Personality Disorders and Stress: DSM-5 Frameworks and Treatments

Chapter 15: Personality Disorders

What is personality?

Personality is a unique and long-term pattern of inner experience and outward behavior.

Big Five Theory of Personality Suggests that personality consists of five broad "supertraits" or factors which are:

Openness to experience

Conscientiousness

Extraversion

Agreeableness

Neuroticism

Why are personality disorders difficult to diagnose?

They are hard to diagnose because they are enduring patterns, easy to misdiagnose, and raise issues of reliability and validity.

DSM-5 Categorical Approach

Classifies personality disorders into distinct categories based on specific criteria.

DSM-5 5-Factor Model

Alternative dimensional model in DSM-5 emphasizing personality traits across a continuum rather than strict categories.

"Dramatic" Personality Disorders

Antisocial Personality Disorder (APD

Characterized by a disregard for others' rights, impulsivity, and deceitfulness.

How do theorists explain APD

Often linked to genetic predispositions, brain differences, and early environmental factors.

Common treatments for APD?

Psychotherapy, cognitive-behavioral approaches; medications may help with symptoms like aggression.

Borderline Personality Disorder (BPD)

Instability in relationships, self-image, and emotions, with impulsive behavior.

How do theorists explain BPD?

Combination of genetic vulnerability, early trauma, and dysfunctional family dynamics.

Treatments for BPD?

Dialectical behavior therapy (DBT), cognitive-behavioral therapy (CBT), sometimes medications for mood or anxiety symptoms.

Histrionic Personality Disorder

Excessive attention-seeking, emotionality, and dramatic behavior.

How do theorists explain it?

Often linked to early reinforcement of dramatic or seductive behaviors.

Treatments?

Psychotherapy focused on self-awareness and healthier ways of seeking attention; sometimes CBT.

Narcissistic Personality Disorder

Grandiosity, need for admiration, and lack of empathy.

How do theorists explain it narcissistic?

Possible early parental overvaluation or neglect, combined with personality vulnerabilities.

Treatments for NPD

Psychotherapy, often long-term, focusing on empathy development and self-esteem regulation

Anxious" Personality Disorders

Dependent Personality Disorder

Excessive reliance on others, difficulty making decisions independently

How do theorists explain it?

Early experiences of parental overprotection or discouragement of autonomy

Treatments?

psychotherapy, especially CBT; assertiveness training; gradual independence-building exercises

Obsessive-Compulsive Personality Disorder (OCPD

Preoccupation with order, perfection, and control at the expense of flexibility.

How do theorists explain it?

Often linked to early reinforcement of rigid, perfectionist behaviors.

Treatments?

Psychotherapy (CBT), stress management, flexibility training; sometimes medications for anxiety.

"Odd" Personality Disorders (Cluster A)

Paranoid Personality Disorder

Distrust and suspicion of others without sufficient basis.

How do theorists explain it?

May involve early trauma, genetic predisposition, or maladaptive thinking patterns.

Treatments?

Psychotherapy focusing on building trust and coping strategies; therapy may be challenging due to suspicion.

Schizoid Personality Disorder

Detachment from social relationships and limited emotional expression.

How do theorists explain it?

Genetic or temperamental predispositions, possible early family environment factors.

Treatments?

Rarely seek therapy; psychotherapy may focus on social skills and emotional awareness.

Schizotypal Personality Disorder

Eccentric behavior, unusual thoughts, and discomfort in close relationships.

How do theorists explain it?

Genetic vulnerability, cognitive-perceptual distortions, and early environment influences.

Treatments?

Psychotherapy, social skills training, low-dose antipsychotic medications if necessary.

What is a key concern with personality disorder diagnoses?

Frequent lack of agreement among clinicians raises concerns about validity (accuracy) and reliability (consistency), and diagnoses can easily be overdone.

Chapter 6 Stress and Anxiety

stress

The process of appraising and responding to a threatening or challenging event.

What are the two parts of the stress process?

Appraisal: Evaluating how threatening or challenging an event is.

Response: How we react physically and psychologically to that event.

Physical Stress (Biological Response)

The body’s physiological reaction to a stressor, often described by the General Adaptation Syndrome (GAS).

General Adaptation Syndrome (GAS)**

Hans Selye's model describing the body's three-stage response to prolonged stress.

three phases of General Adaptation Syndrome

Alarm: The “fight-or-flight” response; body mobilizes resources.

Resistance: Body attempts to cope with the stressor and return to balance.

Exhaustion: Prolonged stress depletes resources, leading to fatigue or illness.

Cognitive Stress

Stress experienced when perceived demands of a situation outweigh perceived resources to handle it.

