Download What personality disorders are recognized by the DSM-IV-TR?

Psychology 305: Theories of Personality
Lecture 19
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Office Hour Invitations by Student Number
July 26th, 3:30-4:30, Kenny 2517
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Announcement
I will hold additional office hours in preparation for the final
exam:
Monday, July 25th: 12:30-2:00
Tuesday, June 26th: 3:30-5:00
Wednesday, July 27th: 1:00-2:30
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Lecture 19 The Cognitive Self-Regulation Perspective
and Personality Disorders
1. Can personality be described in terms of “cognitive
styles?” (continued)
2. What is a personality disorder?
3. What personality disorders are recognized by the
DSM-IV-TR?
4. Are personality disorders better represented by
categories or dimensions?
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By the end of today’s class, you should be able to:
1. describe the constructs: field dependence and
independence, pessimistic attribution style, selfcomplexity, and need for cognition.
2. identify the correlates of a pessimistic attribution style,
self-complexity, and need for cognition.
3. describe the multi-axial system of the DSM-IV-TR.
4. identify the DSM-IV-TR diagnostic criteria for
personality disorders.
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5. list the three clusters of personality disorders identified
in the DSM-IV-TR.
6. distinguish between schizotypal, paranoid, borderline,
histrionic, obsessive-compulsive, and avoidant
personality disorders.
7. discuss criticisms of categorical approaches to the
description of personality disorders.
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Kind
Thoughtful
Stay-at-home
moms
Working moms
Prototype
My mom
Disciplinarian
My
grandmother
Fuzzy set
Pregnancy
Mother
Love
June Cleaver
Exemplars
Gloria DelgadoPritchett
Mother Teresa
Warmth
Hillary Clinton
Mother Schema
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Activation
between units
can be
excitatory or
inhibitory.
Example of a Connectionist Network
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Can personality be described in terms of “cognitive
styles?” (continued)
“The image is one of the human being as an active, aware
problem-solver, capable of profiting from an enormous range of
experiences and cognitive capacities, possessing great potential
for good or ill, actively constructing his or her psychological
world, and influencing the environment but also being influenced
by it in lawful ways …. It is an image that has moved a long way
from the instinctual drive-reduction models, the static global
traits, and the automatic stimulus-response bonds of traditional
personality theories. It is an image that highlights the short
comings of all simplistic theories that view behavior as the
exclusive result of any narrow set of determinants, whether
these are habits, traits, drives, reinforcers, instincts, or genes
and whether they are exclusively inside or outside the person”
(Mischel, 1976).
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Instructions: Describe what you see.
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2. Field Dependence vs. Field Independence
 Proposed as a personality dimension by Witkin in the
1930s.
 Has been studied extensively by cultural psychologists.
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 Field dependence: Reflects a tendency to attend to
the context that surrounds the focal object and the
relationships among the objects in the environment.
Associated with extraversion.
 Field independence: Reflects a tendency to separate
the focal object from its environment and attend to
the attributes of that object.
Associated with introversion.
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How does the boy in the center feel?
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Field-Independent Gaze
Field-Dependent Gaze
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3. Attributional Style
 Refers to individual differences in the attributions that are
made to explain events.
 Attributions for events vary on 3 dimensions: locus
(internal or external to the individual), stability, and
globality.
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 Individual differences in attributions for success and
failure have been linked to susceptibility to depression.
Specifically, individuals prone to depression tend to
display a pessimistic attribution style:
Success: due to external, unstable, and specific factors.
Failure: due to internal, stable, and global factors.
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The Pessimistic Attribution Style: After an exam …
Attributions for Success
Attributions for Failure
Locus
The exam was easy.
I’m not smart.
Stability
This was one in a
million.
This will happen on all
of the exams in this
course.
Globality
This doesn’t mean I’ll do I won’t succeed at
well in my other
anything in my life.
courses.
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4. Self-Complexity
 Refers to:
(a) the number of self-aspects that are used to represent
the self in the self schema.
(b) the degree of redundancy among these self-aspects.
 High self-complexity: many nonredundant self-aspects.
Low self-complexity: few redundant self-aspects.
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 Research (e.g., Linville, 1987; Smith & Cohen, 1993;
Showers & Ryff, 1996) has shown that self-complexity
buffers against the harmful effects of stress by
preventing events that occur in one self-aspect from
“spilling over” and adversely affecting other selfaspects.
