Personality Disorders

Definition of Personality
 “Enduring patterns of perceiving,
relating to, and thinking about the
environment and oneself, which
are exhibited in a wide range of
important social and personal
contexts”
Definition of Personality Disorders
 Personality disorders are “enduring
patterns of perceiving, relating to, and
thinking about the environment and
oneself” that “are exhibited in a wide
range of important social and personal
contexts,” and “are inflexible and
maladaptive, and cause either
significant functional impairment or
subjective distress” (DSM-IV, p. 630)
Main Features of PDs
 Extreme patterns of thinking, feeling, and
behaving that deviate from a person’s culture
 Listed on Axis II of the DSM-IV-TR
 Begin early in life and remain stable
- not contextual or transient
 Inflexible and maladaptive
 Cause significant functional impairment and
subjective distress
- ego-syntonic vs. ego-dystonic
Problems with the PDs
 Low levels of inter-rater reliability
 Comorbidity with both Axis I and Axis II
 Problems with classification system
- Categorical vs. Dimensional System
DSM-IV-TR Personality Disorders
 Paranoid Personality Disorder
 Schizoid Personality Disorder
 Schizotypal Personality Disorder
 Antisocial Personality Disorder
 Borderline Personality Disorder
 Histrionic Personality Disorder
 Narcissistic Personality Disorder
 Avoidant Personality Disorder
 Dependent Personality Disorder
 Obsessive-Compulsive Personality Disorder
Cluster A: Odd or Eccentric
 Paranoid PD – is a pattern of distrust and
suspiciousness such that others’ motives are
interpreted as malevolent
 Schizoid PD – is a pattern of detachment from
social relationships and restricted range of
emotional expression
 Schizotypal PD – is a pattern of acute discomfort
in close relationships, cognitive or perceptual
distortions, and eccentricities of behaviour
Paranoid Personality Disorder
 suspicious of other’s motives
 interprets actions of others as deliberately
demeaning/threatening
 expectation of being exploited
 see hidden messages in benign comments
 easily insulted/ bears grudges
 appear cold and serious
Schizoid Personality Disorder

 indifferent to relationships
 limited social range (some are hermits)
 aloof, detached, called loners
 no apparent need of friends, sex
 solitary activities
 seem to be missing the “human part”
Schizotypal Personality Disorder
 peculiar patterns of thinking and
behaviour
 perceptual and cognitive disturbances
 magical thinking
 not psychotic
 perhaps a distant “cousin” of schizophrenia
Cluster B: Dramatic, Emotional,
or Erratic
 Antisocial PD – is a pattern of disregard for, and
violation of, the rights of others
 Borderline PD – is a pattern of instability in
interpersonal relationships, self-image, and
affects, and marked impulsivity
 Histrionic PD – is a pattern of excessive
emotionality and attention seeking
 Narcissistic PD – is a pattern of grandiosity,
need for admiration, and lack of empathy
Antisocial Personality Disorder
 pattern of irresponsibility, recklessness, impulsivity
beginning in childhood or adolescence (e.g., lying,
truancy)

 adulthood:
 criminal behaviour
 little adherence to societal norms,
 little anxiety
 conflicts with others
 callous/exploitive
Psychopathy
 Egocentric, deceitful, shallow, impulsive
individuals who use and manipulate others
 Callous, lack of empathy
 Little remorse
 Thrill-seeking
 “human predators” (Hare, 1993)
 No “conscience”
Psychopathy Checklist-Revised
(Hare, 1991) – 2 Factors
 Glib and superficial  Impulsive
 Egocentric and  Poor behavior
grandiose controls
 Lack of remorse or  Need for excitement
guilt  Lack of responsibility
 Lack of empathy  Early behavior
 Deceitful and problems
manipulative  Adult antisocial
 Shallow emotions behavior
Quote of the day
“I’m the most cold-hearted son of a b---- you
will ever meet”
 Ted Bundy
Borderline Personality Disorder
 marked instability of mood,
relationships, self-image
 intense, unstable relationships
 uncertainty about sexuality
 everything is “good” or “bad”
 chronic feeling of “emptiness”
 recurrent threats of self-harm/
“slashers”
Borderline and comorbidity
 High degree of overlap with both Axis I
and Axis II disorders
 24%-74% also diagnosed with major
depression; 4% to 20% bipolar
 25% of bulimics also diagnosed with BPD
 67% also diagnosed with substance use
disorder
Histrionic Personality Disorder
 excessive emotional displays/
dramatic behaviour
 attention-seeking, victim stance

