Abnormal PsychologyAbnormal PsychologyOltmanns and EmeryOltmanns and Emery

Chapter nineChapter ninepersonality Disorderspersonality Disorders

presented by:presented by:Mani Rafiee Mani Rafiee

• SymptomsSymptoms

• DiagnosisDiagnosis

• FrequencyFrequency

• Alternative method in DSM 5Alternative method in DSM 5

Chapter OutlineChapter Outline

Personality DisordersPersonality Disorders• PersonalityPersonality refers to enduring patterns of thinking refers to enduring patterns of thinking

and behavior that define the personand behavior that define the person

• Personality disorder:Personality disorder: When enduring patterns of behavior and emotion When enduring patterns of behavior and emotion

bring the person into repeated conflict with othersbring the person into repeated conflict with others and when they prevent the person from and when they prevent the person from

maintaining close relationships with others.maintaining close relationships with others.

• All of the personality disorders are based on All of the personality disorders are based on exaggerated personality traitsexaggerated personality traits..

• In order to qualify for a personality disorder In order to qualify for a personality disorder diagnosis in DSM a person must fit the diagnosis in DSM a person must fit the general general definition definition of personality disorder of personality disorder (which applies (which applies to all 10 subtypes) and must also meet the to all 10 subtypes) and must also meet the specific criteria specific criteria for a for a particular type of particular type of personality disorderpersonality disorder..

OverviewOverview

• duration of the pattern - duration of the pattern - onset that can be traced onset that can be traced back at least to back at least to adolescence or early adulthoodadolescence or early adulthood..

• and the and the social impairment social impairment

• deviatesdeviates markedly from the expectations of the markedly from the expectations of the

individual’s individual’s cultureculture.”.” • evident in two or more of the following domains: evident in two or more of the following domains:

cognitioncognitionemotional responsesemotional responsesinterpersonal functioninginterpersonal functioningimpulse control impulse control

OverviewOverview

• controversial category in DSMcontroversial category in DSM

• They are difficult to identify They are difficult to identify reliably reliably

• their their etiologyetiology is poorly understood is poorly understood

• there is relatively little evidence to indicate there is relatively little evidence to indicate that they can be that they can be treatedtreated successfully. successfully.

• But it is very important in psychopathologyBut it is very important in psychopathology

OverviewOverview

• Importance of personality disorders:Importance of personality disorders:

• significant significant social and occupational social and occupational impairment.impairment.

• risk for the subsequent development of other mental risk for the subsequent development of other mental disorders & represent the beginning stages of the disorders & represent the beginning stages of the onset onset of a more serious form of psychopathologyof a more serious form of psychopathology. .

• the presence of a the presence of a comorbidcomorbid personality disorder can personality disorder can interfere with the treatment of a disorderinterfere with the treatment of a disorder

OverviewOverview

• Most other forms of mental disorder, such as anxiety Most other forms of mental disorder, such as anxiety disorders and mood disorders, are disorders and mood disorders, are ego-dystonicego-dystonic; that ; that is, people with these disorders are distressed by their is, people with these disorders are distressed by their symptoms and uncomfortable with their situations. symptoms and uncomfortable with their situations.

• Personality disorders are usually Personality disorders are usually ego-syntonicego-syntonic—the —the ideas or impulses with which they are associated are ideas or impulses with which they are associated are acceptable to the person.acceptable to the person.

• We might also say that We might also say that they do not have insight into they do not have insight into

the nature of their own problems.the nature of their own problems.

• assessments based exclusively on self-report assessments based exclusively on self-report may have limited validity.may have limited validity.

OverviewOverview

• building blocks of personality :building blocks of personality :Social motivationSocial motivation cognitive perspectives regarding the self and cognitive perspectives regarding the self and

othersothers temperament and personality traits.temperament and personality traits.

SymptomsSymptoms

Social MotivationSocial Motivation

• The concept of a motive refers to a person’s The concept of a motive refers to a person’s desires and goals.desires and goals.

