Personality Disorders

PERSONALITY DISORDERS STUDY GUIDE

DEFINITIONS

  • Personality: Enduring patterns of perceiving, feeling, thinking about, and relating to oneself and the environment.

  • Personality trait: A prominent and consistent part of personality.

  • BIG 5: Refers to the major personality traits that make up the OCEAN model:

    • Openness

    • Conscientiousness

    • Extraversion

    • Agreeableness

    • Neuroticism/Negative Emotionality

  • Continuum of Personality Traits: Personality traits vary on a continuum, indicating they can exist at varying levels (e.g., low to high).

BIG 5 PERSONALITY TRAITS (OCEAN)

  • Openness: Willingness to engage in new experiences and ideas.

  • Conscientiousness: Degree of organization, dependability, and discipline.

  • Extraversion: Level of sociability and outgoingness.

  • Agreeableness: Tendency to be compassionate and cooperative towards others.

  • Neuroticism/Negative Emotionality: Tendency to experience negative emotions such as anxiety, depression, and irritability.

PERSONALITY DISORDERS IN DSM-5

What is a Personality Disorder?

  • Chronic and enduring patterns of thoughts, emotions, interpersonal functioning, or impulse control that differ from cultural expectations and are maladaptive (causing distress or impairment).

  • Characteristics:

    • Pervasive and inflexible.

    • Typically emerge in adolescence or early adulthood.

  • There’s recognition that we all possess traits to some degree, with the DSM-5 establishing an artificial cutoff to define what is considered "disordered" for communication and treatment purposes. This follows a categorical diagnostic model.

  • A dimensional view of personality disorders was considered for the DSM-5 (Alternative Model of Personality Disorders), although it posed challenges regarding treatment decisions.

PREVALENCE OF PERSONALITY DISORDERS (PDs)

  • Prevalence ranges from 1-6% of adults worldwide.

  • Present from childhood and typically chronic.

  • Often comorbid with other PDs and disorders.

    • Ego-syntonic: Symptoms seen as acceptable and aligned with one’s identity.

    • Ego-dystonic: Symptoms not seen as acceptable or aligned with one’s identity.

  • Individuals often do not seek treatment, leading to poor prognosis and less research on effective treatments.

10 PERSONALITY DISORDERS (3 CLUSTERS)

  • Cluster A (Odd/Eccentric): Similarities to schizophrenia but with maintained grasp on reality.

    • Paranoid: Distrust and suspiciousness.

    • Schizoid: Detachment from social relationships.

    • Schizotypal: Eccentric behavior and cognitive distortions.

  • Cluster B (Dramatic/Emotional/Erratic): Impulsivity and emotional instability.

    • Histrionic: Excessive emotionality, need for attention.

    • Narcissistic: Grandiosity, need for admiration, lack of empathy.

    • Borderline: Instability in relationships, self-image, and emotions; impulsivity.

    • Antisocial: Disregard for rights of others, deceitfulness.

  • Cluster C (Anxious/Fearful): Dysfunction in relationships and fear of criticism.

    • Obsessive-Compulsive: Preoccupation with orderliness.

    • Avoidant: Feelings of inadequacy, hypersensitivity to criticism.

    • Dependent: Excessive need to be taken care of.

CLUSTER A PERSONALITY DISORDERS: ODD/ECCENTRIC PD

Characteristics

  1. Schizotypal PD

    • Odd beliefs, reduced capacity for relationships, cognitive/perceptual distortions.

    • Distorted thinking (e.g., magical thinking).

    • Ideas of reference: mistakenly believing random events are personally relevant.

    • Socially isolated, susceptible to social anxiety.

    • Symptoms milder than schizophrenia, resembling a prodromal phase.

  2. Paranoid PD

    • Pervasive and unjustified distrust.

    • Characterized by: paranoia, reading threats into benign comments, holding grudges.

    • Relationships strained due to suspicion.

  3. Schizoid PD

    • Marked detachment from social relationships.

    • Passively indifferent to praise or criticism.

    • Emotional coldness (alexithymia).

Causes and Treatment of Cluster A Disorders

  • Schizotypal PD: Genetic predisposition related to schizophrenia; treatment includes antipsychotic medications and psychotherapy.

  • Paranoid PD: Rooted in distrust and childhood experiences; group therapy may help build relationships.

  • Schizoid PD: Often requires treatment to promote awareness of emotions and improve social skills.