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5. Need for Cognition
 Defined as “the tendency for an individual to engage in
and enjoy thinking.”
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Sample Items from the Abbreviated Need for Cognition Scale
(Cacioppo, Petty, & Kao, 1984)
1.
2.
I would prefer complex to simple problems.
I like to have the responsibility of handling a situation that requires a lot of
thinking.
3. Thinking is not my idea of fun.*
4. I would rather do something that requires little thought than something that is
sure to challenge my thinking abilities.*
5. I find satisfaction in deliberating hard and for long hours.
6. I only think as hard as I have to*
7. I like tasks that require little thought once I have learned them.*
8. I prefer my life to be filled with puzzles that I must solve.
9. The notion of thinking abstractly is appealing to me.
10. I would prefer a task that is intellectual, difficult, and important to one that is
somewhat important but does not require much thought.
11. It’s enough for me that something gets the job done; I don’t care how or why it
works.*
12. I usually end up deliberating about issues even when they do not affect me
personally.
* Reverse-scored items.
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 Need for cognition is associated with:
 the use of planful, self-regulated study strategies and
higher grades.
 less ambivalence about holding conflicting attitudes.
 greater curiosity.
 higher levels of intelligence.
 higher self-esteem (general and social).
 lower social anxiety.
 greater life satisfaction.
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 With respect to the Big 5, need for cognition is:
(a) positively correlated with O and C.
(b) negatively correlated with N.
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What is a personality disorder?
• The American Psychiatric Association characterizes
a personality disorder (PD) as follows:
1. A PD is an enduring pattern of inner experience and
behaviour that deviates markedly from the
expectations of the individual’s culture. This pattern is
manifest in 2 or more of the following areas:
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(a) Cognition (i.e., ways of perceiving and interpreting
the self, others, and events).
(b) Affectivity (i.e., the range, intensity, ability, and
appropriateness of emotional responses).
(c) Interpersonal functioning.
(d) Impulse control.
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2. The enduring pattern is inflexible and pervasive
across a broad range of personal and social situations.
3. The enduring pattern leads to clinically significant
distress or impairment in social, occupational, or other
important areas of functioning.
4. The enduring pattern is stable and of long duration,
and its onset can be traced back to adolescence or
early adulthood.
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5. The enduring pattern is not better accounted for as a
manifestation or consequence of another mental
disorder.
6. The enduring pattern is not due to the direct
physiological effects of a substance (e.g., a drug of
abuse, a medication) or a general medical condition,
such as head trauma.
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• The most widely accepted system for describing and
diagnosing PDs is the Diagnostic and Statistical
Manual of Mental Disorders (i.e., the DSM-IV).
• The DSM-IV lists the symptoms associated with 200
mental disorders, 10 of which are PDs.
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What personality disorders are recognized
by the DSM-IV-TR?
• The 10 personality disorders listed in the DSM-IV are
divided into 3 clusters. We will consider 2 disorders from
each cluster in depth.
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Cluster A: The Eccentric Cluster
 Individuals diagnosed with disorders belonging to this
cluster are characterized by social awkwardness and
odd or eccentric behaviour.
 The disorders included in this cluster are schizotypal
PD, paranoid PD, and schizoid PD.
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(a) Schizotypal PD (SPD)
 According to the DSM-IV, SPD is a “pervasive
pattern of social and interpersonal deficits marked by
acute discomfort with, and reduced capacity for, close
relationships as well as by cognitive or perceptual
distortions and eccentricities of behavior."
 An individual is diagnosed with SPD if s/he displays at
least 5 of the following symptoms:
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 Ideas of reference.
 Odd beliefs or magical thinking.
 Unusual perceptual experiences, including bodily illusions.
 Odd thinking and speech.
 Suspiciousness or paranoid ideation.
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 Inappropriate or constricted affect.
 Behavior or appearance that is odd, eccentric, or
peculiar.
 Lack of close friends or confidants other than relatives.
 Excessive social anxiety that does not diminish with
familiarity and tends to be associated with paranoid
fears rather than negative judgments about self.
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 Thus, the individual with SPD is socially withdrawn
and displays eccentric beliefs, paranoid tendencies,
idiosyncratic speech, perceptual illusions, unusual
appearance, inappropriate affect, and social anxiety
(Frances, 1995).
 Estimated to afflict 3% of the general population. Sex
differences have not been found.
