Personality Disorders

Overview of Personality

  • Personality: Uniquely expressed characteristics that influence behaviors, emotions, thoughts, and interactions.

  • Personality traits: Particular, predictable, flexible characteristics.

  • Personality disorder: An enduring, rigid pattern of inner experience and outward behavior that leads to significant problems and psychological pain for self and others.

Definition and Checklist of Personality Disorders (Part 1)

  • Checklist for Personality Disorder: An individual displays a long-term, rigid, and wide-ranging pattern of inner experience and behavior that results in dysfunction in at least two of the following realms:

    • Cognition: How the individual thinks about themselves and others.

    • Emotion: Emotional responses and how they are manifested.

    • Social interactions: How an individual interacts with others.

    • Impulsivity: Difficulty regulating impulses and behaviors.

  • The individual’s pattern is significantly different from those usually found in their culture.

  • Significant distress or impairment is experienced by the individual.

Characteristics of Personality Disorders (Part 2)

  • Symptoms generally persist for years.

  • Considered among the most challenging psychological disorders to treat.

  • Prevalence: Affect approximately 15 percent of the U.S. population at some point in their life.

  • Commonly associated with comorbidity.

DSM-5 Classification of Personality Disorders (Part 3)

  • The DSM-5 identifies ten personality disorders organized into three clusters:

    • Cluster A (Odd or eccentric behavior): Includes Paranoid, Schizoid, and Schizotypal personality disorders.

    • Cluster B (Dramatic, emotional, or erratic behavior): Includes Antisocial, Borderline, Narcissistic, and Histrionic personality disorders.

    • Cluster C (Anxious or fearful behavior): Includes Avoidant, Dependent, and Obsessive-Compulsive personality disorders.

  • Controversy: Some theorists challenge the DSM-5's categorical approach and propose alternatives.

Odd Personality Disorders

Cluster A Overview (Part 1)

  • The "odd" cluster includes the following personality disorders:

    • Paranoid personality disorder

    • Schizoid personality disorder

    • Schizotypal personality disorder

  • Individuals with cluster A disorders exhibit symptoms similar to, but not as extensive as, schizophrenia.

  • Few individuals seek treatment; success in treatment is limited.

Paranoid Personality Disorder (Part 2)

  • Characteristics: Deep distrust and suspicion of others; limited close relationships; cold and distant affect; excessive trust in own ideas and abilities; critical of others' weaknesses.

  • Prevalence: Experienced by about 4.4 percent of U.S. adults, more common in men.

Theoretical Explanations (Part 3)

  • Psychodynamic: Linked to patterns of early interactions with demanding parents.

  • Cognitive-behavioral: Associated with broad maladaptive assumptions about trust.

  • Biological: Possible genetic causes; however, systematic research is limited.

  • Treatments:

    • Psychodynamic: Therapy focusing on object relations and self perspectives.

    • Behavioral: Anxiety reduction, problem-solving, improving interpersonal skills.

    • Cognitive: Working on developing realistic interpretations of others’ actions.

    • Biological: Occasionally treated with antipsychotic medication.

Distrust in Society (Part 4)

  • The theme of distrust is pervasive even among non-disordered individuals; many report distrust in information sources such as the media.

Schizoid Personality Disorder (Part 5)

  • Characteristics: Persistent avoidance of social relationships, emotional detachment; little interest in praise or criticism; weak social skills; preference for solitude.

  • Prevalence: Present in about 3.1 percent of U.S. adults, slightly more common in men.

Theoretical Perspectives (Part 6)

  • Psychodynamic: Linked to a deep-seated need for human contact unmet by parents.

  • Cognitive-behavioral: Related to thought deficiencies and struggles to pick up emotional cues.

  • Treatments:

    • Psychodynamic: Focus on relationship dynamics and object relations.

    • Behavioral: Social skills education, role-playing, exposure therapy, group therapy.

    • Cognitive: Encouraging recall of pleasurable experiences.

    • Biological: Limited effectiveness of drug therapy.

Schizotypal Personality Disorder (Part 7)

  • Characteristics: Interpersonal problems characterized by extreme discomfort in close relationships, odd thoughts, and eccentric behavior; belief in unrelated events connecting to oneself; bizarre bodily illusions; difficulty maintaining attention.

