Chapter 10
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A person’s characteristic traits, coping
styles, and ways of interacting with the
environment emerge during
childhood and become solid during
adolescence and early adulthood.
These patterns constitute a person’s
personality – the set of unique traits
and behaviors that characterize an
individual.
Most psychologists agree that there
are 5 personality traits: neuroticism,
extraversion/introversion, openness to
experience,
agreeableness/antagonism, and
conscientiousness.
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Our adult personalities tend to be
attuned to the demands of society.
Some people display obvious
symptoms (certain traits) that are
so inflexible and maladaptive that
they are unable to perform at least
some of the varied roles expected
of them by their society. This
means that they have a personality
disorder.
Personality disorders used to be
called, “character disorders”. The
most pervasive characteristics
found in persons with personality
disorders include: chronic
interpersonal difficulties and
problems with one’s identity or
sense of self.
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In order to be diagnosed with a
personality disorder, the behavior of
the individual must be pervasive and
inflexible as well as stable and of
long duration.
It must also cause either clinically
significant distress or impairment in
functioning and be manifested in at
least two of the following areas:
cognition, affectivity, interpersonal
functioning, or impulse control.
These individuals tend to cause as
much difficulty in other’s lives as
they do their own.
Other people tend to find their
behaviors confusing, exasperating,
unpredictable, and unacceptable.
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Individuals with personality
disorders tend not to learn from
their mistakes and tend to make the
same mistakes over and over again.
As an example, a dependent
person may cause the end of
relationships due to incessant
demands to never be left alone at
home.
These disorders tend to not come
from stress. They come from the
gradual development of inflexible
and distorted personality and
behavioral patterns that result in
maladaptive ways of perceiving,
thinking about, and relating to the
world. These can stem from majorly
stressful events in childhood.
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Friends and family may describe these people as: troublesome,
eccentric, or hard to get to know. They tend to have trouble
developing close relationships or getting along with others.
The DSM-IV-TR used to categorize personality disorders into 3
categories:
1) Paranoid, schizoid, and schizotypal personality disorders –
people are odd or eccentric, with behaviors ranging from distrust
and suspiciousness to social detachment.
2) Histrionic, narcissistic, antisocial, and borderline personality
disorders – share a tendency to be dramatic, emotional, and
erratic.
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3) Avoidant, dependent, and obsessive compulsive disorder – show
anxiety and fear.
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These categories will probably not exist in the DSM-5, but many
psychologists still categorize them this way.
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More misdiagnoses occur than
correct diagnoses with
personality disorders. This is so
because there are no sharp
definitions provided concerning
personality disorders.
Most psychologists and
psychiatrists arrive at a
diagnosis for personality
disorders by self-reports and
interviews. There tends to be a
comorbidity that follows
individuals identified with
personality disorders. There is
more evidence showing that
personality disorders come
from heritability.
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Cluster A personality disorders
display unusual behavior such as
distrust, suspiciousness, and social
detachment and come across as
odd or eccentric.
Individuals with paranoid
personality disorder – have a
pervasive suspiciousness and
distrust of others, leading to
numerous interpersonal difficulties.
They tend to see themselves as
blameless even pointing to the evil
motives of others. These people
tend to be “on guard” expecting
trickery and looking for clues to
validate their expectations while
disregarding all evidence to the
contrary.
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These individuals doubt the
loyalty of friends and are
reluctant to confide in others.
They tend to bare grudges,
refuse to forgive insults and
slights, and are quick to react
with anger and sometimes
violent behavior.
These people tend not to be
psychotic. Most of the time
they are in reality. They may
experience psychotic
symptoms during periods of
stress.
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These individuals are usually unable
to form social relationships and
usually lack much interest in doing
so. They do not have good friends,
but may have a close relative.
These people tend to have
problems expressing their feelings
and are often cold and distant. They
often lack social skills and can be
classified as loners, with solitary
interests and occupations.
These individuals do not tend to
marry as they do not take interest in
sexual activity or in other activities.
They tend not to be emotionally
reactive. They rarely experience
positive or negative emotions. They
tend to show an apathetic mood.
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These individuals are excessively
introverted and have pervasive social
and interpersonal deficits.
They tend to have cognitive and
perceptual distortions, as well as
oddities and eccentricities in their
communication and behavior. Highly
personalized and superstitious
thinking is characteristic of people
with schizotypal personality disorder.
These individuals believe that they
have magical powers and may
engage in magical rituals.
Oddities in thinking, speech, and
other behaviors are the most stable
characteristics of schizotypal
personality disorder.
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There has been a significant
amount of research on
schizotypal personality disorder.
