Class notes

Chapter 13 - Personality Disorders

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Course
PSYC 300A

Institution
University Of British Columbia (UBC )

Explore lecture notes on personality disorders. Gain insights into the complexities of various personality disorders, including borderline, narcissistic, and antisocial personality disorders. Examine diagnostic criteria, symptoms, and contributing factors. Discover evidence-based treatments for man...

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Uploaded on May 11, 2023
Number of pages 19
Written in 2021/2022
Type Class notes
Professor(s) Sheila woody
Contains Personality disorders

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PSYC 300
Chapter 13 – Personality Disorders
- Personality disorders (PDs): a heterogeneous group of disorders regarded as long-standing, inflexible, and
maladaptive personality traits that impair social and occupational functioning.
 Heterogeneous group of disorders
 Pervasive on everyday life function
 Inflexible patterns of behaviour make it hard to think and act in different ways
 Some can cause emotional distress
- Research suggests personality disorders and dysfunction should be conceptualized as continuous
dimensions (spectrum) rather than set categories.
- Although symptoms of personality disorders describe characteristics many may possess, actual
personality disorders are defined by extremes of traits and the inflexible way they are expressed.
 Often rigid in their behaviour and cannot change in response to changes in situations
 Emphasis on being rigid fits with the notion that key differences between people can be
conceptualized in personality capabilities, e.g., ability to be flexible in social interactions
- People with dysfunctional personalities cannot adjust their thoughts, feelings, and behaviours to fit
circumstances and people they encounter.
 Most of the personality field focuses on a trait perspective, but a capability perspective provides
a unique view on how to conceptualize personality dysfunction.
o Trait perspective: what a person typically or usually does
o Capability perspective: what a person could do or has the potential to do
- Personalities develop through the years and reflect a persistent means of dealing with challenges, a certain
style of relating to other people.
 Someone may be overly dependent, challenging and aggressive, shy and avoid social contact,
concerned more with appearance and their ego than with relating to others, etc.
 Individuals would not be diagnosed as having personality disorders unless patterns of behaviour
are long-standing, pervasive, and dysfunctional.
o E.g., when entering a crowded room and hearing a loud burst of laughter, one may feel
they are the target of a joke and people are talking about them.
o Concerns become symptoms of paranoid personality disorder if they occur frequently
and intensely and prevent developing close personal relationships.

13.1 Classifying Personality Disorders: Clusters, Categories, and Problems
- The idea that personality can be disordered refers to Hippocrates time and his humoral theory
 Humoral theory  personality traits and human behaviors are based on four separate
temperaments associated with four fluids (“humors”) of the body
1. Choleric temperament (yellow bile from the liver)
2. Melancholic temperament (black bile from the kidneys)
3. Sanguine temperament (red blood from the heart)
4. Phlegmatic temperament (white phlegm from the lungs)
- Personality disorders were listed in early DSMs but were very unreliable.
 One clinician might diagnose a flamboyant client as narcissistic, but another might consider them
psychopathic.
- The publication of DSM-III began a trend toward improved reliability
 In DSM-III personality disorders were placed on an axis (II), to ensure diagnosticians would pay
attention to possible presence of disorders  described many personality disorder categories that
did or did not apply to people with clinical dysfunction.
 Axis element was removed in DSM-5
 Axis it still generally accepted  episodic disorders may be accompanied by a long-lasting
personality disorder, while for some, the disorder is the main problem.

