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Personality Styles and Disorders
Timothy C. Thomason
Northern Arizona University
Ten Personality Disorders in DSM-5
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Paranoid
Schizoid
Schizotypal
Antisocial
Borderline
Histrionic
Narcissistic
Avoidant
Dependent
Obsessive-Compulsive
Additional Personality Disorders
• Personality disorders in DSM-III-R
– Sadistic personality disorder
• A pattern of cruel, demeaning, and aggressive behavior
– Self-defeating personality disorder (masochistic)
• Behavior that undermines one’s pleasure and goals
• Personality disorders in DSM-IV, Appendix B
– Depressive personality disorder
• A pattern of negative thoughts and behaviors
– Passive-aggressive personality disorder (negative)
• A pattern of negative attitudes and passive resistance
Additional Personality Disorders
• Personality disorders in ICD-10
– Dissocial personality disorder
– Emotionally unstable personality disorder
– Anankastic personality disorder (OCD)
– Anxious (avoidant) personality disorder
– Eccentric personality disorder
– Immature personality disorder
– Psychoneurotic personality disorder
Personality Disorder Clusters
• A: the weirds:
Paranoid, schizoid, schizotypal
• B: the wilds:
Antisocial, borderline, histrionic, narcissistic
• C: the wimps:
Avoidant, dependent, obsessive-compulsive
Prevalence of Personality Disorders
• Point prevalence: 10%
• Lifetime prevalence: 30-40%
Prevalence of P. D.s in Descending
Order
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Obsessive-Compulsive
Paranoid
Avoidant
Borderline
Histrionic
Antisocial
Schizoid
Schizotypal
Dependent
Narcissistic
2.1%
1.7
1.7
1.6
1.5
1.1
0.9
0.9
0.7
0.5
Celebrity Examples of Personality
Styles and Disorders
• Paranoid
Richard Nixon; Fox Mulder on “The X-Files”
• Schizoid
Sherlock Holmes; Ted Kaczynski (Unabomber)
• Schizotypal
Prince; Kramer on “Seinfeld”
• Borderline
Princess Diana; Courtney Love; the Lisa character in the
movie Life Interrupted; the Glenn Close character in the
movie Fatal Attraction
• Antisocial
Tony Soprano on “The Sopranos;” Hannibal Lector
• Narcissistic
Donald Trump; Barbra Streisand; Madonna; Bill
Clinton; Gene Simmons; Kanye West; Dali; Picasso
• Histrionic
Scarlett O’Hara in GWTW; Mick Jagger; Bjork; Jerry
Lewis; Jim Carey; Cher; all the singers on “American
Idol;” the characters on “Glee”
• Avoidant
The Boo Radley character in To Kill a Mockingbird
• Dependent
Marilyn Monroe
• Obsessive-Compulsive
The Felix Unger character in “The Odd Couple;” the
Monica character in “Friends;” Stanley Kubrick
Personality Disorders Vary in Severity
• Mild
Dependent; Histrionic; Narcissistic; Antisocial
• Moderate
Schizoid; Avoidant; Obsessive-Compulsive
• Severe
Schizotypal; Paranoid; Borderline
Etiology of Personality Disorders
• Genetic factors contribute 40-50% of the
variation in the development of personality
disorders.
• Personality results from the interaction of
heredity and environment, as shaped in
childhood.
Genetics of Personality
• What are the personality styles of your
parents?
• What is your personality style?
• Is your style the same as one of your parents,
or a mix of their styles?
Interaction of Domains
• Psychological symptoms (eg. anxiety;
depression) are analogous to fever or cough.
• Certain patterns of symptoms compose
mental disorders.
• Mental disorders occur within the context of
the person’s personality. Personality is a
means of coping, analogous to the immune
system.
Interaction of Domains, cont.
• Personality exists within the context of
psychosocial stressors. Marital, economic, and
other stressors are analogous to infectious
agents.
• Psychosocial stressors and Personality
Disorders interact to produce mental
disorders.
Millon’s Typology of Personalities
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Pleasure-deficient personalities
Interpersonally-imbalanced personalities
Intrapsychically-conflicted personalities
Structurally-defective personalities
Pleasure-Deficient Personalities
• Schizoid: the asocial pattern
• Avoidant: the withdrawn pattern
• Depressive: the giving-up pattern
Interpersonally-Imbalanced
Personalities
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Dependent: the submissive pattern
Histrionic: the gregarious pattern
Narcissistic: the egotistic pattern
Antisocial: the aggrandizing pattern
Intra-psychically-Conflicted
Personalities
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Sadistic: the abusive pattern
Compulsive: the conforming pattern
Negativistic: the vacillating pattern
Masochistic: the aggrieved pattern
Structurally-Defective Personalities
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Schizotypal: the eccentric pattern
Borderline: the unstable pattern
Paranoid: the suspicious pattern
Decompensated: the terminal pattern
P. D.s, Strategies and Beliefs
Paranoid – Defensive – “Goodwill hides a hidden
motive.”
