1. Personality Disorders
William P. Wattles, Ph.D.
Francis Marion University

2. Personality Disorders are generalized, inflexible patterns of inner experience and behavior of long-standing.

3. Personality Disorders are long-term, maladaptive patterns of perception, emotional regulation, anxiety, and impulse control.

4. Personality
1.The enduring pattern of inner experiences and outward behavior that is unique to each individual.

5. Personality Disorders
Enduring pattern of inner experience
Deviates markedly from the expectations of the person’s society
Pervasive and inflexible
Onset in adolescence or early adulthood
Is stable over time
Leads to distress or impairment.

6. Personality Traits
Enduring patterns of perceiving, relating to and thinking about the environment and oneself exhibited over a wide range of social and personal contexts. Stable across:
Time
Place
Situation
Only disorders if maladaptive

7. Personality disorder Involves long-term functioning
difficult to assess in one interview
not organic, substance-induced or situational
must go back at least to early adulthood
may be ego-syntonic

8. PD’s frequently overlooked
Client may express more concern with Axis I Problems
Personality styles often hidden and must be inferred
Can be difficult to distinguish between state (clinical) elevations and trait (personality) scales.

9. Cluster A Individuals appear odd or eccentric Paranoid Schizoid
Schizotypal

10. Cluster B Individuals appear dramatic, emotional or erratic Antisocial
Borderline
Histrionic
Narcissistic

11. Cluster C Individuals appear anxious or fearful Avoidant Dependent
Obsessive-Compulsive

12. Paranoid Personality Disorder
Pervasive distrust and suspiciousness of others such that their motives are interpreted as malevolent.

13. Paranoid Personality Disorder
Four of:
Suspects others exploiting, harming or deceiving
preoccupied with unjustified doubts of loyalty of friends and associates
Reluctant to confide in others
Reads hidden demeaning of threatening meanings into benign events
persistently bears grudges
perceives attacks not apparent to others
recurrent suspicions w/o cause regarding fidelity of partner

14. Paranoid P.D. Overreact to minor slights Hold grudges
Constantly vigilant
Quick to counterattack

15. Dichotomy
Normal
Paranoid

16. Points on Continuum Paranoid Traits Paranoid P. D. Delusional Disorder
Normal
Paranoid Schizophrenic
Gullible

17. Delusional Disorder Persecutory Type
Central theme of being conspired against, cheated, spied on, followed, poisoned Maligned, harassed, or obstructed. May engage in repeated attempts to get satisfaction by appeal to courts and government agencies

18. Delusions
Erroneous beliefs that usually involve misinterpretation of perceptions or experiences.
Vapor trails
Delusions are deemed bizarre is they are clearly implausible.
Thought broadcasting

19. Delusional Disorder vs Schizophrenia
Bizarre versus nonbizarre delusions
Bizarre if clearly implausible, not understandable, not derived from ordinary life experience.
Nonbizarre involves thing that can occur in real life: being followed, poisoned loved at a distance, deceived by one’s spouse.

20. Schizophrenia Paranoid type
Preoccupation with prominent delusions or hallucinations

21. Schizoid Personality Disorder
Pervasive pattern of detachment from social relationships and a restricted range of expression of emotions.

22. Schizoid Personality Disorder
Four of:
neither desires nor enjoys close relationships
Usually chooses solitary activities
Has little interest in sex with another person
Take pleasure in few if any activities.
Lacks close friend or confidants
appears indifferent to praise or criticism
shows emotional coldness and flat affect

23. Schizotypal Personality Disorder
Pervasive pattern of social and interpersonal deficits marked by acute discomfort with close relationships as well as by cognitive or perceptual distortions and eccentricities of behavior.