• Two of the most important motives Two of the most important motives

• affiliationaffiliation—the desire for close relationships —the desire for close relationships with other people with other people

• powerpower—the desire for impact, prestige, or —the desire for impact, prestige, or dominancedominance

SymptomsSymptoms

Temperament and Personality TraitsTemperament and Personality Traits

• TemperamentTemperament refers to a person’s most basic, refers to a person’s most basic, characteristic styles of relating to the world, especially characteristic styles of relating to the world, especially those styles that are evident during the first year of life.those styles that are evident during the first year of life.

• Experts disagree about the basic dimensions of Experts disagree about the basic dimensions of temperament and personality. temperament and personality.

• 5 factor model:5 factor model:

• The basic traits (also known as domains) included in The basic traits (also known as domains) included in this model are neuroticism, extraversion, openness to this model are neuroticism, extraversion, openness to experience, agreeableness, and conscientiousness.experience, agreeableness, and conscientiousness.

SymptomsSymptoms

• The authors of DSM-IV-TR have organized The authors of DSM-IV-TR have organized ten specific forms ten specific forms of personality disorder of personality disorder into into three clusters three clusters on the basis of broadly on the basis of broadly defined characteristics.defined characteristics.

DiagnosisDiagnosis

Cluster A: Paranoid, Schizoid, and Schizotypal Cluster A: Paranoid, Schizoid, and Schizotypal Personality DisordersPersonality Disorders

• The behavior of people who fit the subtypes in this The behavior of people who fit the subtypes in this cluster is typically cluster is typically odd, eccentric, or asocial. odd, eccentric, or asocial.

• All three types share similarity with the symptoms of All three types share similarity with the symptoms of schizophreniaschizophrenia..

DiagnosisDiagnosis

Cluster B: Antisocial, Borderline, Histrionic, and Cluster B: Antisocial, Borderline, Histrionic, and Narcissistic Personality DisordersNarcissistic Personality Disorders

• According to DSM these disorders are According to DSM these disorders are characterized by dramatic, emotional, or erratic characterized by dramatic, emotional, or erratic behaviorbehavior

• all are associated with marked difficulty in all are associated with marked difficulty in sustaining interpersonal relationships.sustaining interpersonal relationships.

DiagnosisDiagnosis

Cluster C: Avoidant, Dependent and Obsessive-Cluster C: Avoidant, Dependent and Obsessive-Compulsive Personality DisordersCompulsive Personality Disorders

• The common element in all three disorders is The common element in all three disorders is presumably anxiety or fearfulness. presumably anxiety or fearfulness.

• This description fits most easily with the This description fits most easily with the avoidant and dependent types. avoidant and dependent types.

• In contrast, obsessive–compulsive personality In contrast, obsessive–compulsive personality disorder is more accurately described in terms disorder is more accurately described in terms of preoccupation with rules and with lack of of preoccupation with rules and with lack of emotional warmth than in terms of anxiety.emotional warmth than in terms of anxiety.

DiagnosisDiagnosis

A Dimensional Perspective on Personality A Dimensional Perspective on Personality DisordersDisorders

• There are a lot of people with serious There are a lot of people with serious personality problems who personality problems who do not fit do not fit the the official DSM-IV-TR subtypes. official DSM-IV-TR subtypes.

• Another frequent complaint about the Another frequent complaint about the description of personality disorders is the description of personality disorders is the considerable considerable overlap overlap among categories. among categories.

• Many patients meet the criteria Many patients meet the criteria for more for more than one type.than one type.

DiagnosisDiagnosis

A Dimensional Perspective on Personality A Dimensional Perspective on Personality DisordersDisorders

• It is cumbersome to list multiple diagnoses, especially It is cumbersome to list multiple diagnoses, especially when the clinician is already asked to list problems on when the clinician is already asked to list problems on both both Axis I and Axis IIAxis I and Axis II. .

• Thus, many experts favor the development of an Thus, many experts favor the development of an alternative classification system alternative classification system for PDs, one that for PDs, one that would be based on a dimensional view of personality would be based on a dimensional view of personality pathology.pathology.

• One proposal is to One proposal is to use the five-factor model use the five-factor model as the as the basic structure for a comprehensive description of basic structure for a comprehensive description of personality problems.personality problems.