Schizoid – Autonomous – “Relationships are messy.”
Antisocial – Predatory – “Others are patsies.”
Histrionic – Exhibitionistic – “I can go by my feelings.”
Narcissistic – Competitive – “I’m above the rules.”
Avoidant – Withdrawal – “People will reject me.”
Dependent – Help-Eliciting – “I need people to survive.”
Obsessive – Ritualistic – “Details are crucial.”
Treatment of P. D.s
• Few people who have a personality disorder
request treatment for their personality
disorder.
• Typically they complain of psychological
symptoms that comprise mental disorders.
• If they have a personality disorder, ethically it
should be diagnosed.
Personality Disorders are Treatable
• Personality disorders are not necessarily
chronic.
• In one research study, 40% of patients with
borderline personality disorder no longer met
criteria for the disorder at the two-year
follow-up assessment, and 88% had remitted
after ten years.
• Some people seem to age-out of borderline
personality disorder in middle age.
• In another study, more than half of patients
with borderline, obsessive-compulsive,
avoidant, or schizotypal personality disorders
no longer had the disorder after two years.
• However, most of the patients still had
residual problems, often impairment in social
relationships.
• Aberrant personality traits are more chronic
than personality disorders.
• After treatment, many patients with
borderline P. D. continue to exhibit emotional
instability and inappropriate anger, but their
frantic efforts to avoid abandonment and
repetitive self-injury disappear.
• People with personality disorders have stable
extreme personality traits plus aberrant
behavioral problems designed to cope with
the consequences of these traits.
Dimensional Disorders
• Avoidant P. D. is the same as severe social
anxiety disorder.
• Borderline P. D. may be a severe form of mood
disorder.
• Schizotypal P. D. may be a part of the
schizophrenia spectrum.
Comorbidity
• The average patient who has one personality
disorder meets the criteria for two other
personality disorders.
• When DSM-IV was in use, the third most
common personality disorder diagnosis was
Personality Disorder NOS.
• Patients with seriously disturbed personalities
often fail to fit into one of the DSM categories.
Heterogeneity
• Patients who have the same diagnosis can
differ markedly.
• E.g. To qualify for the Obsessive-compulsive
PD, patients must have 4 of the 8 criteria. One
patient could have the first 4 symptoms while
another patient had the second 4 symptoms.
• Both patients would receive the same
diagnosis without sharing a single symptom.
Research Base
• Only one of the P. D.s has a robust research
base (Borderline).
• Two others have a reasonable data base
(Antisocial and Schizotypal).
• The evidence base for the other seven P.D.s is
very small.
P. D.s and the Five Factor Model
• Patients with borderline, schizotypal,
obsessive-compulsive, or avoidant P. D. scored
high on Neuroticism, low on Agreeableness,
and low on Conscientiousness.
• Some studies suggest that the Five Factor
Model does not distinguish among the
different personality disorders; there is not a
distinct FFM profile for each of the P. D.s.
• Overall, P. D.s tend to be associated with
elevated Neuroticism and low Agreeableness.
• A meta-analysis did find some distinctive
profiles:
Antisocial: very low A and C, average N, E, O
Avoidant: high N, low E, average A, C, O
Borderline: high N, low A, average E, C, O
Patients Are Complicated
• Do not force patients into the procrustean
beds of our diagnostic categories.
• Diagnoses must be flexible, allowing the
distinctive characteristics of patients be
displayed in their full complexity.
• We should be comfortable diagnosing
personality mixtures, such as borderlineavoidant; borderline-histrionic; or any other
combination of two or more prototypes.
• Clinical syndromes should be understood in the
context of personality and psychosocial stressors.
• For example, depression should be understood as
a product of the interaction of a particular
personality type enmeshed in a specific
situational context for which the personality is
vulnerable. Change either the personality or the
stressors, and depression might not result.
Psychotherapy Should Be Tailored to
the Patient’s Personality
• The clinical syndromes should be seen as an
outgrowth of the patient’s overall personality
style.
• Patients with different personality vulnerabilities
perceive and cope with life’s stressors differently.
• Two patients who are depressed will experience
and express the depression differently because
their personalities are different.
• Faced with the same stressor (e.g. divorce) a
dependent and a narcissist will respond
differently. Therapy should be different for
each of these patients.
• Similar symptoms do not necessarily call for
the same treatment if the pattern of patient
vulnerabilities and coping styles differ.
• Treatment should be personalized to match
the patient’s personality.
Resources & Recommended Reading
Books by Theodore Millon:
• Disorders of Personality, 2011
• Personality and Psychopathology, 2006
• Personality Disorders in Modern Life, 2004
• Toward a New Personology, 1990
• Millon’s website: www.millon.net