Task 1. Classification and Aetiology of Personality Disorders
1. What are personality disorders? What are important features (e.g., 3 P’s (problematic,
persistant and pervasive), 3 clusters, ego-syntonic, polythetical classification)?
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Personality disorders = psychological disorders marked by inflexible, disruptive, and
enduring behavior patterns that impair social and other functioning – whether the sufferer
recognizes that or not. They are often considered to be chronic and enduring and they can
range from relatively harmless displays of narcissism, to a troubling lack of empathy for
other people. Personality disorders are difficult to diagnose and understand.
The DSM 5 contains 10 distinct personality disorder diagnoses, grouped into 3 clusters:
1. Cluster A: includes what are often labeled simply as "odd" or "eccentric" personality
characteristics (e.g., someone with paranoid personality disorder may feel a pervasive
distrust of others and be constantly guarded and suspicious).
Paranoid personality disorder
Schizoid personality disorder
Schizotypal personality disorder
2. Cluster B: encompasses dramatic emotional or impulsive personality characteristics. For
example, a narcissistic personality can display a selfish grandiose sense of self-
importance and entitlement. Meanwhile, a histrionic personality might seem like they're
acting strange to get attention, even putting themselves at risk with dramatic,
dangerous, and even suicidal gestures. The behavior of Cluster B can be self-destructive
and frightening, and these disorders are often associated with frequent hospitalization.
Antisocial personality disorder
Borderline personality disorder
Histrionic personality disorder
Narcissistic personality disorder
3. Cluster C: encompasses anxious, fearful, or avoidant personality traits. For example,
those with avoidant and dependent personality disorders often avoid meeting new
people or taking risks and show a lack of confidence, an excessive need to be taken care
of, and a tremendous fear of being abandoned.
Avoidant personality disorder
Dependent personality disorder
Obsessive-compulsive personality disorder
However, many researchers argue that some of these conditions overlap with each other so
much that it can be impossible to tease them apart. One proposed alternative for diagnosing
these disorders is the Dimensional Model, which gets rid of discrete disorders and replaces
them with a range of personality traits or symptoms, rating each person on each dimension.
So, the Dimensional Model would assess a patient not with the aim of diagnosing one
disorder or another, but instead, simply finding out that they rank high on, for example,
narcissism and avoidance.
,Probably the most famous well-established, and frankly, troubling personality disorder
is Antisocial Personality Disorder. People with Antisocial Personality Disorder, usually men,
exhibit a lack of conscience for wrongdoing, even towards friends and family members. Their
destructive behavior surfaces in childhood or adolescence, beginning with excessive lying,
fighting, stealing, violence, or manipulation. As adults, people with this disorder are thought
to generally end up in one of two situations: either they are unable to keep a job and engage
in violent criminal or similarly dysfunctional behavior; or they become clever, charming con-
artists, or ruthless executives who make their way to positions of power.
Lack of empathy, and sometimes criminal behavior, criminality is not always a component of
antisocial behavior. Certainly, many people with criminal records don't fit that psychopathic
profile. Most show remorse, love, and concern for friends and family. But still, although anti-
social personalities make up just about 1% of the general population, they were estimated in
one study to constitute about 16% of the incarcerated population.
The causes are probably a tangled combination of biological and psychological threads, both
genetic and environmental. Although no one has found a single genetic predictor of
Antisocial Personality Disorder, twin and adoption studies do show that relatives of those
with psychopathic features do have a higher likelihood of engaging in psychopathic behavior
themselves. And early signs are sometimes detected at age three or four, often as an
impairment in fear conditioning (i.e., lower than normal response to things that typically
startle or frighten children). A study showed that violent repeat offenders had as much as
11% less frontal lobe tissue than the average brain. Their brains also responded less to facial
displays of stress or anguish, something that's also observed in childhood, so it's possible
that some antisocial personalities lack empathy because they simply don't or can't register
others' feelings. Research has also suggested an overly reactive dopamine reward system,
suggesting that the drive to act on an impulse to gain stimulation or short-term rewards
regardless of the consequences may be more intense than the average person's.
,Question 1: What is the difference between ego-dystonic and ego-syntonic?
Ego-dystonic = those who have them are aware they have a problem and tend to be
distressed by their symptoms (e.g., anxiety and mood disorders)
Ego-syntonic = the person experiencing them doesn’t necessarily think they have a problem
(e.g., personality disorders)
Question 2: How can you explain self-harm behavior in borderline personality disorder?
Borderline Personality Disorder (BPD) sufferers have often learned to use dysfunctional,
unhealthy ways to get their basic psychological needs met, like love and validation, by using
things like outbursts of rage, or on the other end of the spectrum, self-injury behaviors like
cutting or worse. People with BPD were once commonly maligned by clinicians as 'difficult'
or 'attention-seeking', but we now understand BPD as a complicated set of learned
behaviors and emotional responses to traumatic or neglectful environments, particularly in
childhood. In a sense, people with this disorder learn that rage or self-harm helped them
cope with traumatic situations, but as a result, they also end up using them in non-traumatic
situations.