DiagnosisDiagnosis

Prevalence in Community and Clinical SamplesPrevalence in Community and Clinical Samples

• In studies that have examined community based In studies that have examined community based samples of adults, the overall lifetime prevalence samples of adults, the overall lifetime prevalence for having at least one for having at least one Axis II disorder Axis II disorder (any type) (any type) varies varies between 10 and 14 percentbetween 10 and 14 percent..

• Among community samples, the Among community samples, the highest highest prevalence rates are found for obsessive–prevalence rates are found for obsessive–compulsive personality disordercompulsive personality disorder. .

• The other types vary in prevalence The other types vary in prevalence between 1 and between 1 and 2 percent 2 percent of the population. of the population.

FrequencyFrequency

Prevalence in Community and Clinical Samples Prevalence in Community and Clinical Samples (continued)(continued)

• The most obvious exception is The most obvious exception is narcissisticnarcissistic personality disorder, which appears to be the least personality disorder, which appears to be the least common form, affecting only common form, affecting only 0.2 percent 0.2 percent of the of the population.population.

• The overall lifetime prevalence rate The overall lifetime prevalence rate for antisocial for antisocial personality disorder was 3 percentpersonality disorder was 3 percent..

• At least At least 50 percent 50 percent of people who meet the of people who meet the diagnostic criteria for one personality disorder also diagnostic criteria for one personality disorder also meet the criteria for meet the criteria for another personality disorderanother personality disorder..

FrequencyFrequency

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Prevalence in Community and Clinical Samples Prevalence in Community and Clinical Samples (continued)(continued)

• There is also extensive overlap between There is also extensive overlap between personality disorders and disorders that are personality disorders and disorders that are diagnosed on diagnosed on Axis I Axis I of DSM-IV-TR.of DSM-IV-TR.

• Approximately Approximately 75 percent 75 percent of people who of people who qualify for a diagnosis on Axis II also meet qualify for a diagnosis on Axis II also meet criteria for a syndrome such as major criteria for a syndrome such as major depression, substance dependence, or an depression, substance dependence, or an anxiety disorder.anxiety disorder.

FrequencyFrequency

Gender DifferencesGender Differences

• The overall prevalence of personality disorders is The overall prevalence of personality disorders is approximately equal in men and womenapproximately equal in men and women..

• AntisocialAntisocial personality disorder is unquestionably much personality disorder is unquestionably much more common among more common among menmen than among women. than among women.

• Borderline personality disorder and dependent Borderline personality disorder and dependent personality disorder personality disorder may be somewhat more prevalent may be somewhat more prevalent among among womenwomen than men, but the evidence is not than men, but the evidence is not strong.strong.

FrequencyFrequency

Stability of Personality Disorders over TimeStability of Personality Disorders over Time

• In one study the best predictor of an adult In one study the best predictor of an adult diagnosis of antisocial personality was diagnosis of antisocial personality was conduct disorder conduct disorder in childhood. in childhood.

• Another longitudinal study has collected Another longitudinal study has collected information regarding the prevalence and information regarding the prevalence and stability of personality disorders among stability of personality disorders among adolescentsadolescents..

FrequencyFrequency

Stability of Personality Disorders over Time Stability of Personality Disorders over Time (continued)(continued)

• Several studies have examined the Several studies have examined the stability of stability of personality disorders personality disorders among people who have among people who have received professional treatment for their received professional treatment for their problems, especially those who have been problems, especially those who have been hospitalized for schizotypal or borderline hospitalized for schizotypal or borderline disordersdisorders..

• RecoveryRecovery rates are relatively high among patients rates are relatively high among patients with a diagnosis of with a diagnosis of borderline personality borderline personality disorderdisorder..

FrequencyFrequency

Culture and PersonalityCulture and Personality

• In DSM-IV-TR, personality disorders are defined in In DSM-IV-TR, personality disorders are defined in terms of behavior that “deviates markedly from the terms of behavior that “deviates markedly from the expectations of the individual’s culture.”expectations of the individual’s culture.”

• The The personality disorders may be more closely tied to personality disorders may be more closely tied to cultural expectations than any other kind of mental cultural expectations than any other kind of mental disorderdisorder..

FrequencyFrequency