Personality Disorders, Mental Health, and Physical Health

personality disorders

configurations of traits that are socially undesirable and taken to extremes that can create severe problems

what is the purpose of the DSM (Diagnostic and Statistical Manual)

makes diagnosis more objective, insurance billing

How are personality orders defined?

1. Unusually extreme personality attributes

2. Problematic (for the person: anxiety, depression, confusion)

3. Affect social relationships and interactions

4. Stable over time (can begin in childhood or adolescence and are difficult to change with therapy)

5. Ego-syntonic (symptoms are seen as normal and valued aspects of personality by the person with the disorder)

How did the old system classify major personality disorders?

10 major disorders in 3 clusters

1. Cluster A: odd and eccentric patterns of thinking

2. Cluster B: impulsive and erratic patterns of behavior

3. Cluster C: anxious and avoidant emotional styles

How does the new system classify major personality disorders?

six major disorders, no clusters (schizotypal, narcissistic, antisocial, borderline, avoidant, OCPD)

*more useful to think in terms of basic beliefs (cognitive-behavioral therapy to change beliefs)

Describe schizotypal personality disorder

extremely odd thoughts, strange ideas, unconventional behavior, superstitious beliefs, difficulty in close relationships

slightly more common in men

Describe narcissistic personality disorder (NPD)

belief that one is superior, expects and needs recognition from others, expects special treatment and feels entitled, lack of empathy

difficult or impossible to treat

Describe antisocial personality disorder

illegal activities, impulsive and risky behaviors, irritable, aggressive, irresponsible, problems caused to others do not bother them

associated with low economic status and urban settings

much more common in men

Describe Borderline Personality Disorder (BPD)

Hallmark symptom: emotional instability, emotional emptiness

suicide attempts are common along with self-mutilation and self-harm

identity disturbance, difficulty with interpersonal relationships

most severe personality disorder

much more common in women

Describe avoidant personality disorder

expects the worst from others, need constant reassurance of uncritical acceptance, active inhibition of emotional expression, deep cravings for affection and social acceptance

Describe Obsessive-Compulsive Personality Disorder (OCPD)

bound by rituals and rules, severely judgmental of others, lacks a sense of proportion, workaholism, inability to throw things away

can by ego-syntonic, not the same as obsessive-compulsive disorder

The “Bad Five”

New way of organization according to DSM-5

1. Negative affectivity

2. Detachment

3. Antagonism

4. Disinhibition

5. Psychoticism

How does the DSM-5 diagnose disorders?

1. Assess whether personality functioning is seriously impaired and rate the degree of dysfunction

2. Assess whether at least one of the defined types of personality disorder is present

3. Assess degree of the five maladaptive personality traits

Pathologizing

treating someone differently due to a diagnosis (should we refrain from punishing socially undesirable, illegal, or immoral behavior because people suffer from antisocial personality disorder?)

describing behavior as the result of mental illness is problematic

Is labeling productive with personality disorders?

It can be useful and is necessary, but can be misleading, limit understanding, and is not an explanation

How do we differentiate between normal and abnormal in personality disorders?

Disorders may be thought of as exaggerated versions of traits that are advantageous when in normal range (self-confident, proud → narcissism)

no sharp defining line

having a mild degree of a few characteristics does not imply having a disorder

Describe a healthy personality

complex, fully elaborated, and well-integrated psychological world

mostly positive, volitional, and adaptive self-concept; appropriately regulated emotional life; reciprocal and fulfilling relationships

Type A Personality

uptight, driven, highly strung

Type B Personality

easygoing, lower stress levels

Type C Personality

introverted, compliant, eager to please

Type D Personality

interaction of negative affectivity and social inhibition

How are personality and health related?

review of many studies suggests that a general set of characteristics increase individuals’ risk for multiple diseases (hostility, aggression, depression)

What health associations are related to the big 5 trait of openness?

lowers odds of diagnosis of multiple cardiovascular health associations

decreased risk of stroke, high blood pressure, and heart problems

How is conscientiousness related to physical health?

clear, positive relationship related to quality and length of life

related to behaviors that make good health more likely and better able to handle stress

live longer, engage in safe sex, greater use of task-focused coping

protective effect

How can personality be used in interventions to improve heath?

personality and health studies can inform approaches to treatment

measures of personality in health records can help identify patients at increased risk and help doctors more quickly inform personalized care