Personality Disorders

Question 1

intro to personality & personality disorders

Answer 1

• Some people say personality doesn’t exist (just responses to stimuli), whereas others argue it’s one of the most important things about being human
• Anxiety and somatoform disorders can go away, but personality disorders share characteristics with interpersonal styles
• Personality = behavioural patterns/characteristics & coping styles
• • We can use it to predict how people will respond in certain contexts
• Personality disorders = when people behave inflexibly and maladaptively
• • PDM includes all personality disorders found in DSM, including additional ones

Question 2

what influences personality?

Answer 2

• genetics
• temperament
• environment

Question 3

personality disorders

Answer 3

• When behaviour patterns become inflexible and maladaptive to the point of causing distress or social/occupation impairment (self-defeating)
• Don’t stem from reactions to stress; actually from gradual development of inflexible and distorted personality -> have always been there
• Maladaptive ways of perceiving, thinking, and relating to the world
• Can be mild or severe:
• • Mild disorders: people function reasonably well, viewed as troublesome, eccentric, etc.
• • Severe disorders: extreme or unethical behaviour, may be incarcerated
• Trait pattern examples: suspiciousness in every context, excessive self-regard, profound fear of rejection, repetitive maladaptive behaviour

Question 4

DSM Clinical Syndrome vs. Personality Disorders

Answer 4

• Clinical syndrome: specific symptom clusters, time limited, ego-dystonic (viewed as separate from self, unacceptable, objectionable and alien)
• • Ie. Depression, anxiety, psychotic disorders
• Personality disorder: individual with personality disorder is perceived as ego-syntonic (eg. Personality issues are acceptable, unobjectionable, and part of the self); tend to blame others for problems in their lives

Question 5

Difficulties Diagnosing Personality Disorder

Answer 5

• 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

Question 6

DSM Personality Disorder Clusters

Answer 6

• Cluster 1: Odd/Eccentric
• • behaviours similar to schizophrenia, suspiciousness, withdrawal, peculiar thinking
• • Paranoid, Schizoid, Schizotypal
• Cluster 2: Dramatic/Emotional
• • most commonly diagnosed disorders; behaviours are so dramatic, emotional, or erratic that it’s almost impossible to maintain satisfying relationships
• • Antisocial, Histrionic, Narcissistic, Borderline
• Cluster 3: Anxious-Fearful
• • typically display anxiety and fear, similar to anxiety and depressive disorders but no real connection
• • Avoidant, Dependent, Obsessive-Compulsive

Question 7

Paranoid Personality Disorder

Answer 7

• Cluster 1
• 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
• ex. Rev. Jim Jones; student that followed

Question 8

Schizoid Personality Disorder

Answer 8

• Cluster 1
• don’t interact with others (no desire to)
• indifferent to relationships
• limited social range (some are hermits)
• aloof, detached, “loners”
• no apparent need of friends, sex, etc.
• solitary activities
• seem to be missing the “human” part
• Ex. Ted Kaczynski (Unabomber)

Question 9

Schizotypal Personality Disorder

Answer 9

• Strange thoughts; makes people uncomfortable; conspiracies
• Peculiar patterns of thinking and behaviour
• Perceptual and cognitive disturbances
• Magical thinking
• Not psychotic, but perhaps a distant cousin of schizophrenia
• highly comorbid

Question 10

Antisocial/Dissocial Personality Disorder

Answer 10

• Cluster 2
• Pattern of irresponsibility, recklessness, impulsivity beginning in childhood or adolescence (e.g., lying, truancy)
• In 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

Question 11

Histrionic Personality Disorder

Answer 11

• Cluster 2
• Excessive emotional displays/ dramatic behaviour
• Attention‐seeking, victim stance
• Seek reassurance, praise
• Shallow emotions, flamboyant, self‐centred
• Very seductive, “life of the party”
• previously called “hysterical personality disorder”

Question 12

Narcissistic Personality Disorder

Answer 12

• Cluster 2
• Grandiose, sense of self‐importance
• Lack of empathy
• Hypersensitive to criticism
• Exaggerate accomplishments/abilities
• Special and unique
• Entitlement
• But, below surface is fragile self‐esteem
• Narcissistic injury leads to narcissistic rage
• Ex. Armand Hammer

