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Chapter 11

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PSYC 3390
Mary Manson- Hennig

Chapter 11Personality DisordersPg 378individuals personalitythe set of unique traits and behaviours that characterize the individualCLINICAL FEATURES OF PERSONALITY DISORDERSPersonality disorders were formerly known by psychodynamic theorists as character disordersthese disorders stem largely from the gradual development of inflexible and distorted personality and behavioural patternsthat result in persistently maladaptive ways of perceiving thinking about and relating to the worldmajor stressful life events early in life also help set the stage for the development of these inflexible and distorted personality patternsEpidemiological Studies in Canada are few but in an American study of 214 adults91was found to suffer from personality disorders In DSMIVTR as in DSMIII and DSMIIIR the personality disorders are coded on a separate axis Axis II along with mental retardation see Chapter 16 because they are regarded as different enough from the standard psychiatric syndromes which are coded on Axis I to warrant separate classification But they can fit into both Axis I and IImost people with personality disorders also have anxietymood disorders etcas well DIFFICULTIES DOING RESEARCH ON PERSONALITY DISORDERS Difficulties in Diagnosing Personality DisordersOne problem is that diagnostic criteria for personality disorders are not as sharply defined as for most Axis I diagnostic categories so they are oftennot very precise or easy to follow in practiceproblem with reliability and validitysemi structured interviewsand selfreport inventories have gained sustainability but on the basis of different structured interviews or selfreport inventories is often rather low A second problem is that the diagnostic categories are not mutually exclusive People often show characteristics of more than one personality disorderThese problems often lead to unreliability of diagnosessystems of assessment for symptoms and traits involved in personality disorders Dimensional Assessment of Personality Pathology DAPP developed by University of British Columbia researcher John Livesley most influential is the fivefactor model which builds on the fivefactor model of normal personality helps understand the commonalities and distinctions between the different personality disorders by assessing how these individuals score on the five basic personality traitsPg 381in order to measure properly you should measurethe six different facets or components of each of the five basic personality traits See Table 112 on page 389 keep in mind the prototype is being describedan individual does not necessarily fit the description completely Difficulties in Studying the Causes of Personality Disorders One major problem in studying the causes of personality disorders stems from the high level of comorbidity among themThis substantial comorbidity adds to the difficulty of untangling which causal factors are associated with which personality disorderVery little prospective research has yet been conducted with the personality disorders Thus any conclusions about causes that are suggested must be considered very tentative Of possible biological factors it has been suggested that infants temperament may predispose them to the development of particular personality traits and disorders temperament lays in the early foundation for the development of the adult personality but it is not the sole determinant of adult personalityGiven that most temperamental and personality traits have been found to be moderately heritableUniversity of British Columbia Twin Study 1991includes about 1500 monozygotic and dizygotic twins aged 18 to 84 who were raised together the largest twin registry in Canadathe UBC Twin Study includes measures of the personality traits that are thought to underlie personality disordersIt is now recognized that the genetic contribution to personality disorders is probably mediated by the genetic contributions to the primary trait dimensions most implicated in each disorder rather than to the disorders themselvesIn addition to genetics some progress is also being made in understanding the psychobiological substrate of at least some of the traits prominently involved in the personality disorderslearningbased habit patterns and maladaptive cognitive styles have received more attention as possible causal factors of character disordersPage 382Parental psychopathology and ineffective parenting practices have also been implicated as well as early emotional physical and sexual abuse may be important factorsVarious kinds of social stressors societal changes and cultural values have also been implicated as sociocultural causal factorsCATEGORIES OF PERSONALITY DISORDERSThe DSMIVTR personality disorders are grouped into three clusters on the basis of similarities of features among the disordersCluster A Includes paranoid schizoid and schizotypal personality disorders People with these disorders often seem odd or eccentric with unusual behaviour ranging from distrust and suspiciousness to social detachmentCluster BIncludes histrionic narcissistic antisocial and borderline personality disorders Individuals with these disorders share a tendency to be dramatic emotional and erraticCluster C Includes avoidant dependent and obsessivecompulsive personality disorders In contrast to the other two clusters anxiety and fearfulness are often part of these disorders Two additional personality disordersdepressive and passiveaggressive personality disorders are listed in DSMIVTR in a provisional category in the appendix See AppendixDSMNTR Criteria for Paranoid Personality Disorder A Evidence of pervasive distrust or suspiciousness of others present in at least four of the following ways 1 Pervasive suspiciousness of being deceived harmed or exploited 2 Unjustified doubts about loyalty or trustworthiness of friends or associates 3 Reluctance to confide in others because of doubts of loyalty or trustworthiness 4 Hidden demeaning or threatening meanings read into benign remarks or events s Bears grudges does not forgive insults injuries or slights 6 Angry reactions to perceived attacks on his or her character or reputation7 Recurrent suspicions regarding fidelity of spouse or sexual partnerB Does not occur exclusively during course of Schizophrenia Mood Disorder with Psychotic Features or other psychotic disorder
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