Lecture 1: Personality Disorders
Personality Disorders
Definition – a PD is an enduring pattern of inner experience and behavior that deviates
markedly from the expectations of the individual’s culture:
1) Is pervasive and inflexible
2) Has an onset in adolescence and early adulthood
3) Is stable over time
4) Leads to distress or impairment
It is not better explained by another mental disorder, mental condition, or substance use
Unique characteristics do not mean one has a PD
No differences between the DSM-IV and DSM-5 in regards to PD criteria
The Three P’s
1) Persistent – over time
2) Pervasive – across different contexts
3) Pathological – markedly deviates from normal
Etiology
We do NOT know where
they come from
When talking about etiology
– we are talking about the
diathesis-stress model
There is a lot of
comorbidity – suggests the
role of genes
- Not much is known
, Clusters of Personality Disorders
Cluster B PDs are most well-know – due to their impact on society
- Different extents to which people can suffer from these PDs – i.e., continuum
Prevalence of PD clusters – prevalence total of 9.1%
- A (5.7%) – B (1.5%) – C (6.0%)
Positive and Negative Characteristics PDs
Personality Disorder Positives Negatives
Cluster A
Paranoid Careful, caring Paranoid
Schizoid Independent, autonomous Loners
Schizotypal Eccentric, unique Eccentric
Cluster B
Antisocial “Own agenda” Antisocial
Borderline Sensitive Drama-queens
Histrionic Flair Attention seekers
Narcissistic Special, unique Me, myself, and I
Cluster C
Avoidant Shy Shy
Dependent Loyal, people-person Clingy
Obsessive-Compulsive Perfectionistic, conscientious controlling
Cluster A – Odd, Eccentric
Personality Disorder Characteristics
Paranoid Suspiciousness
More male
, Very guarded
Some degree of paranoia can be heathy – but questioning everyone/everything
can become pathological
E.g., Stalin
Schizoid Detached from social relationships
Restricted range of emotional expressions
More male
E.g., Dexter in initial episodes – (1) no desire for social relationships, (2) very
limited living, (3) no need for any social interaction, (4) little connectedness
More observant – not interested in intimacy and sexual relations
Schizotypal Acute discomfort, more atypical, eccentric
Distortions in everyday life – not per se due to stress
Odd, eccentric
Highly misinterpret other people’s behaviors
Off, unusual
Over 50% have a history of a major depressive episode
E.g., Willy Wonka
Cluster B – Dramatic, Emotional, Erratic
Personality Disorder Characteristics
Antisocial Disregard for – or violation of – the rights of others
“I do my own thing – whatever I am doing I do not care about the rights and
boundaries of others, or the consequences”
Lack of empathy
Problems with the law
Very likely conduct disorder during childhood
Self-appraisal, cocky, opinionated
NOT the same as psychopathy!!! – most psychopaths will meet the criteria – but
not all people with antisocial PD are psychopaths!