Question 13

Borderline Personality Disorder

Answer 13

• Cluster 2
• Broad range, but DSM focuses on narrow aspect (one type of borderline disorder)
• Marked instability of mood, relationships, self‐ image
• Intense, unstable relationships
• Uncertainty about sexuality/identity (borrowing identity of others) -> like a lack of object permanence
• Everything is “good” or “bad”
• Chronic feeling of emptiness
• Recurrent threats of self‐harm/ “slashers”
• Self-destructive behaviour -> Drug abuse
• Suicide threats
• Lots of promiscuity
• 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

Question 14

4 core elements of Borderline Personality Disorder

Answer 14

• Difficulties in establishing secure self‐ identity
• Distrust & Splitting (over-idealizing someone and then tearing them down)
• Impulsive and Self-Destructive Behaviour
• Difficulty in controlling anger and other emotions

Question 15

Avoidant Personality Disorder

Answer 15

• overriding sense of social discomfort
• easily hurt by criticism
• always need emotional support
• occasionally try to socialize –so distressing they retreat into loneliness

Question 16

Dependent Personality Disorder

Answer 16

• submissive, clingy behaviour
• fear of separation
• easily hurt by criticism

Question 17

Obsessive-Compulsive Personality Disorder

Answer 17

• excessive control and perfectionism
• Inflexible
• preoccupied with trivial details
• judgmental/moralistic
• workaholic/ignore family members
• often humourless

Question 18

PDM - Paranoid Disorder

Answer 18

• Constitutional/Maturational Patterns: possibly irritable/aggressive
• Central tension/preoccupation: attacking and being attacked by humiliating others
• Central Affects: fear, rage, shame, contempt
• Characteristic Pathogenic Self‐Belief: Hatred, aggression, and dependency are dangerous
• Characteristic Pathogenic Other‐Belief: World is full of potential attackers and users
• Central Ways of Defending: Projection, projective identification, denial, reaction formation

Question 19

PDM - Schizoid Personality Disorder

Answer 19

• Constitutional/Maturational Patterns: Highly Sensitive, shy, easily overstimulated
• Central Tension/Preoccupation: Fear of closeness yet have ongoing need for closeness
• Central Affects: Emotional pain when overstimulated, powerful affects are suppressed
• Characteristic Pathogenic Self-Belief: Dependency and love are dangerous
• Characteristic Pathogenic Other-Belief: Social world is dangerously engulfing
• Central Ways of Defending: Withdrawal (both physically and into fantasies/idiosyncrasies)

Question 20

PDM - Narcissistic Personality Disorder

Answer 20

• Characteristic Pathogenic Self-Belief: I need to be perfect to feel okay
• Characteristic Pathogenic Other-Belief: Others enjoy beauty, riches, power, fame and the more I have of those the better I feel
• Central Ways of Defending: Idealization, Devaluation
• Constitutional/Maturational Patterns: No Clear Data
• Central Tension/Preoccupation: Inflation/Deflation of Self-Esteem
• Central Affects: Shame, Contempt, Envy

Question 21

PDM - Borderline Personality Disorder

Answer 21

PDM has spectrum and numerous personality disorders that reflect severe borderline personality disorganization (neurotic, borderline, psychotic)

Question 22

PDM - Dependent Personality Disorder

Answer 22

• Characteristic Pathogenic Self-Belief: I am inadequate, needy, impotent
• Characteristic Pathogenic Other-Belief: Others are powerful and I need their care
• Central Ways of Defending: Regression, avoidance
• Constitutional/Maturational Patterns: Placidity
• Central Tension/Preoccupation: Keeping/Losing Relationships
• Central Affects: Pleasure when securely attached; sadness/fear when alone

Question 23

Differences between PDM and DSM Disorders

Answer 23

• Schizotypal Personality Disorder not included in PDM
• PDM includes 5 additional disorders not found in DSM:
• • Depressive Personality Disorder
• • Sadistic and Sadomasochistic PD
• • Masochistic (Self‐defeating) PD
• • Somatizing PD
• • Dissociative PD