24. Schizotypal Personality Disorder
Five of:
Ideas of reference
odd beliefs
unusual perceptual experiences
odd thinking and speech
suspiciousness or paranoid ideation
Inappropriate or constricted affect
odd behavior or appearance
lack of close friends or confidants
excessive social anxiety based on paranoid ideation

25. Antisocial Personality Disorder
The essential feature is a pervasive pattern of disregard for the violation of the rights of others.
Since age 15
Sociopathy, psychopathy

26. Antisocial Personality Disorder
Failure to conform to social norms
deceitfulness, lying aliases conning.
Impulsivity and failure to plan ahead
irritability and aggressiveness
reckless disregard for the safety of self and others
consistent irresponsibility
lack of remorse

27. Borderline Personality Disorder
Pervasive pattern of instability of interpersonal relationships, self-image, and affects. Marked impulsivity KM

28. Borderline Personality Disorder
Frantic efforts to avoid abandonment
unstable and intense relationships
identity disturbance
impulsivity: sex, substance abuse, reckless driving, binge eating.
Recent suicidal behavior or threats
affective instability
chronic feelings of emptiness

29. Histrionic Personality Disorder
Pervasive Pattern of excessive emotionality and attention-seeking behavior.

30. Histrionic Personality Disorder
Uncomfortable if not the center of attention.
Inappropriate sexually seductive or provocative behavior.
Rapidly shifting and shallow emotions
Uses physical appearance to draw attention.
Speech is excessively impressionistic and lacking in detail
Self-dramatization, theatricality and exaggerated expression of emotion
Suggestible
Considers shallow relationships intimate

31. Narcissistic Personality Disorder
Pervasive pattern of grandiosity, need for admiration and lack of empathy that begins by early adulthood

32. Narcissistic Personality Disorder
Grandiose sense of self-importance
Preoccupied with fantasies of unlimited success
Believes he or she is special
requires excessive admiration
Sense of entitlement
interpersonally exploitative
lacks empathy
envious
arrogant behavior and attitudes

33. Narcissistic Personality Disorder
Baughman article
Sense of entitlement
Lack of empathy or conscience
No lack of intelligence
No lack of social skills

34. Uconn President
…spending in hard times. There was the $170,000 inauguration with regal fireworks, the half-million-dollar office renovation, the decision to have the state pay $49,000 in rent on a house near campus rather than live in the recently restored presidential mansion (the reason cited was health issues related to mold), and the $3,500 for six life-size cutouts of him around campus.”
Notified board chair from airport by cell phone at 5:30 the day before announcement.

35. Avoidant Personality Disorder
Pervasive pattern of social inhibition, feelings of inadequacy and hypersensitivity to negative evaluation.

36. Avoidant Personality Disorder
Avoids jobs with social contact or evaluation
Unwilling to get involved unless sure of being liked
Restraint in intimate relationships
Preoccupied with being criticized or rejected
Inhibited in new situations due to inadequacy
view self as socially inept
reluctant to take risks

37. Dependent Personality Disorder
Pervasive need to be taken care of that leads to submissive and clinging behavior and fears of separation.

38. Dependent Personality Disorder
Difficulty making decisions
Needs other to take responsibility for life
Difficulty expressing disagreement
Problems with initiative
Excessive need for nurturing
Feels uncomfortable or helpless alone
Urgently seeks new relationship when one ends.
Fears of being left to care for self

39. Obsessive-Compulsive Personality Disorder
Preoccupation with orderliness, perfectionism and mental and interpersonal control.

41. Obsessive-Compulsive Personality Disorder
Preoccupied with details, rules, lists, order.
Perfectionism that interferes with task
Excessively devoted to work and productivity
Rigid and stubborn
Overconscientious about matters of morality, ethics or values.
Unable to discard worthless objects
Reluctant to delegate
Miserly

42. Millon Clinical Multiaxial Inventory MCMI-III
Standardized
Self-report
Adults
8th grade reading level
Focus on Personality Disorders

43. Millon Clinical Multiaxial Inventory MCMI-III
175 items
28 Scales
Closely aligned with Millon’s theory and DSM-IV

44. MCMI-III
Can be used instead of or in addition to MMPI.

45. Theoretical Considerations
Millon’s Theory
Core Principle Polarities of:
Pleasure-pain
Active-passive
Self-other

46. Interpretation BR base rate scores
Used instead of T scores and norm-referencing.
Distribution of scores varies from one personality scale to the next.
MCMI uses criterion referencing rather than norm referencing.
Base rate or prevalence of disorder in the psychiatric population

47. BR scores For clinical scales: BR 75 indicates presence of a trait
BR 85 indicates presence of a disorder

48. 1. Interpret Profile Validity
Validity Scale-3 items, 1 is sign of absurd answer
Disclosure Index- below 34 indicates defensive unwillingness to disclose.
Desirability Index –measure of defensive responding. Scores above BR 75 suggest claims of unusual moral, attractive stable organized.
Debasement index-the extent to which a client describes themselves in negative terms. Above BR 85 bad profile and/or cry for help.

