The concept of personality disorder
Traits- a combinations of which describes there personality
According to DSM –IV-TR, personality traits are “enduring patterns of perceiving, relating to and
thinking about the environment and oneself that are exhibited in a wide range of social and
Ppl with personality disorders, personality are more rigid and inflexible, - their beh seems
DSM-IV-TR only asserts a personality disorder only when it is inflexible and maladaptive/
Personality disorders include conditions that may cause distress primarily for other ppl
o Eg someone with anti-social personality disorder may see nothing wrong with
themselves- or think other ppl have the problem
o They might cause lots of problems to other like lie, manipulate, be violent, with having
little distress about the lack of interaction with others
If we explain the destructible beh of someone with apd , as resulting of an illness then we are
using circular reasoning
There are three large scale perspective longitudinal studies known as children in community
study of developmental course of personality disorder. , the collaborative longitudinal
personality disorders study and the McLean study of adult development, have been consistent
in their conclusions that personality disorder represent a significant health problems for those
with the conditions.
Personality disorders is associated with various forms of personal impairment
The DSM –IV-TR provides five formal criteria in defining personality disorders:
o Criterion A: states that the pattern of behaviour must be manifesting in at least two of
the following areas: cognition, emotion, interpersonal functioning, or impulse control.
o Criterion B: requires that the enduring pattern of beh be rigid and consistent across a
broad range of personal and social situation
o Criterion C: states that this beh should lead to clinical distress
o Criterion D: requires stability and long duration of symptoms, with onset in adolescence
o Criterion E: states that beh can’t be accounted for another mental disorder.
DSM-IV-TR lists the specific personality disorders according to three broad clusters:
o 1. Odd and eccentric disorder ( paranoid, schizoid, and schizotypal)
o 2. Dramatic, emotional and erratic disorder ( antisocial, borderline, narcissistic
o 3. Anxious, fearful disorder. ( avoidant, dependent, OCD)
See table 12.1
Personality disorders can easily disrupt the alliance between a therapist and client
Sometimes personality disorders can be mistake as Axis 1 ( that are less severe)
A wrong diagnosis can lead to a wrong treatment
Studies examining the prevalence examine rates in community Little research has examined the prevalence of personality disorders among the general
According to a 80;s Edmonton study, 1.8 % popn had APD in the 2 month period before the
survey estimated that the one year prevalence rate of APD in the general popn was 1.7 %
Data have major limitations because most ppl hospitalized with personality disorders are a risk
to themselves or to others.
Most are untreated or treated in the community rather than in hospitals.
Among men and women, the highest rates of hospitalization for personality disorders in 1999
were in ppl between 15 and 44 yrs of age.
Personality disorders are associated with other conditions, such as suicidal beh that lead to
The average length of stay in hospitals due to personality disorders was 9.5 days
52% of cases with personality dis were from cluster B type
12.2 show lifelong prevalence date from a community study conducted in the US
6 to 9% of the entire population, including community, hospitalized an outpatient samples, will
have one or more personality disorders during their life.
Cluster A was the most prevalent in men how had been married
Cluster B disorders were more prevalent in poorly educated men , and cluster C disorders were
most common among those who had graduated from high school but who had never married
Overall the risk of having avoidant, dependent, and paranoid personality disorders was greater
for females than males, whereas the risk of having APD was greater for males than females
No gender difference in risk for OCD, schizoid,
Prevalence rates are higher among impatient psychiatric patients than among outpatients.
Eg borderline personality disorder, the most common PD (personality disorder) , was reported
11% for outpatients and 19% for inpatients
For many ppl with personality disorders, their funtioning is egosytonic , that is they do not view
it as problematic
In contrast the axis 1 disorders are generally considered egodystonic (they cause distress and
are viewed as problematic by the individual sufferer.)
Intervention for individuals with PS, then must initially address the issues of motivation for
Many insurance companies will not assist clients with the cost of treatment for PD
With respect to diagnosis, two indices are reliability are important,
o 1. Inter-rater reliability – agreement between two raters
o 2. Test retest reliability
There are other challenges to the DSM definition of personality disorder and whether a
diagnosis is even warranted. There are many problems with the notion of personality disorder that have not been resolved,
and it is clear that further research is needed before a clear defined set of criteria is developed.
Researchers have identified gender and cultural bias in the diagnostic criteria, as subjects of
concern. These biases suggests unsatisfactory reliability
Gender and cultural issues
In a culturally diverse area clinicians may misdiagnose if they do not take adequate precautions
to determine whether certain attitudes and behaviours are apppropriate¸ For distinct cultures or
o Economically disadvantaged children living in inner cities may learn self-interested
strategies in order to survive
These strategies may, in the eyes of a more privileged clinician, appear to reveal
psychopathology, whereas in reality they are adaptive given the environmental context.
