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PSY 239 401 CHAPTER 18 SLIDES
- 1. Chapter 18: Disorders ofPersonality The Personality Puzzle Sixth Edition by David C. Funder Slides created by Tera D. Letzring Idaho State University © 2013 W. W. Norton & Company, Inc. 1
- 2. Objectives • Discuss whatpersonality 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 © 2013 W. W. Norton & Company, Inc. 2
- 3. Personality Disorders • Definition •There is not an exact point that differentiates between normal and disordered personality © 2013 W. W. Norton & Company, Inc. 3
- 4. The Diagnostic andStatistical 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 © 2013 W. W. Norton & Company, Inc. 4
- 5. DSM: Organization • AxisI: 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 selfsufficiently © 2013 W. W. Norton & Company, Inc. 5
- 6. Psychological Evaluation Withthe DSM-IV © 2013 W. W. Norton & Company, Inc. 6
- 7. 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 © 2013 W. W. Norton & Company, Inc. 7
- 8. 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 © 2013 W. W. Norton & Company, Inc. 8
- 9. Bases for Diagnosis •Clinical impression – Open and flexible – Unreliable • Self-report scales – Advantages – Disadvantages © 2013 W. W. Norton & Company, Inc. 9
- 10. 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 © 2013 W. W. Norton & Company, Inc. 10
- 11. The Major PersonalityDisorders • 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 © 2013 W. W. Norton & Company, Inc. 11
- 12. Cluster A: Odd/EccentricDisorders • 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 © 2013 W. W. Norton & Company, Inc. 12
- 13. Cluster A: Odd/EccentricDisorders • 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 © 2013 W. W. Norton & Company, Inc. 13
- 14. Cluster A: Odd/EccentricDisorders • Schizoid personality disorder – No pleasure from social interaction – Indifferent to the opinions of others – Rarely experiences strong feelings © 2013 W. W. Norton & Company, Inc. 14
- 15. Cluster A: Odd/EccentricDisorders • Paranoid personality disorder – Assume the worst of everyone – Alert for signs of betrayal – Reluctant to trust or confide in anyone © 2013 W. W. Norton & Company, Inc. 15
- 16. Cluster B: Impulsive/ErraticDisorders • 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 16 © 2013 W. W. Norton & Company, Inc.
- 17. Cluster B: Impulsive/ErraticDisorders • 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 © 2013 W. W. Norton & Company, Inc. 17
- 18. Cluster B: Impulsive/ErraticDisorders • Antisocial personality disorder – Illegal activities – Risky behaviors – Irritable, aggressive, and irresponsible – Problems caused to others does not bother them © 2013 W. W. Norton & Company, Inc. 18
- 19. Cluster B: Impulsive/ErraticDisorders • 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 © 2013 W. W. Norton & Company, Inc. 19
- 20. Cluster B: Impulsive/ErraticDisorders • Characteristics of BPD 6. 7. 8. 9. Chronic emptiness Unstable relationships Fear of abandonment Confusion and feelings of unreality • Possible origins • Treatment: dialectical behavioral therapy © 2013 W. W. Norton & Company, Inc. 20
- 21. Cluster C: Anxious/AvoidantDisorders • Excessive anxiety, avoidance of social contact and relationships, behavioral patterns driven by anxiety • Dependent personality disorder – Submissive interpersonal style – Fear disagreeing with others © 2013 W. W. Norton & Company, Inc. 21
- 22. Cluster C: Anxious/AvoidantDisorders • Avoidant personality disorder – Expect the absolute worst from others – Need constant reassurance of uncritical acceptance – Deep cravings for affection and social acceptance © 2013 W. W. Norton & Company, Inc. 22
- 23. Cluster C: Anxious/AvoidantDisorders • 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 © 2013 W. W. Norton & Company, Inc. 23
- 24. Cluster C: Anxious/AvoidantDisorders • OCPD 5. Packrat behavior 6. Inability to delegate 7. Miserliness 8. Rigidity and stubbornness – Somewhat ego-syntonic © 2013 W. W. Norton & Company, Inc. 24
- 25. Disorder Prototypes • Noclear-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 © 2013 W. W. Norton & Company, Inc. 25
- 26. 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 © 2013 W. W. Norton & Company, Inc. 26
- 27. Organizing the PersonalityDisorders • 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. © 2013 W. W. Norton & Company, Inc. 27
- 28. Organizing the PersonalityDisorders • 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 © 2013 W. W. Norton & Company, Inc. 28
