What is personality
disorder?
Empowering you with the
language and concepts
Personality
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We all have one.
It makes us unique.
It shapes how we understand and interact
with the world
3 P’s
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Pattern of relating to self, other and the world that deviates from cultural norm.
50-78% prisoners believed to meet criteria for one or more PD.
10% of people in the community would meet criteria for PD.
A helpful way of thinking about PD relates to the 3 P’s
Persistent
Pervasive
– happens frequently
– across different circumstances
Problematic
– and cause problems for themselves and others
Immune system metaphor
Millon (2004)
Personality =
Psychological equivalent of
body’s immune system
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Robust immune system responds constructively
& appropriately to our environment.
PD = system that interacts with the environment
Rigidity in strategies + Others reactions
=
Repeated bad one-act play
PD Diagnosis
Labelling and the Disease model
Classification into PD types
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Categories based on “pure” prototype.
Assumes each personality disorder is
distinct
Akin to diagnosing a disease
that you either have or don’t
have
Diagnostic systems
DSM IV-TR
ICD-10
Paranoid
Schizoid
Schizotypal
Antisocial
Borderline
Histrionic
Narcissistic
Avoidant
Dependent
Obsessive Compulsive
Not Otherwise Specified
Paranoid
Schizoid
Dissocial
Emotionally unstable
Histrionic
Anankastic
Anxious
Dependent
Other specific PD
Unspecified PD
Mixed and other PD
DSM Clusters
Cluster A
Odd / Ecentric
Cluster B
Dramatic / Erratic
Cluster C
Anxious / Fearful
Character Assassination
Schizoid
Schizotypal
Borderline
Antisocial/ Psychopathy
Histrionic
Pros and Cons of Types
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Facilitates communication by the use familiar language between
professionals. It’s best we’ve got at the moment.
Enables quick signposting to services
Rarely find “pure types” in real life.
People are individuals. BPD = 5 of 9 criteria = potentially only 1
symptom overlap.
Lack of empathic understanding of the origins and maintenance of
the problem which is central to therapy.
Stigma facilitates reactions in others which perpetuates the problem
(eg. verbal attack driven by paranoid interpretation is met by
defensiveness, which further creates suspicion in the individual).
Dimensions of
personality
The direction to be taken in
DSM-V?
Dimensional perspective
1)
2)
Personality represented by severity of traits
rather than distinct categories.
Or, ASPD variations =
Normal variation:
Pathological variation
Adventurer,
Independent,
Courageous
Callous,
Lacking conscience
Breaks rules Impulsive
‘Normal’ continua of
Antisocial
Normal variation
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Adventurer, lives life on the edge, pioneers, risk-takers, courageous and
tough.
Slight pathological normal variation
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Does things own way, flirts with legal boundaries, dislikes daily routine,
action-oriented, independent thinkers, confrontational and masterful
leaders.
Cusp
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No forensic history but only due to being good at covering their tracks,
will deceive and exploit by minimising negatives and exaggerating
positives but not physically cruel, industrialists, exploit legal
technicalities and loopholes for personal gain, “smooth-talking
businessman”, “dodgy used-car salesman”.
‘Normal’ continua of
Paranoid
Normal variation
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Highly independent, value their freedom, sensitive to issues of
power, authority and domination. Cautious and reserved with
others and enter relationships only after careful consideration.
Touchy, but not intimidated, when given criticism
Paranoid “style”
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Distant from others, places premium on honesty and loyalty.
Plays cards closely to chest with acquaintances. Attuned to
subtleties and nuances of communication at many levels.
Skeptical.
Dimensions of personality
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Five Factor Model (Costa & McCrae, 1992) - five dimension (primary traits):
Openness to experience vs tradition/convention
a general appreciation for art, emotion, adventure, unusual ideas, imagination, curiosity,
and variety of experience
Conscientiousness vs negligence
tendency to show self-discipline, act dutifully, and aim for achievement.
Preference for planned rather than spontaneous behaviour
Extraversion vs introversion
characterized by positive emotions engagement with the external world enthusiastic,
action-oriented individuals
Agreeableness vs antagonistic
tendency to be compassionate and cooperative rather than suspicious and antagonistic
towards others
Neuroticism vs emotional stability
emotionally reactive and vulnerable to stress
DAPP (Livesley & Jackson 2009)
Cluster label
Contributing dimensions
Emotional dysregulation
Affective lability
Cognitive dysregulation
Insecure attachment
Submissiveness
Anxiousness
Identity problems
Oppositionality
Dissocial Behaviour
Conduct problems
Narcissism
Stimulus seeking
Callousness
Rejection
Social Avoidance
Compulsiveness
Intimacy problems
Restrictive expression
Compulsivity
Low affiliation
Pros and Cons of Dimensions
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Research gives greater support to the dimensional view of
personality
Engenders a more compassionate understanding of personality
Diagnostic types can be translated into dimensions
No consensus about nature and number of dimensions
More complex picture of personality = more difficult to comprehend
and communicate to other clinicians