© 2013 W. W. Norton & Company, Inc. The Personality Puzzle Sixth Edition by David C. Funder Chapter 18: Disorders of Personality 1

Objectives Discuss what personality disorders are and the characteristics of the disorders Discuss four bases for diagnosis Briefly discuss the Diagnostic and Statistical Manual (DSM) Discuss the prototype model of diagnosis 2 © 2013 W. W. Norton & Company, Inc.

Personality Disorders Definition: patterns of thought, feeling, and behavior beyond the normal range of psychological variation There is not an exact point that differentiates between normal and disordered personality How common? 15% of all adult Americans 3 © 2013 W. W. Norton & Company, Inc.

The Diagnostic and Statistical Manual (DSM) The most recent (5 th ) edition – Describes the primary indicators of disorders and how many need to be present to make a diagnosis Purposes – Make diagnosis more objective – Insurance billing 4 © 2013 W. W. Norton & Company, Inc.

DSM: Organization Axis I: severe psychopathologies Axis II: personality disorders Axis III: physical conditions related to mental health Axis IV: stressors in the patient’s social life Axis V: current ability to function self- sufficiently 5 © 2013 W. W. Norton & Company, Inc.

Defining Personality Disorders 1) Unusually extreme personality attributes – In terms of cultural context – Denial of reality 2) Problematic – For the person: anxiety, depression, confusion – Or for others 3) Affect social relationships 6 © 2013 W. W. Norton & Company, Inc.

Defining Personality Disorders 4) Stable over time – Begin in adolescence or childhood – Difficult to change with therapy 5) Ego-syntonic – Symptoms are seen as normal and valued aspects of personality – They think others are the ones with a problem 7 © 2013 W. W. Norton & Company, Inc.

Bases for Diagnosis Clinical impression – Open and flexible – Unreliable Self-report scales – Advantages – Disadvantages 8

Bases for Diagnosis Structured interviews – Advantages – Disadvantages Informant report – Advantages and disadvantages of I data Consensus about symptoms The most information, from the widest possible number of sources, will lead to the most accurate diagnosis 9 © 2013 W. W. Norton & Company, Inc.

The Major Personality Disorders Cluster A: odd and eccentric patterns of thinking – Schizotypal, schizoid, paranoid Cluster B: impulsive and erratic patterns of behavior – Histrionic, narcissistic, antisocial, borderline Cluster C: anxious and avoidant emotional styles – Dependent, avoidant, obsessive-compulsive 10 © 2013 W. W. Norton & Company, Inc.

Cluster A: Odd/Eccentric Disorders Thinking is strange, eccentric, or delusional Schizotypal personality disorder 1.Ideas of reference 2.Magical thinking, bizarre fantasies, believing in odd phenomenon 3.Strange perceptual experiences 4.Odd speech or thinking 11 © 2013 W. W. Norton & Company, Inc.

Cluster A: Odd/Eccentric Disorders Schizotypal personality disorder 5.Suspiciousness or paranoia 6.Inappropriate or flattened emotions 7.Odd, peculiar, or eccentric actions or appearance 8.Failure to develop friendships and a lack of social ties other than to one’s immediate family 9.Anxiety being around other people that does not go away (even after knowing each other for years) 12 © 2013 W. W. Norton & Company, Inc.

Cluster A: Odd/Eccentric Disorders Schizoid personality disorder – No pleasure from social interaction – Indifferent to the opinions of others – Rarely experiences strong feelings Minimal reaction to losing a job or loved one 2 min 22 seconds 13 © 2013 W. W. Norton & Company, Inc.

Cluster A: Odd/Eccentric Disorders Paranoid personality disorder – Assume the worst of everyone – Alert for signs of betrayal – Reluctant to trust or confide in anyone – Angry, stubborn and bitter 14 © 2013 W. W. Norton & Company, Inc.

Cluster B: Impulsive/Erratic Disorders Problems in regulating behavior and thinking lead to impulsive and erratic behavior Histrionic personality disorder – Goal is to always be the center of attention – Express strong opinions without basis – Strong emotions that suddenly change or disappear – Not taken seriously by others, difficult to get along with, serious difficulties in relationships without understanding why 15

Cluster B: Impulsive/Erratic Disorders Narcissistic personality disorder (NPD) – Excessive self-love – Belief that one is exceptional – More extreme than the trait of narcissism – Needs the admiration of others – Exploits others – Lack of empathy – Extreme arrogance 16 © 2013 W. W. Norton & Company, Inc.

Cluster B: Impulsive/Erratic Disorders Antisocial personality disorder – Illegal activities – Risky behaviors – Irritable, aggressive, and irresponsible – Problems caused to others does not bother them 17 © 2013 W. W. Norton & Company, Inc.