There is generally a 2%
prevalence within the general
population.
These individuals tend to show
mild impairments in cognitive
functioning, including deficits in
their ability to sustain attention,
and deficits in working memory,
and both of which are common in
schizophrenia.
These individuals show language
abnormalities in their auditory
processing.
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Histrionic Personality Disorder – tend to
have excessive attention-seeking behavior
and emotionality are the key characteristics.
These individuals tend to feel
unappreciated if they are not the center of
attention; their lively, dramatic, and
excessively extraverted styles often ensure
that they can charm others into attending to
them.
In craving stimulation and attention, their
appearance and behavior are often quite
theatrical and emotional as well as sexually
provocative and seductive. Their speech is
often vague and impressionistic, and they
are usually considered self-centered, vain,
and excessively concerned about the
approval of others, who see them as overly
reactive, shallow, and insincere.
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Narcissistic Personality Disorder
– shows an exaggerated sense of
self-importance, a preoccupation
with being admired, and a lack of
empathy for the feelings of
others.
There is grandiose and
vulnerable narcissism.
The grandiose narcissism have
traits related to grandiosity,
aggression, and dominance.
These individuals tend to
overestimate their abilities and
accomplishments while
underestimating the abilities and
accomplishments of others.
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Persons with narcissistic
personality disorder tend to have
a sense of entitlement that
astonishes others.
They believe they can only be
understood by high-status people
or that they should only associate
with certain individuals.
They tend not to forgive others
for perceived slights and they
easily take offense.
These individuals also tend to
have fragile and unstable selfesteems. They may avoid
interpersonal relationships due
to fear of rejection or criticism.
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For the grandiose narcissist, the
family and friends may be more
concerned about the behavior of the
person than the person themselves.
Some individuals may fluctuate
between grandiosity and
vulnerability. These individuals have
an extremely difficult time
understanding other’s perspectives.
If they do not receive the validation
or assistance they desire, they are
inclined to be hypercritical and
retaliatory. This tends to be seen in
more men than more women.
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Antisocial Personality Disorder –
continually violate and show
disregard for the rights of others
through deceitful, aggressive, or
antisocial behavior, typically
without remorse or loyalty to
anyone.
They tend to be impulsive,
irritable, and aggressive and to
show a pattern of generally
irresponsible behavior.
This pattern must have occurred
since the age of 15 and before 15
years old, the person must have
had symptoms of conduct
disorder. This disorder has been
researched substantially.
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People with BPD tend to show a
pattern of behavior characterized
by impulsivity and instability in
interpersonal relationships, selfimage, and moods.
BPD has a long and rather
confusing history. The current
diagnosis is no longer related to
schizophrenia.
The central characteristic of BPD
is affective instability, which has
emotional responses to
environmental triggers. This is
also characterized by drastic and
rapid changes from one emotion
to another.
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These individuals do not tend to have
stable self-images. Their relationships
tend to be stormy, involve
disillusionment, disappointment, and
anger.
Their fears of abandonment are huge.
There is also intense and often
uncontrollable rage.
There is an impulsivity characterized
by rapid responding to environmental
triggers without thinking (or caring)
about long-term consequences. These
often lead to self-destructive
behaviors such as gambling sprees or
reckless driving. They tend to partake
in lots of suicide attempts. They are
also at-risk for self-mutilation.
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About 75% with BPD have
cognitive symptoms that
include: being out of contact
with reality and can
experience hallucinations,
paranoid ideas, or severe
dissociative symptoms.
1-2% of the population may
qualify for the diagnosis of
BPD, but they represent about
10% of patient in outpatient
and 20% of patients in
inpatient clinical settings.
Genetic factors tend to play a
role with BPD. The 5-HTT
gene could be responsible for
BPD.
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These individuals often show anxiety and
fearfulness, characteristics that we have
not seen in the other two clusters.
Avoidance Personality Disorder – show
extreme social inhibition and introversion,
leading to lifelong patterns of limited
social relationships and reluctance to
enter into social interactions.
They do not seek out other people, yet
they desire to seek out other people. They
do desire affection and are often lonely
and bored.
These individuals do not seem to enjoy
their aloneness; their inability to relate
comfortably to other people causes acute
anxiety which is often accompanied by
depression.
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The key difference
between the loner with
schizoid personality
disorder and the loner who
is avoidant is that the one
with avoidant is shy,
insecure, and
hypersensitive to criticism.
The avoidant also desires
interpersonal contact, but
avoids it for fear of
rejection. There is a modest
genetic influence.
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These individuals show an extreme need to be taken
care of, which leads to clinging and submissive
behavior. They also show acute fear at the possibility of
separation or sometimes of simply having to be alone.
