Personality Disorders

Definition of Personality
Enduring

patterns of perceiving,
relating to, and thinking about the
environment and oneself, which
are exhibited in a wide range of
important social and personal
contexts

Definition of Personality Disorders

Personality disorders are enduring

patterns of perceiving, relating to, and
thinking about the environment and
oneself that are exhibited in a wide
range of important social and personal
contexts, and are inflexible and
maladaptive, and cause either
significant functional impairment or
subjective distress (DSM-IV, p. 630)

Main Features of PDs

Extreme patterns of thinking, feeling, and

behaving that deviate from a persons culture
Listed on Axis II of the DSM-IV-TR
Begin early in life and remain stable
- not contextual or transient
Inflexible and maladaptive
Cause significant functional impairment and
subjective distress
- ego-syntonic vs. ego-dystonic

Problems with the PDs

Low levels of inter-rater reliability

Comorbidity with both Axis I and Axis II
Problems with classification system
- Categorical vs. Dimensional System

DSM-IV-TR Personality Disorders

Paranoid Personality Disorder

Schizoid Personality Disorder
Schizotypal Personality Disorder
Antisocial Personality Disorder
Borderline Personality Disorder
Histrionic Personality Disorder
Narcissistic Personality Disorder
Avoidant Personality Disorder
Dependent Personality Disorder
Obsessive-Compulsive Personality Disorder

Cluster A: Odd or Eccentric

Paranoid PD is a pattern of distrust and

suspiciousness such that others motives are
interpreted as malevolent
Schizoid PD is a pattern of detachment from
social relationships and restricted range of
emotional expression
Schizotypal PD is a pattern of acute discomfort
in close relationships, cognitive or perceptual
distortions, and eccentricities of behaviour

Paranoid Personality Disorder

suspicious of others 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

Schizoid Personality Disorder

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 Personality Disorder

peculiar patterns of thinking and

behaviour
perceptual and cognitive disturbances
magical thinking
not psychotic

perhaps a distant cousin of schizophrenia

Cluster B: Dramatic, Emotional,

or Erratic

Antisocial PD is a pattern of disregard for, and

violation of, the rights of others
Borderline PD is a pattern of instability in
interpersonal relationships, self-image, and
affects, and marked impulsivity
Histrionic PD is a pattern of excessive
emotionality and attention seeking
Narcissistic PD is a pattern of grandiosity,
need for admiration, and lack of empathy

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

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

Glib and superficial

Egocentric and
grandiose
Lack of remorse or
guilt
Lack of empathy
Deceitful and
manipulative
Shallow emotions

Impulsive
Poor behavior
controls
Need for excitement
Lack of responsibility
Early behavior
problems
Adult antisocial
behavior

Quote of the day

Im the most cold-hearted son of a b---- you
will ever meet
Ted Bundy

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

Borderline and comorbidity

High degree of overlap with both Axis I

and Axis II disorders
24%-74% also diagnosed with major
depression; 4% to 20% bipolar
25% of bulimics also diagnosed with BPD
67% also diagnosed with substance use
disorder

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

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

Cluster C: Anxious or Fearful

Avoidant PD is a pattern of social inhibition,

feelings of inadequacy, and hypersensitivity to
negative evaluation
Dependent PD is a pattern of submissive and
clinging behaviour related to an excessive need
to be taken care of
Obsessive-Compulsive PD is a pattern of
preoccupation with orderliness, perfectionism,
and control at the expense of flexibility

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

Personality Disorder Not

Otherwise Specified

Meets general criteria for a PD but no

specific criteria for a specific PD.
Exhibit at least 10 symptoms of PDs
across all subtypes

Comorbidity
Average number of PD diagnoses per
patient:
- 4.6 (Skodal et al., 1988)
- 2.8 (Zanaarini et al., 1987)
- 3.75 (Widiger et al., 1986)

DSM Categorical Approach

Based on the medical model

Disorder is present or absent

Assumptions of the DSM

Personality pathology is suited to be

classified into discrete types or disorders
These disorders group themselves into
three clusters
The diagnostic criteria naturally fall into
the particular personality disorders to
which they have been assigned
Empirical Evidence doesnt support these assumptions!!!

David Klonsky University of Virgina

the DSM practice of putting expert opinions into writing and
only then conducting tests of reliability and validity cannot
lead to an acceptable classification system. Rather it directs
scientists to conduct research on, and practitioners to put
their trust in, diagnostic labels that may or may not map
onto valid constructs that exist in nature. Instead,
researchers must turn to objective, empirical methodologies
to discover the dimensions or personality pathology, letting
the data fall where they may and letting the data determine
how personality disorder is best classified

John Livesley - UBC

Dimensional Assessment of Personality

Pathology Basic Questionnaire (DAPP)
4 Dimensions: Emotional Dysregulation;
Dissocail Behaviour; Inhibitedness;
Compulsivity

 the evidence on this point is so

unequivocal that the only issue to explain
is the fields reluctance to accept empirical
evidence
~ W. John Livesley, (2000) Journal of
Personality Disorders, 14, 2, p. 139-140.

The Big 5 Personality Traits

Openness to experience
Conscientiousness
Extraversion
Agreeableness
Neuroticism

personality disorders represent

extreme variations of OCEAN

Advantages of Categorical
System
Ease in conceptualization and
communication
Familiarity
Consistency with clinical decision
making

Disadvantages of the Categorical

Approach
Complex and cumbersome
Arbitrary cut-off points
Loss of important information

Advantages of the Dimensional

Model

Resolution of a variety of classification

dilemmas
Retention of Information
Flexibility

Disadvantages of the
Dimensional Approach

Lack of clinical utility?

Lack of familiarity?

Bottom line: not too many disadvantages

and most researchers favor it likely to be
adopted in DSM-V