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Case Study:
Fred is an unemployed 29 year old man. He states that he can often read
people’s minds, and finds it disturbing to be in crowds. He thinks other people
know that he is reading their mind and resent him. He often feels he is
leaving his body, but can concentrate on not “slipping away.” He states he
does not have hallucinations, but he does think that he can help his family by
concentrating really hard on their safety when, for example, they take a trip
on an airplane.
He had a girlfriend for about a year when he was in college. He said that "she
got tired of my reading her mind." She also wanted to go out and do more,
but Fred stated that he was just too uncomfortable in social situations.
Fred has held a number of relatively unskilled jobs such as dishwasher, parks
cleaner, and book store clerk. He often had difficulty getting to work on time,
and felt that his boss was always watching him. He has trouble with
schedules, and sometimes feels “too spacy” to be around anyone.
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(b) Paranoid PD (PPD)
 According to the DSM-IV, PPD is a “pattern of
pervasive distrust and suspiciousness of others such
that their motives are interpreted as malevolent."
 An individual is diagnosed with PPD if s/he displays at
least 4 of the following symptoms:
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 Suspects, without sufficient basis, that others are
exploiting, harming, or deceiving him/her.
 Is preoccupied with unjustified doubts about the loyalty
or trustworthiness of friends or associates.
 Is reluctant to confide in others because of unwarranted
fear that the information will be used maliciously against
him/her.
 Reads hidden demeaning or threatening meanings into
benign remarks or events.
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 Is unforgiving of perceived insults, injuries, or slights on
his or her character or reputation that are not apparent
to others and is quick to react angrily or to
counterattack.
 Has recurrent suspicions, without justification, regarding
the fidelity of his/her spouse or sexual partner.
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 Thus, the individual with PPD is suspicious, guarded,
and vindictive. This individual tends to view him/herself
as righteous and mistreated, and will pursue perceived
conflict with great tenacity, never seeming to tire in the
quest for self-vindication (Beck, 1990; Kantor, 1992).
 Estimated to afflict 0.5 – 2.5% of the general population.
PPD is more common in men than in women.
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Case Study:
Derek worked in a large office as a computer programmer. When another
programmer received a promotion, Derek felt that the supervisor "had it in
for him" and would never recognize his worth. He was sure that his coworkers were subtly downgrading him. Often he watched as others took
coffee breaks together and imagined they spent this time talking about him.
If he saw a group of people laughing, he knew they were laughing at him.
He spent so much time brooding about the mistreatment he received that
his work suffered and his supervisor told him he must improve or receive a
poor performance rating. This action reinforced all of Derek's suspicions.
He began to look for a new job. Within a few weeks, he found a position in
another large company. Soon, however, he began to feel that others in the
office didn't like him, excluded him from all conversations, made fun of him
behind his back, and eroded his position. Derek quit. Soon thereafter, he
mailed angry letters to his former co-workers, threatening to sue them.
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Cluster B: The Erratic Cluster
 Individuals diagnosed with disorders belonging to this
cluster are characterized by poor emotional control.
 The disorders included in this cluster are borderline
PD, histrionic PD, narcissistic PD, and antisocial PD.
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(a) Borderline PD (BPD)
 According to the DSM-IV, BPD is a “pervasive pattern
of instability of interpersonal relationships, self-image,
and affects, and marked impulsivity."
 An individual is diagnosed with BPD if s/he displays at
least 5 of the following symptoms:
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 Frantic efforts to avoid real or imagined abandonment.
 A pattern of unstable and intense interpersonal
relationships characterized by alternating between
extremes of idealization and devaluation.
 Markedly and persistently unstable self-image or sense
of self.
 Impulsivity in at least two areas that are potentially selfdamaging (e.g., spending, sex, substance abuse,
reckless driving, binge eating).
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 Recurrent suicidal behavior, gestures, or threats, or selfmutilating behavior.
 Affective instability due to a marked reactivity of mood
(e.g., intense episodic dysphoria, irritability, or anxiety).
 Chronic feelings of emptiness.
 Inappropriate, intense anger or difficulty controlling
anger.
 Transient, stress-related paranoid ideation or severe
dissociative symptoms.
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 Thus, the individual with BPD experiences intense
abandonment fears and inappropriate anger even when
faced with a time-limited separation. They may believe
that this "abandonment" implies they are "bad." They are
intolerant of being alone. Their frantic efforts to avoid
abandonment include impulsive actions such as selfmutilation or suicidal behaviors.
 Estimated to afflict 2% of the general population. BPD is
more common in women than in men.