E.g., Joran van der Sloot – Dutch serial killer
,Borderline Pattern of instability in how they see themselves, how they feel, and in social
relationships
Predominantly women
Self-harm, impulsivity, difficulty with separation and rejection
Chronic feelings of emptiness and overall instability
E.g., Angelina Jolie, Amy Winehouse, Lindsay Lohan
Histrionic “Hysteria” or “hysterical neurosis”
Excessive emotionality and attention seeking
Overlap with borderline – but more about being the center of attention
Assume different roles – e.g., “victim” or “princess” – whichever gets more
attention
More sexually seductive behavior – as it is an easy way to get attention
E.g., Regina George
Narcissistic Grandiosity, need for admiration, lack of empathy
“Me, myself, and I”
Snobbish, disdainful
More men
E.g., Donald Trump, Kanye West, Kim K
Cluster C – Anxious, Fearful
Personality Disorder Characteristics
Avoidant Social inhibition, restraint
Feelings of inadequacy
Very worried and sensitive
Gender is quite equal
Fear of being criticized or rejected
Shy, timid, lonely, isolated
Some overlap with schizoid
E.g., Michael Jackson
Dependent Super submissive, clingy to others, excessive need to be taken care of
, Controlling fear by clinging to others
Similar to avoidant – fear of criticism and rejection
If they do not cling onto others – they do not know what to do with their fear
Obsessive-Compulsive Preoccupation with orderliness, perfectionism, control
(OCPD) Strict adherence to rules and systems
Desire for everything to be clean, ordered, structured
At times difficult to prioritize – as everything is seen as important
Linked to violence in the home
NOT the same as OCD – (1) OCD – compulsions and behavior related to dealing
with own stress – i.e., I have to… otherwise… – (2) OCPD – interpersonal as
they want others to stick to their rules as well
OCD is ego-dystonic – people do not like it but compulsion to do it
OCPD is ego-syntonic – they care about rules as they are important to them and
they should be important to others as well
E.g., Steve Jobs
Lecture 2: Personality Organization
Personality Organization
Otto Kernberg – introduced different levels of severity
A continuum to identify the severity of mental illness – ranging from reasonably healthy to
severely ill
1) Neurotic Personality Organization (NPO)
2) Borderline Personality Organization (BPO)
3) Psychotic Personality Organization (PPO)
The organization – is the foundation of a house – and the house is the personality disorder
- All of us have a certain personality organization
, NPO BPO PPO
Defense Mature Immature Immature
Identity Integration Yes No No
Reality Testing Intact Intact No
Observing Ego Yes Limited No
Primary Conflict Separation-
Oedipal Existential
Individuation
(Counter)Transference Working Alliance All Good/Bad Parental
Identity Integration – knowing who one is
and what one stands for
Reality Testing – whether there is
confusion over what is true and what is
not true
Observing Ego – ability to think for
oneself in the third person; ability to
reflect on one’s own functioning
Oedipal – tendency to struggle in life with
the things one wants, needs, the goals one
has
- Not so much about whether one
exists or what is real
Defense Mechanisms
Definition – defense mechanisms (DMs) are psychological strategies that are used
unconsciously to (1) protect us or (2) help us cope with the anxiety related to
unwanted/unacceptable thoughts and emotions – protecting our sense of self
, Gender Differences – reveal that:
1) Women – use more internalizing DMs
2) Men – use more externalizing DMs
Healthy vs Maladaptive
1) Healthy – a variety of mature defenses which differ depending on context
2) Maladaptive – always using the same defense mechanism – regardless of context
Defense Mechanisms – are related to personality
Characteristics Examples
Mature/Neurotic Greater ability to adapt to reality Repression
Effectively distance threatening feelings Sublimation
without distorting the reality Humor
Suppression
Altruism
Undoing
Reaction formation
Idealization
Intellectualization
Displacement
Immature Severe alteration of painful mental contents Projection
and/or radical distortion of external reality Acting out
Unacceptable feelings are kept outside of Denial
consciousness Dissociation
Feelings and impulses are not recognized as Regression
being one’s own Passive aggression
Splitting
Autistic fantasy
Somatization
, Mature/Neurotic Defense Mechanisms
Defense Description
Mechanism
Repression An unpleasant or unacceptable feeling or thought – is pushed out of
consciousness
Differs from suppression – in that the thought or feeling is unconsciously Neurotic
eliminated – and the content can NO longer be obtained
E.g., victims of sexual abuse
Sublimination Expressing a personally unacceptable or unattainable feeling in a socially
acceptable or useful way
Considered a more adaptive DM as it can transform negative anxiety into Mature
positive energy
E.g., sticking to the task at hand keeps me from feeling depressed or anxious
Humor Expressing uncomfortable feelings – e.g., in the form of jokes – without
causing oneself discomfort Mature
E.g., I am usually able to see the funny side of an otherwise painful situation
Suppression Pushing the unpleasant or unacceptable feeling, thought, or desire
