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Personality Disorders
Neurotic Beh
-Anxiety-based
-No distortions in reality
-Recognizes problem
-No great personality
disorganization
B
o
r
d
e
r
l
i
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e
Psychotic
-Gross distortions in
reality (e.g., perception)
-Some personality
disorganization
-Does not recognize
problem
Personality Disorders
 When
behaviour patterns become
inflexible and maladaptive to the point
of causing distress or social/occupation
impairment can say have Personality
Disorder
Personality Disorders
 Don’t
stem from reactions to stress but
from gradual development of inflexible
and distorted personality
 Maladaptive ways of perceiving,
thinking, relating to world
Personality Disorders
 Excessively
rigid patterns of behaviour
or ways to relating to others that
prevents people from adjusting to
external demands and, thus, become
self-defeating.
 Have always been there for an
individual
Personality Disorders
 Mild:
Function reasonably well, viewed
as troublesome, eccentric, etc.
 Severe: Extreme or unethical
behaviour, may be incarcerated.
Quote From Lorna Benjamin (1996)
“A great way to come down with a case
of “medical student disease
(syndrome)” is to read a survey of
personality disorders”
Some Trait Pattern Example
 Suspiciousness
 Excessive
Self-regard
 Fear of Rejection
 Come
to dominate reactions to new
situations
 Repetitive maladaptive behaviour
Difference between DSM’s Clinical
Syndromes & PD
 Clinical
Syndrome specific symptom
clusters, time limited, ego-distonic
(viewed as separate from self,
unacceptable, objectionable and alien)
– E.g., depression, anxiety disorders,
psychotic disorders
Continued
Personality Disorder Individual with
PD are perceived as ego-syntonic (e.g.,
personality issues are acceptable,
unobjectionable and part of the self).
Tend to blame others for problems in
their lives.
Difficulties with Diagnosis of
Personality Disorder




Need to infer traits to make diagnosis, do
not have specific behaviours clinician can
judge
Disorders and criteria are relatively new,
therefore not as much research has been
done on them
Great deal of overlap among the disorders
Hard to draw a line between disorder and
normal behaviour
Personality Disorder Clusters
 Cluster
One: Odd-Eccentric:
– Behaviours similar to schizophrenia,
suspiousness, withdrawal, peculiar
thinking
The Odd Eccentric PD Group
1. Paranoid Personality Disorder
2. Schizoid Personality Disorder
3. Schizotypal Personality Disorder
Paranoid Personality Disorder
Reverend Jim Jones
People’s Temple
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

Paranoid Personality Disorder
Example
 Undergraduate
followed
student/patient who
Schizoid Personality Disorder
Theodore Kaczynski: Unabomber
Schizoid
 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
 peculiar
patterns of thinking and
behaviour
 perceptual and cognitive disturbances
 magical thinking
 not psychotic
– perhaps a distant “cousin” of schizophrenia
Personality Disorder Clusters
 Cluster
Two: Dramatic-Emotional:
– Behaviours are so dramatic, emotional, or
erratic that it is almost impossible to have
truly giving and satisfying relationships
– More commonly diagnosed than other
PD’s
The Dramatic-Emotional PD Group
1. Antisocial Personality Disorder
(Dissocial)
2. Borderline Personality Disorder
3. Histrionic Personality Disorder
4. Narcissistic Personality Disorder
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
 Difficulties
in establishing secure
identity
 Distrust
 Impulsive and self-destructive behavior
 Difficulty in controlling anger and other
emotions
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
Armand Hammer

“There has never
been anyone like
me, and my likes
will never be seen
again.”
Armand Hammer - Again
“The brilliance of my
mind can only be
described as dazzling.
Even I am impressed by
it.”
Histrionic Personality Disorder
 excessive
emotional displays/
dramatic behaviour
 attention-seeking, victim stance
 seek re-assurance, praise
 shallow emotions, flamboyant, selfcentred
 very seductive, “life of the party”
Personality Disorder Clusters
 Cluster
Three: Anxious-Fearful:
– Display anxiety and fear typically
– Similar to anxiety and depressive disorders
but no real connection
The Anxious-Fearful Group
1. Avoidant Personality Disorder
2. Dependent Personality Disorder
3. Obsessive-Compulsive Personality
Disorder (Anankastic)
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
Focus on Borderline PD
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”
 Single
White Female (Jennifer Jason
Leigh) or Fatal Attraction (Glen Close).
Good Depictions of BPD
Borderline Personality Disorder
 Therapist
“killers” (not really killers)
 Very difficult to treat
 Tend to be avoided by many clinicians
 Takes lots of training and experience to
treat effectively
 Lots of turmoil in treatment
Borderline Personality Disorder:
Four Core Elements
 Difficulties
in establishing secure self-
identity
 Distrust & Splitting
 Impulsive and Self Destructive
Behaviour
 Difficulty in controlling anger and other
emotions
Borderline Examples: From
Therapist
 First
experience with BPD under my
supervision
Identity Disturbance