- 29. Organizing the PersonalityDisorders • Circumplex models • The Big Five personality traits – When traits are at the extremes © 2013 W. W. Norton & Company, Inc. 29
- 30. © 2013 W.W. Norton & Company, Inc. 30
- 31. Toward the DSM-V • • • • Majorrevision—2013 Major reorganization of personality disorders Main goals Retain 6 of 10 disorders © 2013 W. W. Norton & Company, Inc. 31
- 32. 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 © 2013 W. W. Norton & Company, Inc. 32
- 33. 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 © 2013 W. W. Norton & Company, Inc. 33
- 34. 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 © 2013 W. W. Norton & Company, Inc. 34
- 35. 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 © 2013 W. W. Norton & Company, Inc. 35
- 36. 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 © 2013 W. W. Norton & Company, Inc. 36
- 37. 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 © 2013 W. W. Norton & Company, Inc. 37
- 38. Normal and Abnormal ©2013 W. W. Norton & Company, Inc. 38
- 39. 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? © 2013 W. W. Norton & Company, Inc. 39
- 40. Clicker Question #1 Someonewith a personality disorder a)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. © 2013 W. W. Norton & Company, Inc. 40
- 41. Clicker Question #2 Peoplewho have personality disorders a)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. © 2013 W. W. Norton & Company, Inc. 41
- 42. Clicker Question #3 Inorder for someone to be diagnosed with a personality disorder, they must have a)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. © 2013 W. W. Norton & Company, Inc. 42
Editor's Notes
- #4 Definition: patterns of thought, feeling, and behavior beyond the normal range of psychological variation
- #5 First edition: included a list and description of personality disorders TR = text revision Make diagnosis more objective: ensures a common vocabulary for describing problems, which should make discussions and analyses more useful; especially important for research Insurance billing: so care for the patient will be reimbursed
- #6 Axis III: injuries, poisoning, and brain diseases that impair mental functioning such as Alzheimer’s Axis IV: unemployment, bereavement, recent divorce Axis V: hold a job, maintain a relationship
- #7 Figure 18.1
- #8 Five general characteristics Affect social relationships: other people are required for the symptoms (inflexible, deceitful) to be expressed
- #9 Stable over time: disorders are about as stable as personality itself Ego-syntonic: The people who have them do not think anything is wrong; only applies to some personality disorders.
- #10 Clinical impression: based on unstructured interviews and clinical intuition and experience; most common Open and flexible: adjust diagnosis criteria if necessary; use common sense Unreliable: differences in experience and accuracy, interviews, application of criteria, and ultimately diagnosis Self-report scales: ask people whether they exhibit signs of personality disorders Advantages: inexpensive, easy to obtain, scores can be easily compared with other information, valid (same as S data) Disadvantages: lack of insight about symptoms or unwillingness to respond accurately
- #11 Structured interviews: series of questions designed to maintain objectivity while zeroing in on relevant characteristics; often seen as the gold standard for diagnosis Advantages: better reliability than clinical impression, requires minimal training Disadvantages: rigid structure may inhibit client’s ability to talk about real problems, similar to self-report (lack of insight or honesty) Advantages and disadvantages (based on limited information, biased opinion) of I data Oltmanns & Turkheimer article in the reader: Person perception and personality pathology
- #12 Cluster B disorders tend to be the most stable
- #13 Schizotypal personality disorder: an extreme pattern of odd beliefs and behaviors, and of difficulties relating to others 9 basic indicators (5 needed for diagnosis) Ideas of reference: seeing irrelevant or innocuous events as pertaining to the self Magical thinking, bizarre fantasies, believing in odd phenomenon Strange perceptual experiences Odd speech or thinking Suspiciousness or paranoia Inappropriate or flattened emotions Odd, peculiar, or eccentric actions or appearance Failure to develop friendships and a lack of social ties other than to one’s immediate family Anxiety being around other people that does not go away
