© 2013 W. W. Norton & Company, Inc. The Personality Puzzle Sixth Edition by David C. Funder Chapter 18: Disorders of Personality 1

© 2013 W. W. Norton & Company, Inc.

The Personality PuzzleSixth Edition

by David C. Funder

Chapter 18: Disorders of Personality

1

Objectives

• Discuss what personality disorders are and the characteristics of the disorders

• Discuss four bases for diagnosis• Briefly discuss the Diagnostic and Statistical

Manual (DSM)• Discuss the prototype model of diagnosis

2© 2013 W. W. Norton & Company, Inc.

Personality Disorders

• Definition: patterns of thought, feeling, and behavior beyond the normal range of psychological variation

• There is not an exact point that differentiates between normal and disordered personality

• How common? • 15% of all adult Americans


The Diagnostic and Statistical Manual (DSM)

• The most recent (5th) edition – Describes the primary indicators of disorders and

how many need to be present to make a diagnosis• Purposes

– Make diagnosis more objective– Insurance billing


DSM: Organization

• Axis I: severe psychopathologies• Axis II: personality disorders• Axis III: physical conditions related to mental

health• Axis IV: stressors in the patient’s social life• Axis V: current ability to function self-

sufficiently


Defining Personality Disorders

1) Unusually extreme personality attributes– In terms of cultural context– Denial of reality

2) Problematic– For the person: anxiety, depression, confusion– Or for others

3) Affect social relationships


Defining Personality Disorders

4) Stable over time– Begin in adolescence or childhood– Difficult to change with therapy

5) Ego-syntonic– Symptoms are seen as normal and valued aspects

of personality– They think others are the ones with a problem


Bases for Diagnosis

• Clinical impression– Open and flexible– Unreliable

• Self-report scales– Advantages– Disadvantages

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Bases for Diagnosis• Structured interviews

– Advantages– Disadvantages

• Informant report– Advantages and disadvantages of I data

• Consensus about symptoms

• The most information, from the widest possible number of sources, will lead to the most accurate diagnosis


The Major Personality Disorders

• Cluster A: odd and eccentric patterns of thinking– Schizotypal, schizoid, paranoid

• Cluster B: impulsive and erratic patterns of behavior– Histrionic, narcissistic, antisocial, borderline

• Cluster C: anxious and avoidant emotional styles– Dependent, avoidant, obsessive-compulsive


Cluster A: Odd/Eccentric Disorders

• Thinking is strange, eccentric, or delusional • Schizotypal personality disorder

1. Ideas of reference2. Magical thinking, bizarre fantasies, believing in

odd phenomenon3. Strange perceptual experiences4. Odd speech or thinking



• Schizotypal personality disorder5. Suspiciousness or paranoia6. Inappropriate or flattened emotions7. Odd, peculiar, or eccentric actions or appearance8. Failure to develop friendships and a lack of social

ties other than to one’s immediate family9. Anxiety being around other people that does not

go away (even after knowing each other for years)



• Schizoid personality disorder– No pleasure from social interaction– Indifferent to the opinions of others– Rarely experiences strong feelings

• Minimal reaction to losing a job or loved one• https://www.youtube.com/watch?v=IM8nVnrgk8o• 2 min 22 seconds



• Paranoid personality disorder– Assume the worst of everyone– Alert for signs of betrayal– Reluctant to trust or confide in anyone– Angry, stubborn and bitter


Cluster B: Impulsive/Erratic Disorders• Problems in regulating behavior and thinking

lead to impulsive and erratic behavior• Histrionic personality disorder

– Goal is to always be the center of attention– Express strong opinions without basis– Strong emotions that suddenly change or disappear– Not taken seriously by others, difficult to get along

with, serious difficulties in relationships without understanding why

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Cluster B: Impulsive/Erratic Disorders

• Narcissistic personality disorder (NPD)– Excessive self-love– Belief that one is exceptional– More extreme than the trait of narcissism– Needs the admiration of others– Exploits others– Lack of empathy– Extreme arrogance



• Antisocial personality disorder– Illegal activities– Risky behaviors– Irritable, aggressive, and irresponsible– Problems caused to others does not bother them



• Borderline personality disorder (BPD)– Most severe personality disorder1. Rapid mood shifts2. Uncontrollable anger3. Self-destructive acts4. Self-damaging behaviors5. Identity disturbance



• Characteristics of BPD6. Chronic emptiness/ boredom7. Unstable relationships8. Fear of abandonment9. Confusion and feelings of unreality

• Genetics, emotional rejection, problems with Opiod system.

