Personality Disorders

Lecture 6

what is personality?

consistent behavioural responses across situations based on ways of coping, behaviours, and traits

develop in childhood and often stabilise in adulthood

5 factor model of personality

1. extravert

2. anxious

3. neurotic

4. agreeableness

5. openness

HEXACO model added 6. honestly/humility

people fall on a continuum for all these personality factors

personality trait

differences among individuals in typical tendency to behave, think or feel in some conceptually related ways across time and situations

personality disorders

maladaptive personality traits resulting in maladaptive ways of perceiving and interacting with the world

impair functioning of cognition, affectivity, interpersonal functioning, and impulse control

not usually a reaction to stress, but rather a gradual development

DSM-5 approach to classification of PDs

separate personality disorders based on personality disorder clusters:

• Cluster A

• Cluster B

• Cluster C

Cluster A Disorder definition

display unusual behaviours such as distrust, suspiciousness, detachments and are quicker to react with anger and less likely to forgive

Cluster A disorders

1. Paranoid Personality Disorder

2. Schizoid Personality Disorder

3. Schizotypal Personal Disorder

Paranoid Personality Disorder

suspicious of others and find hidden meanings in ordinary remarks

tend to blame others for personal issues

1.5% mean point prevalence

men = women

less studied

Schizoid Personality Disorder

difficulties forming social relationships and lack interest in forming these relationships

seen by others as cold and distant

view self as self-sufficient

largely genetic

1.2% point prevalence

men > women

not well-studies

Schizotypal Personality Disorder

interpersonal deficits with peculiar thought patterns, perceptions, and speech which interfere with communication and social interaction (similar to schizophrenia but less severe)

experience psychosis under extreme stress

Cluster B disorder definition

dramatic, erratic, and inconsistent behaviour with inflated self-esteem, rule breaking, and high emotional reactions

Cluster B Disorders

1. Antisocial Personality Disorder

2. Borderline Personality Disorder

3. Narcissistic Personality Disorder

4. Histrionic Personality Disorder

Antisocial personality disorder

characterised by lack of moral/ethical development, deceitfulness, conduct problems, aggressiveness, and impulsivity

genetic/psychological components

1-3% point prevalence

men>women

Borderline Personality Disorder

characterised by impulsivity, instability in relationships and mood, quick emotion/mood changes and suicidal thoughts/behaviours

increased sensitivity to rejection (from parental styles?)

1.4% point prevalence

men=women

Narcissistic Personality Disorder

characterised by grandiosity, entitlement, preoccupation with receiving attention, self-promoting, and lack of empathy

some types are masking low self-esteem

<1% point prevalence

men>women

Histrionic Personality Disorder

characterised by self-dramatisation, concern with attractiveness, tendency to irritability and anger, and often misread relationships are more than they are

not included in the DSM-5 alternative model

1.2% point prevalence

women>men

Cluster C Disorder Definition

disorders characterised by fear of criticism, disapproval, or rejection and try to avoid negative feedback in personal and professional situations

shy and reserved in social situations but they want a personal connection despite struggling with it

Cluster C Disorders

1. Avoidant personality disorder

2. obsessive-compulsive PD

3. dependent personality disorder

Avoidant Personality Disorder

characterised by hypersensitivity to rejection or social derogation, shyness/insecurity in social situations and initiating relationships, and views self as socially inept, unappealing, or inferior

comorbid with social anxiety disorder

2.5% prevalence

women>men

Obsessive-Compulsive Personality Disorder

characterised by excessive concern with order, rules, and trivial details (perfectionism), lack of expressiveness/warmth, and difficulty relaxing and having pleasure

not tied to difficulties in relationships with others and not OCD

2.1% prevalence

men>women

Dependent Personality Disorder

characterised by difficulty separating from relationships, discomfort at being alone, neglect needs to be alone, and indecisiveness without advice from others