These individuals build their lives around other people
and subordinate their own needs and views to keep
people involved with them.
These people often fail to get angry with others
because of a failure of losing their support. These
people will remain in psychologically or physically
abusive relationships. They have difficulties with
everyday simple decisions and they have a lack of selfconfidence. They can function as well as they are not
required to be on their own.
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It is very common for those
with dependent personality
disorders to have anxiety and
depression. These individuals
tend to have a need for
assurance.
It is difficult for individuals with
this disorder to get out of
relationships because they do
not want to be on their own.
They have a need to be taken
care of. These individuals fear
criticism and rejection.
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Perfectionism and an excessive concern
with maintaining order are the
characteristics of those with OCPD.
There is careful attention paid to rules,
order, and schedules. They are
preoccupied with the details of events and
things.
This perfection is often quite dysfunctional
in that it can mean never finishing projects.
They tend to be obsessed with work and
don’t care about putting off leisure
activities. They have trouble relaxing and
having fun. They have difficulty giving
tasks to others and are rigid, color, and
stubborn. Others tend to view them this
way, too. These individuals do not have
extreme anxiety or obsessive or
compulsive rituals.
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The three main characteristics
are: perfectionism,
preoccupation with details, and
hoarding.
These individuals have high
levels of conscientiousness,
which leads to an extreme
devotion to work,
perfectionism, and excessive
controlling behavior.
They like to comply and be
assertive.
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Personality disorders are very
difficult to treat because they
are enduring, pervasive, and
inflexible patterns of behavior
and inner experience.
Many different goals of
treatment can be formulated,
and some are more difficult to
achieve than others.
Goals might include reducing
subjective distress, changing
specific dysfunctional
behaviors, and changing
patterns of behavior or the
entire structure of the
personality.
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People with personality disorders
enter treatment only at someone else’s
insistence and often do not believe
that they need to change.
These individuals often have trouble
trusting therapists and maintaining
good relationships.
They may disrupt their sessions may
being loud and main refuse to
complete treatment. 37% of
individuals will drop out of therapy,
prematurely. Sometimes, individuals
will need to be hospitalized. They may
live in rehabilitation centers during the
weekdays. In-patient treatment seems
to be more effective than out-patient
treatment.
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With BPD, there generally needs
to be psychotherapy as well as
medication. The medication
sometimes creates more suicidal
behavior.
Antidepressants are considered
most safe and useful for treating
rapid mood shifts, anger, and
anxiety.
These individuals tend to have a
high incidence of self-mutilation.
Patients show some improvement
in depression, anxiety, suicide,
impulsive aggression, rejection
sensitivity, and especially
transient psychotic symptoms.
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Mood-stabalizing medications such as carbazemine may be
useful in reducing irritability, suicidal behaviors, and
impulsive aggression.
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Overall, drugs tend to be mildly beneficial for BPD.
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Psychotherapy may be very effective for this disorder.
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Dialectical behavior therapy – is a unique kind of cognitive
and behavioral therapy specifically adapted for this
disorder. One of the goals of this therapy is to help
individuals realize they have negative afffect and not to
engage in self-harming behavior. There is an increase in
teaching coping skills. There are individual, group, and
phone components to this therapy. They are encouraged not
to put everyone under the label of “good” or “bad”. This
treatment is expensive and time-consuming.
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People with antisocial personality
disorder (ASPD) tend to disregard and
violate the rights of others. They do this
through deceitful, aggressive, and
antisocial behaviors. They tend to have
unsocialized and irresponsible behavior
with little regard for safety.
Only those that are above 18 years of age
can be diagnosed with this disorder. Much
of the population with this disorder are in
prison.
Other symptoms include: repeatedly
performing acts that are grounds for
arrest, showing repeated deceitfulness,
impulsivity, irritability, and
aggressiveness, shows disregard for
safety, shows consistent irresponsibility in
work or financial matters. The person may
have had conduct disorder before the age
of 15 years old.
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The earliest description of
psychopathy was made by
Cleckley in 1941.
Psychopathy includes the
symptoms of Antisocial
Personality Disorder, but also
has a lack of empathy, inflated
and arrogant self-appraisal,
and glib and superficial charm.
1% of females are ASPD. 3% of
males fit the criteria of ASPD.
This may be as low as 1%,
though.
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Robert Hare and his coworkers developed
a 20-item Psychopathy Checklist Revised
(PCL-R). This was a way that clinicians and
researchers could diagnose psychopathy
on the basis of the Cleckley criteria.
This can be done through an extensive
interview and careful checking of school
records, police records, and prison
records.