49. 2. Interpret Personality Disorder scales
The primary focus for diagnosis is on the Severe Personality Disorders.
Unless elevations on others were high compared to SPD
Other personality pattern scales used to elaborate on Severe Personality Disorder Scale.

50. 3. Interpret Clinical Syndrome Scales
Precedence given to elevations on Severe Clinical Syndrome scales
All can be elevated

51. Schizoid Scale 1
Little or no interest in other people

52. Avoidant Scale 2A
A desire to be with other people that is blocked by an intense fear of being rejected or humiliated.

53. Depressive Scale 2B
Clients perceive themselves as worthless, vulnerable, inadequate, unsuccessful, and guilty. The frequently engage in self-criticism and frame events in a defeatist manner.

54. Dependent Scale 3
They feel incapable and incompetent of functioning independently. They quickly form alliances and give up responsibility for decisions. See themselves as placating, insecure, passive and immature.

55. Histrionic Scale 4
Histrionic persons are dramatic, colorful and emotional. Tolerance for boredom is low and they constantly seek novel situations.
Elevations of Histrionic are associated with an above average number of positive life events, low levels of distress and good social adjustment.

56. Narcissistic Scale 5
Exaggerated sense of self-importance and competence.

57. Antisocial Scale 6A
Competitiveness along with impulsive acting-out of anti-social feelings. Provocative, violent, vicious, self-centered, dominant, dishonest, brutal an devious.

58. Aggressive Scale 6B
Competitive, energetic, hard-headed, authoritarian and socially intolerant. Predisposed toward aggressive outburst with little sensitivity.

59. Compulsive Scale 7
Conformity, discipline, self-restraint, formality. Strictly adhere to social norms. Conscientious, well prepared, reghteous, and meticulous.

60. Passive-Aggressive Scale 8A
Passive compliance combined with resentment and opposition.

61. Self-defeating 8B
Present themselves as inferior, nonindulgent, self-effacing, insecure. They do not deserve pleasure.

62. Schizotypal Scale S
Eccentricity, disorganization and social isolation.

63. Bordeline Scale C
Instability and unpredictability of mood and behavior.

64. Paranoid Scale P
Suspicious and defensive

65. Anxiety Scale A
Tension, difficulty relaxing, indecisiveness, and apprehension.

66. Somatoform Scale H
Somatic complaints in the for of generalized pain, fatigue, multiple vague complaints, preoccupation with health problems.

67. Bipolar: Manic Scale N
Moods swings that range from elation to depression.

68. Dysthymia Scale D Sadness, pessimism
hopelessness, apathy, low self-esteem, guilt

69. Alcohol Dependence Scale B
A history of problem drinking.

70. Drug Dependence Scale T
Recurring difficulties with drug abuse

71. Posttraumatic Distress Disorder Scale R
Extreme experience leading to fear, helplessness and arousal.

72. Thought Disorder SS
Inconsistent, bizarre, fragmented and disorganized thoughts.

73. Major Depression Scale CC
Severe depression-difficulty with effective daily living.

74. Delusional Disorder PP
Irrational but interconnected delusions, persecutory thoughts and grandiosity

75. MCMI Commendable and innovative
Generally a well-constructed psychometric instrument
Test-retest reliabilities moderate to high
Factor analysis generally supports organization of scales.

76. MCMI problems No “gold standard” or benchmark to validate scale.
Low interdiagnostician agreement
May over diagnose and over pathologize

77. MCMI problems
“Our ability to describe different personality disorders has outstripped out ability to diagnose them accurately in real-world clinical settings.”

78. MCMI Axis 1 State Axis 2 Trait
MCMI frequently revised to keep it consistent with the DSM
Should be used only with clinical populations

79. The End