PSYC 4750 Lecture Notes - Dialectic, Conduct Disorder, Neuroticism

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5 Feb 2013

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Personality disorder (PDs): a heterogeneous group of disorders that
are coded on axis II of the DSM. They are regarded as long-standing,
pervasive and inflexible patterns of behaviour and inner experience that
deviate from the expectation of a person’s culture and that impair social
and occupational functioning (some but not all cause emotional distress)
An actual personality disorder is defined by extremes of several traits and
by the inflexible way these traits are expressed
They are often rigid in their behaviour and cannot change it in response to
changes in the situation they experience
Individuals would not be diagnosed as having personality disorders unless
the patterns of behaviour were long-standing, pervasive and dysfunctional
Often co-morbid with axis I disorders
Classifying Personality Disorders: Clusters, Categories and Problems
The reliability of personality disorder diagnoses have improved because of
2 developments
oThe publication of specific diagnostic criteria
oThe development of structured interviews specially designed for
assessing personality disorders
Test-rests reliability is also an important factor for evaluation
It is often difficult to diagnose a single, specific personality disorder
because many disordered people exhibit a wide range of traits that make
several diagnoses applicable
Personality disorders can be construed as the extremes of characteristics
we all possess
(Livesley, Schoroeder, Jackson and Jang) personality disorder is a failure or
inability to come up with adaptive solutions to life tasks...
oTo form stable, integrated and coherent representation of self and
oTo develop the capacity for intimacy and positive affiliations with
other people
oTo function adaptively in society by engaging in prosocial and
cooperative behaviours
Assessing Personality disorders
Many disorders are ego-syntonic, that is the person with a personality
disorder is unaware that a problem exists and may not experience
significant distress
The disorders may need to be diagnosed via clinical interview led by
trained professionals
Although clinical interviews are preferable, researchers often rely on self-
report measures when assessing personality disorder symptoms
MMPI-2 has been created to assess the symptoms of specific personality
disorders – the PSY-5 consists of dimensions of assessing negative
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emotionality/neuroticism, lack of positive emotionality, aggressiveness,
lack of constraint, and pychoticism
The most widely used measure of personality disorder symptoms is the
Millon Clinical Multiaxial Inventory which is now in its third edition
oIt’s a 175 true false inventory that was revised for DSM-IV
oProvides subscale measures of 11 clinical personality scales and 3
severe personality pathology scales
oAlso provides symptom ratings for clinical syndromes located on
Axis I of the DSM-IV
oIncludes a validity index and 3 response style indices that correct
for such tendencies as denial and random responding
oIt’s only moderately effective in terms of its ability to detect faking
Issues of self report measures of personality disorders
oEmpirical tests comparing the various self-report measures show
that they differ in their content and are not equivalent
oCut-off points used to determine the presence of personality
disorder often overestimate the number of people who meet
diagnostic criteria for particular disorders
The goal is to obtain accurate diagnoses; MCMI-III is best used in
conjunction with a clinical interview such as the Personality disorder
Personality Disorder Clusters
When a categorical approach is used the DSM-IV-TR criteria are involved,
personality disorders are grouped into 3 clusters
oIndividual in cluster A (paranoid, schizoid, and schizotpyal) seem
odd or eccentric (they reflect oddness and avoidness of social
oThose in cluster B (antisocial, borderline, histrionic and
narcissistic) seem dramatic, emotional, or erratic (extrapunitive and
oThose in cluster C (avoidant, dependent, and obsessive
compulsive) appear fearful
Patients with both borderline & schizotypal personality disorders would
probably have been diagnosed as schizophrenic using DSM II criteria
Odd/Eccentric Cluster
3 paranoid, schizoid, and schizotypal PDs
Symptoms are similar to those of schizophrenia (especially its prodromal
and residual phase)
Paranoid Personality Disorder
They are suspicious of others
They expect to be mistreated or exploited by others and thus are
secretive and always on the lookout for possible signs of trickery and
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They are reluctant to confide in others and tend to blame them even
when they themselves are at fault
They can be extreme jealous and unjustifiably question the fidelity of a
spouse or lover
Preoccupied with unjustified doubts about the trustworthiness or loyalty of
Difference from schizophrenia: hallucinations are not present, there is less
impairment in social/occupational functioning
Difference from delusional disorder: full-blown delusions are not present
More frequent in men
Co-occurs with schiotypal, borderline and avoidant personality disorders
Schizoid Personality Disorder
Do not appear to desire or enjoy social relationships, usually have no
close friends
Appear dull, bland and aloof and have no warm, tender feelings for others
Rarely report strong emotions, have no interest in sex and experience few
pleasurable activities
Loners with solitary interests
Prevalence is <1% (slightly less common in women)
Co-occurs with schizotypal, avoidant and paranoid personality disorder
Symptoms are similar to prodromal and residual phase of schizophrenia
Schizotypal Personality Disorder
Grew out of the adopted children of schizophrenic parents
Usually have the interpersonal difficulties of schizoid personality and
excessive social anxiety that does not diminish as they get to know others
More eccentric symptoms, like hose that defined prodromal and residual
phase of schizophrenia
May have odd beliefs or magical thinking (that they are telepathic)
Have recurrent illusions (spirits etc)
May use words in a unusual and unclear fashion and may talk to
Ideas of reference: the belief that events have a particular and unusual
meaning for the person
Suspiciousness and paranoid ideation
Affect appears to be constricted and flat
Prevalence 3% & slightly more frequent in men
Co-occurs with other personality disorders
o33% also have borderline personality disorder
o59% have avoidant personality disorder
o59% for paranoid personality disorder
o44% for schizoid personality disorder
Etiology of the Odd/Eccentric Cluster
These disorders are genetically linked to schizophrenia
Family studies provide some evidence that these are clustered to
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