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Ch.8 Personality and Impulse Control Disorders Pt.I this section includes: What is personality? Etiological and Treatment Considerations for Personality Disorders (Five factor model and personality disorders) Diagnostic Issues (Reliability, Categorical

Course Code
Kathy Foxall

of 6
Personality and Impulse Control Disorders
5-15% of hospital and outpatient admissions
lifetime prevalence of 10-13%
characterized by inflexible, long-standing, and maladaptive personality traits that
cause significant functional impairment or subjective distress for the individual
usually people with personality disorders are hospitalized only when a second,
superimposed disorder so impairs social functioning that they require inpatient
the rationale for having two axes for mental disorders is that Axis II disorders
generally begin in childhood or adolescence and persist in a stable form into
oaxis I disorders usually fail to show these characteristics
What is personality?
oWays that people understand, experience and interpret the world
ohow person responds to their perceptions
o‘typical’ behaviours
how approach tasks
o‘big picture’ vs. detailed observer
stable in adulthood
Etiological and Treatment Considerations for Personality Disorders
Five factor model and personality disorders
-helpful in understanding PDs
5 key dimensions of personality
1. extraversion
preference for interpersonal interactions, being fun-loving and active
2. neuroticism
emotional adjustment and stability
3. openness to experience
curiosity, willingness to entertain new ideas and values, and emotional
4. agreeableness
being good-natured, helpful, forgiving, and responsive
5. conscientiousness
being organized, persistent, punctual, and self-directed
the FFM (five-factor model) – allows researchers and clinicians to assess
personality disorders as a particular set of personality characteristics and to
compare different disorders
genetic characteristics may affect environmental factors, which in turn influence
There are 10 personality disorders in the DSM-IV
the traits must be extreme and inflexible, and cause occupational, interpersonal
seen across cultures
For a diagnosis
1) The person must exhibit the behaviours for the particular disorder
2) The behaviours are exhibited in a wide range of contexts, not just in
particular circumstances
3) The behaviours are of sufficient intensity that they are maladaptive, and
interfere with the persons’ occupational and social functioning
4) The patterns of behaviour are evident in adolescence or early adulthood
5) The behaviours are not a temporary reaction to stress
6) Not due to other mental disorders (ex. schizophrenia)
7) Not due to medical conditions
Diagnostic Issues
very low reliability before DSM III
placed on Axis II with DSM III
interrater reliability now as high as with Axis I
omore than 1 clinician diagnosing a patient at a given time
some disorders low test-retest reliability, e.g. dependent and schizotypal
antisocial personality disorder has highest test-retest reliability
specific criteria
structured interviews
sometimes include interviews with others who know the person
Categorical vs. dimensional criteria
categorical rather than dimensional diagnostic criteria
John Livesly (psychologist, BC) has found that people with PD have similar
structures to normal people, but more extreme
high co-morbidity rates for PDs
very easy to over-diagnose PDs
many people with PDs believe that there is nothing wrong with them (ego-
syntonic symptoms)
dimensional diagnostic criteria – spectrum or range
Comorbidity and Diagnostic overlap
Comorbidity means that the same person has 2 or more different disorders
there are high levels of comorbidity for the personality disorders, especially BPD
in BPD, 55% also schizoptypal, 47% also APD (antisocial personality disorder),
57% histrionic
diagnostic overlap means that there are similarities in the criteria for two or more
e.g., narcissistic PD and antisocial pd are both egocentric
avoidant PD and paranoid PD are both hypersensitive to criticism
Gender and Cultural Issues
need to understand what is normal for a culture or sub-culture
Are diagnostic criteria for some PDs gender biased?
e.g., more men are diagnosed as ASPD than women, more women diagnosed as
Borderline and Histrionic than men
Do these different rates reflect true differences in symptoms, or are they biased?
e.g. 1978 study, histrionic diagnosis gender biased in response to vignette
another study, 1989, looked at case histories of real patients
found that women diagnosed as Histrionic P.D. more than men