- #14 9 basic indicators (5 needed for diagnosis) Ideas of reference: seeing irrelevant or innocuous events as pertaining to the self Magical thinking, bizarre fantasies, believing in odd phenomenon Strange perceptual experiences Odd speech or thinking Suspiciousness or paranoia Inappropriate or flattened emotions Odd, peculiar, or eccentric actions or appearance Failure to develop friendships and a lack of social ties other than to one’s immediate family Anxiety being around other people that does not go away About 3% of the population Slightly more common in males
- #15 Schizoid personality disorder: an extreme pattern of seeming indifferent to others and cold, bland style of behavior Over 3% of the population Equally common in men and women
- #16 Paranoid personality disorder: an extreme pattern of suspicion, hostility, and resentment About 5% of the population More common in women
- #17 Histrionic personality disorder: an extreme pattern of attention-getting behavior and shallow but dramatically expressed emotions 2%–3% of the population Equally common in men and women, but with different manifestations: examples: women get attention with revealing clothing; men get attention by being macho or overly-masculine
- #18 Narcissistic personality disorder (NPD): an extreme pattern of arrogant, exploitative behavior combined with a notable lack of empathy Needs the admiration of others (even if it’s not genuine) Exploits others: expects special treatment and feels justified in taking advantage of others to get what he feels he deserves Lack of empathy: because no one else really matters Adolf Hitler was a textbook case, also Mussolini and Stalin Less than 1% of the population More common in males Activity 18-1. Narcissistic personality disorder and Charles Manson Activity 18-2. Case history of Hitler
- #19 Antisocial personality disorder: an extreme pattern of deceitful, manipulative, and sometimes dangerous behavior Illegal activities: such as vandalism, theft, and drug dealing Risky behaviors: such as reckless driving, drug abuse, and dangerous sexual practices Ted Bundy 3.5% of the population More common in men, declines with age
- #20 Borderline personality disorder (BPD): an extreme and sometimes dangerous pattern of emotional instability, emotional emptiness, confused identity, and tendencies toward self-harm Must have at least 5 of 9 characteristics for diagnosis Rapid mood shifts: with little or no cause Uncontrollable anger: also often with little or no cause Self-destructive acts: suicide, self-mutilation; recent understanding of cutting and self-harm is that it short-circuits the build-up of anxiety and other negative emotion; 8%–10% commit suicide Self-damaging behaviors: including drug abuse, compulsive gambling, eating disorders, shoplifting, etc.; undermining oneself at the moment of success Identity disturbance: not knowing who they are and how they appear to others, lack of understanding of own values, goals, sexual identity, and actions
- #21 Chronic emptiness: feeling bored, don’t have satisfying and enjoyable activities, don’t have meaningful relationships Unstable relationships: confusing, chaotic, noisy, and unpredictable relationships; often view people as all good or all bad (splitting) Fear of abandonment: put great effort into trying to avoid abandonment Confusion and feelings of unreality: feeling extremely upset can make people unable to think straight Possible origins: genetic risk factor combined with early family environment that doesn’t teach children how to understand and regulate emotions; problems with the endogenous opioid system that regulates natural painkillers Dialectical behavioral therapy: teaches skills for emotional self-control 2%–6% of the population Equally common in men and women Activity 18-3. Thoughts from a man with borderline personality disorder
- #22 Dependent personality disorder: an extreme pattern of relying on others to take care of one’s needs and make decisions, combined with a bitter kind of agreeableness Fear disagreeing with others: and having to think on their own Rare (½ of 1%) More common among women
- #23 Avoidant personality disorder: fear of failure, criticism, or rejection leads to avoidance of normal activities Expect the absolute worst from others: criticism, contempt, rejection Deep cravings for affection and social acceptance: but they inhibit emotional expression toward others and others cannot get close to them About 2.5% of the population Similar prevalence in men and women
