Chapter 11.docx

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Chapter 11 Personality Disorders
Pg 378
- individual's personality-the set of unique traits and behaviours that characterize the individual.
CLINICAL FEATURES OF PERSONALITY DISORDERS
- Personality disorders were formerly known by psychodynamic theorists as character disorders.
- these disorders stem largely from the gradual development of inflexible and distorted personality and
behavioural patterns - that result in persistently maladaptive ways of perceiving, thinking about, and relating to
the world.
- major stressful life events early in life also help set the stage for the development of these inflexible and
distorted personality patterns.
- Epidemiological Studies in Canada are few, but in an American study of 214 adults, 9.1 % was found to
suffer from personality disorders
- In DSM-IV-TR, as in DSM-III and DSM-III-R, 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 II -> most people with personality disorders also have anxiety, mood disorders etc. as
well.
DIFFICULTIES DOING RESEARCH ON PERSONALITY DISORDERS
Difficulties in Diagnosing Personality Disorders
- One problem is that diagnostic criteria for personality disorders are not as sharply defined as for most Axis I
diagnostic categories, so they are often not very precise or easy to follow in practice.
- problem with reliability and validity -> semi structured interviews and self-report inventories have gained
sustainability, but on the basis of different structured interviews or self-report 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 disorder
- These problems often lead to unreliability of diagnoses
- systems 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 five-factor model, which builds on the five-factor 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 traits
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- in order to measure properly, you should measure the six different facets or components of each of the five
basic personality traits. ** See Table 11.2 on page 389 **
- keep in mind, the prototype is being described an 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 them.
- This substantial comorbidity adds to the difficulty of untangling which causal factors are associated with
which personality disorder.
- Very little prospective research has yet been conducted with the personality disorders. Thus, any conclusions
about causes that are suggested must be considered very tentative.
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- 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 personality.
- Given that most temperamental and personality traits have been found to be moderately heritable
- University of British Columbia Twin Study- 1991 - includes about 1500 monozygotic and dizygotic twins
aged 18 to 84 who were raised together (the largest twin registry in Canada)
- the UBC Twin Study includes measures of the personality traits that are thought to underlie personality
disorders,
- It 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
themselves
- .In 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 disorders
- learning-based habit patterns and maladaptive cognitive styles have received more attention as possible causal
factors of character disorders
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- Parental psychopathology and ineffective parenting practices have also been implicated, as well as early
emotional, physical, and sexual abuse may be important factors
- Various kinds of social stressors, societal changes, and cultural values have also been implicated as
sociocultural causal factors
CATEGORIES OF PERSONALITY DISORDERS
- The DSM-IV-TR personality disorders are grouped into three clusters on the basis of similarities of features
among the disorders.
Cluster 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 detachment.
Cluster B : Includes histrionic, narcissistic, antisocial, and borderline personality disorders. Individuals with
these disorders share a tendency to be dramatic, emotional, and erratic.
Cluster C: Includes avoidant, dependent, and obsessive-compulsive personality disorders. In contrast to the
other two clusters, anxiety and fearfulness are often part of these disorders.
- Two additional personality disorders-depressive and passive-aggressive personality disorders- are listed in
DSM-IV-TR in a provisional category in the appendix. *See Appendix*
DSM-N-TR 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 reputation .
(7) Recurrent suspicions regarding fidelity of spouse or sexual partner.
B. Does not occur exclusively during course of Schizophrenia, Mood Disorder with Psychotic Features, or other
psychotic
disorder.
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Paranoid Personality Disorder
- people who have paranoid personality disorder have a pervasive suspiciousness and distrust of others, they see
themselves as blameless, some are always "on guard;' constantly expecting trickery and looking for clues to
validate their expectations, while disregarding all evidence to the contrary, They are often preoccupied with
doubts about the loyalty of friends, bear grudges, refuse to forgive, may act with anger
- paranoid people are not psychotic although they may experience transient psychotic symptoms during periods
of stress
- People with paranoid schizophrenia (see Chapter 14) share some symptoms found in paranoid personality, but
they have many additional problems including more persistent loss of contact with reality, delusions, and
hallucinations.
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CAUSAL FACTORS
- little is known about the4 casual factors -> Genetic transmission might occur
- Psychosocial causal factors that are suspected to play a role include parental neglect or abuse and exposure to
violent adults,
Schizoid Personality Disorder
- Individuals with schizoid personality disorder are usually unable to form social relationships and lack interest
in doing so (see DSM table).
- typically they do not have friends, are unable to express their feelings, seen as cold and distant, lack social
skills, “loners / introverts”, solitary interests and occupations
- tend not to take pleasure in many activities, including sex and rarely marriage , not emotional, general
apathetic mood which may appear cold and aloof
DSM-IV-TR Criteria for Schizoid Personality Disorder
A. Evidence of a pervasive pattern of detachment from social relationships and a restricted range of expression
of emotions in interpersonal settings shown in at least four of the following ways:
(1) Neither desires nor enjoys close relationships.
(2) Almost always chooses solitary activities.
(3) Has little if any interest in sexual experiences with another perso n.
(4) Takes pleasure in few if any activities.
(s) Lacks close friends or confidants.
(6) Appears indifferent to the praise or criticism of others.
(7) Shows emotional co ldness, detachment, or flat affect.
B. Does not occur exclusively during course of Schizophrenia, Mood Disorder with Psychotic Features, or other
psychotic disorder, or a Pervasive Developmental Diso rder.
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