Download Personality Disorders

Personality Disorder
Cluster B Traits
Specific Traits for Diagnosis
Axis 1 - clinical disorders
Axis 2 - personality disorders
Egosentonic - want and embrace their personality disorder (its who they are)
Disorders are not temporary (chronic), persistent, and pervasive
Rigid way of thinking and behaving
They don’t see themselves as being a problem but they cause problems for other people
Feel no need to change, so they never go to therapy
DSM 5 deleted axis 2, put it in a section for personality disorder
⅗ of people who have a personality disorder have another disorder (like MDD)
If an adolescent has depression and a personality disorder, you are hard to treat
40% of outpatient individuals are suffering from personality disorders
Diagnoses of a personality disorder
The nature of an abnormal personality disorder
Extreme and dysfunctional personality traits, which affects their sense of self, emotional
responses, interpersonal relations, capacity for empathy, ability to set goals for themselves, etc.
Don’t believe they have a problem so they do not seek out help
Can’t diagnose personality disorder without knowing the surrounding context
Need to ask - is the person suffering from a PD or is there another disorder that is
influencing the personality? To answer that, you need to look at these questions: does this
necessarily reflect their typical behavior? Is this behavior a response to a situational stressor? Is
there a physiological problem? Neurological problems? Substance use?
The clinician must interview not just the client, but a family member to get a clear picture
to see how the client handles interpersonal relations and to see if they’re having an identity
problems
The clinician should look at culture, ethnicity, and social background
The clinician must determine if behaviors cause distress to others
Dimensional Approach
Looking at the severity of the personality trait, not whether it is there or not
Criteria A approach - looked at significant impairment and adaptive failure in 3 areas:
self-functioning (self-identity problems), interpersonal relation problems (intimacy, cooperation,
social responsibility), and have to have 6 of the next 7 traits: manipulative, callous, deceitful,
hostility, risk-taking, impulsivity, irresponsibility
Personality traits are on a continuum
Criteria B
Big five would take out paranoid, Schizoid, histrionic, and dependent
Keep antisocial, avoidant, borderline, narcissistic, obsessive-compulsive, schizotypal
Stereotypes and Gender Bias and Personality Disorders
The picture regarding differences is complicated. Certain personality disorders may be
diagnosed more frequently in females as a result of:
1) Women are more likely to receive a diagnosis of certain Personality Disorders
2) Diagnostic criteria may be more descriptive of Stereotypical females or Stereotypical
males
3P’s
Persistent
Pervasive
Pathological
Is it so different from the norms of the persons culture? Have to look at the ABCs of personality
disorders
A - Affect (the range of intensity and accessibility of emotions)
B - Behavior (ability to control impulses and delay gratification
Cognition (ways of perceiving self and events)
Can show up in childhood and early adulthood
If they show up before the age of 18, they must be present for at least one year
Notes from Handouts
Multicultural Factors: Research Neglect
A. Given the enormous interest in personality disorders, it is striking how little multicultural
research has been conducted
a. Clinical theorists have suspicions, but no compelling evidence, that cultural
differences exist or that such differences are important to the field’s
understanding and treatment of personality disorders.
B. The lack of multicultural research is of special concern with regard to borderline
personality disorder
a. Theorists are convinced that gender and other cultural differences may be
particularly important in both the development and diagnosis of the disorder
Culturally Normative Examples of Traits Associated with DSM Personality Disorders
● Paranoid - Immigrant and minority populations may express extreme mistrust of
institutions and authorities
● Schizotypal - Shaman or mystics in some societies engage in magical thinking and have
unusual perceptual experiences
● Histrionics - An intensely expressive emotional style that appears excessive or
flamboyant by Americanstandards is not unusual in some Mediterranean cultures.
Margaret Mead documented similar traits among the males of the Tchambuli tribe of
New Guinea (1963)
● Narcissistic - The culturally valued trait of “machismo,” as sometimes expressed by
young Latino males, can be mistaken for narcissism.
● Avoidant - Immigrant and minority cultures may have avoidant traits while in the process
of becoming acculturated to a new culture or community.
●
●
Dependent - Passivity, extreme politeness, and deference to others and their opinions is
a normal, culturally valued behavior in some Asian and Arctic societies.
Obsessive-compulsive - Devout religious believers may appear to be overly scrupulous
with regard to morality and preoccupied with rules and rituals.
“Stereotypes and Gender Bias and Personality Disorders”
Certain personality disorders may be diagnosed more frequently in females as a result of:
1) Women are more likely to receive a diagnosis of certain Personality Disorders
2) Diagnostic criteria may be more descriptive of Stereotypical females or stereotypical
males, and therefore, be more inclined to be used for females or males respectively.