 seek re-assurance, praise

 shallow emotions, flamboyant, self-

centred
 very seductive, “life of the party ”
Narcissistic Personality Disorder

 grandiose, sense of self-importance

 lack of empathy
 hyper-sensitive to criticism
 exaggerate accomplishments/ abilities
 special and unique
 entitlement
 below surface is fragile self-esteem
Cluster C: Anxious or Fearful
 Avoidant PD – is a pattern of social inhibition,
feelings of inadequacy, and hypersensitivity to
negative evaluation
 Dependent PD – is a pattern of submissive and
clinging behaviour related to an excessive need
to be taken care of
 Obsessive-Compulsive PD – is a pattern of
preoccupation with orderliness, perfectionism,
and control at the expense of flexibility
Avoidant Personality Disorder
 over-riding sense of social discomfort
 easily hurt by criticism

 always need emotional support

 occasionally try to socialize

 so distressing they retreat into
loneliness
Dependent Personality Disorder

 submissive, clingy behaviour

 fear of separation

 easily hurt by criticism

Obsessive-Compulsive
Personality Disorder
 excessive control and perfectionism
 inflexible

 preoccupied with trivial details

 judgmental/moralistic

 workaholic/ignore family members

 often humourless
Personality Disorder Not
Otherwise Specified
 Meets general criteria for a PD but no
specific criteria for a specific PD.
 Exhibit at least 10 symptoms of PDs
across all subtypes
Comorbidity
 Average number of PD diagnoses per
patient:
- 4.6 (Skodal et al., 1988)
- 2.8 (Zanaarini et al., 1987)
- 3.75 (Widiger et al., 1986)
DSM – Categorical Approach

 Based on the medical model

 Disorder is present or absent

Assumptions of the DSM
 Personality pathology is suited to be
classified into discrete types or disorders
 These disorders group themselves into
three clusters
 The diagnostic criteria naturally fall into
the particular personality disorders to
which they have been assigned

Empirical Evidence doesn’t support these assumptions!!!

David Klonsky – University of Virgina
“the DSM practice of putting expert opinions into writing and
only then conducting tests of reliability and validity cannot
lead to an acceptable classification system. Rather it directs
scientists to conduct research on, and practitioners to put
their trust in, diagnostic labels that may or may not map onto
valid constructs that exist in nature. Instead, researchers
must turn to objective, empirical methodologies to discover
the dimensions or personality pathology, letting the data fall
where they may and letting the data determine how
personality disorder is best classified”
John Livesley - UBC
 Dimensional Assessment of Personality
Pathology Basic Questionnaire (DAPP)
 4 Dimensions: Emotional Dysregulation;
Dissocail Behaviour; Inhibitedness;
Compulsivity
“ …the evidence on this point is so
unequivocal that the only issue to explain
is the field’s reluctance to accept empirical
evidence”

~ W. John Livesley, (2000) Journal of

Personality Disorders, 14, 2, p. 139-140.
The “Big 5” Personality Traits
 Openness to experience
 Conscientiousness
 Extraversion
 Agreeableness
 Neuroticism

 personality disorders represent

extreme variations of OCEAN
Advantages of Categorical
System
 Ease in conceptualization and
communication
 Familiarity

 Consistency with clinical decision

making
Disadvantages of the Categorical
Approach
 Complex and cumbersome
 Arbitrary cut-off points

 Loss of important information

Advantages of the Dimensional
Model
 Resolution of a variety of classification
dilemmas
 Retention of Information
 Flexibility
Disadvantages of the
Dimensional Approach
 Lack of clinical utility?
 Lack of familiarity?

Bottom line: not too many disadvantages

and most researchers favor it – likely to be
adopted in DSM-V