• Treatment: behavioral therapy teaching emotional self-control


Cluster C: Anxious/Avoidant Disorders• Excessive anxiety, avoidance of social contact

and relationships, behavioral patterns driven by anxiety

• Dependent personality disorder– Submissive interpersonal style– Fear disagreeing with others


Cluster C: Anxious/Avoidant Disorders

• Avoidant personality disorder– Expect the absolute worst

from others– Need constant

reassurance of uncritical acceptance

– Deep cravings for affection and social acceptance



• Obsessive-compulsive personality disorder (OCPD)– Not the same as obsessive compulsive disorder1. Overconcern with rules and details2. Perfectionism3. Workaholism 4. Inflexibility of thinking and behaving



• OCPD5. Packrat behavior6. Inability to delegate7. Miserliness8. Rigidity and stubbornness

– Ego-syntonic despite the anxiety (makes them resistant to treatment)


The Major Personality Disorders

• Cluster A: odd and eccentric patterns of thinking– Schizotypal, schizoid, paranoid

• Cluster B: impulsive and erratic patterns of behavior– Histrionic, narcissistic, antisocial, borderline

• Cluster C: anxious and avoidant emotional styles– Dependent, avoidant, obsessive-compulsive


Diagnosis• No clear requirements for diagnosis of a

personality disorder• Each disorder can be presented in a number of

ways• BPD has 256 possible patterns

• People with the same diagnosis may not resemble each other

• Possible to have characteristics of several disorders at once (Charles Manson)

© 2013 W. W. Norton & Company, Inc.25

Disorder Prototypes

• Alternative: think of diagnosis in terms of prototypes– Assess degree to which a person’s symptoms

match a disorder prototype– Acknowledge the complexity of diagnosis, the

overlap of categories, and the heterogeneity within categories


Disorder Commonality

• All disorders seem to be associated with an inability to hold thoughts in active, working memory



Toward the DSM-V

• Ratings of 5 maladaptive personality traits– Negative affectivity– Detachment– Antagonism– Disinhibition– Psychoticism

• Advantage of these ratings– Implies the differences between abnormal and

normal personality lie along a continuum29

© 2013 W. W. Norton & Company, Inc.

Toward the DSM-V

• New modes of diagnosis– Assess whether personality functioning is seriously

impaired– Assess whether a personality disorder is present– Assess degree of each of the maladaptive traits


Personality and Disorder

• Pathologizing behaviors– Do all bad people have personality disorders?– Should we refrain from punishing socially

undesirable, illegal, or immoral behavior because people suffer from antisocial personality disorder?

– Describing behavior as the result of mental illness is too easy



• Mental health– Pathologizing tells us almost nothing about the

nature of mental health– Improving mental health requires an

understanding of normal personality



• Labeling– The DSM labels are misleading– Can limit understanding– A label is not an explanation– Labels can be useful and are necessary


Normal and Abnormal

• There is not a sharp dividing line.• Having a mild degree of a few characteristics

does not imply having a disorder.• Disorders may be thought of as exaggerated

versions of traits that are advantageous when in the normal range.– Vigilant, wary, a survivor: paranoid– Strong, willful, self-reliant: antisocial– Sensitive, quiet, a homebody: avoidant


Normal and Abnormal


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© 2013 W. W. Norton & Company, Inc. The Personality Puzzle Sixth Edition by David C. Funder Chapter 18: Disorders of Personality 1