There are two aspects of psychopathy: 1)
This involves a lack of remorse or guilt,
callousness/lack of empathy,
glibness/superficial charm, grandiose
sense of self-worth, and pathological lying.
2) This also involves: impulsive and
socially deviant lifestyles with a need for
stimulation, poor behavior controls,
irresponsbility, and a parasitic lifestyle.
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In the prison population, 70-80% of
inmates fall into the category of ASPD. 2530% fall into psychopathy.
This checklist appears to be the best
indicator of future violence and recidivism.
Those individuals with psychopathy are three
times more likely to reoffend and four
times more likely to reoffend violently
following prison terms.
Individuals that are not in jail, but still might
show signs of psychopathy include:
predatory business professionals,
manipulative lawyers, high-pressure
evangelists, and crooked politicians. Not
much research exists on psychopaths that
have stayed out of the prison system.
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Even though psychopathy might be
charming, spontaneous, and likable
when you meet them; they are
deceitful and manipulative and use
others to meet their own ends.
Psychopaths tend to live in the
moment and not in the past or future.
They may also be hostile and act out in
remorseful and senselessly violent
ways.
Psychopaths appear unable to
understand and accept ethical values
except on a verbal level. Their
conscience development is severely
retarded or nonexistent. They
generally act as though laws do not
apply to them. Their intellectual
development is typically normal.
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Psychopaths tend to take what
they want and not earn it. They
are prone to thrill seeking and
deviant and unconventional
behavior. They often break the
law impulsively with no regard
of the consequences.
Some of these individuals have
high rates of alcohol abuse
and dependent and other
substance-abuse/dependent
disorders.
Antisocial personalities tend
to have elevated rates of
suicide attempts and
completed suicides
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Psychopaths seem to have good
insights into people’s needs and
weaknesses and are adept at
exploiting them. These individuals
are not sorry if they are caught in a
lie. Psychopaths are seldom able to
keep good friends.
Psychopaths tend to not understand
love in others or give it in return.
Manipulative, exploitative, and
sometimes coercive in sexual
relationships, they tend to be
unfaithful mates.
Those with psychopathy tend to
show very little emotion or reaction
to pictures of mutilated or assaulted
people. These individuals tend to
show less activity in the amygdala.
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These children take part in:
theft, running away from home,
and associating with criminal
deviants.
Those individuals with poor
parental supervision, harsh or
erratic parenting styles, physical
abuse or neglect, disrupted
family lifestyle, and a convicted
mother increase the chances of
conduct disorder given children.
The first disorder that tends to
come before conduct disorder is
ODD (oppositional defiant
disorder) and ADHD (attention
deficit hyperactivity disorder).
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Whether or not a child
develops conduct disorder
depends upon their parent’s
antisocial behaviors, divorce,
poverty, a crowded-inner-city
neighborhood, and parental
stress.
All of these characteristics
contribute to poor and
ineffective parenting skills –
especially in ineffective
disciplining, monitoring, and
supervising, which is highly
predictive of antisocial
behavior.
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There are a wide range of cultures
that have individuals that fit on the
psychopathology scale. The
manifestations of the disorders are
influenced by cultural factors, an
encouragement or
discouragement of the factors.
One of the ways in which
psychopathology is different in
different cultures is the amount of
aggressiveness and/or violent
behavior that the person takes part
in. In China, psychopaths are much
less likely to engage in violent
behavior.
Individualism tends to stem
psychopaths and their behaviors.
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Most psychopathic
individuals do not suffer from
much personal distress and do
not believe they need
treatment.
If psychopaths take part in
rehabilitation programs, they
are unlikely to be helped by
them. Professionals that work
with psychopaths often state
that it is nearly impossible to
treat them. There are certain
treatments that will increase
the bad behaviors of
psychopaths. Biological
treatments (medicines) do not
seem to help much either.
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Punishment by itself is generally
ineffective for changing
antisocial behavior.
Cognitive-behavioral treatments
have been most effective given
treatment. The goals of this
program tend to include:
increasing self-control, selfcritical thinking, and social
perspective taking, 2) increasing
victim awareness, 3) teaching
anger management, 4) changing
antisocial attitudes, and 5) curing
drug addiction. These treatments
only tend to make small changes,
though. These tend to work better
with young offenders versus
older offenders.
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Many criminal activities of
many psychopathic and
antisocial personalities
seem to decline after the
age of 40 even without
treatment, maybe because
of weaker biological
drives, better insight into
self-defeating behaviors,
and the cumulative effects
of social conditions. 50% of
psychopaths still tended to
be arrested for criminal
acts. The social damage
that psychopaths do tends
to continue after the 40’s.