Personality disorders

Chapter 9: Personality Disorders

Overview

  • Personality disorders are characterized by patterns of thinking, feeling, and behaving that markedly deviate from cultural expectations.

  • Key features include significant distress for the individual and functional impairment across various aspects of life.

  • Must be stable patterns typically evident by early adulthood and must be chronic rather than episodic.

  • An essential distinction is made that these patterns cannot be better explained by another mental health disorder, substance use, or medical condition.

Personality Traits

  • Define how individuals feel, interact with others, and interpret events.

  • Personality Trait: An aspect of personality that remains stable over time and across different situations.

  • Big 5 Model: Organizes personality across five broad traits:

    • Negative Emotionality vs. Emotional Stability

    • Extraversion vs. Introversion

    • Openness vs. Closedness to experience

    • Agreeableness vs. Antagonism

    • Conscientiousness vs. Undependability

The Big 5 Personality Factors

  • Each factor of the Big 5 model consists of various facets:

Factor 1: Negative Emotionality vs. Emotional Stability

  • Facets:

    • Anxiousness: Fearful, apprehensive.

    • Angry Hostility: Angry, bitter.

    • Depressiveness: Pessimistic, glum.

    • Self-Consciousness: Timid, embarrassed.

    • Impulsivity: Tempted, urgent.

    • Vulnerability: Helpless, fragile.

  • Individuals High On This Facet:

    • Characterized by fearfulness and being easily upset.

  • Individuals Low On This Facet:

    • Relaxed and cool under pressure, even-tempered and optimistic.

Factor 2: Extraversion vs. Introversion

  • Facets:

    • Warmth: Cordial and affectionate vs. cold and distant.

    • Gregariousness: Sociable and outgoing vs. withdrawn and isolated.

    • Assertiveness: Dominant and forceful vs. unassuming and quiet.

    • Activity Level: Active and energetic vs. passive and lethargic.

    • Excitement Seeking: Reckless and daring vs. cautious and dull.

    • Positive Emotions: High-spirited vs. placid and anhedonic.

Factor 3: Openness vs. Closedness to Experience

  • Facets:

    • Fantasy: Dreamers and imaginative vs. practical and concrete.

    • Aesthetics: Appreciation for beauty vs. lack of aesthetic involvement.

    • Feelings: Self-awareness vs. constricted and unaware.

    • Actions: Unconventional vs. routine and stubborn.

    • Ideas: Unusual and creative vs. rigid and dogmatic.

    • Values: Permissive and broad-minded vs. traditional and inflexible.

Factor 4: Agreeableness vs. Antagonism

  • Facets:

    • Trust: Gullible and naïve vs. skeptical and cynical.

    • Straightforwardness: Honest and confiding vs. cunning and manipulative.

    • Altruism: Giving and self-sacrificing vs. stingy and selfish.

    • Compliance: Cooperative vs. oppositional and aggressive.

    • Modesty: Humble and self-effacing vs. confident and boastful.

    • Tender-mindedness: Soft and empathetic vs. callous and ruthless.

Factor 5: Conscientiousness vs. Undependability

  • Facets:

    • Competence: Perfectionistic and efficient vs. lax and disorganized.

    • Order: Methodical and organized vs. casual and undependable.

    • Dutifulness: Reliable and dependable vs. careless and unethical.

    • Achievement Striving: Ambitious and hardworking vs. aimless and negligent.

    • Self-Discipline: Self-disciplined vs. hasty and careless.

    • Deliberation: Cautious and reflective vs. rash and desultory.

Personality Disorders

  • Defined as stable patterns that cause distress and functional impairment.

  • Must be evident across multiple settings and cannot be attributed to other mental health issues.

  • The following characteristics are often noted in personality disorders:

    • Patterns of behavior, thought, and feeling leading to dysfunctional social interactions or occupations.

    • Varying patterns ranging from functional to highly dysfunctional, affecting social and occupational domains.

Classification of Personality Disorders (according to DSM-5-TR)

Cluster A: Odd-Eccentric Personality Disorders

  • Symptoms resemble schizophrenia, such as odd thought and speech patterns, while maintaining reality perception.

Cluster B: Dramatic-Emotional Personality Disorders

  • Individuals are manipulative and emotional, often showing impulsivity and volatility.

Cluster C: Anxious-Fearful Personality Disorders

  • Characterized by fear of criticism and dysfunctional relationships.

Specific Personality Disorders

Cluster A Disorders

  1. Paranoid Personality Disorder

    • Characteristics: Mistrust, suspiciousness, hypersensitivity to criticism, interpretation of others' motives as malevolent.

    • Treatment: Crisis intervention, focusing on social skills, and enhancing handling of problems.

  2. Schizoid Personality Disorder

    • Characteristics: Emotional detachment, indifference to social relationships, blunted emotional experience.

    • Treatment: Focus on awareness and expression of feelings and improving social skills.

  3. Schizotypal Personality Disorder

    • Characteristics: Social isolation, discomfort in social settings, eccentric behaviors, and thoughts such as paranoia and illusions.

    • Treatment: Antipsychotics, antidepressants, and psychotherapy focused on reality testing.

Cluster B Disorders

  1. Borderline Personality Disorder

    • Characteristics: Instability in self-image and emotions, hypersensitivity to abandonment, self-harm, and impulsivity.

    • Treatment: Dialectical behavior therapy focusing on emotional regulation and problem-solving skills.

  2. Histrionic Personality Disorder

    • Characteristics: Attention-seeking behaviors, inappropriate seductiveness, and unstable identities.

    • Treatment: Uncovering repressed emotions via psychodynamic therapy and cognitive techniques to foster autonomy.

  3. Narcissistic Personality Disorder

    • Characteristics: Grandiosity, need for admiration, and lack of empathy.

    • Treatment: Cognitive approaches to develop realistic expectations and sensitivity to others' needs.

  4. Antisocial Personality Disorder

    • Characteristics: Disregard for the rights of others, deceitful behavior, lack of remorse, must show evidence of conduct disorder pre-age 15.

    • Treatment: Behavioral control focusing on accountability; interventions aim at increasing social awareness and empathy.

Cluster C Disorders

  1. Avoidant Personality Disorder

    • Characteristics: Social inhibition, low self-esteem, fear of criticism; overlap with social anxiety disorder.

    • Treatment: Cognitive-behavioral therapies focusing on social skills and challenging negative self-perceptions.

  2. Dependent Personality Disorder

    • Characteristics: Belief in inability to care for oneself, willingness to endure abuse for dependence.

    • Treatment: Psychodynamic therapy focusing on caregiver insight, cognitive-behavioral techniques to increase assertiveness.

  3. Obsessive-Compulsive Personality Disorder

    • Characteristics: Excessive perfectionism and control, rigidity in thoughts and behavior,

    • Treatment: Cognitive-behavioral therapies to reduce compulsivity and manage anxiety related to control.

Conclusion

  • Understanding personality disorders requires comprehensive knowledge of their characteristics, underlying theories, and approaches to treatment. Each disorder in the clusters presents unique challenges and necessitates tailored therapeutic approaches to enhance individual functioning.