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Case Study:
Becky is 25 years old. She was recently released from the hospital after
she drove her car into her boyfriend’s office. She said she wanted to kill
herself and him because he split up with her, and she is "devastated" with
pain.
Becky has had 7 live-in boyfriends since she left her parents home at the
age of 15. She usually meets someone, falls “madly in love” and moves in
with them within weeks. After a few months she discovers that they are not
as wonderful as she first thought. She starts to see the men as mean,
withholding, selfish, and lazy. They often have numerous fights with
separations and reunions. After a year or so, Becky usually finds a new
man, and begins the cycle again. Becky had been living with her most
recent boyfriend for about 3 months prior to the accident.
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Case Study, continued:
Becky has held numerous jobs. She is often enthusiastic and a great
worker for the first few weeks. She then starts to complain about the coworkers, and begins to have conflicts with her supervisor. She often
quits, or is fired after an angry shouting match with her supervisor.
Becky is requesting rehabilitation services because she is so
“depressed” and hurt she is not sure she will ever feel happy again. She
still sometimes thinks about killing herself. She wants help finding a job
where the people will appreciate her, and they don't all turn out to be
mean and selfish.
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(b) Histrionic PD (HPD)
 According to the DSM-IV, HPD is a “pervasive pattern of
excessive emotionality and attention seeking."
 An individual is diagnosed with HPD if s/he displays at
least 5 of the following symptoms:
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 Is uncomfortable in situations in which s/he is not the
center of attention.
 Interaction with others is often characterized by
inappropriate sexually seductive or provocative behavior.
 Displays rapidly shifting and shallow expression of
emotions.
 Consistently uses physical appearance to draw attention
to self.
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 Has a style of speech that is excessively impressionistic
and lacking in detail.
 Shows self-dramatization, theatricality, and exaggerated
expression of emotion.
 Is suggestible or easily influenced by others or
circumstances.
 Considers relationships to be more intimate than they
actually are.
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 Thus, the individual with HPD seeks continuous
excitement, attention and appreciation. S/he is
characterized by shallow and labile affect, selfdramatization, suggestibility, and self-indulgence. This
individual may engage in inappropriate seductiveness
and is excessively concerned with physical
attractiveness. S/he longs to be loved and taken care of
by someone who is both powerful and able to be
controlled through the use of charm and seductiveness.
 Estimated to afflict 2 – 3 % of the general population.
HPD is more common in women than in men.
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Case Study:
Roxanne was a student who also worked in the evenings as a dancer at a
strip club. She would tell people that her job was temporary. However, she
readily admitted that the job met her two most important needs: money and
attention, “two things I cannot live without.” Roxanne decided to take some
psychology courses for self-improvement. She typically came to class
“dressed to kill” and seemed out of place. Once she went to her professor’s
office yet did not seem to have any direct questions to discuss. Instead,
she seemed just to want to talk about herself and her job. After this
meeting, she told several students that she was on a first-name basis with
her professor and that he was her good friend. In class, she frequently
behaved in ways that drew attention to herself, such as sighing loudly when
the professor made a point, or blurting out answers to rhetorical questions.
Toward the end of the course, Roxanne stopped going to class and missed
the final exam. She e-mailed her professor, saying that she had been
experiencing a debilitating condition and had been seen by several doctors.
The professor never heard from her again.
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Cluster C: The Anxious Cluster
 Individuals diagnosed with disorders belonging to this
cluster are characterized by behaviours that are
designed to reduce or avoid anxiety.
 The disorders included in this cluster are obsessivecompulsive PD, avoidant PD, and dependent PD.
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(a) Obsessive-Compulsive PD (OCPD)
 According to the DSM-IV, OCPD is a “pervasive
pattern of preoccupation with orderliness,
perfectionism, and mental and interpersonal control, at
the expense of flexibility, openness, and efficiency.”
 An individual is diagnosed with OCPD if s/he displays
at least 4 of the following symptoms:
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 Is preoccupied with details, rules, lists, order,
organization, or schedules to the extent that the major
point of the activity is lost.
 Shows perfectionism that interferes with task completion.
 Is excessively devoted to work and productivity to the
exclusion of leisure activities and friendships.
 Is excessively conscientious, scrupulous, and inflexible
about matters of morality, ethics, or values.
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 Is unable to discard worn-out or worthless objects even
when they have no sentimental value.
 Is reluctant to delegate tasks or to work with others
unless they submit to exactly his/her way of doing
things.
