PSYB32H3 Chapter Notes - Chapter 13: Disconnection, Limbic System, Twin Study
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Chapter 13 – Personality Disorders
o Personality disorders (PDs): heterogeneous group of disorders that are regarded as long-standing,
pervasive, and inflexible patterns of behaviour and inner experience that deviate from expectations
of a person’s culture and that impair social and occupational functioning
o Personality that we develop over years reflects a persistent means of dealing with life’s
challenges, certain style of relating to other people
CLASSIFYING PERSONALITY DISORDERS: CLUSTERS, CATEGORIES, AND PROBLEMS
o Theodore Million: 3 key criteria that help distinguish normal vs. disordered personality:
1. Disordered personality is indicated by rigid and inflexible behaviour difficulty altering
behaviour according to changes in situation
2. Person engages in self-defeating behaviour that fosters vicious cycles behaviours and
cognitions perpetuate and exacerbate existing conditions: gets us further away from our
goals
3. Structural instability fragility to self that cracks under condition of stress
o Livesley (1998): identified 3 types of life tasks and proposed that filature with any one task is
enough to warrant PD diagnosis:
1. Form stable, integrated, and coherent representations of self and others
2. To develop capacity for intimacy and positive affiliations with other people
3. To function adaptively in society by engaging in prosocial and cooperative behaviours
o General personality disorder
o PDs reflect extreme characteristics we all possess
o Problem of categorical approach: low stability more stable over time, test-retest reliability is
important factor in evaluation
o Cluster B disorders had greatest stability over time
ASSESSING PERSONALITY DISORDERS
o Significant challenge is that many disorders are egosyntonic: person with personality disorder is
typically unaware that problem exists and may not be experiencing significant personal distress
lack insight into own personality assessment enhanced when significant others in individual’s
life become informants
o Narcissists: highly inflated and grandiose self-views
o Challenge: lots deemed to have general PD or PDNOS --? Don’t fit into existing PD diagnostic
categories
o Verheul and Widiger (2004): PD not otherwise specified is 3rd most prevalent type of PD diagnosed
via structured interviews, with prevalence of PDNOS ranging from 8%-13%
o MMPI-2 scales used to assess 5 dimensional personality constructs to reflect psychopathology
(PSY-5): negative emotionality/neuroticism, lack of positive emotionality, aggressiveness, lack of
constraint, and psychoticism
o Most widely used measure of PD symptoms: Million Clinical Multiaxial Inventory (MCMI-III): 175-
item true-false inventory at an 8th-grade reading level: provides measure of 11 clinical personality
scales
o MCMI-III includes validity index and 3 response-style indices that correct tendencies as denial and
random responding
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o Grossman Facet Scales: therapy-guiding facet scales added to facilitate Million and
Grossman’s new treatment of personalized therapy modified therapies to recognize each
person’s unique needs and personality styles
o 2 key issues involving self-report measures of PD:
1. various self-report measures differ in content and not equivalent
2. general concern involving self-report measures, including PD measures, is that cut-off
points used with self-report responses to determine presence of PD often overestimate #
of people who meet diagnostic criteria for particular disorder
PERSONALITY DISORDER CLUSTERS
o 3 clusters:
1. Cluster A (paranoid, schizoid, and schizotypal) seem odd or eccentric reflect oddness
and avoidance of social contact
2. Cluster B (borderline, histrionic, narcissistic, and anti-social) seem dramatic, emotional, or
erratic behaviours are extra punitive and hostile
3. Cluser C (avoidant, dependent, and obsessive-compulsive) appear fearful
ODD/ECCENTRIC CLUSTER
o 3 diagnoses: paranoid, schizoid, and schizotypal PDs
o symptoms bear some similarity to schizophrenia but less severe symptoms of its prodromal and
residual phases
PARANOID PERSONALITY DISORDER (PPD)
o PPD is suspicious of others
o Secretive and always on lookout for possible signs of trickery and abuse
o Reluctant to confide in others and tend to blame them even when they themselves are at fault
o Extremely jealous and unjustifiability question fidelity of spouse/lover
o Preoccupied with unjustified doubts about trustworthiness or loyalty of others
o Read hidden negative/threatening messages into events
