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Chapter 12: Personality -Personality: all the ways we have of acting, thinking, believing, and feeling that make each of us unique Personality trait=complex pattern of behavior, thought and feeling that is stable across time and across many situations 1. DEFINING AND DIAGNOSING PERSONALITY DISORDERS -Personality disorder: long-standing pattern of maladaptive behaviors, thoughts and feelings Symptoms must be shown by adult since adolescence or early adulthood DSM: diagnosed in separate Axis, Axis 2 instead of Axis 1 w/ acute disorders -Often comorbidity w/ personality disorder and acute disorders (major depression, substance abuse); hard to see behaviors that constitute their personality disorder as maladaptive therefore, usually see clinician once they have major depression/substance abuse and problems w/ relationships -DSM4 groups personality disorders in 3 clusters: Cluster A: Odd-eccentric personality disorders o Features of schizophrenia but ppl w/ this disorder not psychotic (maintain grasp of reality): inappropriate/flat affect, odd thought + speech pattern, paranoia (i.e. become suspicious of ppl/speak in odd ways ppl cant understand) Cluster B: Dramatic-Erratic Personality Disorder o Features dramatic, erratic, emotional behavior and interpersonal relationships o Manipulative volatile, uncaring in social relationships, prone to impulsive/violent behavior that show little regard for their safety/safety of others, behave in wild and exaggerated ways, try to gain attn (suicidal attempts) Cluster C: Anxious-Fearful Personality Disorder o Anxious-fearful emotions and chronic self-doubt o Concerned w/ being criticized/abandoned by others, little self- confidence and difficult relationships with other s 1.1 Problems with the DSM Categories -Highly controversial: b/c of problems in conceptualizing and organization of disorders and ways of assessing them -Lively and Jackson: A. DSM treats disorders as categories Disorder described as if it represents something qualitatively different from a normal personality but in reality, just extreme versions of normal personality traits Axis 2 disorders represent a restricted list of normal personality traits; overlap in axis 2 is b/c of common underlying traits B. Overlap in the diagnostic criteria for various personality disorders Ppl diagnosed for 1 disorder meet the criteria for at least 1 more personality disorder; hard to have reliable diagnoses There may be fewer personality disorders that account for the variation in personality disorder symptoms C. Diagnosing a personality disorder often requires information that is hard for a clinician to obtain Info needed: how individual treats others, how individual behaves in variety of situations, stability of behavior since childhood, etc. Clinicians must observe behavior and infer which traits are responsible for manifestations D. Personality disorders are conceptualized as stable characteristics of an individual Longitudinal studies: ppl diagnosed w/ disorders vary over time in how many symptoms they exhibit and severity of these symptoms, so they go in and out of the diagnosis over time Personality disorder symptoms seem to diminish when axis 1 disorder symptoms subside Axis 2 disorders include assessment of features that are stable, personality disorders built into this diagnostic -Problems: reliability of diagnosis, hard to do research on personality disorders (less research on epidemiology, causes, treatments) -Merits of categorical vs. dimensional models of personality disorders 1.2 Gender and Ethnic Biases in Construction and Application -Differences in gender and ethnicity for personality disorders results from biases in the construction of these disorders/clinicians application to the diagnostic criteria -Biases: A. Kaplan: Diagnoses are extreme versions of negative stereotypes of womens/mens personalities Women=Histrionic, dependent and borderline personality disorders: flamboyant behaviors, emotionality, dependence on others Men=antisocial, paranoid, and obsessive-compulsive personality disorder: violent, hostile, controlling Clinicians may be too quick to see these characteristics in women /men and apply these diagnoses B. Not recognizing that the expressions of the symptoms of a disorder may naturally vary between groups I.E. women with antisocial personality disorder are less likely than men w/ the disorder to engage in such overt antisocial behavior (callous, cruel, committing crimes) Ethnic groups, European North Americans, are better able to hide their symptoms of callous and cruel behavior b/c they hold more social power and can exercise tendencies in ways that are more acceptable Gender differences in childhood precursor to antisocial personality disorder: conduct disorder DSM4 downplays masculine ways of expressing dependent, histrionic and borderline personality disorder o Wording of criterion: histrionic personality disorder consistently uses physical appearance to draw attention to one self C.Based in application Too quick to see histrionic, dependent and borderline personality disorders in women or antisocial personality disorders in men Research shows that clinicians presented w/ description of a person who exhibits many of the symptoms, more likely to make diagnosis if person is female for histrionic Clinicians misapplying DSM -Widiger: structured interviews vs. unstructured should be used in assessing personality disorders Structured interviews vs. unstructured should be used in assessing personality disorders o Increases chances of DSM applied systematically fairly to men, women and ppl of various ethnic groups o Show less gender bias vs. studies w/ unstructured interviews but still greater number of females in the described disorders and more men in antisocial personality disorder o Structured interview vs. self report: produce similar results -Kaplan: DSM4 should be balanced to include equal # of symptoms and diagnoses that are variants of masculine and feminine personality traits Tried w/ masculine forms of dependency and feminine versions of masculine symptoms BUT DSM should strive for greater balance in pathologizing men and women -If diagnostic constructs yield equal numbers of men and women w/ each disorder/equal numbers of ppl in different ethnic groups, doesnt mean that criteria reflect the true structure and distribution of personality disorders in ppl 2. ODD-ECCENTRIC PERSONALITY DISORDERS -Odd-eccentric personality disorder: behave in ways that are similar to behaviors of people with schizophrenia or paranoid psychotic disorder, but they retain their grasp on reality to a greater degree compared to psychotic ppl - Inappropriate/flat affect, odd thought + speech pattern, paranoia (i.e. become suspicious of ppl/speak in odd ways ppl cant understand); have unusual beliefs/experiences that fall short of delusions and hallucinations -May be precursors to schizophrenia/mild versions of schizophrenia -Often occur in ppl who have 1 degree relatives with schizophrenia 2.1 Paranoid Personality Disorder -Paranoid Personality disorder: pervasive and unwarranted mistrust of others that is maladaptive -Believe ppl are chronically trying to deceive/exploit them or are preoccupied with concerns a bout loyalty/trustworthiness of others -Hypervigilant for confirming evidence of their suspicions; penetrating observers of situations, note details that most ppl miss -Consider these events meaningful and try to decipher these clues about ppls true intentions -Sensitive to criticism/potential criticism -Misinterpret/overinterpret situations in line w/ their situations (i.e. wifes cheerfulness=affair ) -Resistant to rational arguments about their suspicions (every1 arguing against them=evidence of conspiracy against them) -Weak relationship w/ schizophrenia Prevalence and Prognosis -0.5-5.6% have this disorder (U.S.; no Cdn stats b/c focus on antisocial personality disorder)
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