Personality
CHAPTER 18: PERSONALITY
DISORDERS
John Oldham, M.D.
Past APA president, member Personality Disorders Work Group
1. “from the beginning of the development process for DSM-5,
the personality disorders were identified as a place where we
needed to move beyond the categorical diagnostic system of
discrete disorders in DSM-IV toward a more dimensional system”
2. “personality types, traits, and disorders are on a continuous
spectrum, much like blood pressure and hypertension.
3. “too much of a useful, adaptive trait may become a problem”
2
Personality Disorders (PD)
• The PD Work Group
proposed sweeping
changes:
– New conceptualization of
PD
– Fewer types of PD’s
– Trait rating scales
• Changes were not approved
• DSM-5 retains DSM-IV-TR
disorders
– General criteria for a PD
– Organization
– But…updated text
Three Major Clusters
• Odd/Eccentric Cluster
– Paranoid Personality Disorder
– Schizoid Personality Disorder
– Schizotypal Personality Disorder
• Emotional/Erratic Cluster
–
–
–
–
Antisocial Personality Disorder
Borderline Personality Disorder
Histrionic Personality Disorder
Narcissistic Personality Disorder
• Anxious/Fearful Cluster
– Avoidant Personality Disorder
– Dependent Personality Disorder
– Obsessive-Compulsive Personality Disorder
• Diagnostic tip: First try to locate the appropriate cluster,
then narrow to the specific disorder within that cluster.
Everyone has personality
• Everyone has STUFF.
• That’s why we start with the personalitystuff, and we’ll add in
other disorders as we go.
Kluckhorn and Murray’s
1950 model of personality
•
Universal (We are all alike in some ways)
•
Group (Everyone in my group is alike in
some ways--but different from non-group)
•
Individual (We are each unique in some ways)
Personality as a set of skills
• Each style represents a skill
• to be able to take on a particular persona, assume a particular
role, mask, or face.
• It’s important to have several of these from which to choose.
• Don’t need all of them
• Genetically, we are more comfortable taking on a subset of styles
Problems related to personality
• Failing to switch to a more role-appropriate style
• In a situation that calls for an extroverted role, you need to be able to
do that
Problems related to personality
• Problem 1: Lack of available styles
• (lack of personality skill sets)
• Problem 2: Inflexibility
• unwillingness or inability to move out of a specific style
Personality Differentiation
• Categorical Model
• pregnant
Dimensional Model
• Descriptive
• from DSM III on
Interpretive
- tall/short
- hypertension
- Big 5
- assumes causes
Big 5 Personality Dimensions
• Openness to Experience
• Conscientiousness
• Extraversion
• Agreeableness
• Neuroticism
The Golden Mean of Aristotle
• Falls equidistant between the extremes
• Preferred alternative to panic
• not fearlessness, but prudence
Normalizing the MMPI
Scale Scale name
Underlying
Dimension
Negative
Positive
Hs
Hypochondriasis
conservation
dependent, irritable, complaining,
bodily preoccupations
conscientious, careful, considerate, sincere
D
Depression
evaluation
critical, anxious, depressed,
pessimistic
deliberate, objective, contemplative, realistic
Hy
Hysteria
expression
denial, psychosomatic reactions,
suggestible, overreactive
empathetic, responsive, sensitive, optimistic
assertion
hostile, manipulative, impulsive,
antisocial
energetic, enterprising, venturesome, social
role-flexibility
self-recrimination, sex-role
deviancy, identity confusion,
unconventional
colorful, dilettante, interesting
investigative, curious, questioning,
discriminatory
Pd
Mf
Psychopathic Deviance
Masculinity-Femininity
Pa
Paranoia
inquiring
grandiose, hypersensitive,
suspicious, distrustful
Pt
Psychasthenia
organization
rigid, compulsive, obsessive,
ritualistic
methodical, systematic, convergent thinker,
organized
Sc
Schizophrenia
imagination
bizarre, irrational, confused,
idiosyncratic
spontaneous, creative, imaginative, divergent
thinker
enthusiastic, eager, wholehearted, exuberant
independent, self-reliant,
Ma
hypoMania
zest
hyper, ineffectual, disorganized,
agitated
Si
Social Introversion
autonomy
reclusive, asocial, alienated
free lance
Ivey’s Developmental Personality Styles
Nancy McWilliams’ Developmental
Dimensions of Personality
Sperry’s Developmental Levels of Personality
Personality Style and Disorder Clusters
• Cluster A (overlap with psychotic disorders)
•
Vigilant style & Paranoid personality disorder
•
Solitary style & Schizoid personality disorder
•
Idiosyncratic style & Schizotypal personality disorder
•
• Cluster B (overlap with depression and impulse-control disorders)
•
Adventurous style & Antisocial personality disorder
•
Mercurial style & Borderline personality disorder
•
Dramatic style & Histrionic personality disorder
•
Self-Confident style & Narcissistic personality disorder
•
• Cluster C (overlap with anxiety disorders)
•
Sensitive style & Avoidant personality disorder
•
Devoted style & Dependent personality disorder
•
Conscientious style & Obsessive-compulsive personality disorder
•
(Leisurely style & Passive Aggressive personality disorder)
•
• Others
•
Aggressive style & Sadistic personality disorder
•
Self-Sacrificing style & Self-Defeating personality disorder
•
Serious style & Depressive personality disorder
•
National online NPSP Sample
DSM-5 criteria for Personality Disorders
• Diagnosis of a personality disorder must satisfy the following general criteria in addition to the
specific criteria listed under the specific personality disorder under consideration.
