3.5 CHAP 6 personality disorders

personality disorders

4 Dimensions from which personality and human behaviour are studied

Personal

Biological

Social

Functional

Social dimension

Focuses on social bases of behaviour.

Biological dimension

Focuses on organic bases of behaviour.

Functional dimension

Analyses the set of psychological properties (e.g. memory, learning, language,...) and their adaptation.

Personal dimension

It encompasses aspects of social, biological and functional dimensions in a congruent whole that explains the individual's behaviour.

We analyze an individual's personality in two ways:

• Holistically or by focusing on specific traits

• Through various theoretical approaches to personality

In everyday life, we understand personality as

• A scientific construct based on different types of behaviors that people perform daily.

• Studied through systematic observation of behavior.

• Studied in social situations where people feel free to act.

Main aims in the personality study

• Define personality characteristics individuals

• To analyze underlying psychological processes

• To define the causes that originate individual differences

Personality disorder

Pattern of characteristic thoughts, feelings, & behaviors that distinguish people from one another and that persist over time & across situations.

Healthy personality

• Ability to cope with the environment flexibly.

• Perceptions and typical behaviors foster increased personal satisfaction (SELF-EFFICIENCY)

(Un-healthy) Personality disorder

The usual way of being is unhealthy, pathological, or abnormal, because it is not the most frequent way of being (typical behaviors), or because it is not what is expected of the individual.

PD indicate in the way of being and behaving of the person as they affect

• The way individual thinks about him/herself and his/her relationships with others.

• Experiences emotions

• Interpersonal relationship

• The control of impulses

Two most important classification system for personality disorder

• Diagnostic and Statistical Manual of Mental Disorders (DSM)

  • developed by the American Psychiatric Association (APA).

• International Classification of Diseases (ICD)

  • developed by the World Health Organization (WHO).

According to DSM-5 personality disorder is

• An ongoing pattern of inner experience

• Behaviour that deviates markedly from the expectations of the subject's culture

• Is a pervasive and inflexible phenomenon that is stable over time

• Has its onset in adolescence or early adulthood

• Results in distress or impairment.

DSM PD cluster A

• Paranoid

• Schizoid

• Schizotypal

DSM PD cluster A characteristics

• They refer to traits that indicate oddity, eccentricity, social isolation and suspicion.

• People who show difficulties or lack of adequate styles of interpersonal relationships.

^Odd/Eccentric^

Paranoid

• 4 out of 7 features

• is a pattern of distrust and suspiciousness such that others’ motives are interpreted as malevolent.

• “distrust towards others”

Schizoid

• 4 out of 7 features

• is a pattern of detachment from social relationships and a restricted range of emotional expression.

• “prefer to be alone, & show little emotions, they do not care about relationships”

Schizotypal

• 5 out of 9 features

• is a pattern of acute discomfort in close relationships, cognitive or perceptual distortions, and eccentricities of behaviour.

• “characterised by weird behaviour, clothes, magical thinking. They often tend to have social anxiety because no ones wants to their friends, they feel special & unique”

DSM PD cluster B

Antisocial

Borderline

Histrionic

Narcissistic

DSM PD cluster B characteristics

• People who are exaggerated, emotional, variable and with poor impulse control.

• Individuals with difficulty in controlling emotions and relating to others.

• ^Dramatic, emotional, erratic^

Antisocial

• 5 out of 9 features

• is a pattern of disregard for, and violation of, the rights of others.

• “they have lack of empathy, & are very delinquent/rebel”

Borderline

• 5 out of 9 features

• Is a pattern of instability in interpersonal relationships, self-image, and affects, and marked impulsivity.

• “characterised by emotional instability, they are dramatic because they are overwhelmed by their own emotions".

• “I hate you, I love you”

Histrionic

• 5 out of 8 features

• is a pattern of excessive emotionality and attention seeking.

• “they wants to be the centre of attention, sexually provocative, “the influencer””.

Narcissistic

• 5 out of 9 features

• is a pattern of grandiosity, need for admiration, and lack of empathy.

• “they feel very superior”

DSM PD cluster C

Avoidant

Dependent

Obsessive-compulsive

DSM PD cluster C characteristics

• Anxious, fearful and perfectionist people.

• Focus on anxiety avoidance.

^Anxious, fearful^

Avoidant

• 4 out of 7 features

• is a pattern of social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation.

• they avoid social relationships because of low self-esteem, “I am inadequate” — they are very fearful of rejection, thus they avoid social relationships in order to avoid feelings of being rejected”.

Dependent

• 5 out of 8 features

• is a pattern of submissive and clinging behaviour related to an excessive need to be taken care of.

• I cant take decisions myself, I need someone to make them. It is characterised by the need of being dependent on others → the biggest fear is to be alone.

Obsessive-compulsive

• 4 out of 8 features

• is a pattern of preoccupation with orderliness, perfectionism, and control.

• “perfectionism, being on time, routines, structure”.

Personality change due to another medical condition

• is a persistent personality disturbance that is judged to be due to the direct physiological effects of a medical condition (e.g., frontal lobe lesion).

Other specified personality disorder and unspecified personality disorders (two situations)

1. the individual’s personality pattern meets the general criteria for a personality disorder, and traits of several different personality disorders are present, but the criteria for any specific personality disorder are not met.