In terms of identity disturbance, she relied heavily on
a sort of reflected identity from others and saw
herself as she believed others saw her.
With respect to her poor ego boundaries and the
melding of her identity with my own, one
particularly surprising thing she said to me was that
she had googled my name on the internet and found
out that I had won a presitious academic award. She
said she felt really sad because she did not have an
award herself.
Distrust and Splitting

She vascillated quite wildly between
idealizing me (including telling me that she
loved me and at times wanted us to sit
together on the couch so I could hold her) and
devaluing me (lots of anger in session, and a
fairly caustic email that said "Ain't it so nice
and easy. Tell you what M***, go out and get
ourself abused, loose that charming smile of
yours and come back and tell me who's
mentally ill", which was followed shortly
after by an apologetic one.)
Continued
 It
was difficult for me to predict from
week to week whether she would tell
me I was dirt or idealized. She was a
good example of someone who used
splitting defenses where she saw other
people (me in particular) in all good or
all bad terms and made rapid shifts
between these two positions.
Affective Instability


Affective instability (went along with the wild
swings between this sort of coy, coquettish behavior
and the pronounced anger in session), but also
exhibited shallow affect and incongruent affect.
For example, she often smiled or giggled when she
told me about her difficulties and began to
ocassionally exhibit sadness in session by crying.
However, a little later in therapy she told me that in
fact the tears were fake and that she was using them
because she felt closer to me when I responded to her
tears.
More on Distrust

She had a long history of interpersonal
problems and difficulty connecting with
people. She was quite paranoid about what
others thought of her and this was quite
evident in her comments about her coworkers whom she felt were against her (and,
frankly, she may have been right) and in her
desire to see her chart in the hopes that it
would finally reveal the intense dislike for
her that she imagined I felt.
Termination: Always difficult

We spent about 2 months preparing for and
discussing termination and it still went poorly. She
was angry and her parting gift to me was a plant that
contained a set of tiny clay pots (sort a decorative
thing) partially submerged in the soil. She gave the
clinic secretary the same thing, but she was careful to
say "this one is for the secretary, and this one is for
you", when I looked at the two later, the one that she
gave me had the tiny clay pots smashed, while
Geraldine's were intact. A final parting message.
Self-Destructive Behaviour
 Drug
abuse
 Suicide threats
 Lots of promiscuity
Classification Models with respect to
PD
 Classical
Categorical Model: Used by
DSM - - Views disorders as discrete
syndromes (i.e., distinct boundaries
between PD’s and homogeneous within
the boundaries)
 Consistent with traditional conception
of medical disorders
Dimensional Assessment of
Personality Pathology
 W.
John Livesley at the University of
British Columbia
 Dimensions
–
–
–
–
of PD and their traits:
Emotional dysregulation
Dissocial behaviour
Inhibitedness
Compulsivity
Epidemiology
 gender:
similar prevalence rates overall
– consistent differences across disorders
– bias in diagnoses?
 temporal
stability
 culture
– Wide variations in cultural expectations
Further Thoughts:
Impulse Control Disorders

psychological disorders
characterized by lack of control
over inappropriate behaviour
 Intermittent
Control Disorder
 Pathological Gambling
 Trichotillomania
 Pyromania
Schizotypal Personality Disorder
 increased
prevalence among
relatives of individuals with
schizophrenia
 some response to antipsychotic and
antidepressant medications
 poor response to insight-oriented
psychotherapy
Borderline Personality Disorder
 Historical:
– Kernberg’s psychodynamic theory:
borderlines see people and events as good
or bad
 Etiology:
– sexual abuse
– neurotransmitter dysregulation
 Treatment:
– dialectical behaviour therapy (DBT)
Psychopathy
Associated
with APD and
Dissocial Personality Disorder
Not a disorder itself
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

