Personality Disorders

1
Personality Disorders

• Lecture 1
• Why look at?
• How look at?
• How evaluate?

2
Why look at?

• Everyday hear people speaking of terms such as
• Psychopath
• Narcissist
• Psychotic
• Disordered personality etc.
• But what exactly does such terminology mean?

3
Definition

• Personality Disorders
• characterized by inflexible and enduring
  behaviour patterns that impair social
  functioning
• longstanding, inflexible, and maladaptive
  personality traits which impair social and/or
  occupational functioning'

4
DSM-IV-TR(Axis 2)

• Specifies ten different personality disorders
• Each with different markers making a specific
  syndrome of characteristics with which to
  identify them
• Each personality disorder being thought to
  feature differential levels of co-morbidity with
  the other nine
• .and also the other plethora of DSM
  classifications

5
How look at

• Look at the ten disorders identified by DSM and
  do three things
• Establish their identifying characteristics
• Articulate theory and research relating to their
  general and particular aetiology
• Reify each disorder with a brief case study
  often drawn from forensic setting

6
How evaluate?

• Consider utility of each putative disorder i.e

• Does it represent a psychological disorder?
• Or
• - just bad manners!
• - Quirky/off-the wall personality

7
Also

• Is the process of couching people in terms of
  personality disorders and adopting that
  classificatory system providing us with bona fide
  insight?
• OR
• Is it contributing little or nothing further than
  the person next to you in the bus queue couldnt
  articulate?
• Albeit colloquially!
• e.g.
• Sweetie
• Tosser
• Impatient git
• Etc.

8
Also

• Are the various, putative personality disorders
  sufficiently, discretely defined to warrant stand
  alone status?
• Do they adequately articulate the psychological
  phenomena they purport to articulate?
• Are key aspects of reality in their definition
  sacrificed on the alter of empiricism?

9
Overview of Approach

• To look at the ten Personality Disorders in turn
  with respect to
• Three clusters specified by DSM-IV-TR
• Cluster A Odd/Eccentric
• Cluster B Dramatic/Emotional
• Cluster C Anxious/Fearful

10
CLUSTER AOdd-Eccentric

• Paranoid
• Schizoid
• Schizotypal

11
Cluster A Generic Characteristics

• Some overlap with Schizophrenic behaviour but NOT
  psychotic
• Odd and/or difficult for normal population to
  understand
• Egs some paranoia, strange thoughts, and/or
  flatness in affective tone

12
CLUSTER BDramatic/Emotional

• Antisocial
• Histrionic
• Borderline
• Narcisisstic

13
Cluster BGeneric Characteristics

• Interpersonal relationships
• Unduly
• Dramatic
• Erratic
• Emotional
• Wild
• Volatile
• Uncaring
• Impulsive

14
CLUSTER CAnxious/Fearful

• Dependent
• Avoidant
• Obsessive-Compulsive

15
Cluster CGeneric Characteristics

• Lacking variously in
• Self-esteem
• Dependence on others
• Self-confidence
• Ease in relationships

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Difficulties to bear in mind

• Disordered
• vs
• Extreme versions of normal personality traits
• Alternative models better?
• (e.g. Widiger and Costa 1994 Widiger et al 2002)

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Difficulties - continued

• Evidence that majority of people diagnosed with
  one disorder also fit criteria for at least one
  further disorder
• gt Too much overlap?
• gt Need for fewer disorders in the classificatory
  system which are more accurate?
• gt Current system at once too vague and too
  specific?

18
Difficulties continued

• Rationale for putting the personality disorders
  on Axis 2 is that they relate to enduring
  conditions in life
• Yet there is evidence that the disorders DO come
  and go over time (e.g. Shea et al 2002)

19
Difficulties continued

• A lot rests on knowing how an individual behaves
  and also has behaved over time
• Some disorders are inherently very manipulative
  and deceitful (e.g. BPD) and this can make
  getting accurate information near impossible

20
Difficulties continued

• Possible Gender Bias in judgement
• Do gender stereotypes cause differential
  diagnoses to be made?
• e.g.
• Dependent PD gt likelihood of diagnosis in women?
• Anti-social PD gt likelihood of diagnosis in men?

21
Difficulties continued

• Possible ethnic bias in clinical judgement
• E.g.
• Would a stereotype of black males being
  associated with violent crime cause an elevated
  likelihood of diagnosing Anti-social Personality
  Disorder?

22
Difficulties continued

• Possible societal bias in clinical judgement
• e.g.
• Someone who exhibits very limited interactivity
  with others at a social level and displays
  limited emotional expression may be regarded as
  Schizoid
• Does that make a Tibetan Monk schizoid?!

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Conclusionsand what to take away

• There are ten Personality Disorders identified by
  DSM-IV-TR
• They are classified therein on three clusters
• Each Personality Disorder has its own collection
  of characteristics
• Some theorists and practitioners have objected to
  their use on conceptual and methodological grounds

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What NOT to take away over the next five sessions!

• Dont fall in to the trap of ascribing
  personality disorder/s to yourself. Very common
  misattribution effect
• We all do some things which may be regarded as
  being odd, impulsive, aloof, unsocial even
  sometimes anti-social.

25
SO.

• It does not mean that we are personality
  disordered!
• In fact in some ways if we were wed be the last
  to realize it!

26
Reading

• Suggest start by reading the chapters in the
  introductory Abnormal Psychology books (e.g.
  Davison and Neale Comer etc.)
• Also can look at the case study books e.g.
  Oltmanns, T (2007) Case studies in abnormal
  psychology. John Wiley and Son.