PSY 239 401 CHAPTER 18 SLIDES

© 2013 W. W. Norton & Company, Inc.

The Personality PuzzleSixth Edition

by David C. Funder

Chapter 18: Disorders of Personality

Slides created byTera D. LetzringIdaho State University 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• There is not an exact point that differentiates

between normal and disordered personality


The Diagnostic and Statistical Manual (DSM)

• First edition—1952• The most recent edition (DSM-IV-TR)—2000

– Describes the primary indicators of disorders and how many need to be present to make a diagnosis

• Purposes– Make diagnosis more objective– Insurance billing


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


6

Psychological Evaluation With the DSM-IV


Defining Personality Disorders

• Unusually extreme personality attributes– In terms of cultural context– Denial of reality

• Problematic– For the person: anxiety, depression, confusion– Or for others

• Affect social relationships


Defining Personality Disorders

• Stable over time– Begin in adolescence or childhood– Difficult to change with therapy

• Ego-syntonic– Symptoms are seen as normal and valued aspects

of personality– They think others are the ones with a problem


Bases for Diagnosis• Clinical impression

– Open and flexible– Unreliable

• Self-report scales– Advantages– Disadvantages


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


The Major Personality Disorders

• 10 major disorders in 3 clusters• Cluster A: odd and eccentric patterns of

thinking• Cluster B: impulsive and erratic patterns of

behavior• Cluster C: anxious and avoidant emotional

styles


Cluster A: Odd/Eccentric Disorders

• Thinking is strange, eccentric, or delusional • Schizotypal personality disorder

1. Ideas of reference2. Magical thinking, bizarre fantasies, believing in

odd phenomenon3. Strange perceptual experiences4. Odd speech or thinking



• Schizotypal personality disorder5. Suspiciousness or paranoia6. Inappropriate or flattened emotions7. Odd, peculiar, or eccentric actions or appearance8. Failure to develop friendships and a lack of social

ties other than to one’s immediate family9. Anxiety being around other people that does not

go away



• Schizoid personality disorder– No pleasure from social interaction– Indifferent to the opinions of others– Rarely experiences strong feelings



• Paranoid personality disorder– Assume the worst of everyone– Alert for signs of betrayal– Reluctant to trust or confide in anyone


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



• 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



• Antisocial personality disorder– Illegal activities– Risky behaviors– Irritable, aggressive, and irresponsible– Problems caused to others does not bother them



• Borderline personality disorder (BPD)– Most severe personality disorder1. Rapid mood shifts2. Uncontrollable anger3. Self-destructive acts4. Self-damaging behaviors5. Identity disturbance



• Characteristics of BPD6. Chronic emptiness7. Unstable relationships8. Fear of abandonment9. Confusion and feelings of unreality

• Possible origins• Treatment: dialectical behavioral therapy


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



• Avoidant personality disorder– Expect the absolute worst from others– Need constant reassurance of uncritical

acceptance– Deep cravings for affection and social acceptance



• Obsessive-compulsive personality disorder (OCPD)– Not the same as obsessive compulsive disorder1. Overconcern with rules and details2. Perfectionism3. Workaholism 4. Inflexibility of thinking and behaving



• OCPD5. Packrat behavior6. Inability to delegate7. Miserliness8. Rigidity and stubbornness

– Somewhat ego-syntonic


Disorder Prototypes

• No clear-cut requirements for diagnosing a personality disorder– Disorders can be exhibited in different ways– People can exhibit characteristics of several

disorders at once

• All disorders seem to be associated with an inability to hold thoughts in active, working memory


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


Organizing the Personality Disorders

• Psychologists have proposed many other disorders.

• The list of disorders is continuously being reorganized and rethought.

• A major project for the next revision of the DSM is to rethink how personality disorders are organized.



• Goal: identify a set of dimensions that can describe the entire range of personality, including normal and abnormal patterns

• Biosocial learning model: the ways people focus on themselves or others, are active or passive, and primarily seek reward or avoid pain



• Circumplex models• The Big Five personality traits

– When traits are at the extremes



Toward the DSM-V

• Major revision—2013• Major reorganization of personality disorders• Main goals• Retain 6 of 10 disorders


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 continuum32


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


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



• Mental health– Pathologizing tells us almost nothing about the

nature of mental health– Improving mental health requires an

understanding of normal personality



• Labeling– The DSM labels are misleading– Can limit understanding– A label is not an explanation– Labels can be useful and are necessary


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


Normal and Abnormal


Think About It

• It is generally good to be tolerant of individual differences and to accept people as they are. Is this wise in the case of someone with a personality disorder? Does this depend on which disorder the person has?

• What are the characteristics of a healthy personality?


Clicker Question #1

Someone with a personality disordera)does not have any advantageous characteristics.b)is likely to grow out of the disorder.c)has thoughts, feelings, and/or behaviors that are beyond the normal range of variation.d)can easily be given a specific diagnosis.


Clicker Question #2

People who have personality disordersa)can and will always tell you about their symptoms.b)might think that there is nothing wrong with them.c)are incapable of forming relationships.d)always wish to get rid of their symptoms.


Clicker Question #3

In order for someone to be diagnosed with a personality disorder, they must havea)a certain number of characteristics of a specific disorder.b)all of the characteristics of a specific disorder.c)symptoms that only fit one disorder.d)self-report scores outside the normal range.


Education

PSY 239 401 CHAPTER 18 SLIDES