2. the individual’s personality pattern meets the general criteria for a personality disorder, but the individual is considered to have a personality disorder that is not included in the DSM-5 classification (e.g., passive-aggressive personality disorder).

Concomitant personality disorders

• means that individuals often have more than one personality disorder at the same time.

Clusters

Refer to the grouping of personality disorders into three categories (A, B, and C), based on their shared traits:

• Cluster A: Odd or eccentric disorders (e.g., paranoid, schizoid, schizotypal).

• Cluster B: Dramatic, emotional, or erratic disorders (e.g., borderline, narcissistic, antisocial, histrionic).

• Cluster C: Anxious or fearful disorders (e.g., avoidant, dependent, obsessive-compulsive).

prevalence estimates of Cluster A disorders

affect 5.7% of the population.

prevalence estimates of Cluster B disorders

affect 1.5% of the population.

prevalence estimates of Cluster C disorders

affect 6.0% of the population.

prevalence estimates of Any personality disorder

affects 9.1% of the population.

• there is a frequent overlap between disorders from various clusters (A, B, and C).

General Personality Disorder

• The person exhibits a consistent, long-term pattern of thinking, feeling, and behaving that is significantly different from what their culture expects.

• must affect two or more areas:

  • Cognition (person perceives themselves, others, and events)

  • Affectivity (range intensity, and appropriateness of their emotional responses)

  • Interpersonal Functioning (how they interact with others)

  • Impulse Control (the ability to control urges or behaviour)

The enduring pattern of GPD

• is inflexible and pervasive across a broad range of personal and social situations.

• leads to clinically significant distress or impairment in social, occupational, or other important areas of functioning.

• stable and of long duration, and its onset can be traced back at least to adolescence or early adulthood.

• not better explained as a manifestation or consequence of another mental disorder.

• not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition (e.g., head trauma).

DSM – 5

Section III

• based on the damage caused by personality functioning and pathological personality traits.

• includes a personality-trait disorder which does not fit the diagnostic criteria for specific disorders.

PERSONALITY DISORDERS - SECTION III

GENERAL CRITERION

• Moderate to severe impairment in (interpersonal) personality functioning.

• One or more pathological personality traits.

• Relatively permanent and inflexible traits and impairment in functioning in different situations (social and personal).

• Relatively stable over time.

• Onset in adolescence or early adulthood.

• Not best explained by another mental disorder.

• Not attributable to addictive substances or medical illness.

• Not better understood by age (development) or socio-cultural environment.

PERSONALITY DISORDERS - SECTION III classification of A & B

A = personality disorder is defined by a typical impairment in personality functioning

B = personality disorder is defined by a characteristic pathological personality traits

ELEMENTS OF PERSONALITY FUNCTIONING IN SECTION III

• Self-functioning

•  Interpersonal functioning

Self-functioning involves 

 identity and self-direction

 interpersonal functioning involves

empathy and intimacy

The Level of Personality Functioning Scale (LPFS) (involved in CLASSIFICATION A)

(involved in CLASSIFICATION A)

• differentiate five levels of impairment, ranging from little or no impairment:

• healthy and adaptive functioning, level 0

• mild, level 1

• moderate, level 2

• severe, level 3

• extreme, level 4

The use of The Level of Personality Functioning Scale (LPFS)

global indicator of personality functioning

Criterion B: Pathological personality traits: five major domains

1. Negative affect

2. Detachment

3. Antagonism

4. Disinhibition

5. Psychoticism

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NÅR DRAR AMALIE PÅ DAGEN

• Negative mood (Negative affect)

• Avoids others (Detachment)

• Blames people (Antagonism)

• Acts without thinking (Disinhibition)

• Believes weird stuff (Psychoticism)

Negative affect

• number of traits 6 vs. Emotional Stability)

• Frequent and intense experiences of high levels of a wide range of negative emotions (e.g., anxiety, depression, guilt/ shame, worry, anger)

• their behavioural (e.g., self-harm) and interpersonal (e.g., dependency) manifestations.

• can be associated with BORDERLINE PD

Detachment

• number of traits 6

vs. Extraversion

• Avoidance of socio-emotional experience, including both withdrawal from interpersonal interactions, ranging from casual, daily interactions to friendships to intimate relationships

• restricted affective experience and expression, particularly limited hedonic capacity.

• can be associated with AVOIDANT PD

Antagonism

• number of traits 5

  vs. Agreeableness

• Behaviours that put the individual at odds with other people

• exaggerated sense of self-importance

• concomitant expectation of special treatment

• a callous antipathy toward others, encompassing both unawareness of others’ needs and feelings

• readiness to use others in the service of self-enhancement.

• can be associated with NARCISSISTIC PD

Disinhibition

• number of traits 5

  vs. Conscientiousness

• Orientation toward immediate gratification, leading to impulsive behavior

  driven by current thoughts, feelings, and external stimuli, without regard for past learning or consideration of future consequences.

• can be associated with OBSESSIVE-COMPULSIVE PD

Psychoticism

• number of traits 3

  vs. Lucidity

• Exhibiting a wide range of culturally incongruent odd, eccentric, or unusual behaviors and cognitions, including both process (e.g., perception, dissociation) and content (e.g., beliefs).

• can be associated with SCHIZOTYPAL PD