Chapter 10 Personality Disorder

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CHAPTER 10:
PERSONALITY
DISORDER
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Chapter 10: Personality Disorder Page 1 of 66

GENERAL FEATURES OF
PERSONALITY DISORDERS

PERSONALITY
the set of unique traits and behaviors that

characterize the individual

PERSONALITY DISORDER
Formerly known as character disorder, is certain
traits that are so inflexible and maladaptive that
they are unable to perform adequately at least
some of the varied roles expected of them by
their society, in which case we may say that they
have a personality disorder

Five Factor Model of
Personality Traits
Neuroticism
Extraversion/Introversion
Openness to Experience
Agreeableness/ Antagonism
Conscientiousness

CLINICAL FEATURES
1. chronic interpersonal difficulties
2. problems with one’s identity or

sense of self

CLINICAL FEATURES
They certain traits that are so inflexible and
maladaptive that they are unable to perform
adequately at least some of the varied roles expected
of them by their society, in which case we may say
that they have a personality disorder (formerly known
as a character disorder).

According to general DSM-5 criteria for diagnosing a
personality disorder, the person’s enduring pattern of
behavior must be pervasive and inflexible, as well as
stable and of long duration. It must also cause either
clinically significant distress or impairment in
functioning and be manifested in at least two of the
following areas: cognition, affectivity, interpersonal
functioning, or impulse control

Personality disorders typically do not stem from
debilitating reactions to stress in the recent past.
Rather, these disorders stem largely from the gradual
development of inflexible and distorted personality
and behavioral patterns that result in persistently
maladaptive ways of perceiving, thinking about, and
relating to the world

Three Clusters of Personality
Disorders
1. Cluster A: Includes paranoid, schizoid,
and schizotypal personality disorders
Cluster B: Includes histrionic, narcissistic,

2. antisocial, and borderline personality
disorders.

Three Clusters of Personality
Disorders
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Cluster C: Includes avoidant, dependent,
and obsessivecompulsive personality
disorders.

Personality disorders are often associated with
anxiety disorders, mood disorders, substance
use problems and sexual deviations. One
summary of evidence estimated that about
three-quarters of people diagnosed with a
personality disorder also have another disorder
as well

DIFFICULTIES IN DIAGNOSING

MISDIAGNOSIS
A special caution is in order regarding the diagnosis
of personality disorders because more misdiagnoses
probably occur here than in any other category of
disorder. There are a number of reasons for this. One
problem is that diagnostic criteria for personality
disorders are not as sharply defined as they are for
most other diagnostic categories

MISDIAGNOSIS
Because the criteria for personality disorders are
defined by inferred traits or consistent patterns of
behavior rather than by more objective behavioral
standards (such as having a panic attack or a
prolonged and persistent depressed mood), the
clinician must exercise more judgment in making the
diagnosis than is the case for many other disorders

LITTLE CAUSAL FACTORS
Relatively little is known about the causal factors
involved in the development of most personality
disorders. One reason for this is that personality
disorders only began to receive consistent attention
from researchers after they entered the DSM in
1980.Another problem stems from the high level of
comorbidity among them.

BIOLOGICAL FACTORS
It has been suggested that infants’ temperament
may predispose them to the development of
particular personality traits and disorders. One way
of thinking about temperament is that it lays the
early foundation for the development of the adult
personality, but it is not the sole determinant of adult
personality

CLUSTER A
People with Cluster A personality disorders display unusual behaviors
such as distrust, suspiciousness, and social detachment and often come
across as odd or eccentric.

CLUSTER A
Paranoid Personality Disorder
Schizoid Personality Disorder
Schizotypal Personality Disorder

Individuals with paranoid personality disorder have a

pervasive suspiciousness and distrust of others, leading
to numerous interpersonal difficulties. They tend to see
themselves as blameless, instead blaming others for
their own mistakes and failures—even to the point of
ascribing evil motives to others.

People with paranoid schizophrenia share some

symptoms found in paranoid personality, but they have
many additional problems including more persistent
loss of contact with reality, delusions, and
hallucinations.


Causal Factors of Paranoid
Personality Disorder
Some have argued for partial genetic transmission that may
link the disorder to schizophrenia, but results examining this
issue are inconsistent, and if there is a significant relationship it
is not a strong one. . There is a modest genetic liability to
paranoid personality disorder itself that may occur through the
heritability of high levels of antagonism (low agreeableness)
and neuroticism (angry-hostility),

Causal Factors of Paranoid
Psychosocial causal factors that are suspected to play a role

include parental neglect or abuse and exposure to violent
adults, although any links between early adverse experiences
and adult paranoid personality disorder are clearly not specific
to this one personality disorder and may play a role in other
disorders as well

Individuals with schizoid personality disorder are usually

unable to form social relationships and usually lack
much interest in doing so. Consequently, they tend not
to have good friends, with the possible exception of a
close relative. Such people are unable to express their
feelings and are seen by others as cold and distant.