- #24 Obsessive-Compulsive Personality Disorder (OCPD): an extreme pattern of rigidly conscientiousness behavior, including an anxious and inflexible adherence to rules and rituals, perfectionism, and a stubborn resistance to change Not the same as obsessive compulsive disorder: less severe because it does not include specific compulsions Must have at least 4 of 8 characteristics for diagnosis Overconcern with rules and details: may forget the real point; inflexibility in following the rules; not able to see the big picture (when rules don’t apply, when a flawed detail is not important) Perfectionism: difficult to work with; difficult to finish anything Workaholism: work long hours but don’t get much done Inflexibility of thinking and behaving: apply values, ethics, and principles mindlessly
- #25 Packrat behavior: unable to throw anything away because they think they might need it later Inability to delegate: because no one else will do it right Somewhat ego-syntonic: for some symptoms but not others; some of these characteristics may be useful About 8% of the population (most common personality disorder) Equal prevalence among males and females Activity 18-4. Thoughts from a woman with dependent personality disorder Activity 18-5. Thoughts from a woman with avoidant personality disorder
- #26 No clear-cut requirements for diagnosing a personality disorder: only some of the symptoms need to be present All disorders seem to be associated with an inability to hold thoughts in active, working memory: which prevents finding different ways to solve problems
- #27 Prototypes: ideal exemplars; real objects may match a prototype more or less well, even while differing from each other
- #29 Biosocial learning model: arrange personality disorders according to three dimensions; not consistently supported by empirical research
- #30 Circumplex models: similar to those for goals and emotions The Big Five: one of the best supported and most accepted structures; seen by some as the foundation of most of the variation in personality
- #31 Table 18.1 Almost all disorders include high neuroticism. Useful to see similarities and differences across disorders
- #32 Main goals: be more in line with modern research; correct important shortcomings (disorganized and unclear criteria for diagnosis, categorical classifications) Retain 6 of 10 disorders: antisocial, avoidant, borderline, narcissistic, obsessive-compulsive, schizotypal
- #33 Ratings of 5 maladaptive personality traits: part of clinical assessment Negative affectivity: anxiety, depression, suspicion Detachment: tendency to withdraw from and avoid emotional contacts with others Antagonism: including deceitfulness, grandiosity, callousness, and manipulativeness Disinhibition: lack of self-control leading to impulsive behavior Psychoticism: tendency to have bizarre thoughts or experiences, and to exhibit eccentric behavior Advantage of these ratings: maps onto the Big Five: negative affectivity & neuroticism; detachment and low extraversion; antagonism and low agreeableness; disinhibition and low conscientiousness; psychoticism and openness
- #34 Assess whether personality functioning is seriously impaired: if so, assess degree of dysfunction Avoids making a single diagnosis
- #35 The current DSM as 365 diagnoses. Pathologizing behaviors: describing them as the result of mental illness; there are disadvantages to describing so many behaviors as pathological Describing behavior as the result of mental illness is too easy: because there is a diagnosis for almost everything
- #36 Pathologizing tells us almost nothing about the nature of mental health: Mental health means more than not having any of the symptoms listed in the DSM-IV. Improving mental health requires an understanding of normal personality: not just mental illness and personality disorders; this is one motivator of positive psychology
- #37 The DSM labels are misleading: sometimes a little, sometimes a lot; because no one fits the exact criteria for any category, people often have characteristics of several categories, and they are difficult to apply consistently and reliably Can limit understanding: by leading to not taking the person’s feelings, outlook, and rights seriously and decreasing empathy Labels can be useful: for knowing what characteristics and behaviors tend to go together Labels are necessary: for describing clients, for research purposes, for discussing disorders with precision
- #39 Table 18.2 Disorders may be thought of as exaggerated versions of traits that are advantageous when in the normal range.
- #41 Correct answer: c
- #42 Correct answer: b
- #43 Correct answer: a