2. Classification of personality disorders? How does the DSM classify personality disorders?
What are the advantages and disadvantages of the DSM categorical system of
personality disorder classification? What are the alternatives to the DSM categorical
system?
Davey, G. (2014). Personality disorders, in: Psychopathology: research, assessment and
treatment in clinical psychology. Chichester: BPS Blackwell, pp 407-412.
Introduction
Personalities tend to be enduring features of individuals that determine how we respond to
life events and experiences, and they also provide a convenient means by which others can
label and react to us. To this extent, a personality is a global term that describes how you
cope with, adapt to, and respond to a range of life events, including challenges, frustrations,
opportunities, successes and failures. A personality is something that we inwardly
experience ourselves and outwardly project to others.
Most people will learn and evolve with their experiences, and they will learn new and
effective ways of behaving that will enable them to adapt with increasing success to life's
demands. In contrast, some others possess an ingrained and unchanging way of dealing with
life's challenges. They rarely learn to adapt their responses or learn new ones. They develop
a form of dealing with life events that are fixed and unchanging. They can also introduce
disruption and hardship into the lives of others, and frequently cause emotional distress to
themselves and those they interact with. Such characteristics are typical of those individuals
who are diagnosed with personality disorders.
DSM-5 defines a personality disorder (PD) as an enduring pattern of inner experience
and behaviour that deviates markedly from the expectations of the individual's culture, is
pervasive and inflexible, has an onset in adolescence or early adulthood, is stable over time,
and leads to distress and impairment. They are often associated with unusual ways of
interpreting events, unpredictable mood swings, or impulsive behaviour. Two of the most
well-known of these disorders are borderline personality disorder (BPD), characterized by
major and regular shifts in mood, impulsivity and temper tantrums, and an unstable self-
, image, and antisocial personality disorder (APD), which is characterized by a chronic
indifference to the feelings and rights of others, lack of remorse, impulsivity, and pursuit of
the individual's own goals at any cost. Individuals with APD are often labelled as ‘sociopaths’
or ‘psychopaths’.
Individuals diagnosed with a personality disorder will frequently deny their
psychopathology, will often be unable to comprehend that their behaviour is contrary to
conventional and acceptable ways of behaving, and will not associate their own
psychological difficulties with their own inflexible ways of thinking and behaving. As a
consequence, such disorders are very difficult to treat because they represent ingrained
ways of thinking and acting. Many personality disorders are also associated with poor or
unstable self-image and are frequently comorbid with other mental health problems –
particularly depression and many of the anxiety disorders.
12.1 Contemporary issues in the diagnosis of personality disorders
12.1.1 The categorical approach to personality disorder in DSM-IV-TR and DSM-V
DSM-IV-TR listed 10 diagnostically independent personality disorders and these were
organized into three primary clusters (this is still the way that DSM-5 categorizes personality
disorders): (1) odd/eccentric personality disorders, (2) dramatic/ emotional personality
disorders, and (3) anxious/ fearful personality disorders.
The personality disorders grouped in Cluster A have characteristics that resemble
many of the symptoms of schizophrenia but there is no apparent loss of touch with reality,
nor the experiencing of sensory hallucinations. However, people with Cluster A disorders
may behave in ways that are indicative of delusional thinking or exhibit rambling or poorly
organized speech (e.g. schizotypal personality disorder). The three subtypes of Cluster A are
(1) paranoid personality disorder, (2) schizotypal personality disorder, and (3) schizoid
personality disorder.
Cluster B includes people diagnosed with dramatic/ emotional personality disorders
who tend to be erratic in their behaviour, self-interested to the detriment of others,
emotionally labile and attention-seeking. These are arguably the most problematic of the
personality disorders in terms of the extremes of behaviour, and the emotional and personal
distress that they inflict on others. This category includes (1) antisocial personality disorder,
(2) borderline personality disorder, (3) narcissistic personality disorder, and (4) histrionic
personality disorder.
People with an anxious/ fearful personality disorder (Cluster C) exhibit anxious and
fearful behaviour. However, unlike the main anxiety disorders, the anxious and fearful
behaviour exhibited will have been a stable feature of their behaviour from late childhood
into adulthood, and it is usually not possible to identify a specific experience or life event
that might have triggered this fear and anxiety. These personality disorders may be
comorbid with some anxiety disorders, where triggers for the latter can be identified. But
the pattern of behaviour exhibited by individuals with anxious/fearful personality disorders
generally tends to represent ingrained ways of dealing and coping with many of life’s
perceived threats. The disorders described in Cluster C are (1) avoidant personality disorder,
(2) dependent personality disorder and (3) obsessive compulsive personality disorder.
