Disorders of Personality
DSM-IV Definition
• Enduring patterns of perceiving, relating to,
and thinking about the environment that are:
– Exhibited in wide range of important social and
personal contexts.
– Inflexible and maladaptive.
– Cause significant functional impairment or
subject distress.
• Onset: childhood or adolescence
• Course: stable over time.
•Source of continued controversy:
Categorical vs. Dimensional Models of
Personality
•Three “clusters” of disorders (A,B, & C)
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Cluster A: “odd” or “eccentric”
• Paranoid Personality: pervasive pattern of distrust
& suspiciousness.
Others’ motives interpreted as malevolent.
• Schizoid Personality: pervasive pattern of
detachment from social relationships & restricted
emotional range.
• Schizotypal Personality: pervasive pattern of
acute discomfort in close relationships, cognitive
or perceptual distortions, and eccentricities of
behavior.
Cluster B: “dramatic,” “emotional,” or “erratic”
• Antisocial Personality: Pattern of disregard for, and
violation of, the rights of others. Marked by impulsivity,
deceitfulness, lack of remorse.
• Borderline Personality: Pattern of instability in
interpersonal relationships, self-image, and affects, and
marked impulsivity. Intense affect, fear of abandonment.
• Histrionic Personality: Pattern of excessive emotionality
and attention-seeking.
• Narcissistic Personality: Pattern of grandiosity, need for
admiration, and lack of empathy.
Cluster C: “anxious” or “fearful”
• Avoidant Personality: Pattern of social inhibition,
feelings of inadequacy, and hypersensitivity to negative
evaluation.
• Dependent Personality: Pattern of submissive and
clinging behavior related to an excessive need to be
taken care of.
• Obsessive-Compulsive Personality: Pattern of
preoccupation with orderliness, perfectionism, and
control. (little flexibility, openness, or efficiency)
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Treatment of Borderline PD: Dialectic Behavior
Therapy (Marsha Linehan, 1993)
• Blends aspects of:
Psychodynamic, client-centered, strategic, interpersonal,
cognitive-behavioral, and crisis intervention approaches.
• Core problem:
– Dealing with invalidating environment.
– Significant others negate or respond erratically to person’s
emotional experiences.
• Treatment phases:
– Stability, connection, and safety.
– Exposure & emotional processing of the past.
– Synthesis
Who is at the Personality Disorder Party?
1. Donna danced into the party and immediately
became the center of attention. With sweeping
gestures of her arms and dramatic displays of
emotion, she boasted about her career as an actress
in a local theater group. During a private
conversation, a friend inquired about the rumors
that she was having some difficulties in her
marriage. In an outburst of anger, she denied any
problems and claimed that her marriage was “as
wonderful and charming as ever.” Shortly
thereafter, while drinking her second martini, she
fainted and had to be taken home.
2. Peter arrived at the party exactly on time. He made
a point of speaking to every guest for five minutes.
He talked mostly about technology and finance, and
avoided any inquiries about his feelings or personal
life. He left precisely at 10 p.m. because he had work
to do at home.
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3. Winston spent most of his time talking about his
trip to Europe, his new Mercedes, and his favorite
French restaurants. People seemed bored being
around him, but he kept right on talking. When he
made a critical remark about how one woman was
dressed - and hurt her feelings - he could not apologize
for his obvious blunder. He tried to talk his way
around it, and even seemed to be blaming her for
being upset.
4. William walked into the party but didn’t stay long.
The “negative forces” in the room were unsettling to
his “psychic soul spot.” The few guests he spoke to
felt somewhat uneasy being with this aloof “space
cadet.”
5. Sherry paraded into the party drunk and continued
to drink throughout the night. Laughing and giggling,
she flirted with many of the men and to two of them
expressed her “deep affection.” Twice during the
evening she disappeared for half an hour, each time
with a different man. After a violent argument with
one of them, because he “took too long” to get her a
drink, she locked herself into the bathroom and
attempted to swallow a bottle of aspirin. Her friends
encouraged her to go home, but she was afraid to be
alone in her apartment.
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6. Harold wasn’t invited to the party. No one really
knows him very well because he rarely talks. In fact,
he prefers to spend most of his time alone at home
reading.
7. Long before she was a teenager, Gladys was
impulsive, self-centered, irresponsible, and insensitive
to others. Gladys appears very charming to people
who do not know her very well. Gladys will often
hurt others in order to get what she wants. She is an
accomplished liar and has even stolen objects in order
to obtain them. When she does hurt others, Gladys
feels no guilt or remorse for what she has done.
8. Steve is uncertain about his goals, values, career
and friends. Sometimes he is not even certain if he is
heterosexual or homosexual. His emotions change
from one extreme to the other in a matter of hours.
Steve’s relationships are rocky. For example, last
month he and one of his closest friends, Rob, got into
an argument about where to eat dinner and now Steve
claims Rob is his enemy. Steve often goes on
drinking binges long enough to cause him problems at
work.
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