PERSONALITY DISORDERS

PSY 348
 INTRODUCTION

• The DSM-5 defines as a personality disorder as “an enduring pattern of inner experience and
behavior that deviates markedly from the expectations of the individual’s culture, is pervasive
and inflexible, has an onset in adolescence or early adulthood, is stable over time, and leads to
distress or impairment” (p. 645)
• An estimated 10-15% of the general population may meet the criteria for one of the 10 DSM-5
personality disorders; the prevalence within clinical settings is estimated to be well above
50% (Zimmerman & Mattia, 1999)
• Personality disorders can be among the most difficult disorders to treat because they involve
well-established behaviors that can be integral to a client’s self-image (Millon, 2011)
 • The DSM-5 includes 10 personality disorders
organized into 3 clusters
• Cluster A (the odd-eccentric cluster)
• Paranoid personality disorder
• Schizoid personality disorder
• Schizotypal personality disorder
• Cluster B (the dramatic-emotional-erratic cluster)
INTRODUCTION
• Antisocial personality disorder
CONTINUED
• Borderline personality disorder
• Histrionic personality disorder
• Narcissistic personality disorder
• Cluster C (the anxious-fearful cluster)
• Avoidant personality disorder
• Dependent personality disorder
• Obsessive-compulsive personality disorder
 • Although the DSM-5 uses a categorical model to
examine personality disorders, recently there has been
a shift towards a dimensional understanding of
personality disorders
• Dimensional models can be coordinated with the Five-
FIVE-FACTOR Factor Model of Personality, which has identified five
MODEL OF fundamental dimensions of personality: neuroticism (or
PERSONALITY negative affectivity), extroversion, openness to
DISORDER experience, agreeableness, and conscientiousness
• There has been substantial empirical support for the
FFM (McCrae & Costa, 2003)
• Each DSM-5 personality disorder can be understood as
a maladaptive variant of the FFM domains
 • Defined by a pervasive pattern of disregard for and
violation of the rights of others; diagnostic criteria
include deceitfulness, impulsivity, recklessness,
aggressiveness, irresponsibility, criminal activity, and
indifference to the mistreatment of others
• The term “psychopathy” refers to a particularly severe
variant of ASPD
ANTISOCIAL • Twin and adoption studies indicate that approximately
PERSONALITY 50% of the variance in antisocial behavior is
DISORDER genetically contributed
• Shared environmental influences (e.g., low family
income, parental conflict, young mother) account for
15-20% of the variance
• Non-shared environmental influences (e.g., peer
influences, individual social experiences, physical
abuse) account for the other 30% of the variance
 • Psychophysiological deficiencies have been
associated with psychopathy, including low levels of
physiological arousal and/or fear response (Fowles &
Dindo, 2006)
• Studies have found reduced skin conductance in
response to a conditioned stimulus paired with
electric shock, indicating that psychopaths may not
ASPD CONTINUED develop the expected anticipatory arousal from threat
of physical punishment (Derefinko & Widiger, 2016)
• Individuals with ASPD may also have abnormally low
levels of distress-proneness (FFM neuroticism) and
attentional self-regulation (FFM conscientiousness)
 • The NIMH Epidemiologic Catchment Area study
estimated that 3% of males and 1% of females meet
criteria for ASPD
• Within prison and forensic settings, the rate of ASPD
has been estimated to be as high as 50% (Kessler et
al., 1994)
• The “successful” psychopath: these individuals share
ASPD CONTINUED many psychopathic traits (low neuroticism, high
extraversion, low agreeableness) but are high in
conscientiousness; many of these individuals may end
up in white-collar careers (Hall & Benning, 2006)
• ASPD is difficult to treat, as these individuals may
manipulate and exploit staff and fellow patients;
therapeutic techniques should focus on the rational
arguments against repeating past mistakes (Young et
al., 2003)
 NARCISSISTIC PERSONALITY
DISORDER

• Defined by a grandiose sense of self-importance, preoccupation with status, the belief that one is
special, a demand for excessive admiration, a sense of entitlement, a lack of empathy, and
arrogance (APA, 2000)
• Recently, a two-factor model of narcissism has emerged, distinguishing this “grandiose” subtype
from “vulnerable” narcissism indicated by egocentrism, self-devaluation, and feelings of
vulnerability
• There has been little systematic research on the etiology of narcissism; twin studies support
heritability for narcissistic personality traits (South et al., 2012)
• The “mask model” of narcissism suggests that these individuals may seek recognition to
compensate for an underlying feeling of inadequacy (Miller et al., 2010)
 NPD CONTINUED

• Estimates of prevalence for NPD are as low as 2%, but may underestimate: many
individuals are reluctant to acknowledge arrogance, a sense of entitlement, lack of
empathy, and conceit (Cooper et al., 2012)
• NPD is diagnosed more frequently in males (APA, 2013)
• Narcissism is associated with relationship failure, as the lack of consideration for and
exploitative use of others becomes more apparent over time (Miller et al., 2010)
• Individuals with this disorder rarely seek treatment for their narcissism: instead, they often
enter treatment for substance use or mood disorders
• Idealization and devaluation of the therapist are common
 • The most frequently diagnosed and studied personality
disorder, BPD is characterized by a pervasive pattern of
impulsivity and instability in interpersonal relationships,
affect, and self-image (Gunderson, 2001)
BORDERLINE • Studies support a distinct genetic disposition for BPD, but
PERSONALITY many genes may be shared with mood and impulse control
DISORDER disorders (South et al., 2012)
• There is substantial support for a childhood history
physical and/or sexual abuse as a risk factor, and BPD is
highly comorbid with PTSD and dissociative disorders
(Gunderson et al., 2001)
 • It is estimated that 1-2% of the general population would
meet the criteria for BPD (Torgersen, 2012)
• BPD is the most common personality disorder in clinical
settings, with approximately 15% of all inpatients and 8%
of all outpatients meeting criteria
• Approximately 75% of individuals diagnosed with BPD
BPD CONTINUED are female (Lynam & Widiger, 2007)
• It is estimated that 3-10% of those with BPD complete
suicide by age 30 (Gunderson, 2001)
• Both psychodynamic and cognitive-behavioral treatments
exist, including Mentalization-Based Treatment (MBT)
and Dialectical Behavior Therapy (DBT)
 • DPD involves a pervasive and excessive need to be
taken care of that leads to submissiveness, clinging,
and fears of separation (APA, 2013)
• Insecure interpersonal attachment is considered to be
central to its etiology (Bornstein, 2005)
• DPD is estimated to occur in 2-4% of the general
DEPENDENT population and 5-30% of inpatients
PERSONALITY • DPD is diagnosed much more often in females, which
DISORDER some argue reflects a bias towards what constitutes a
personality disorder (Bornstein, 2005)
• There are no empirically validated treatments, but an
important component may be an exploration of the
need for support, potentially through group therapy
which provides interpersonal feedback (Leahy &
McGInn, 2012)