•
• A. An enduring pattern of inner experience and behavior that deviates markedly from the
expectations of the individual's culture. This pattern is manifested in two (or more) of the following
areas:
•
cognition (perception and interpretation of self, others and events)
•
affectivity (the range, intensity, lability, and appropriateness of emotional response)
•
interpersonal functioning
•
impulse control
•
• B. The enduring pattern is inflexible and pervasive across a broad range of personal and social
situations.
•
• C. The enduring pattern leads to clinically significant distress or impairment in social, occupational,
or other important areas of functioning.
• D. The pattern is stable and of long duration and its onset can be traced back at least to
adolescence or early adulthood.
•
• E. The enduring pattern is not better explained as a manifestation or consequence of another
mental disorder.
•
• F. The enduring pattern is not attributable to the physiological effects of a substance (a drug of
abuse, a medication) or another medical condition (e.g., head trauma).
PRE890 Top Personality Styles
2011
2009
2007
2005
Conscientious
Conscientious
Conscientious
Conscientious
Dramatic
Dramatic
Dramatic
Dramatic
Serious
Serious
Vigilant
Devoted
Sensitive
Sensitive
Leisurely
Solitary
Serious
Self Sacrificing
Self Sacrificing Devoted
Vigilant
Self Sacrificing Self Sacrificing Leisurely
B
F
X
X
X
C
X
X
X
D
X
X
X
E
X
X
X
X
A
X
J
K
X
L
X
M
N
X
O
X
P
X
2
3
7
X
X
G
X
X
X
H
X
X
X
X
X
X
I
4
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
s
5
X
X
X
X
Vigil
an
t
Solit
ary
Serio
u
Sens
itive
Self S
acrif
ic i
6
ng
Self C
onfid
ent
urial
Leisu
rely
Merc
ious
ncra
t ic
atic
ted
Idios
y
1
Dram
RANK
Devo
Cons
cient
Aggr
essiv
e
Adve
nturo
us
PSP for PRE 890 2013
8
X
X
X
X
TK
A
1
2
3
nturo
urial
4
5
t
ary
us
Vigil
an
Solit
Serio
Sensi
tive
6
ent
icing
Self S
acrif
Merc
rely
c
ious
us
yncr
ati
L e i su
Idios
atic
ted
cient
Dram
Devo
Cons
Aggr
essiv
e
Adve
Self C
onfid
7
Tom
B
C
D
E
F
G
H
I
J
K
L
M
N
<== Total
TK 2013
TK 2007
Personality Self Portrait Exercise
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1. List things about the personality style that you would consider STRENGTHS. For example, my highest score is on
the Conscientious style, and some things about that style that come in handy include things like:
Being capable of immense, single-minded effort.
Whenever they commit to a task, they do the job completely and thoroughly.
When a problem arises, they work tirelessly until it is solved.
2. List things about the personality style that, if unchecked, might get you into trouble. Again, going with the
Conscientious style, things that might apply to me would include:
Many Conscientious people find it difficult to relax and experience pleasure.
They expect the same thoroughness and devotion from others, which may not always be appropriate.
Sometimes lack skills required for top managerial positions such as making quick decisions, setting priorities, and
delegating responsibility.
3. Finally, list things you might not do easily because of your style, but things you would do well to consider doing
more of BECAUSE OF your style. For the Conscientious style, those might include:
Concentrate on relaxing and enhancing your leisure time.
When you have difficulty making a decision, always keep in mind that it often makes no difference which decision
you make, as long as you do something.
To manage your time more efficiently at work, aim for results that are good enough and not necessarily perfect.
Personality Self Portrait Exercise
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1.
2.
3.
How does this style relate to others?
How does this style go about achieving their goals?
How does this style cope with stress?
4.
5.
What does this style look like at work?
How should I best interact with this style at work?
6.
7.
What does this style look like in a close relationship?
How should I best interact with this style in a close relationship?
8.
As a therapist, how might I LIKE to respond to this personality
disorder?
• 9.
How might I most therapeutically respond to this personality
disorder?
•
• 10. What cultural / gender / age considerations might be relevant to
this style?
• At issue is not whether we attend to normal or
abnormal, or that we focus on strengths or
weaknesses, but that we tell the human story
from a hopeful and instrumental perspective:
even our inevitable failings can be accepted –
integrated – managed – lived. We (counselors
and counseling psychologists) present a
perspective that allows – even demands – soul.
• The debate should not be about where the
line is between normal and abnormal, not
about the field’s focus on strengths vs.
pathology, but on our commitment to
embracing, in a hopeful and positive way,
the whole of the human experience.