Personality Disorders: Distinct Features

Personality Disorders: Distinct Features 

Criterion: Extreme Traits

Personality traits:  relatively stable patterns of emotion, motivation, cognition, and behavior, which every person possesses to some extent

e.g., curiosity, kindness, talkativeness

Criterion: Extreme Traits

Personality traits: relatively stable patterns of emotion, motivation, cognition, and behavior, which every person possesses to some extent

Implicit in definition: long duration/early onset 

Criterion: Extreme Traits

Personality Development  

Extreme Traits: reflection

Are there traits you think all people possess, or do you think people vary? Talk to a seat-neighbor. 

• A menu of traits to pick from: Compassion, Irritability, Sociability, Well-Being, Sensation-Seeking, Anxiety, Honesty, Industry, Intellect, Creativity, Impulsivity, Attention-Seeking, Order, Authoritarianism, Charisma, Trust, Humor, Emotional Expressiveness, Art Appreciation, Introspection, Perfectionism, Self-Control, Conformity, Adaptability, Easy-Goingness, Emotional Stability, Conservatism

Extreme Traits: Cybernetics

Does our personality inform our explicit and implicit goals? What are your thoughts? Extreme Traits: Cybernetics

Distress or impairment?

e.g., Antisocial, Narcissistic PDExtreme Traits/Distress & Impairment in Sociocultural context

Person-environment fit (Niches)Being extremely high or low in a given trait (which is what some people call “extreme” traits)  can be both maladaptive - Perspective: Trait Bipolarity 

Being extremely high or low in a given trait (which is what some people call “extreme” traits)  can be both maladaptive AND adaptive - Perspective: Trait Dialectics (I “coined” this term. Trying to make it a thing.)

Extreme Traits in the DSM-5 AMPD; perspective: trait unipolarity 

Surveyed clinicians about characteristics of PD patients

Wrote 220+ items (PID-5)

Administered to patients

Factor analyzed -> 5 factors

PDs as trait combinations?

Probabilistic v.s. Deterministic

Summary: What distinguishes PDs from other mental disorders?Extreme traits

• Low or high expressions of Personality traits

• Stable, long duration, originates in childhood/adolescence

• Maladaptive tendencies borne by traits appear across situations

• Distress/impairment

  • Tend to be Ego-syntonic, therefore, people with PDs might cause distress/impairment to others

  • The individual’s personality tends to drives interpersonal issues (or is responsible for instigating the interpersonal issues)

• Always remember: PD criteria depend on society/culture/other people

• Summary: What distinguishes PDs from other mental disorders?

• Beliefs/thoughts, behavioral strategy/style

• Cluster A: the odd or eccentric types; paranoid, schizoid, and schizotypal personality disorders.

• Cluster B: the dramatic, emotional, or erratic types; antisocial, borderline, histrionic, and narcissistic personality disorders. 

• Cluster C: the anxious or fearful types; the avoidant, dependent, and obsessive-compulsive personality disorders.

  

• Paranoid Personality Disorder

Paranoid personality disorder (PPD) is characterized by a general suspicion and distrust of others that presents with at least four or more of the following:

• suspicion that others are exploiting or harming them

• a preoccupation with doubting the loyalty of friends

• a reluctance to share information with others for fear it will be used against them

• views harmless comments or events as threatening or demeaning

• holds grudges

• quick to defend or attack perceived threats to their reputation or character

• has recurrent suspicions about the infidelity of a partner

• Schizoid Personality Disorder

Schizoid personality disorder (often abbreviated as SPD or SzPD) is a personality disorder characterized by a lack of interest in social relationships, a tendency toward a solitary or sheltered lifestyle, secretiveness, emotional coldness, detachment, and apathy.  

SPD is indicated by at least four of the following:

• Neither desires nor enjoys close relationships, including being part of a family.

• Almost always chooses solitary activities.

• Has little, if any, interest in having sexual experiences with another person.

• Takes pleasure in few, if any, activities.

• Lacks close friends or confidants other than first-degree relatives.

