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Chapter 13

Chapter 13

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Konstantine Zakzanis

Chapter 13 Personality DisordersPersonality disorder PDs a heterogeneous group of disorders that are coded on axis II of the DSM They are regarded as longstanding 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 distressAn actual personality disorder is defined by extremes of several traits and by the inflexible way these traits are expressedThey are often rigid in their behaviour and cannot change it in response to changes in the situation they experienceIndividuals would not be diagnosed as having personality disorders unless the patterns of behaviour were longstanding pervasive and dysfunctionalOften comorbid with axis I disordersClassifying Personality Disorders Clusters Categories and ProblemsThe reliability of personality disorder diagnoses have improved because of 2 developmentsoThe publication of specific diagnostic criteriaoThe development of structured interviews specially designed for assessing personality disordersTestrests reliability is also an important factor for evaluationIt is often difficult to diagnose a single specific personality disorder because many disordered people exhibit a wide range of traits that make several diagnoses applicablePersonality disorders can be construed as the extremes of characteristics we all possessLivesley Schoroeder Jackson and Jang personality disorder is a failure or inability to come up with adaptive solutions to life tasksoTo form stable integrated and coherent representation of self and othersoTo develop the capacity for intimacy and positive affiliations with other peopleoTo function adaptively in society by engaging in prosocial and cooperative behavioursAssessing Personality disordersMany disorders are egosyntonic that is the person with a personality disorder is unaware that a problem exists and may not experience significant distressThe disorders may need to be diagnosed via clinical interview led by trained professionalsAlthough clinical interviews are preferable researchers often rely on selfreport measures when assessing personality disorder symptomsChapter 13 Personality DisordersPage 11MMPI2 has been created to assess the symptoms of specific personality disordersthe PSY5 consists of dimensions of assessing negative emotionalityneuroticism lack of positive emotionality aggressiveness lack of constraint and pychoticismThe most widely used measure of personality disorder symptoms is the Millon Clinical Multiaxial Inventory which is now in its third editionoIts a 175 true false inventory that was revised for DSMIVoProvides subscale measures of 11 clinical personality scales and 3 severe personality pathology scalesoAlso provides symptom ratings for clinical syndromes located on Axis I of the DSMIVoIncludes a validity index and 3 response style indices that correct for such tendencies as denial and random respondingoIts only moderately effective in terms of its ability to detect fakingIssues of self report measures of personality disordersoEmpirical tests comparing the various selfreport measures show that they differ in their content and are not equivalent oCutoff points used to determine the presence of personality disorder often overestimate the number of people who meet diagnostic criteria for particular disordersThe goal is to obtain accurate diagnoses MCMIIII is best used in conjunction with a clinical interview such as the Personality disorder ExaminationPersonality Disorder ClustersWhen a categorical approach is used the DSMIVTR criteria are involved personality disorders are grouped into 3 clustersoIndividual in cluster A paranoid schizoid and schizotpyal seem odd or eccentric they reflect oddness and avoidness of social contactoThose in cluster B antisocial borderline histrionic and narcissistic seem dramatic emotional or erratic extrapunitive and hostileoThose in cluster C avoidant dependent and obsessive compulsive appear fearfulPatients with both borderlineschizotypal personality disorders would probably have been diagnosed as schizophrenic using DSM II criteriaOddEccentric Cluster3paranoid schizoid and schizotypal PDsSymptoms are similar to those of schizophrenia especially its prodromal and residual phaseParanoid Personality DisorderThey are suspicious of othersChapter 13 Personality DisordersPage 11
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