1% point prevalence

women > men

PDs not included in the DSM-5 Alternative Model

due to not enough evidence to support these:

1. Paranoid PD

2. Schizoid PD

3. Histrionic PD

4. Dependent PD

Common risk factors for PDs

two main risk factors:

1. heritability

2. odds ratio

also…

3. psychodynamic theory

4. cognitive theory

Heritability of PDs

Many PDs share genetic vulnerability (vulnerability to one means vulnerability to others)

estimated heritability (likelihood to develop if parent has PD) ranges from .64 to .78

Odds ratio of PDs

children experiencing abuse/neglect are more likely to develop personality disorders

odds ration shows how many times more likely they are to develop the PD if they’ve been abused in childhood compared with not

e.g. children experiencing abuse are 18.21% more likely to develop Narcissistic PD

Psychodynamic theory of PDs

Freud emphasises childhood as most important = root of the PD

How childhood experiences shape behaviour as an adult (must reconsider these beliefs in therapy)

Cognitive theory of PDs

negative cognitions contribute to PDs

must become aware of these negative beliefs and challenge these maladaptive cognitions in e.g. CBT

Treatments for PDs

1. Medication (antipsychotics & antidepressants)

2. CBT

3. Dialectal Behaviour Therapy

note: PDs only see small to moderate results with these treatments but helps reduce suicide risk/self-harm

Dialectal Behavioural Therapy

most validated treatment for BPD

similar to CBT but involves dialogue between patient and therapist that focuses on awareness of symptoms

combines empathy and acceptance with social skills, emotional regulation, emotional awareness in non-judgemental way

notice and sit in emotions rather than being impulsive

improve self-esteem and impulsivity

Issues with traditional DSM-5 classification of PDs

3 major issues leading to high rate of misdiagnosis (most of all disorders):

1. PDs are not stable over time (99% do not have the same diagnosis over time)

2. Symptom thresholds are arbitrary (except for schizotypal, PDs exist on a continuum so cut-off points lead to missed diagnoses making diagnostic tool impractical)

3. PDs are highly comorbid with other PDs (a lot of PD symptoms overlap leading to many with amPD meeting criteria for another)

Alternative DSM-5 Model for Personality Disorders

Personality Inventory of DSM-5 reduced number of disorders and diagnosed PDs based on extreme ends of personality scales/trait measurements

after determining significant functional impairment, clinicians determine PD diagnosis by considering the personality traits which explain those difficulties in functioning through

1. Personality Trait Domains

2. Personality Facets (of domains)

scores on continuum of both domains and facets guide diagnosis

Personality Trait Domains

1. Negative Affectivity (vs. Emotional Stability)

2. Detachment (vs. Extraversion)

3. Antagonism (vs. Agreeableness)

4. Disinhibition (vs. Conscientiousness)

5. Psychoticism

Negative Affectivity Facets

1. Anxiousness

2. Emotional lability

3. Hostility

4. Preservation

5. Separation insecurity

6. Submissiveness

Detachment Facets

1. Anhedonia

2. Depressivity

3. Intimacy avoidance

4. Suspiciousness

5. Withdrawal

6. Restricted affectivity

Antagonism Facets

1. Attention seeking

2. Callousness

3. Deceitfulness

4. Grandiosity

5. Manipulativeness

Disinhibition Facets

1. Distractibility

2. Impulsivity

3. Irresponsibility

4. (Lack of) rigid perfectionism

5. Risk taking

Psychoticism

1. Eccentricity

2. Cognitive perceptual dysregulation

3. Unusual beliefs and experiences

Benefits of the Alternative Model of PDs (AMPD)

• personality traits are more stable than personality disorders

• more information in trait scores than diagnosis

• PDs are related to other psychological disorders

• personality traits robustly predict important outcomes like happiness, quality of friendships, etc.

• clinicians rate the personality trait profiles as easier to discuss with clients and more helpful for treatment planning

• allows for cross-cultural evaluations