  • Prevalence: Affects 3.9 percent of adults, slightly more common in males.

Theoretical Explanations (Part 8)

  • Symptoms linked with family conflicts and psychological issues within families.

  • Shared biological factors with schizophrenia, such as high dopamine activity.

  • Associated with mood disorders, especially depression.

  • Treatments:

    • Behavioral: Aims to help clients reconnect to the world and challenge their unique thoughts.

    • Cognitive-behavioral: Focus on recognizing unusual beliefs, social skills training.

    • Biological: Some benefit from low-dose antipsychotic drugs.

Dramatic Personality Disorders

Cluster B Overview (Part 1)

  • The "dramatic" cluster includes:

    • Antisocial personality disorder

    • Borderline personality disorder

    • Histrionic personality disorder

    • Narcissistic personality disorder

  • Individuals with these disorders often make establishing relationships difficult, as dramatic emotional problems persist.

  • Cause origins are not well understood; treatments usually range from ineffective to moderately effective.

Antisocial Personality Disorder (Part 2)

  • Characteristics: Persistent disregard of others' rights, deceitfulness, impulsivity, lack of remorse; includes behaviors such as lying, recklessness, and violence.

  • Prevalence: Found in 3.6 percent of U.S. adults, with a fourfold increase in incidence among men compared to women.

Theoretical Explanations (Part 3)

  • Psychodynamic: Lack of parental love creates mistrust; correlations with childhood stresses.

  • Behavioral: Antisocial behaviors learned through reinforcement and imitation.

  • Cognitive: Difficulty recognizing feelings and viewpoints of others.

  • Biological: Genetic predispositions; lower serotonin activity; dysfunctional brain circuits.

  • Treatments: Less effective; include educational interventions, therapeutic communities, psychotropic medications.

Mass Murders Connection (Part 4)

  • A considerable number of clinicians argue that mass killers suffer from mental disorders but debate the specifics (antisocial, paranoid, etc.).

Borderline Personality Disorder (Part 5)

  • Characteristics: Major mood instability, identity disturbance, impulsivity, unstable interpersonal relationships; prone to self-directed violence and aggression.

  • Prevalence: Affects 5.9 percent of U.S. adults, with a significant gender disparity (75% women).

Theoretical Explanations (Part 6)

  • Psychodynamic: Linked to unstable early parental relationships underpinning identity distress.

  • Biological: Genetic predispositions affecting serotonin levels and brain structure/function.

  • Sociocultural: Influenced by rapidly changing societal dynamics.

  • Integrative Explanations:

    • Biosocial: A mix of intrinsic emotional dysregulation and external factors.

    • Developmental psychopathology: Childhood trauma contributing to unhealthy relationships.

  • Treatments:

    • Psychodynamic: Emphasis on relational dynamics, including dialectical behavior therapy (DBT).

    • Biological: Use of multiple psychotropic drugs adjunctively with therapy.

Histrionic Personality Disorder (Part 7)

  • Characteristics: Individuals are extremely emotional and attention-seeking; marked by dramatic behaviors and dependency on praise.

  • Prevalence: Present in 3.6 percent of U.S. adults, notably more common in women.

Theoretical Perspectives (Part 8)

  • Psychodynamic: Involves unhealthy childhood relationships, leading to emotional volatility.

  • Cognitive-behavioral: Focused on the lack of substance in emotional responses resulting from dependency.

  • Sociocultural/multicultural: Influenced by cultural expectations and norms regarding behavior, particularly gender.

  • Treatment: Varies across theoretical approaches, focusing on emotional processing, relational dynamics, and societal contributions.

Narcissistic Personality Disorder (Part 9)

  • Characteristics: Grandiosity, lack of empathy, need for admiration, self-absorption; commonly leads to manipulative behaviors, including suicidal gestures aimed at manipulation.

  • Prevalence: Found in 6.2 percent of U.S. adults, with a significant incidence in men (up to 75%).

Theoretical Perspectives (Part 10)

  • Psychodynamic: Links back to childhood experiences of rejection.