• Appears indifferent to the praise or criticism of others.

• Shows emotional coldness, detachment, or flattened affectivity.

• Schizotypal Personality Disorder

Schizotypal personality disorder is characterized by severe social anxiety, thought disorder, paranoid ideation, transient psychosis, and often unconventional beliefs. At least five of the following symptoms must be present:

• ideas of reference

• strange beliefs or magical thinking that influences behavior and is inconsistent with subcultural norms abnormal perceptual experiences, including bodily illusions

• strange thinking and speech 

• suspiciousness or paranoid ideation

• inappropriate or constricted affect

• strange behavior or appearance

• lack of close friends

• excessive social anxiety that does not diminish with familiarity and tends to be associated with paranoid fears rather than negative judgments about self

Compared to schizophrenia:

• Less severe

• Less cyclic

• An alternative model based on empirical evidence

• Some PD diagnoses were not coherent, common, or distinct enough from other disorders to be useful (heterogeneity, comorbidity)

• Attempted move from categorical to dimensional

• Politics =(DSM-5 AMPD criteriaResembles the DSM-5 official criteria

• Impairment (will be defined later)

• Extreme traits

  • Better operationalized

• Stable, Long duration

• Example PID-5 items

• PID 5 -> HiTOPNarcissistic Personality Disorder

Narcissistic Personality Disorder (NPD) is characterized by the personality traits of persistent grandiosity, an excessive need for admiration, and a personal disdain and lack of empathy for other people. NPD possesses at least five of the following nine criteria:

• Has a grandiose sense of self-importance (e.g. exaggerates achievements and talents, expects to be recognized as superior without commensurate achievements).

• Is preoccupied with fantasies of unlimited success, power, brilliance, beauty, or ideal love.

• Believes that he/she/they is "special" and unique and can only be understood by, or should associate with, other special or high-status people (or institutions).

• Requires excessive admiration.

• Has a sense of entitlement (i.e., unreasonable expectations of especially favorable treatment or automatic compliance with their expectations).

• Is interpersonally exploitative (i.e., takes advantage of others to achieve their own ends).

• Lacks empathy: is unwilling to recognize or identify with the feelings and needs of others.

• Is often envious of others or believes that others are envious of him/her/them.

• Shows arrogant, haughty behaviors or attitudes.Narcissism is not always impairing; NPD is

• Antisocial Personality Disorder

Antisocial Personality Disorder (ASPD) (sometimes referred to as psychopathy; formerly sociopathic PD) involves showing no regard for other people’s rights or feelings. The majority of diagnostic criteria is indicated by three (or more) of the following:

• Failure to conform to social norms concerning lawful behaviors, such as performing acts that are grounds for arrest.

• Deceitfulness, repeated lying, use of aliases, or conning others for pleasure or personal profit.

• Impulsivity or failure to plan.

• Irritability and aggressiveness, often with physical fights or assaults.

• Reckless disregard for the safety of self or others.

• Consistent irresponsibility, failure to sustain consistent work behavior, or honor monetary obligations.

• Lack of remorse, being indifferent to or rationalizing having hurt, mistreated, or stolen from another person.

• Histrionic Personality Disorder

Histrionic Personality Disorder (HPD) is characterized by a pattern of excessive attention-seeking behaviors, usually beginning in early childhood, including inappropriate seduction and an excessive need for approval.

A pervasive pattern of excessive emotionality and attention-seeking, beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following:

• is uncomfortable in situations in which they are not the center of attention

• interaction with others is often characterized by inappropriate sexually seductive or provocative behavior

• displays rapidly shifting and shallow expression of emotions

• consistently uses physical appearance to draw attention to self

• has a style of speech that is excessively impressionistic and lacking in detail

• shows self-dramatization, theatricality, and exaggerated expression of emotion

• is suggestible, i.e., easily influenced by others or circumstances

• considers relationships to be more intimate than they actually are

• Borderline Personality Disorder

Borderline personality disorder (BPD) is a mental illness characterized by a long-term pattern of unstable relationships, distorted sense of self, and strong emotional reactions. Diagnosis consists of 5 or more of the following:

• Frantic efforts to avoid real or imagined abandonment. Doesn’t include suicidal or self-mutilating behavior  (Hannah to edit: criterion 5)

• A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation

• Identity disturbance: Markedly and persistently unstable self-image or sense of self

• Impulsivity in at least 2 areas that are potentially self-damaging, for example, spending, sex, substance abuse, reckless driving, binge eating. Note: Do not include suicidal or self-mutilating behavior covered in criterion 5.

