Personality Disorders

Chapter 13: Personality Disorders

1. Classification of Personality Disorders

  • Criteria Distinguishing Normal vs. Disordered Personality (Millon, 1986):
      - Self-defeating behavior leading to a vicious cycle that perpetuates troubled thinking and behavior.
      - Structural instability and fragility, resulting in 'cracking' under stress.
      - Rigid and inflexible responses to life tasks.

  • Normal Personality:
      - Successful adaptation involves having flexible solutions to life tasks.
      - According to Livesley et al. (1994), there are three life tasks:
        1. Forming stable, integrated, and coherent representations of self and others.
        2. Developing capacity for intimacy and positive interpersonal relationships.
        3. Engaging in pro-social and cooperative behaviors for adaptive functioning.
      - Personality Disorders occur when there is an adaptive failure to manage these life tasks.

2. Assessment of Personality Disorders

  • Clinical Interviews:
      - Challenge: Many personality disorders are egosyntonic (lack of insight).
      - 3rd Most Prevalent: Personality Disorder Not Otherwise Specified (PDNOS).

  • MMPI (Minnesota Multiphasic Personality Inventory):
      - PSY-5 Scales reflect:
        - Negative emotionality/neuroticism.
        - Lack of positive emotionality.
        - Aggressiveness.
        - Lack of constraint.
        - Psychoticism.
      - Useful in predicting symptoms of paranoid, schizotypal, narcissistic, and antisocial personality disorders.

  • Millon Clinical Multiaxial Inventory (MCMI-IV):
      - True/false self-report inventory with a 5th-grade reading level.
      - Measures:
        - 12 clinical personality scales (e.g., schizoid, avoidant, melancholic).
        - 3 severe personality pathology scales (schizotypal, borderline, paranoid).
      - Concerns:
        - Various measures differ in content leading to different results.
        - Cut-off points may overestimate the number of individuals meeting criteria for a personality disorder.

3. Personality Disorder Clusters

A. Odd/Eccentric Cluster

  1. Paranoid Personality Disorder:
       - Characteristics:
         - Suspiciousness of others, expecting mistreatment.
         - Reluctance to confide in others, blame others for issues.
         - Extremely jealous.
       - Prevalence and Comorbidity:
         - Occurs in approximately 0.5% of the population.
         - Comorbid with schizotypal, borderline, and avoidant personality disorders.

  2. Schizoid Personality Disorder:
       - Characteristics:
         - Lack of desire or enjoyment of social relationships.
         - Dull, aloof demeanor; rarely experiences strong emotions.
         - Indifference to praise and criticism, prefers solitary activities.
       - Prevalence: Less than 1%, more common in men.
       - Comorbid with schizotypal and avoidant personality disorders.

  3. Schizotypal Personality Disorder:
       - Characteristics:
         - Odd beliefs, magical thinking, recurrent illusions.
         - Suspiciousness and paranoid ideation.
         - Eccentric behavior and appearance.
       - Prevalence: Approximately 3%, more common among men.
       - Comorbid with borderline (33%) and avoidant personality disorders (59%).

B. Dramatic/Erratic Cluster

  1. Borderline Personality Disorder (BPD):
       - Characteristics:
         - Impulsivity and instability in relationships, mood, and self-image.
         - Erratic emotional responses; tendencies for self-harm and suicidal behaviors.
         - Mortality rate due to suicide is significant (10% die by suicide).
       - Prevalence: Ranges from 1 to 2% to approximately 6% in recent data.
       - Comorbid conditions include mood disorders, substance abuse, PTSD, and other personality disorders.

  2. Histrionic Personality Disorder:
       - Characteristics:
         - Overly dramatic, attention-seeking behaviors; use of physical appearance to attract attention.
         - Emotionally superficial, with an excessive need for approval.
       - Prevalence: 2 to 3%, more common among women and individuals who are separated/divorced.
       - Comorbid with depression and borderline personality disorder.

  3. Narcissistic Personality Disorder:
       - Characteristics:
         - Grandiose self-image; preoccupation with fantasies of success and admiration.
         - Lack of empathy, exploitive relationships, and feelings of entitlement.
       - Prevalence: Less than 1%, often comorbid with borderline personality disorder.

  4. Antisocial Personality Disorder:
       - Characteristics:
         - History of conduct disorder before age 15; pattern of anti-social behavior into adulthood.
         - Irritize and aggressive behavior without remorse for misdeeds.
       - Prevalence: 1-4%, higher in younger individuals, and associated with low socioeconomic status.
       - Often comorbid with substance use disorders.

C. Anxious/Fearful Cluster

  1. Avoidant Personality Disorder:
       - Characteristics:
         - Extreme sensitivity to criticism and rejection, leading to avoidance of social situations.
         - Belief of incompetence and inferiority, leading to higher levels of life impairment.
       - Prevalence: Approximately 2%, often comorbid with dependent personality disorder and anxiety disorders.

  2. Dependent Personality Disorder:
       - Characteristics:
         - Over-reliance on others for emotional and decision-making support.
         - View themselves as weak and others as powerful, leading to discomfort when alone.
       - Prevalence: Not clearly outlined, but comorbid with various anxiety disorders and depression.

  3. Obsessive-Compulsive Personality Disorder (OCPD):
       - Characteristics:
         - Preoccupation with orderliness, perfectionism, and control at the expense of flexibility.
         - Does not possess the obsessions and compulsions that characterize Obsessive-Compulsive Disorder (OCD).
       - Prevalence: 1-2%, often comorbid with OCD and depression.

4. Therapies for Personality Disorders

  • General Therapeutic Approaches:
      - Psychodynamic therapy aims to understand and alter the underlying childhood problems causing the disorder.
      - Cognitive Behavioral Therapy (CBT) can help in schema therapy to change dysfunctional attitudes.

  • Therapies for BPD:
      1. Object-Relations Therapy:
         - Focuses on strengthening the client's ego and reducing splitting behavior.
       2. Dialectical Behavior Therapy (DBT):
         - Goals:
           1. Modulate emotional responses and behavior.
           2. Tolerate distress.
           3. Develop trust in one's thoughts and emotions.
           4. Address black-and-white thinking patterns and teach assertiveness skills.

  • Psychopathy:
      - Often resistant to treatment; therapeutic nihilism is prevalent in treatment approaches.
      - Psychopaths typically do not seek therapy and struggle to form trusting relationships with therapists.
      - Large doses of anti-anxiety medications may be used to mitigate hostility but are largely ineffective.

Conclusion

  • Personality disorders encompass a range of maladaptive behaviors and emotional responses that can significantly impair functioning. Their understanding requires a multifaceted approach, including classification, assessment, and treatment strategies. The characteristics, prevalence, and implications of various disorders provide a framework for future research and therapeutic practices.