In terms of the five-factor model, they show extremely

high levels of introversion (especially low on warmth,
gregariousness, and positive emotions). They are also
low on openness to feelings (one facet of openness to
experience) (Widiger, Trull et al., 2002) and on
achievement striving


Causal Factors of Schizoid
Early theorists considered a schizoid personality to be a likely

precursor to the development of schizophrenia, but this
viewpoint has been challenged, and any genetic link that may
exist is very modest. Some theorists have suggested that the
severe disruption in sociability seen in schizoid personality
disorder may be due to severe impairment in an underlying
affiliative system.

Causal Factors of Schizoid
Cognitive theorists propose that individuals with schizoid

personality disorder exhibit cool and aloof behavior because of
maladaptive underlying schemas that lead them to view
themselves as self-sufficient loners and to view others as
intrusive.

Individuals with schizotypal personality disorder are

also excessively introverted and have pervasive social
and interpersonal deficits, but in addition they have
cognitive and perceptual distortions, as well as oddities
and eccentricities in their communication and behavior.

Although contact with reality is usually maintained,

highly personalized and superstitious thinking is
characteristic of people with schizotypal personality,
and under extreme stress they may experience
transient psychotic symptoms. Other cognitive–
perceptual problems include ideas of reference (the
belief that conversations or gestures of others have
special meaning or personal significance), odd speech,
and paranoid beliefs

Causal Factors of Schizotypal
Estimates of the prevalence of this disorder in the general

population have varied somewhat, but one good review of such
studies has estimated that the prevalence is about 2 to 3
percent in the general population (Raine, 2006). The heritability
of schizotypal personality disorder is moderate.

Causal Factors of Schizotypal
A genetic relationship to schizophrenia has also long been
suspected. In fact, this disorder appears to be part of a
spectrum of liability for schizophrenia that often occurs in some
of the first-degree relatives of people with schizophrenia. .
Moreover, teenagers who have schizotypal personality disorder
have been shown to be at increased risk for developing
schizophrenia and schizophrenia-spectrum disorders in
adulthood


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CLUSTER B
PERSONALITY
DISORDER
Cluster B personality disorders are
characterized by dramatic, overly
emotional or unpredictable thinking
or behavior. They include:
antisocial personality disorder,

borderline personality disorder,
histrionic personality disorder
narcissistic personality disorder.
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Excessive attention-seeking behavior and
Histrionic Personality emotionality are the key characteristics of

individuals with histrionic personality disorder.
As you can see from the table of DSM-5 criteria,
Disorder these individuals tend to feel unappreciated if they
are not the center of attention; their lively,
dramatic, and excessively extraverted styles often
20 ensure that they can charm others into attending to
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them.

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Have you ever

been on a club?
This woman could be just “clowning
around” one night in a bar with friends.
But if she frequently seeks opportunities
to engage in seductive and attention-
seeking behavior, she could have
histrionic personality disorder.
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Very little systematic research has been conducted on
histrionic personality disorder, perhaps as a result of
the difficulty researchers have had in differentiating it
from other personality disorders.
Causal Factors

Narcissistic Individuals with narcissistic personality
disorder show an exaggerated sense of self-
importance, a preoccupation with being
Personality Disorder admired, and a lack of empathy for the
feelings of others
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There is some evidence that grandiose narcissism is
associated with parental overvaluation. By contrast,
vulnerable narcissism has been associated with
emotional, physical, and sexual abuse, as well parenting
styles characterized as intrusive, controlling, and cold .
Causal Factors

Individuals with antisocial personality
disorder (ASPD) continually violate and show
Antisocial Personality disregard for the rights of others through
deceitful, aggressive, or antisocial behavior,
Disorder typically without remorse or loyalty to

anyone. They tend to be impulsive, irritable,
and aggressive and to show a pattern of
generally irresponsible behavior.
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People with borderline personality disorder
(BPD) show a pattern of behavior
Borderline characterized by impulsivity and instability in

interpersonal relationships, self-image, and
moods.
Personality Disorder Affective instability
Highly unstable self-image
Impulisivity
20 Self-mutilation
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Self Mutilation - Deliberately hurting
your own body, such as by cutting or
burning, is a harmful way to cope with
emotional pain, intense anger and
frustration.

Question?
Do you think that Nonsuicidal Self-Injury (NSSI):
is a form of Distinct Disorder or Symptom of
Borderline Personality Disorder?
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Comorbidity With
Other Disorder
BPD commonly co-occurs with a variety of
other disorders ranging from unipolar
and bipolar mood and anxiety disorders
(especially panic and PTSD) to substance-
use and eating disorders (Hooley et al.,
2012; Pagura et al., 2010).
There is also substantial co-occurrence of

BPD with other personality disorders—
especially histrionic, dependent,
antisocial, and schizotypal personality
disorders.
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Research suggests that genetic factors play
a significant role in the development of
BPD: 5-HTT gene
There has also been an intense search for
the biological substrate of BPD: lowered
functioning of the neurotransmitter
serotonin
Causal Factors Paris's diathesis-stress theory of BPD.

Multidimensional Diathesis-Stress
Theory of Borderline Personality
Disorder.
Source: Paris (1999).