CLUSTER B PERSONALITY DISORDERS: DRAMATIC/EMOTIONAL/ERRATIC PD

Characteristics

  1. Histrionic PD

    • Pervasive pattern of excessive emotionality and attention-seeking.

    • Relies on physical appearance to draw attention.

    • Highly self-centered and often seeks approval.

  2. Narcissistic PD

    • Grandiose sense of self-importance; need for admiration.

    • Exploits others; often envious and lacks empathy.

    • Can exist in two forms: grandiose and vulnerable narcissism.

  3. Borderline PD

    • Instability in emotions, self-image, and interpersonal relationships.

    • Characterized by impulsivity, emotional reactivity, and chronic feelings of emptiness.

    • Symptoms include frantic efforts to avoid abandonment and patterns of idealization and devaluation in relationships.

BORDERLINE PERSONALITY DISORDER (BPD)

DSM-5 Criteria

To be diagnosed with BPD, 5 or more of the following must be present:

  • Frantic efforts to avoid abandonment.

  • Unstable relationships, oscillating between idealization and devaluation.

  • Identity disturbance.

  • Impulsivity in self-damaging areas.

  • Recurrent suicidal behavior or gestures.

  • Chronic feelings of emptiness.

  • Emotionally unstable, intense anger episodes.

Prevalence of BPD

  • About 6% prevalence in primary care settings.

  • Women are diagnosed three times more than men.

  • Significant comorbidity with other disorders like bipolar disorder and PTSD.

Diagnosis Issues and Controversy

  • Underdiagnosis in certain populations: BIPOC may receive different diagnoses; adolescents often underdiagnosed despite possible early onset.

  • Controversial terminology: labels like "borderline" may perpetuate stigma.

Linehan's Bio-Social Theory of BPD

Emphasizes an interaction of:

  • Genetic Predisposition: Emotional sensitivity and difficulty regulating emotions.

  • Invalidating Environment: Environment that rejects emotional experiences, leading to maladaptive behaviors.

  • Leads to difficulty in emotion regulation, impulsive behaviors, and challenges in relationships.

Treatment

  • Dialectical Behavior Therapy (DBT): Combined behavioral treatment focusing on skills in mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness.

  • Medication: SSRIs or antipsychotics may be used but are not primary treatments.

CLUSTER C PERSONALITY DISORDERS: ANXIOUS/FEARFUL PD

  1. Avoidant PD

    • Patterns of social avoidance due to fear of judgment; low self-esteem but desire for relationships.

    • Treatment: Cognitive Behavioral Therapy (CBT) for anxiety.

  2. Dependent PD

    • Excessive need for care leading to submissive behavior; fears of separation.

    • Treatment focuses on fostering autonomy and self-confidence.

  3. Obsessive-Compulsive PD

    • Focus on orderliness, perfection, and control to the detriment of flexibility.

    • Cognitive therapy may help alleviate rigid thinking patterns.

SUMMARY OF PERSONALITY DISORDERS

Cluster A: Odd, Eccentric

  • Paranoid: Distrustful and suspicious.

  • Schizoid: Detached and emotionally cold.

  • Schizotypal: Eccentric and distorted thinking.

Cluster B: Dramatic, Emotional, Erratic

  • Histrionic: Attention-seeking, overly emotional.

  • Narcissistic: Grandiosity, exploitation of others.

  • Borderline: Emotional instability, impulsivity.

  • Antisocial: Disregard for the rights of others.

Cluster C: Anxious/Fearful

  • Avoidant: Inhibited due to fears of rejection.

  • Dependent: Clingy, needs others for support.

  • Obsessive-Compulsive: Rigid, perfectionistic.

ISSUES WITH CURRENT DIAGNOSIS

  • Overlap in criteria among disorders leads to confusion.

  • Categorical diagnosis in contrast to the dimensional view of personality traits—an ongoing debate in the field.

ALTERNATIVE MODEL IN DSM-5 PROPOSAL

  • Proposes assessing impairments in:

    • Sense of self and interpersonal relationships.

    • Identifies which Big Five traits are impaired to improve diagnosis and treatment options.

  • Additional research required to determine its efficacy against current categorical systems.

DSM-5 CRITERIA FOR PERSONALITY DISORDERS

  • Detailed criteria outlined for each disorder in the DSM-5, useful in educational contexts to understand the nuances of each PD.