What are the two stages of cognitive stress appraisal?

First (Primary Appraisal): Evaluating whether an event is a threat, challenge, or harmless.

Second (Secondary Appraisal): Assessing our ability to cope with or control the situation.

How does stress relate to self and control?

Stress often arises from situations with potential negative consequences for the self that we believe we cannot control.

Stressors

Events or conditions that trigger stress responses.

what are the 3 types of stressors

Catastrophes: Unpredictable, large-scale events (e.g., natural disasters, war).

Significant Life Changes: Major transitions (e.g., loss, marriage, moving).

Daily Hassles: Everyday minor irritations (e.g., traffic, deadlines).

Stress and Psychological Disorders

Certain disorders in DSM-5 categorized as “Trauma and Stressor-Related Disorders,” including Acute Stress Disorder and Posttraumatic Stress Disorder (PTSD).

Stress and Physical (Psychophysiological) Disorders

Physical illnesses influenced by psychological stress (e.g., ulcers, hypertension).

DSM-5 Category: “Psychological Factors Affecting Medical Conditions.”

Acute Stress Disorder

Short-term reaction to traumatic stress, with symptoms lasting from 3 days to 1 month after the event.

Posttraumatic Stress Disorder (PTSD)**

Long-lasting distress following trauma; symptoms persist for more than 1 month and may appear months or years later.

Combat and Stress Disorders

PTSD and acute stress disorder can result from combat exposure; often called "shell shock" or "combat fatigue."

Disasters and Stress Disorders

Natural or accidental disasters (e.g., earthquakes, floods) often cause high rates of acute or posttraumatic stress disorders.

Victimization and Stress Disorders

People who experience assault, abuse, or terrorism are at increased risk of developing stress disorders.

Why do people develop Acute and Posttraumatic Stress Disorders?

Biological and genetic factors: Overactive stress pathways, inherited vulnerability.

Personality factors: Pessimism, poor coping skills, or preexisting anxiety.

Childhood experiences: Early trauma or neglect.

Social support: Lack of support increases risk.

Multicultural factors: Minority stress and cultural views of trauma.

Severity of trauma: The more severe or prolonged, the higher the risk.

Treatment for Stress Disorders

Common treatments include:

Cognitive Behavioral Therapy (CBT): Helps process and reframe traumatic memories.

Exposure Therapy: Gradual confrontation of trauma-related stimuli.

Eye Movement Desensitization and Reprocessing (EMDR): Combines exposure with guided eye movements.

Medication: Antidepressants or anti-anxiety drugs.

Group or Family Therapy: Builds support and understanding.

Generalized Anxiety Disorder (GAD)**

A disorder characterized by chronic, excessive, and uncontrollable worry about various aspects of life.

How is GAD connected to stress?

Prolonged stress can lead to heightened anxiety sensitivity and constant worry, key features of GAD.

Chapter 6 continued trauma

Dissociative Disorders

A group of disorders involving disruptions or discontinuity in consciousness, memory, identity, or perception — often linked to traumatic experiences.

What is the main feature of dissociative disorders?

They involve a disconnection between thoughts, memories, surroundings, actions, and identity — as if parts of the self become detached.

Dissociative Amnesia

Inability to recall important personal information, usually of a traumatic or stressful nature, that cannot be explained by ordinary forgetfulness.

What are the four types of dissociative amnesia?

Localized Amnesia: Loss of memory for events during a specific time period (e.g., right after trauma).

Selective Amnesia: Remembering some, but not all, events during a certain time.

Generalized Amnesia: Forgetting one’s entire life history, including identity.

Continuous Amnesia: Forgetting new events as they occur after the trauma.

Dissociative Fugue

A subtype of dissociative amnesia where individuals forget their personal identity and may travel or assume a new identity for hours, days, or longer.

What happens when a dissociative fugue ends?

The person often regains previous memories but loses memory of what happened during the fugue state.

Dissociative Identity Disorder (DID)**

Also known as Multiple Personality Disorder; involves two or more distinct identities or “subpersonalities” that take control of a person’s behavior at different times.

How do subpersonalities interact in DID?

Mutually Amnesic Relationships: Subpersonalities are unaware of each other.

Mutually Cognizant Patterns: Each subpersonality is aware of the others.

One-Way Amnesic Relationships: Some subpersonalities know about others, but not vice versa.

How do subpersonalities differ from each other?

They may have distinct names, ages, genders, abilities, memories, handwriting, physiological responses (like heart rate), and even allergies.

How common is DID?

It is rare but more recognized today; most cases are linked to severe childhood trauma, such as prolonged abuse.