 Adopts a miserly spending style toward both self and
others; money is viewed as something to be hoarded.
 Shows rigidity and stubbornness.
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 Thus, the individual with OCPD is afraid of making a
mistake or being accused of being imperfect. In
response, the individual engages in a quest for perfection
that results in inconsiderate domination of others and an
inclination to blame and criticize people with whom they
are connected. They engage in blind obedience to
authority or principle. They are extremely self-disciplined,
restrained, and self-critical (Benjamin, 1993)
 Estimated to afflict 1% of the general population. OCPD
is more common in men than in women.
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Case Study:
Maria was a 39-year old woman who had been married for 18 years. She
was always orderly and kept a very neat house. She vacuumed every day,
whether or not the house needed it. She constantly nagged her husband or
was angry at him because he did not seem to care as much as her that
things be neat, clean, and orderly. They did not have children because,
according to Maria, children would be too much additional work for her, and
she certainly could not count on her husband to do anything right in terms
of taking care of children or the house. Besides, children would disrupt the
order and neatness of her life.
Maria’s boss often complained that she was slow. Her boss did not
appreciate the fact that she checked her work over and over again before
turning it in. Maria also had difficulties working as part of a team because
none of the other workers met her standards. She felt they were sloppy and
imprecise. Her boss eventually had to isolate her and give her independent
work because she could not get along with her co-workers. Maria did not
have many friends. She claimed she never had time for friends.
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(b) Avoidant PD (APD)
 According to the DSM-IV, APD is a “pervasive pattern
of social inhibition, feelings of inadequacy and
hypersensitivity to negative evaluation.”
 An individual is diagnosed with APD if s/he displays
at least 4 of the following symptoms:
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 Avoids occupational activities that involve significant
interpersonal contact because of fears of criticism,
disapproval or rejection.
 Is unwilling to get involved with people unless certain of
being liked.
 Shows restraint within intimate relationships because of
the fear of being shamed or ridiculed.
 Is preoccupied with being criticized or rejected in social
situations.
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 Is inhibited in new interpersonal situations because of
feelings of inadequacy.
 Views self as socially inept, personally unappealing or
inferior to others.
 Is unusually reluctant to take personal risks or to engage
in any new activities because they may prove
embarrassing.
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 Thus, the individual with APD feels inadequate,
unacceptable, and incapable of being loved. S/he retreats
from others in anticipation of rejection and, therefore,
leads a socially impoverished life. Interpersonally, s/he is
ill at ease, awkward, and tense. S/he experiences
unremitting self-consciousness and self-contempt,
yearning for social relations that are perceived to be
unattainable (Oldham, 1990).
 Estimated to afflict 0.5 - 1% of the general population.
Sex differences have not been found.
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Case Study:
John is 21 year old university student who has gone to the university’s
psychological clinic with the general complaint that he is uncomfortable in
social settings. Because he is so shy and nervous, he keeps his contact
with others to a minimum. He is worried about starting new classes next
semester and having to be in rooms with total strangers. He is especially
worried about his psychology courses, where “they might find out I am a
nutcase.” He adds that he is thinking of switching his major from
psychology to computer science. Although he is curious about people, and
therefore likes psychology, he nevertheless feels awkward around them.
Computers, he thinks, are much easier to get along with.
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Case Study, continued:
John reports that, as a child, he was teased mercilessly by other children.
He remembers withdrawing from others at about this time in his life. He
says that in grade school he would try to make himself small and
inconspicuous, so others would not notice him.
John has never held a real job. At university, he apparently has no friends,
or at least cannot name any. He says he is afraid others will not like him
“when they find out what I am really like,” so he avoids social contact.
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Are personality disorders better represented
by categories or dimensions?
• Although the DSM-IV uses categories to differentiate
personality disorders, many theorists argue that the use
of categories is flawed. Among the primary criticisms
offered by these theorists are:
1. the subjective identification of diagnostic categories.
2. the occurrence of comorbid diagnoses.
3. the high rate of “PD NOS” diagnoses.
4. the poor test-retest reliability of diagnoses.
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Lecture 19 The Cognitive Self-Regulation Perspective
and Personality Disorders
1. Can personality be described in terms of “cognitive
styles?” (continued)
2. What is a personality disorder?
3. What personality disorders are recognized by the
DSM-IV-TR?
4. Are personality disorders better represented by
categories or dimensions?
Psychology 305
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