3) Clinicians may be more inclined to diagnoses females with certain personality disorders
4) Assessments and the way they are used may be biased
a) Women are given the diagnoses for 3 personality disorders more than men:
i)
Histrionic Personality Disorder
ii)
Borderline Personality Disorder (3x more often diagnosed in women than
men)
iii)
Dependent Personality Disorder
b) Why - Because women are stereotyped as:
i)
Highly emotional
ii)
Concerned with their appearance (reason they wear makeup)
iii)
Dependent on others for self esteem and they act seductively to
manipulate men
c) Men are given the diagnoses for 3 personality disorders more often than women
i)
Paranoid Personality Disorder
ii)
Narcissistic Personality Disorder
iii)
Antisocial Personality Disorder
d) Is their clinician bias or is there truly higher rates of these disorders in women
and men?
i)
Men can be Histrionic
ii)
They can demonstrate exaggerated patterns of masculinity (1) Have macho imagine
(2) Brag about their athletic abilities
(3) Have substance abuse problems
The DSM-5 Model for Diagnosing Personality Disorders - Criteria B
The “Big Five” Theory of Personality and Personality Disorders
● A large body of research conducted with diverse populations consistently suggests that
the basis structure of personality may consist of five “supertraits” or factors
○ Neuroticism
○ Extroversion
○ Openness to experiences
○ Agreeableness
○ Conscientiousness
● Each of these factors (the “Big Five”) consists of a number of subfactors
●
●
○ Anxiety and hostility are subfactors of the neuroticism factors
○ Optimism and friendliness are subfactors of the extroversion factors
Theoretically, everyone’s personality can be summarized by a combination of these
supertraits. One person may display high levels of neuroticism and agreeableness,
medium extroversion, and low conscientiousness and openness to experiences. In
contrast, another person may display high levels of agreeableness and
conscientiousness, medium neuroticism and extroversion and low openness to
experiences, and so on.
Many proponents of the Big Five model have argued further that it would be best to
describe all people with personality disorders as being high, low, or in between on the
five supertraits and to drop the use of personality disorder categories altogether
○ For example, a particular person who currently qualifies for a diagnosis of
avoidant personality disorder might instead be described as displaying a high
degree of neuroticism, medium degrees of agreeableness and
conscientiousness, and very low degrees of extroversion and openness to new
experiences.
○ Another example, a person currently diagnosed with narcissistic personality
disorder might be described inthe Big Five approach as displaying very high
degrees of neuroticism and extroversion, medium degrees of conscientiousness
and openness to new experiences, and a very low degree of agreeableness.
The Big Five - Theorists argue for Dimensional Approach & Use 5 Factors
● Neuroticism
○ The tendency to experience negative emotions such as: anxiety, anger &
depression accompanied by disruptions of behavior and distressed thinking.
○ Neuroticism is contrasted with Emotional Stability - which is typical of people who
tend to remain calm in stressful situations.
● Extroversion
○ A preference for social interaction and a tendency to be active, talkative,
optimistic, and affectionate. Introverts tend to prefer solitude and are less active
than extroverts.
○ Introverts appear sober, aloof, quiet, and task oriented. They seem to have less
need for stimulation.
● Openness
○ Interest in new experiences and receptivity to new activities and ideas for their
own sake. People who score high on this dimension are creative, curious, and
untraditional.
○ People who score low on this dimension tend to be more interested in concrete
or practical pursuits. They appear set in their ways and emotionally
unresponsive.
● Agreeableness
○ Compassionate interest in others. People who score high on this dimension are
usually trusting and tender-hearted. They are generous in caring for others
●
●
sometimes to the point of putting others’ needs before their own or even
appearing gullible.
○ People who score low on agreeableness are apt to be competitive and are more
likely to be manipulative, cynical, skeptical, and openly hostile or rude.
Conscientiousness
○ Well organized dedication to work. People who score high on this dimension are
ambitious and persistently strive to be achievers.
○ Those who score low on this dimension are less demanding of themselves and
others and may seem unreliable and careless.
According to the Big Five Theorists, extreme scores on one or more of these dimensions
may be sufficient to describe the maladaptiveness of a personality disorder.