  • Cognitive-behavioral: Highlights overvaluation of self-worth due to excessive positive reinforcement during formative years.

  • Sociocultural: Correlation with cultural eras emphasizing narcissism.

  • Treatment: Considered difficult due to self-centered behaviors; approaches range from psychodynamic to cognitive strategies, with limited successful outcomes.

Connection to Selfies (Part 11)

  • The phenomenon of selfies raises debates about narcissism, with some suggesting that excessive posting reflects a pursuit of validation rather than a clinical condition.

Anxious Personality Disorders

Cluster C Overview (Part 1)

  • The "anxious" cluster includes:

    • Avoidant personality disorder

    • Dependent personality disorder

    • Obsessive-compulsive personality disorder

  • Individuals typically display anxious and fearful behaviors.

  • Research on these disorders is notably limited.

Avoidant Personality Disorder (Part 2)

  • Characteristics: Persistent discomfort in social situations, feelings of inadequacy, extreme sensitivity to negative evaluation.

  • Prevalence: At least 2 percent of adults; incidence equally across genders.

Theoretical Perspectives (Part 3)

  • Theoretically, causes often mirror those of anxiety disorders; connection not firmly established.

  • Psychodynamic: Focus on shame stemming from childhood experiences.

  • Cognitive-behavioral: Emphasizes harsh childhood criticism leading to expected rejection and inadequate social skills.

Treatment (Part 4)

  • Therapy is typically sought for reassurance.

  • Approaches include cognitive-behavioral therapies, group therapy applications, and occasionally medication for comorbid conditions.

Dependent Personality Disorder (Part 5)

  • Characteristics: An overwhelming need for care, feelings of helplessness, and distress about separation.

  • Prevalence: Affects fewer than 1 percent of the population, evenly across genders.

Theoretical Perspectives (Part 6)

  • Psychodynamic: Similar to cases in depression (Freudian conflicts).

  • Behavioral: Reinforcement of clinging behaviors from overprotective parenting.

  • Cognitive: Patterns of maladaptive thinking leading to dependency.

Treatment (Part 7)

  • Focuses on transference in therapy; employs cognitive-behavioral strategies to bolster assertiveness and counter maladaptive beliefs.

Obsessive-Compulsive Personality Disorder (Part 8)

  • Characteristics: Intense focus on perfectionism, control, and rigidity; relationships often lack warmth.

  • Prevalence: Found in approximately 7.9 percent of adults; tends to be more prevalent in men.

Theoretical Perspectives (Part 9)

  • Freudian: Linked to strict toilet training leading to anal-retentive behaviors.

  • Cognitive-behavioral: Identifies illogical thought patterns contributing to rigidity.

Treatment (Part 10)

  • Individuals often do not seek treatment unless comorbid with anxiety or depression.

  • Respond well to psychodynamic and cognitive therapies; SSRIs may also be beneficial.

Multicultural Factors and Classifications

Multicultural Factors (Part 1)

  • DSM-5 stipulates that personality disorders must diverge significantly from cultural expectations.

  • The lack of multicultural research, especially for Borderline Personality Disorder, is concerning.

Alternative Classifications for Personality Disorders (Part 2)

  • Presenting challenges with DSM-5's categorical classification; potential benefits from adopting a dimensional approach.

  • Big Five Theory: Asserts personality consists of five supertraits/factors:

    • Neuroticism

    • Extraversion

    • Openness to experience

    • Agreeableness

    • Conscientiousness

Proposed Dimensional Approach (Part 3)

  • Personality disorder—trait specified (PDTS): Proposed alternative to current categorical classifications; focuses on the severity of personality traits and functionality.

  • Enables assigning diagnoses based on significant impairments caused by a person's traits, rather than categorical presence or absence.

Problematic Traits (Part 4)

  • Five groups of problematic traits can lead to a PDTS diagnosis:

    • Negative affectivity: Vulnerability to negative emotions.

    • Detachment: Withdrawn behaviors and lack of engagement.

    • Antagonism: Oppositional and hostile behaviors.

    • Disinhibition: Lack of restraint and impulsive behaviors.

    • Psychoticism: Unusual thought patterns and perceptions.

  • This dimensional approach may enhance the understanding and classification of personality disorders.