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Chapter 13

PSYB32H3 Chapter Notes - Chapter 13: Avoidant Personality Disorder, Histrionic Personality Disorder, Narcissistic Personality Disorder

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Konstantine Zakzanis

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Chapter 13: Personality Disorders
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 persons 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
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 others
oTo develop the capacity for intimacy and positive affiliations with other people
oTo function adaptively in society by engaging in prosocial and cooperative
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 disordersthe
PSY-5 consists of dimensions of assessing negative 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
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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-
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
The goal is to obtain accurate diagnoses; MCMI-III is best used in conjunction with a clinical
interview such as the Personality disorder Examination
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 contact)
oThose in cluster B (antisocial, borderline, histrionic and narcissistic) seem dramatic,
emotional, or erratic (extrapunitive and hostile)
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 abuse
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 others
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
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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
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
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 themselves
Ideas of reference: the belief that events have a particular and unusual meaning for the
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 schizophrenia
Schizotypal personality disorder people have deficits in cognitive and neuropsychological
functioning (similar to schizophrenia)
Schizoptypal people have enlarged ventricles and less temporal-lobe grey matter
Dramatic/Erratic Cluster
They have a wide variety of symptoms inflated self-esteem exaggerated emotional
display & antisocial behaviour
Borderline Personality Disorder
Impulsivity and instability in relationships, mood and self image
Emotions are erratic and can shift abruptly, from passionate idealizations to contemptuous
They are argumentive, irritable, sarcastic, quick to take offence and very hard to live with
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