was to increase clinical and research attention to personality disorders.
Personality disorders are characterized by pervasive and inflexible patterns of behavior that cause distress or impairment and are not due to another disorder, drugs, or intoxication.
The categorization and understanding of personality disorders in the DSM-IV were not necessarily based on empirical personality theories.
Cluster A Personality Disorders
Cluster A personality disorders are characterized by odd or eccentric behavior.
Paranoid personality disorder involves paranoia, mistrust of others, irrational suspicions, reluctance to confide, and holding grudges.
Schizoid personality disorder is characterized by detachment from interpersonal relationships, emotional coldness, indifference to praise or criticism, and a preference for solitary activities.
Schizotypal personality disorder involves distortions in thinking, feelings, and perceptions, such as ideas of reference, magical thinking, and perceptual illusions, as well as discomfort in social situations and suspicions.
Cluster B Personality Disorders
Cluster B personality disorders are characterized by dramatic, emotional, and erratic behavior.
Antisocial personality disorder is characterized by a lack of empathy and remorse, disregard for others, failure to conform to norms or laws, impulsivity, deceitfulness, irresponsibility, and disregard for safety.
Histrionic personality disorder involves an excessive need for approval, a desire to be the center of attention, shallow and over-dramatic emotions, and an inflated view of relationships.
Narcissistic personality disorder is characterized by an inflated sense of self-importance, a sense of entitlement, a need for attention and admiration, fantasies of success, arrogance, and a lack of empathy.
Borderline personality disorder involves unstable personal relationships, frantic efforts to avoid abandonment, identity disturbances, feelings of emptiness or worthlessness, self-harming behaviors, and impulsivity.
Cluster C Personality Disorders
Cluster C personality disorders are characterized by anxious or fearful behavior.
Avoidant personality disorder involves social inhibition, fear of rejection and criticism, low self-worth, and a reluctance to engage in new things due to fear of embarrassment.
Dependent personality disorder is characterized by a persistent psychological dependence on others, a lack of confidence in taking responsibility, and a tendency to agree with others and seek out new relationships.
Obsessive-compulsive personality disorder involves a preoccupation with orderliness, rules, moral codes, excessive devotion to work, inflexibility, and overly conscientiousness.
Personality Disorders and the Big Five
The continuity hypothesis suggests that there is no clear boundary between normal personality traits and personality disorders, and disorders represent an exaggeration of traits seen in the general population.
The Big Five model of personality (openness, conscientiousness, extraversion, agreeableness, neuroticism) has been used to understand the relationship between personality disorders and traits.
Conceptual profiles have been developed to describe how strongly each facet or trait of the Big Five is expected to correlate with each personality disorder based on diagnostic criteria or associated features.
McCrae et al. (2001) found modest to moderate correlations between personality disorder measures and Big Five facet scores, suggesting that the profiles may indicate the risk but not the diagnosis of a personality disorder.
There may be a need to revise the current diagnostic classification system for personality disorders to improve validity and better align with empirical personality models.
Suggestions for DSM-5: Dimensional Approach
Widiger, Costa, and McCrae (2002) proposed a dimensional approach for personality disorders in DSM-5.
The first step would be to assess the individual’s personality facet profile using a measure such as the NEO-PI-R.
The second step would involve assessing personality-related social and occupational impairments and distress.
If the dysfunction and distress are clinically significant, a personality disorder diagnosis would be made.
It is important to determine if the individual’s profile matches the descriptor of a specific personality disorder category.
DSM-5 Section III: Emerging Measures and Models
DSM-5 retained all 10 personality disorders and clusters in the main diagnostic section.
However, an additional section called “Emerging Measures and Models” was introduced.
Criterion A in this section focuses on the severity of impairments in self and interpersonal functioning, including identity, self-direction, empathy, and intimacy.
Criterion B assesses one or more pathological personality trait domains or facets using the “Maladaptive Trait Model” developed by Krueger et al. (2012).
The personality disorders included in this section are Borderline PD, Obsessive-Compulsive PD, Avoidant PD, Schizotypal PD, Antisocial PD, Narcissistic PD, and PD - Trait Specified.
Dissociative Identity Disorder (DID)
According to DSM-5, Dissociative Identity Disorder (DID) is a mental disorder characterized by the presence of two or more distinct identities or personalities.
DID can also be diagnosed as Dissociative Amnesia, Depersonalization/Derealization Disorder, or Other Specified/Unspecified Dissociative Disorder.
Key features include amnesia for prior or recent events, distress, and functional impairment.
The disorder is not attributed to substances, cultural practices, or imaginative play.
Features and Observations of DID
Reports of severe childhood sexual or physical abuse are commonly associated with DID.
Patients with DID tend to be highly suggestible.
Clustering of cases has been observed geographically and by therapist.
The prevalence of DID has increased over time, with reports becoming more extreme.
Multiple personalities in DID can range from a few alters to over 100, including animals.
Post-Traumatic Model suggests that dissociation is a response mechanism to escape trauma, becoming a coping strategy for future stress.
Socio-Cognitive Model proposes that symptoms of DID emerge as a product of therapy and suggestibility plays a role.
Controversies and Conclusions on DID
The causes and validity of DID remain topics of debate.
Some argue that DID was a brief fad that lacked acceptance in the scientific community.
Criticisms have been raised regarding the failure of DSM-5 to meet criteria for a valid diagnosis.
Evidence suggests a link between dissociative disorders, trauma, and specific neural mechanisms.
Experimental manipulations, hypnosis, and leading questions have been shown to reveal apparent hidden selves or past life identities in psychologically healthy individuals.
Transcripts of therapy sessions with famous cases, such as “Sybil,” suggest that the multiple personality narrative was imposed.
Further research is needed to better understand the nature and underlying mechanisms of DID.