Similar concerts exist for gender biases in the diagnosis of personality disorders.
Sex role stereotypes may influence the clinician`s determination of the presence of personality
Henry and Cohen have suggested that clinicians typically over diagnose borderline personality
disorder in women.
Ford and widiger also examined these issues but looked at gender bias both in the diagnostic
criteria and in the diagnosis of histrionic personality disorder. They found that while the specific
diagnostic criteria for histrionic personality disorder were found with equal frequency among
men and women, women were more likely to be diagnosed with the disorder in another study
of historic personality disorder women were more commonly diagnosed
Biases in referrals to psychiatric clinics for ppl with histrionic feats or that the application of the
diagnosis among those ware are referred is gender biased
Gender bias can become `systemic ‘meaning that men and women are excluded from a
diagnosis category because of their gender.
o Eg more male inmates are classified as psychopath , very few women are because it is
o But this is not the case psychopathy exists in women too
It is hard to see gender difference in PD
There may be patters, suggesting that there are true cultural differences in the risk of certain
Reliability of diagnosis.
There is a failure in reliability for PD, suggesting that clinicians often fail to agree on a particular
diagnosis for a specific patient.
Interviews to measure the exact diagnosis take a really long time. And clinicians may be
unwilling to spend that time Zanarinin a examined both the inter-rater ant test retest reliability of axis I and II using
structured DSM based interview
o The results indicated at least `fair to good `inter rater reliability for all personality
disorders diagnosed by experiment clinicians
A major goal for the above mentioned research was to determine the stability of personality
disorder over time.
Comorbidity and diagnostic overlap
The two terms overt are synonymous. but t they are not
Comorbidity – used to describe the occurrence in the same person of two or more diff disorders
Overlap- similarity of symptoms of two or more disorders.
Greater attention to that we call APD
In the 19 century, scholars cont. to describe ppl who engaged in antisocial beh in the absence
of obvious cognitive or psychiatric dysfunction
Similar to Pinel`s notion. psychiatrist James Pritchard coined the term moral insanity to
delineate a mental contdion characterized by an absence of morality rather than madness
The thought the moral principle of the mind were `perverted or depraved `in these men
Sociologist replaced the term psychopath with sociopath.
They said psychopathic inferiority were exhibiting a `social `disorder and coined the term
sociopath, reflecting the idea that the condition involved in the anti-society
The current idea of psychopathy is founded largely in the clinically observation of psychiatrist
hervet cleckly .
He proposed that there are a number of defining characteristic of the disorder, including
emotional, interpersonal and beh elements
He saw that psychopaths were unresponsive to social control and behaved in a socially
Aside from the hereditary taint , little consideration are given to the cause of PD in the 19 cent
In the 40;s many theories were published .
Psychodynamic views Psychoanalysts see PD as a result form disturbance in the parent – child relationship , esp.
This process by which the child learns that he or she is an individual separate f ormthe mother
and other ppl
Thus difficulties in this process result in adequate sense of self or problems with dealing with
others ( avoidant)
Dominate thinking on the nature nurture debate has undergone dramatic shifts over time.
Many theorists are again turning to the role of early relationships in contributing to personality
pathology in adulthood
o Attachment through –asserts that children learn how to relate to others. Esp. in
affectionate ways , by the way in which their parents relate to them
When the attachment bond between parents and the child is positive ( supportive ) then they
will develop the skills and confidence necessary to relate effectively to others.
The parent child bond serve as a template for all later relationships
When this bond is poor, the child will lack confidence in relation with others.
This analysis has been applied to various personality disorders and the evidence appears to
support the role disrupted attachments in the etiology of these disorders.
Research shows that if parent child attachments are poor,, the child will typically develop adult
relationship styles that are ambivalence, fear or avoidance.
Poor attachment leads to poor development of intimacy, such that various maladaptive ways of
dealing with interpersonal relationships are likely
Levy has argued that poor attachment bods are an antecedent to violence and antisocial
patterns in children
The fact that personality disorders usually become obvious during late adolescence when the
demands for social interaction become perminent lends some support to the importance of
attachment deficits in the origin of these disorder.
Battle examined the childhood histories of 600 patients diagnosed with personality disorders or
major depressive disorder, in a mulit site investigation.
The study confirmed that rates of childhood maltreatment among individuals with personality
disorders are generally higher ( 73-82 %)
It is not possible to est. causation using this approach because the findings show that very high
prevalence of negative childhood experience with PD
Cognitive behavioural perspective
They suggests variety of factors that may contribute to the emergence of PD
Cognitive strategies or schemas are said to d