Many studies have shown that people with
borderline personality disorder report a large
number of negative, even traumatic, events
in childhood. These include abuse and
neglect, and separation and loss.

CLUSTER C
PERSONALITY
DISORDER
Cluster C personality disorders are
characterized by anxious, fearful
thinking or behavior. They include:
avoidant personality disorder
dependent personality disorder
obsessive-compulsive personality
disorder.
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Avoidant Personality Individuals with avoidant personality
disorder show extreme social inhibition and
introversion, leading to lifelong patterns of
Disorder limited social relationships and reluctance to
enter into social interactions.
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Schizoid Personality Disorder Avoidant Personality Disorder
more aloof, cold, and relatively shy, insecure, and hypersensitive to

indifferent to criticism. criticism.
a lack of desire or ability to desires interpersonal contact but
form social relationships avoids it for fear of rejection.
A less clear distinction is that

between avoidant personality
disorder and generalized social
phobia.

Innate “inhibited” temperament that leaves the
infant and child shy and inhibited in novel and
ambiguous situations.
fear of being negatively evaluated
introversion and neuroticism are also both
elevated
Causal Factors

Dependent Individuals with dependent personality
disorder show an extreme need to be taken
care of, which leads to clinging and
Personality Disorder submissive behavior. They also show acute
fear at the possibility of separation or
sometimes of simply having to be alone
20 because they see themselves as inept.
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Modest genetic influence on dependent
personality traits.
Neuroticism and agreeableness that are also
prominent in dependent personality disorder also
have a genetic component.
Adverse effects of parents who are authoritarian
and overprotective
Causal Factors

Perfectionism and an excessive concern with
Obsessive-Compulsive maintaining order and control characterize
individuals with obsessive-compulsive
Personality Disorder personality disorder (OCPD). Their
preoccupation with maintaining mental and
interpersonal control occurs in part through
20 careful attention to rules, order, and
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schedules.

Individuals with obsessive-compulsive personality
disorder are highly perfectionistic, leading to
serious problems finishing various projects. They
are also excessively devoted to work, inflexible
about moral and ethical issues, and have
difficulty delegating tasks to others. They are also
inclined to be ungenerous with themselves and
others.

these individuals have excessively high levels of
conscientiousness
high on assertiveness and low on compliance.
have low levels of novelty seeking and reward
dependence but high levels of harm avoidance.
Causal Factors

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Page 01

Chapter 10: Personality Disorder Page 1 of 66

Chapter 10: Personality Disorder Page 2 of 66

the set of unique traits and behaviors that

Chapter 10: Personality Disorder Page 3 of 66

Chapter 10: Personality Disorder Page 4 of 66

Chapter 10: Personality Disorder Page 5 of 66

2. problems with one’s identity or

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Chapter 10: Personality Disorder Page 8 of 66

Chapter 10: Personality Disorder Page 9 of 66

Cluster B: Includes histrionic, narcissistic,

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Schizoid Personality Disorder

Schizotypal Personality Disorder

Chapter 10: Personality Disorder Page 19 of 66

Individuals with paranoid personality disorder have a

Chapter 10: Personality Disorder Page 20 of 66

People with paranoid schizophrenia share some

Chapter 10: Personality Disorder Page 21 of 66

Chapter 10: Personality Disorder Page 22 of 66

Chapter 10: Personality Disorder Page 23 of 66

Psychosocial causal factors that are suspected to play a role

Chapter 10: Personality Disorder Page 24 of 66

Individuals with schizoid personality disorder are usually

Chapter 10: Personality Disorder Page 25 of 66

In terms of the five-factor model, they show extremely

Chapter 10: Personality Disorder Page 26 of 66

Chapter 10: Personality Disorder Page 27 of 66

Early theorists considered a schizoid personality to be a likely

Chapter 10: Personality Disorder Page 28 of 66

Cognitive theorists propose that individuals with schizoid

Chapter 10: Personality Disorder Page 29 of 66

Individuals with schizotypal personality disorder are

Chapter 10: Personality Disorder Page 30 of 66

Although contact with reality is usually maintained,

Chapter 10: Personality Disorder Page 31 of 66

Estimates of the prevalence of this disorder in the general

Chapter 10: Personality Disorder Page 32 of 66

Chapter 10: Personality Disorder Page 33 of 66

Chapter 10: Personality Disorder Page 34 of 66

antisocial personality disorder,

Chapter 10: Personality Disorder Page 35 of 66

Histrionic Personality emotionality are the key characteristics of

Chapter 10: Personality Disorder Page 36 of 66

Have you ever

Chapter 10: Personality Disorder Page 37 of 66

Chapter 10: Personality Disorder Page 38 of 66

Chapter 10: Personality Disorder Page 40 of 66

Chapter 10: Personality Disorder Page 41 of 66

Disorder typically without remorse or loyalty to

Chapter 10: Personality Disorder Page 44 of 66

Borderline characterized by impulsivity and instability in

Chapter 10: Personality Disorder Page 45 of 66

Chapter 10: Personality Disorder Page 46 of 66