Personality Disorders
Definition of Personality
 “Enduring
patterns of perceiving,
relating to, and thinking about the
environment and oneself, which
are exhibited in a wide range of
important social and personal
contexts”
Definition of Personality Disorders
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Personality disorders are “enduring
patterns of perceiving, relating to, and
thinking about the environment and
oneself” that “are exhibited in a wide
range of important social and personal
contexts,” and “are inflexible and
maladaptive, and cause either
significant functional impairment or
subjective distress” (DSM-IV, p. 630)
Main Features of PDs
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Extreme patterns of thinking, feeling, and
behaving that deviate from a person’s culture
Listed on Axis II of the DSM-IV-TR
Begin early in life and remain stable
- not contextual or transient
Inflexible and maladaptive
Cause significant functional impairment and
subjective distress
- ego-syntonic vs. ego-dystonic
Problems with the PDs
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Low levels of inter-rater reliability
Comorbidity with both Axis I and Axis II
Problems with classification system
- Categorical vs. Dimensional System
DSM-IV-TR Personality Disorders
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Paranoid Personality Disorder
Schizoid Personality Disorder
Schizotypal Personality Disorder
Antisocial Personality Disorder
Borderline Personality Disorder
Histrionic Personality Disorder
Narcissistic Personality Disorder
Avoidant Personality Disorder
Dependent Personality Disorder
Obsessive-Compulsive Personality Disorder
Cluster A: Odd or Eccentric
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Paranoid PD – is a pattern of distrust and
suspiciousness such that others’ motives are
interpreted as malevolent
Schizoid PD – is a pattern of detachment from
social relationships and restricted range of
emotional expression
Schizotypal PD – is a pattern of acute discomfort
in close relationships, cognitive or perceptual
distortions, and eccentricities of behaviour
Paranoid Personality Disorder
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suspicious of other’s motives
interprets actions of others as deliberately
demeaning/threatening
expectation of being exploited
see hidden messages in benign comments
easily insulted/ bears grudges
appear cold and serious
Schizoid Personality Disorder
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indifferent to relationships
limited social range (some are hermits)
aloof, detached, called loners
no apparent need of friends, sex
solitary activities
seem to be missing the “human part”
Schizotypal Personality Disorder
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peculiar patterns of thinking and
behaviour
perceptual and cognitive disturbances
magical thinking
not psychotic
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perhaps a distant “cousin” of schizophrenia
Cluster B: Dramatic, Emotional, or
Erratic
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Antisocial PD – is a pattern of disregard for, and
violation of, the rights of others
Borderline PD – is a pattern of instability in
interpersonal relationships, self-image, and
affects, and marked impulsivity
Histrionic PD – is a pattern of excessive
emotionality and attention seeking
Narcissistic PD – is a pattern of grandiosity,
need for admiration, and lack of empathy
Antisocial Personality Disorder
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pattern of irresponsibility, recklessness, impulsivity
beginning in childhood or adolescence (e.g., lying,
truancy)
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adulthood:
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criminal behaviour
little adherence to societal norms,
little anxiety
conflicts with others
callous/exploitive
Psychopathy
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Egocentric, deceitful, shallow, impulsive
individuals who use and manipulate others
Callous, lack of empathy
Little remorse
Thrill-seeking
“human predators” (Hare, 1993)
No “conscience”
Psychopathy Checklist-Revised
(Hare, 1991) – 2 Factors
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Glib and superficial
Egocentric and
grandiose
Lack of remorse or
guilt
Lack of empathy
Deceitful and
manipulative
Shallow emotions
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Impulsive
Poor behavior
controls
Need for excitement
Lack of responsibility
Early behavior
problems
Adult antisocial
behavior
Quote of the day
“I’m the most cold-hearted son of a b---- you
will ever meet”
 Ted Bundy
Borderline Personality Disorder
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marked instability of mood,
relationships, self-image
intense, unstable relationships
uncertainty about sexuality
everything is “good” or “bad”
chronic feeling of “emptiness”
recurrent threats of self-harm/
“slashers”
Borderline and comorbidity