Cluster B: Impulsive/Erratic Disorders Borderline personality disorder (BPD) – Most severe personality disorder 1. Rapid mood shifts 2. Uncontrollable anger 3. Self-destructive acts 4. Self-damaging behaviors 5. Identity disturbance 18 © 2013 W. W. Norton & Company, Inc.

Cluster B: Impulsive/Erratic Disorders Characteristics of BPD 6.Chronic emptiness/ boredom 7.Unstable relationships 8.Fear of abandonment 9.Confusion and feelings of unreality Genetics, emotional rejection, problems with Opiod system. Treatment: behavioral therapy teaching emotional self-control 19 © 2013 W. W. Norton & Company, Inc.

Cluster C: Anxious/Avoidant Disorders Excessive anxiety, avoidance of social contact and relationships, behavioral patterns driven by anxiety Dependent personality disorder – Submissive interpersonal style – Fear disagreeing with others 20 © 2013 W. W. Norton & Company, Inc.

Cluster C: Anxious/Avoidant Disorders Avoidant personality disorder – Expect the absolute worst from others – Need constant reassurance of uncritical acceptance – Deep cravings for affection and social acceptance 21 © 2013 W. W. Norton & Company, Inc.

Cluster C: Anxious/Avoidant Disorders Obsessive-compulsive personality disorder (OCPD) – Not the same as obsessive compulsive disorder 1. Overconcern with rules and details 2. Perfectionism 3. Workaholism 4. Inflexibility of thinking and behaving 22 © 2013 W. W. Norton & Company, Inc.

Cluster C: Anxious/Avoidant Disorders OCPD 5.Packrat behavior 6.Inability to delegate 7.Miserliness 8.Rigidity and stubbornness – Ego-syntonic despite the anxiety (makes them resistant to treatment) 23 © 2013 W. W. Norton & Company, Inc.

The Major Personality Disorders Cluster A: odd and eccentric patterns of thinking – Schizotypal, schizoid, paranoid Cluster B: impulsive and erratic patterns of behavior – Histrionic, narcissistic, antisocial, borderline Cluster C: anxious and avoidant emotional styles – Dependent, avoidant, obsessive-compulsive 24 © 2013 W. W. Norton & Company, Inc.

Diagnosis No clear requirements for diagnosis of a personality disorder Each disorder can be presented in a number of ways BPD has 256 possible patterns People with the same diagnosis may not resemble each other Possible to have characteristics of several disorders at once (Charles Manson) © 2013 W. W. Norton & Company, Inc. 25

Disorder Prototypes Alternative: think of diagnosis in terms of prototypes – Assess degree to which a person’s symptoms match a disorder prototype – Acknowledge the complexity of diagnosis, the overlap of categories, and the heterogeneity within categories 26 © 2013 W. W. Norton & Company, Inc.

Disorder Commonality All disorders seem to be associated with an inability to hold thoughts in active, working memory 27 © 2013 W. W. Norton & Company, Inc.

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Toward the DSM-V Ratings of 5 maladaptive personality traits – Negative affectivity – Detachment – Antagonism – Disinhibition – Psychoticism Advantage of these ratings – Implies the differences between abnormal and normal personality lie along a continuum 29 © 2013 W. W. Norton & Company, Inc.

Toward the DSM-V New modes of diagnosis – Assess whether personality functioning is seriously impaired – Assess whether a personality disorder is present – Assess degree of each of the maladaptive traits 30 © 2013 W. W. Norton & Company, Inc.

Personality and Disorder Pathologizing behaviors – Do all bad people have personality disorders? – Should we refrain from punishing socially undesirable, illegal, or immoral behavior because people suffer from antisocial personality disorder? – Describing behavior as the result of mental illness is too easy 31 © 2013 W. W. Norton & Company, Inc.

Personality and Disorder Mental health – Pathologizing tells us almost nothing about the nature of mental health – Improving mental health requires an understanding of normal personality 32 © 2013 W. W. Norton & Company, Inc.

Personality and Disorder Labeling – The DSM labels are misleading – Can limit understanding – A label is not an explanation – Labels can be useful and are necessary 33 © 2013 W. W. Norton & Company, Inc.

Normal and Abnormal There is not a sharp dividing line. Having a mild degree of a few characteristics does not imply having a disorder. Disorders may be thought of as exaggerated versions of traits that are advantageous when in the normal range. – Vigilant, wary, a survivor: paranoid – Strong, willful, self-reliant: antisocial – Sensitive, quiet, a homebody: avoidant 34 © 2013 W. W. Norton & Company, Inc.

Normal and Abnormal 35 © 2013 W. W. Norton & Company, Inc.