FACTOR 1 emotional/
interpersonal
characteristics
(e.g., lack remorse,
shallow affect)

FACTOR 2 – social
deviance
(e.g., early behaviour
problems, impulsivity)
Etiology
 Biological
– interaction of genetics and environment
 Social
– negative child/parent interactions
 Psychological
– affective impairment
– lack of inhibition
Treatment
 little
evidence for treatment
effectiveness
 psychopaths may become worse
– increased violent crimes following
treatment
– some treatment programs may help
psychopaths manipulate others better
Dependent Personality Disorder

Historical:
– introduced in DSM-III
– sociotropy: dependency leads to depression

Etiology:
– little research
– biological: little evidence
– psychological: anxious/insecure attachment

Treatment:
– assertiveness training
– problem-solving strategies
Problems with Classical Model
 Exaggerates
similarity among patients
 Inconsistencies in idiosyncracies are
ignored
 Focus on stereotypic features of patients
Classification Models with respect to
PD
Prototype Categorical Model: Used by
Theodore Millon (big wig) – attempts to place
people in categories, but the categories are
not necessarily discrete but have “fuzzy”
boundaries.
 Symptoms are often but not necessarily
present (e.g., concept of bird includes flying
creatures like blue jay, but also nonflying like
penguins)

Prototype Categorical Model
 Allows
for multiple diagnoses
 Improves reliability of diagnoses:
disagreement over single features less
likely to affect agreement over presence
or absence of disorder
Classification Models with respect to
PD
 Dimensional
Model: Does not place
people into diagnostic categories
 Key characteristics are identified and
the degree to which a person has the
key characteristic is determined.
 Rather than asking is a PD present or
absent, it asks how much?
Different Dimensions of PD
 Eysenck:
Neuroticism, Psychoticism,
and Introversion
 Cloninger: Novely seeking, Harm
avoidance, and Reward dependence
 Costa/McCrae: Neuroticism,
Extroversion, Openness, Agreeableness,
and Conscientious
PD’s Being considered
An Impulse Control Disorder can be loosely defined
as the failure to resist an impulsive act or behaviour that
may be harmful to self or others. For purposes of this
definition, an impulsive behaviour or act is
considered to be one that is not premeditated or not
considered in advance and one over which the
individual has little or no control
There are six categories under this general diagnosis:
Trichotillomania, Intermittent Explosive Disorder, Pathological
Gambling, Kleptomania, Pyromania, and Not Otherwise
Specified. The first five are the most prevalent and common
Impulse Control Disorders.
The Negativistic (Passive-Aggressive)
Personality Disorder appears in Appendix B
of the Diagnostic and Statistical Manual
(DSM), titled "Criteria Sets and Axes
Provided for Further Study."
People suffering from this disorder are
pessimistic and have negativistic attitudes.
They say things like: "good things don't
last", "it doesn't pay to be good", "the future
is behind me". They frustrate others'
expectations and requests and resist even
reasonable and minimal demands to
perform in workplace and social settings.
Passive-aggressives resent authority figures
(boss, teacher, parent-like spouse).

There are many form of passive-aggressive
negativism: procrastination, malingering,
perfectionism, forgetfulness, neglect, truancy,
intentional inefficiency, stubbornness, and
outright sabotage. This misconduct affects the
passive-aggressive's social milieu: it obstructs
the efforts of his colleagues in the workplace,
for instance.
People diagnosed with the Negativistic (PassiveAggressive) Personality Disorder resemble narcissists: they
chronically complain and criticize. They feel
unappreciated, underpaid, cheated, and misunderstood.
They blame their failures, misfortune, and defeats on
others.
Passive-aggressives sulk and give the "silent treatment" in
reaction to real or imagined slights. They are
counterfactually convinced that, behind their backs, they
are the subjects of derision, contempt, and condemnation
("ideas of reference"). Some passive-aggressives are mildly
paranoid and believe in a wide-ranging conspiracy against
them. In the words of the DSM: "They may be sullen,
irritable, impatient, argumentative, cynical, skeptical and
contrary." They are also hostile, explosive, lack impulse
control, and, sometimes, reckless.
People diagnosed with the Negativistic (PassiveAggressive) Personality Disorder envy the
fortunate, the successful, the famous, their
superiors, those in favor, and the happy. They are
openly defiant, but, when reprimanded, they
immediately beg forgiveness, go on a charm
offensive,, and promise to behave and perform
better in the future.