• Affective instability due to a marked reactivity of mood, for example, intense episodic dysphoria, irritability, or anxiety usually lasting a few hours and only rarely more than a few days

• Chronic feelings of emptiness

• Inappropriate, intense anger or difficulty controlling anger, for example, frequent displays of temper, constant anger, recurrent physical fights

• Transient, stress-related paranoid ideation or severe dissociative symptoms

• Categorical vs Dimensional approaches to BPD

• Avoidant Personality Disorder

Individuals with Avoidant Personality Disorder (AvPD): consider themselves to be socially inept or personally unappealing and avoid social interaction for fear of being ridiculed, humiliated, rejected, or disliked. Four of seven symptoms should be present:

• avoids occupational activities that involve significant interpersonal contact, because of fears of criticism, disapproval, or rejection

• is unwilling to get involved with people unless certain of being liked

• shows restraint within intimate relationships because of the fear of being shamed or ridiculed

• is preoccupied with being criticized or rejected in social situations

• is inhibited in new interpersonal situations because of feelings of inadequacy

• views self as socially inept, personally unappealing, or inferior to others

• is unusually reluctant to take personal risk or to engage in any new activities because they may prove embarrassing

• Dependent Personality Disorder

Dependent personality disorder (DPD): a long-term condition in which people depend on others to meet their emotional and physical needs, with only a minority achieving normal levels of independence.At least five of the following factors:

• Has difficulty making everyday decisions without an excessive amount of advice and reassurance from others.

• Needs others to assume responsibility for most major areas of their life.

• Has difficulty expressing disagreement with others because of fear of loss of support or approval.

• Has difficulty initiating projects or doing things on their own (because of a lack of self-confidence in judgment or abilities rather than a lack of motivation or energy).

• Goes to excessive lengths to obtain nurturance and support from others, to the point of volunteering to do things that are unpleasant.

• Feels uncomfortable or helpless when alone because of exaggerated fears of being unable to care for themselves.

• Urgently seeks another relationship as a source of care and support when a close relationship ends.

• Is unrealistically preoccupied with fears of being left to take care of themselves.

Obsessive-Compulsive Personality Disorder

Obsessive–compulsive personality disorder (OCPD) is a cluster C personality disorder marked by an excessive need for orderliness, neatness, and perfectionism.

Marked by an excessive obsession with:  

• rules, lists, schedules, and order; 

• a need for perfectionism that interferes with efficiency and the ability to complete tasks

• a devotion to productivity that hinders interpersonal relationships and leisure time

• rigidity and zealousness on matters of morality and ethics

• an inability to delegate responsibilities or work to others.

Ego-syntonicity in OCPD

Can often be productive, at least in the short term

Treating Personality Disorders

Treatment Options for Personality Disorders

Some modalities of treatment used for personality disorders include:

• Individual psychotherapy

• Family therapy, including couples therapy

• Group therapy for personality dysfunction

• Psychological-education and self-help groups

• Psychiatric medications for treating symptoms of personality dysfunction or co-occurring conditions.

• Milieu therapy, a kind of group-based residential approach, has a history of use in treating personality disorders, including therapeutic communities

• The practice of mindfulness that includes developing the ability to be nonjudgmentally aware of unpleasant emotions appears to be a promising clinical tool for managing different types of personality disorders.

• Dialectical behavior therapy, a form of cognitive-behavior therapy that draws on principles from Zen Buddhism, dialectical philosophy, and behavioral science.

PDs as interpersonal disorders?

Stigma