Personality Disorders

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Chapter 12

• Personality Disorders

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Personality Disorders

• Axis II in the DSM-IV
• Can be organized according to three clusters
• Cluster A Odd-eccentric personality disorders
• Characterized by symptoms that are consistent
  with a diagnosis of schizophrenia (e.g., flat
  affect, odd thought processes, paranoia). Unlike
  schizophrenia, these individuals are connected to
  reality
• Cluster B Dramatic-emotional personality
  disorders
• May be impulsive, emotionally intense,
  emotionally reactive, difficulty interpersonal
  relationships
• Cluster C Anxious-fearful personality disorders
• Characterized by avoidance, inhibition, anxiety,
  fears of evaluation and criticism.

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Specific Disorders within each Cluster

• Cluster A
• Paranoid distrust of others
• Schizoid avoids relationships, restricted
  emotion in relationships
• Schizotypal discomfort in relationships
• Cluster B
• Borderline affective instability in emotional
  relationships
• Antisocial disregard for others
• Narcissistic self-focused, craves attention
• Histrionic emotional, attention seeking
• Cluster C
• Avoidant feels inadequate, sensitive to
  criticism
• Dependent submissive, seeks caretakers
• Obsessive Compulsive need for perfection

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Personality Disorders

• An enduring pattern of inner experience and
  behavior that deviates markedly from the
  expectations of the individuals culture.
  Manifested through
• Cognition (i.e., ways of perceiving others and
  the self)
• Affectivity (i.e., intensity, lability of
  emotional response)
• Interpersonal functioning
• Impulse control
• Enduring pattern is inflexible and pervasive
  across many situations
• The enduring pattern leads to distress or
  impairment
• The pattern is stable and of long duration with
  its onset being traced to adolescence or early
  childhood

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Criticisms

• Little research on many of the personality
  disorders.
• May just be extreme versions of normal
  personality traits or may be extreme versions of
  Axis I disorders.
• Some personality disorders may simply be part of
  normal life transitions.
• Not chronic or stable. Personality is a poor
  description of these disorders.
• Too much overlap across disorders.
• Gender bias

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Cluster A Paranoid Personality Disorder

• A pervasive distrust and suspiciousness of others
  such that their motives are interpreted as
  malevolent. Indicated by four of the following
• Suspects, without sufficient basis, that others
  are exploitive, harming or deceiving him/her.
• Is preoccupied with unjustified doubts about the
  loyalty or trustworthiness of others.
• Is reluctant to confide in others because of fear
  the information can be used against him/her.
• Reads hidden demeaning or threatening meanings
  into benign remarks or events.
• Persistently bears grudges.
• Perceives attacks on his/her character that are
  not apparent to others.
• Has recurrent suspicions, without justification,
  regarding the fidelity of spouse or sexual
  partner.
• Paranoid Personality Disorder (premorbid) ?
  occurs prior to onset of schizophrenia.

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Schizoid Personality Disorder

• A pervasive pattern of detachment from social
  relationships and restricted range of emotions in
  interpersonal settings. Indicated by four of the
  following
• Neither desires nor enjoys close relationships,
  including being part of the 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.
• Schizoid (premorbid) ? occurs prior to the onset
  of schizophrenia.

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Schizotypal Personality Disorder

• 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. Indicated by five
  of the following
• Ideas of reference
• Odd beliefs or magical thinking
• Unusual perceptual experiences
• Odd thinking and speech
• 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.
• Schizotypal (premorbid) ? prior to the onset of
  schizophrenia

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Cluster C Avoidant Personality Disorder

• Pervasive pattern of social inhibition, feelings
  of inadequacy, and hypersensitivity to negative
  evaluation. Indicated by four of the following
• Avoids occupational activities that involve
  interactions with others because of fears of
  disapproval, criticism, etc.
• Unwilling to get involved with people unless
  certain of being liked.
• Shows restraint within intimate relationships due
  to fears of being shamed.
• Preoccupied with being criticized or rejected in
  social situations.
• Inhibited in new interpersonal situations because
  of feelings of inadequacy.
• Views self as socially inept, personally
  unappealing, or inferior to others.
• Reluctant to take personal risks or engage in new
  activities

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Avoidant Personality Disorder

• More severe than social anxiety disorder.
• May exist on a spectrum ranging from shyness to
  social anxiety disorder to avoidant PD.
• Presence of a comorbid avoidant personality
  disorder is a marker of more chronic course and
  non-remittance for some PDs (e.g., BPD).
• Different from Schizoid PD in that individuals
  with Avoidant PD want to be close to others.

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Dependent Personality Disorder

• Pervasive and excessive need to be taken care of
  that leads to submissive and clinging behavior
  and fears of separation. Indicated by five of the
  following
• Difficulty making everyday decisions without
  excessive advice
• Needs others to assume responsibility for major
  areas of life
• Difficulty expressing disagreement
• Difficulty initiating projects on his/her own
• Goes to excessive lengths to obtain nurturance
  and support from others, even to the extent of
  doing unpleasant things
• Feels uncomfortable or helpless when alone due to
  fears of being unable to care for oneself
• Urgently seeks another relationship as a source
  of care when another one ends
• Unrealistically preoccupied with fears of being
  left to take care of oneself

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Obsessive-Compulsive Personality Disorder

• Pervasive pattern of preoccupation with
  orderliness, perfectionism, and mental and
  interpersonal control, at the expense of
  flexibility, openness, and efficiency. Indicated
  by four of the following
• Preoccupied with details, rules, lists, order,
  etc.
• Shows perfectionism that interferes with task
  completion.
• Excessively devoted to work and productivity to
  the exclusion of leisure activities.
• Overconscientious and inflexible about matters of
  morality, ethics, or values.
• Unable to discard worn-out or worthless objects.
• Reluctant to delegate tasks.
• Adopts a miserly spending style both towards self
  and others
• Shows rigidity and stubbornness.