○ For example: An extremely high score on Neuroticism point to probable
adjustment problems and an extreme low score on Extroversion - suggesting
discomfort in social situations, which is the essential features of avoidant
personality disorder
The Big Five Personality Factors
● Factor 1: Negative Emotionality Versus Emotional Stability
○ Anxiousness
■ High: fearful, apprehensive
■ Low: relaxed, unconcerned, cool
○ Angry hostility
■ High: angry, bitter
■ Low: even-tempered
○ Depressiveness
■ High: pessimistic, glum
■ Low: optimistic
○ Self-consciousness
■ High: timid, embarrassed
■ Low: self assured, glib, shameless
○ Impulsivity
■ High: tempted, urgent
■ Low: controlled, restrained
○ Vulnerability
■ High: helpless, fragile
■ Low: clear thinking, fearless, unflappable
● Factor 2: Extraversion versus Introversion
○ Warmth
■ High: cordial, affectionate, attached
■ Low: cold, aloof, indifferent
○ Gregariousness
■ High: sociable, outgoing
■ Low: withdrawn, isolated
○ Assertiveness
●
●
■ High: dominant, forceful
■ Low: unassuming, quiet, resigned
○ Activity
■ High: unassuming, quiet, resigned
■ Low: passive, lethargic
○ Excitement seeking
■ High: reckless, daring
■ Low: cautious, monotonous, dull
○ Positive emotions
■ High: high spirited
■ Low: placid, anhedonic
Factor 3: Openness versus Closedness to One’s Own Experience
○ Fantasy
■ High: dreamers, unrealistic, imaginative
■ Low: practical, concrete
○ Aesthetics
■ High: aberrant interests, aesthetic
■ Low: constricted, uninvolved, no aesthetic interests
○ Feelings
■ High: self aware
■ LowL constricted, unaware
○ Actions
■ High: unconventional, eccentric
■ Low: routine, predictable, habitual, stubborn
○ Ideas
■ High: unusual, creative
■ Low: pragmatic, rigid
○ Values
■ High: permissive, broad-minded
■ Low: traditional,inflexible, dogmatic
Factor 4: Agreeableness versus Antagonism
○ Trust
■ High: gullible, naive, trusting
■ Low: skeptical, cynical, suspicious, paranoid
○ Straightforwardness
■ High: confiding, honest
■ Low: cunning, manipulative, deceptive
○ Altruism
■ High: sacrificial, giving
■ Low: stingy, selfish, greedy, exploitative
○ Compliance
■ High: docile, cooperative
■ Low: oppositional, combative, aggressive
○ Modesty
●
■ High: meek, self-effacing, humble
■ Low: confident, boastful, arrogant
○ Tender-mindedness
■ High: soft, empathetic
■ Low: tough, callous, ruthless
Factor 5: Conscientiousness versus Undependability
○ Competence
■ High: perfectionistic, efficient
■ Low: lax, negligent
○ Order
■ High: ordered, methodical, organized
■ Low: haphazard, disorganized, sloppy
○ Dutifulness
■ High: rigid, reliable, dependable
■ Low: casual, undependable, unethical
○ Achievement
■ High: workaholic, ambitious
■ Low: aimless, desultory
○ Self-discipline
■ High: dogged, devoted
■ Low: hedonistic, negligent
○ Deliberation
■ High: cautious, ruminative, reflective
■ Low: hasty, careless, rash
The 5 Personality Trait Domains and 25 Facets in the DSM-5
I.
Negative Affectivity (vs. Emotional Stability)
1. Anxiousness - I worry a lot about terrible things that might happen.
2. Emotional lability - I never know where my emotion will go from moment
to moment.
3. Hostility - I’m nasty and short to anybody who deserves it.
4. Preservation - I got fixated on certain things and can’t stop.
5. Separation insecurity - I dread being without someone to love me.
6. Submissiveness - I do what other people tell me to do.
II. Detached (vs. Extraversion)
7. Anhedonia - I almost never enjoy life.
8. Depressivity -The future looks really hopeless to me.
9. Intimacy avoidance - I steer clear of romantic relationships.
10. Suspiciousness - Plenty of people are out to get m,e
11. Withdrawal - I don’t like spending time with others.
12. Restricted affectivity - I don’t react much to things that seem to make
others emotional.
III. Antagonism (vs. Agreeableness)
13. Attention Seeking - I do things to make sure people notice me.
14. Callousness - I don’t care about other people’s problems.
15. Deceitfulness - I don’t hesitate to cheat if it gets me ahead.
16. Grandiosity - To be honest. I’m just more important than other people.
17. Manipulativeness - It is easy for me to take advantage of others.
IV. Disinhibition (vs. Conscientiousness)
18. Distractibility - I can’t concentrate on anything.
19. Impulsivity - I always do things on the spur of the moment.
20. Irresponsibility - I make promises that I don’t really intend to keep.
21. (Lack of) rigid perfectionism - If something I do isn’t absolutely perfect, it’s
simply not acceptable.
22. Risk taking - I have no limits when it comes to doing dangerous things.
V. Psychoticism
23. Eccentricity - Other people seem to think my behavior is weird.
24. Cognitive perceptual dysregulation - Things around me often feel unreal
or more real than usual.
25. Unusual beliefs and experiences - Sometimes I can influence other
people just by sending my thoughts to them.