How do theorists explain DID and other dissociative disorders?

Psychodynamic View: Dissociation is a defense mechanism to repress painful memories or conflicts.

Behavioral View: Dissociation is reinforced through escape from anxiety.

Cognitive View: Memory fragmentation due to stress or trauma.

Biological View: Brain activity differences between identities.

Treatment for Dissociative Amnesia and Fugue

Psychodynamic Therapy: Helps uncover and process repressed memories.

Hypnotherapy: Uses hypnosis to recover lost memories.

Drug Therapy: Barbiturates or truth serums may help calm and facilitate recall

Treatment for Dissociative Identity Disorder

Focuses on integrating the different subpersonalities into one unified self and processing underlying trauma.Phases:

Recognizing the disorder (establishing trust with each subpersonality).

Recovering memories (exploring trauma).

Integrating subpersonalities into a single identity.

Depersonalization-Derealization Disorder

Definition: A dissociative disorder marked by persistent or recurrent experiences of detachment from one’s body (depersonalization) or from surroundings (derealization).

What is depersonalization?

Feeling detached from one's own thoughts, body, or emotions — as if observing oneself from outside.

What is derealization?

Feeling as if one's surroundings are unreal, dreamlike, or distorted.

When is depersonalization-derealization disorder diagnosed?

When these experiences are persistent, cause distress, and are not due to substances or another medical condition.

How do theorists explain depersonalization-derealization disorder?

It may result from severe stress, trauma, or anxiety; theorists suggest it is a short-term escape from overwhelming experiences.

What treatments help dissociative disorders overall?

Trauma-focused psychotherapy

Hypnosis or EMDR (for trauma recall)

Integration therapy for DID

Grounding techniques for depersonalization

Supportive therapy and stress management

Gender

Refers to the state of being male, female, or another identity as defined by social, cultural, and psychological factors.

How is gender different from sex?

Sex: Refers to biological differences between males and females (chromosomes, anatomy, hormones).

Gender: Refers to identity, expression, and social roles related to being male, female, or other identities.

Biological Sex

The physical and biological attributes (such as genitalia and chromosomes XX or XY) that define someone as male or female.

Gender Identity

One’s personal sense of who they are — how they identify internally (e.g., male, female, both, neither).

Q: “Who do you think you are?” — how one aligns with or differs from social norms of gender.

Gender Expression

The external presentation of one's gender identity, through behavior, clothing, voice, or mannerisms (masculinity, femininity, or both).

Gender Roles

Societal norms and expectations dictating what behaviors and traits are appropriate or desirable for individuals based on their perceived sex.

Gender Dysphoria

A psychological condition marked by distress due to a discrepancy between one's assigned biological sex and experienced gender identity.

What are the common patterns of Gender Dysphoria identified in the DSM-5?

Female-to-Male Type: Born female but identify as male.

Male-to-Female, Androphilic Type: Born male, attracted to men, desire to live as women.

Male-to-Female, Autogynephilic Type: Born male, attracted to the idea of themselves as female.

What are the goals of treatment for Gender Dysphoria?

To reduce distress and help individuals achieve a sense of comfort with their gender through therapy, hormone therapy, or gender-affirming procedures.

Sexual Dysfunctions

Disorders in which individuals cannot respond normally in one or more phases of the sexual response cycle.

How common are sexual dysfunctions?

As many as 31% of men and 43% of women in the U.S. experience one at some point in their lives.

What are common emotional effects of sexual dysfunctions?

Sexual frustration, guilt, loss of self-esteem, and relationship or interpersonal problems.

Human Sexual Response Cycle

The sequence of physiological and emotional changes occurring during sexual activity.

what are the four phases to the human sexual response cycle

Desire

Excitement

Orgasm

Resolution

Which phases are most often affected by sexual dysfunctions?

The first three: Desire, Excitement, and Orgasm

Disorders of Excitement

Problems during the arousal phase, involving physical changes such as heart rate, muscle tension, and genital response.

What characterizes the excitement phase?

Increased blood flow, muscle tension, and lubrication (in women) or erection (in men).

What are the two main dysfunctions of the excitement phase?

Female Sexual Arousal Disorder (formerly “frigidity”)

Male Erectile Disorder (formerly “impotence”)

Disorders of Orgasm

Problems in the orgasm phase where sexual pleasure peaks and tension is released through muscle contractions in the pelvic region.

What are the three main orgasmic disorders?

Early Ejaculation

Delayed Ejaculation

Female Orgasmic Disorder

Q: How common is early ejaculation?

About 30% of men experience it at some point in their lives.