,- Theodore Millon  important contributor as a prominent theorist in personality disorders field.
- Millon (1986) identified three key criteria that help distinguish normal vs. disordered personality.
1. Disordered personality is indicated by rigid and inflexible behaviour.
o Afflicted person finds it difficult to alter their behaviour according to changes in their
situation.
2. Person engages in self-defeating behaviour that fosters vicious cycles.
o Behaviours and cognitions perpetuate and exacerbate existing conditions.
o Self-defeating behaviour gets one farther away from their goals.
3. “Structural instability.”
o Millon used this term to refer to a fragility of the self that “cracks” under stress.
o E.g., a student who functions at a reasonably high level during the early part of a term but
loses the ability to cope due to mounting pressure of multiple deadlines and exams
- Personality disorder can be viewed as failure or inability to come up with adaptive solutions to life tasks.
- Livesley (1998) identified three types of life tasks  proposed failure with any one task is enough to
warrant a personality disorder diagnosis.
1. Ability to form stable, integrated, and coherent representations of self and others
2. Develop capacity for intimacy and positive affiliations with other people
3. Function adaptively in society by engaging in prosocial and co-operative behaviours.
- Categorical approach still prevails in DSM-5.
 Contains description to outline when a general personality disorder exists so assessment can
establish whether someone is characterized by a specific subset of PD
o General personality disorder: reflects whether a personality disorder exists in general
and then helps evaluate whether criteria of a specific personality can be applied.
- DSM-5 diagnosis explains “enduring patterns of inner experience and behaviour deviates from the
expectations of the individual's culture. Pattern manifests in two (or more) areas”:
 Cognition (i.e., ways of perceiving and interpreting self, others, and events)
 Affectivity (i.e., range, intensity, lability, and appropriateness of emotional response)
 Interpersonal functioning
 Impulse control
- Dimensional differences exist when characterizing normal vs. abnormal personality
 PDs reflect extreme and rigid response tendencies that differ in degree (not kind) from responses
of people without disorders
 PDs can be construed as the extremes of characteristics we all possess.
- Top researchers focused on coming up with decision rules that would serve as diagnostic thresholds that
would enable clinicians to use dimensional data to make categorical decisions.
 When thresholds were established, the new diagnostic model was applied successfully to many
specific personality disorders.
- Low stability of personality disorder diagnoses is one problem that has plagued the categorical approach.
 PDs are presumed to be more stable over time than some episodic disorders (e.g., depression)
 Test–retest reliability is also an important factor in their evaluation.
o Comparison on whether clients receive the same diagnosis when they are assessed twice
with some time interval separating the two assessments
- Durbin and Klein (2006)  assessed stability of PDs in mood disorder patients and found 10-year
stability of categorical diagnoses was “relatively poor”
 Stability coefficients were greater with dimensional views of PDs and in shorter time intervals
 Found greater stability of anti-social disorders
 Cluster B disorders (dramatic/erratic) had the greatest stability over time
- Problem with PD diagnoses  difficult to diagnose a single, specific personality disorder, many
disordered people exhibit a wide range of traits that make several diagnoses applicable

, Perfectionism
- Perfectionism is a construct that deserves more attention in terms of its role in personality dysfunction.
- Perfectionism is considered in DSM-5 as a symptom of obsessive-compulsive personality disorder
 Extreme perfectionists can have workaholism and relentless striving that results in great distress
for them or the people around them in ways that do not fit the description of OCPD.
- Hewitt (2012)  outlined reasons why multi-dimensional perfectionism merits consideration
 Believed personality style is unique and accounts for significant variance in personality
dysfunction beyond other trait dimensions that comprise multi-trait models.
- Treatment research suggests perfectionism is persistent and ingrained  CBT-based interventions lower
but do not eliminate problematic perfectionism
 Another indication that perfectionism deserves more consideration
 Need for a complex approach is reflected in an alternative interpersonal psychodynamic
approach that sees perfectionism as a by-product of interpersonal experiences and unmet
interpersonal needs

SUMMARY
- Personality disorders are defined as enduring patterns of behaviour and inner experience that disrupt
social and occupational functioning.
- Classic theorists emphasize a lasting pattern of rigid and self-defeating behaviours that reflects insecurity
and instability in the self.
- Personality disorders tend to be expressed in terms of dysfunctional emotional, cognitive, and
interpersonal tendencies.

13.2 Assessing Personality Disorders
- Significant challenge in assessing personality disorders  many disorders are egosyntonic
 People with a PD are typically unaware a problem exists and may not experience significant
personal distress (lack insight into their personality)
- People who interact with PD (oblivious) individuals may have discomfort  suggests diagnosis of PDs
are enhanced when significant others become informants. Shown in study of symptoms of narcissistic PD.
 Narcissists tend to have highly inflated and grandiose self-views.
 Informants (friends, family, etc.) tend to report higher symptoms than the people do themselves
 Because of the lack of personal self-awareness PDs need to be diagnosed via clinical interviews
led by trained personnel.
- Diagnosis challenge  a substantial proportion of clients are deemed to have a general PD
 These clients do not fit clearly into existing and specific PD diagnostic categories.
- Clinical interviews are preferable when seeking to make diagnoses
- Researchers often rely on use of self-report measures when assessing PD symptoms.
 Scoring schemes using MMPI items have been created to assess symptoms of specific
personality disorders
- Harkness (1995)  described a set of MMPI-2 scales developed to assess five-dimensional personality
framework to reflect psychopathology, known as the PSY-5.
 PSY-5 consists of dimensions assessing:
1. Negative emotionality
2. Neuroticism
3. Lack of positive emotionality
4. Aggressiveness
5. Lack of constraint
6. Psychoticism.
 PSY-5 dimensions have been corroborated via factor analyses  seem relevant to certain forms
of personality dysfunction.

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