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Chapter 13


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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 o The publication of specific diagnostic criteria o The development of structured interviews specially designed for assessing personality disorders 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... o To form stable, integrated and coherent representation of self and others o To develop the capacity for intimacy and positive affiliations with other people o To function adaptively in society by engaging in prosocial and cooperative behaviours 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 C h a p t e r 1 3 : P e r s o n a l i t y D i s Page 1e r s MMPI-2 has been created to assess the symptoms of specific personality disorders the 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 o Its a 175 true false inventory that was revised for DSM-IV o Provides subscale measures of 11 clinical personality scales and 3 severe personality pathology scales o Also provides symptom ratings for clinical syndromes located on Axis I of the DSM-IV o Includes a validity index and 3 response style indices that correct for such tendencies as denial and random responding o Its only moderately effective in terms of its ability to detect faking Issues of self report measures of personality disorders o Empirical tests comparing the various self-report measures show that they differ in their content and are not equivalent o Cut-off points used to determine the presence of personality disorder often overestimate the number of people who meet diagnostic criteria for particular disorders 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 o Individual in cluster A (paranoid, schizoid, and schizotpyal) seem odd or eccentric (they reflect oddness and avoidness of social contact) o Those in cluster B (antisocial, borderline, histrionic and narcissistic) seem dramatic, emotional, or erratic (extrapunitive and hostile) o Those 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 C h a p t e r 1 3 : P e r s o n a l i t y D i s Page 1e r s 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 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 activities Loners with solitary interests Prevalence is <1% (slightly less common in women) Co-occurs with schizotypal, avoidant and paranoid personality disorder
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