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High degree of overlap with both Axis I
and Axis II disorders
24%-74% also diagnosed with major
depression; 4% to 20% bipolar
25% of bulimics also diagnosed with BPD
67% also diagnosed with substance use
disorder
Histrionic Personality Disorder
excessive emotional displays/
dramatic behaviour
 attention-seeking, victim stance
 seek re-assurance, praise
 shallow emotions, flamboyant, selfcentred
 very seductive, “life of the party”
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Narcissistic Personality Disorder
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grandiose, sense of self-importance
lack of empathy
hyper-sensitive to criticism
exaggerate accomplishments/ abilities
special and unique
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entitlement
below surface is fragile self-esteem
Cluster C: Anxious or Fearful
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Avoidant PD – is a pattern of social inhibition,
feelings of inadequacy, and hypersensitivity to
negative evaluation
Dependent PD – is a pattern of submissive and
clinging behaviour related to an excessive need
to be taken care of
Obsessive-Compulsive PD – is a pattern of
preoccupation with orderliness, perfectionism,
and control at the expense of flexibility
Avoidant Personality Disorder
over-riding sense of social discomfort
 easily hurt by criticism
 always need emotional support
 occasionally try to socialize
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so distressing they retreat into
loneliness
Dependent Personality Disorder
 submissive,
clingy behaviour
 fear of separation
 easily hurt by criticism
Obsessive-Compulsive
Personality Disorder
excessive control and perfectionism
 inflexible
 preoccupied with trivial details
 judgmental/moralistic
 workaholic/ignore family members
 often humourless
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Personality Disorder Not
Otherwise Specified
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Meets general criteria for a PD but no
specific criteria for a specific PD.
Exhibit at least 10 symptoms of PDs
across all subtypes
Comorbidity
Average number of PD diagnoses per
patient:
- 4.6 (Skodal et al., 1988)
- 2.8 (Zanaarini et al., 1987)
- 3.75 (Widiger et al., 1986)
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DSM – Categorical Approach
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Based on the medical model
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Disorder is present or absent
Assumptions of the DSM
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Personality pathology is suited to be
classified into discrete types or disorders
These disorders group themselves into
three clusters
The diagnostic criteria naturally fall into
the particular personality disorders to
which they have been assigned
Empirical Evidence doesn’t support these assumptions!!!
David Klonsky – University of Virgina
“the DSM practice of putting expert opinions into writing and
only then conducting tests of reliability and validity cannot
lead to an acceptable classification system. Rather it directs
scientists to conduct research on, and practitioners to put
their trust in, diagnostic labels that may or may not map onto
valid constructs that exist in nature. Instead, researchers
must turn to objective, empirical methodologies to discover
the dimensions or personality pathology, letting the data fall
where they may and letting the data determine how
personality disorder is best classified”
John Livesley - UBC
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Dimensional Assessment of Personality
Pathology Basic Questionnaire (DAPP)
4 Dimensions: Emotional Dysregulation;
Dissocail Behaviour; Inhibitedness;
Compulsivity
“ …the evidence on this point is so
unequivocal that the only issue to explain
is the field’s reluctance to accept empirical
evidence”
~ W. John Livesley, (2000) Journal of
Personality Disorders, 14, 2, p. 139-140.
The “Big 5” Personality Traits
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Openness to experience
Conscientiousness
Extraversion
Agreeableness
Neuroticism
 personality disorders represent
extreme variations of OCEAN
Advantages of Categorical
System
Ease in conceptualization and
communication
 Familiarity
 Consistency with clinical decision
making
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Disadvantages of the Categorical
Approach
Complex and cumbersome
 Arbitrary cut-off points
 Loss of important information
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Advantages of the Dimensional
Model
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Resolution of a variety of classification
dilemmas
Retention of Information
Flexibility
Disadvantages of the
Dimensional Approach
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Lack of clinical utility?
Lack of familiarity?
Bottom line: not too many disadvantages
and most researchers favor it – likely to be
adopted in DSM-V