o Hallucinations not present and less impairment in social and occupational functioning
o Differs from delusional disorder because full-blown delusions not present
SCHIZOID PERSONALITY DISORDER
o Schizoid personality disorder: do not appear to desire or enjoy social relationships and usually
have no close friends
o Appear dull, bland, and aloof and have no warm, tender feelings for others
o Rarely report strong emotions, have no interest in sex, and experience few pleasurable activities
o Indifferent to praise and criticism, individuals with this disorder are loners with solitary interests
o Prevalence < 1%, less common in women
o Comorbidity highest for schizotypal, avoidant, and PPD because similar diagnostic criteria
o Diagnostic criteria similar to some symptoms of prodromal and residual phases of schizophrenia
SCHIZOTYPAL PERSONALITY DISORDER
o Interpersonal difficulties of schizoid personality and excessive social anxiety that does not diminish
as they get to know others
o May have odd beliefs or magical thinking and recurrent illusions
o Speech: may use words in an unusual and unclear fashion
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o Ideas of reference, suspiciousness, and paranoid ideation
o Prevalence is 3%, more frequent in men
o Problem in diagnosis: comorbidity with other PDs
ETIOLOGY OF THE ODD/ECCENTRIC CLUSTER
o Causes:
o Family studies: higher than average rates in relatives of people with schizophrenia and
delusional disorder
o People with schizophrenia are at increased risk for this disorder
o Increased rates in 1st-degree relatives of people with depression related to disorders
other than schizophrenia
o Genetic factors play some role: lowest heritability found in schizotypal personality disorder and
largest heritability estimate found for anti-social personality disorder no evidence for unique
genetic factors distinguishing cluster A, B, and C
o Associated with enlarged ventricles and less temporal-lobe grey matter
DRAMATIC/ERRATIC CLUSTER
o Diagnoses: borderline, histrionic, narcissistic, and anti-social PDs
BORDERLINE PERSONALITY DISORDER (BPD)
o Core features: impulsivity and instability in relationships, mood, and self-image
o Emotions are erratic and can shift abruptly, particularly from passionate idealization to
contemptuous anger
o Argumentative, irritable, sarcastic, quick to take offence, and very hard to live with
o Unpredictable and impulsive behaviour of BPD: gambling, spending, indiscriminate sexual activity,
and eating sprees potentially self-damaging
o Not developed a clear coherent sense of self and remain uncertain about values, loyalties, and
career choices
o Cannot bear to be alone, have fears of abandonment, and demand attention
o Chronic feelings of depressions and emptiness
o Often attempt suicide and engage in various forms of self-harm and self-mutilating behaviour
o Sources of diagnostic criteria:
1. Gunderson, Kolb, and Austin (1981): set of specific diagnostic criteria similar to those
appear in DSM-III
2. Spitzer et al (1979): study of relatives of those people with schizophrenia
o Comorbidity found with substance abuse, PTSD, eating disorder, and personality disorders from
odd/eccentric cluster
Etiology of Borderline Personality Disorder
o Views concerning causes of BPD: object-relations theory, biological research, and Linehan’s
diathesis-stress theory
Object-relations theory
o Concerned with way children incorporate (or introject) values and images of important people
focus is on manner in which children identify with people to whom they have strong emotional
attachments
o Introjected people become part of person’s ego but can come into conflict with wishes, goals, and
ideals of developing adult (e.g. take parents values to self)
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Document Summary
Personality that we develop over years reflects a persistent means of dealing with life"s challenges, certain style of relating to other people. 2: grossman facet scales: therapy-guiding facet scales added to facilitate million and. Odd/eccentric cluster: 3 diagnoses: paranoid, schizoid, and schizotypal pds, symptoms bear some similarity to schizophrenia but less severe symptoms of its prodromal and residual phases. Schizoid personality disorder: schizoid personality disorder: do not appear to desire or enjoy social relationships and usually have no close friends. Ideas of reference, suspiciousness, and paranoid ideation: prevalence is 3%, more frequent in men, problem in diagnosis: comorbidity with other pds. Etiology of the odd/eccentric cluster: causes, family studies: higher than average rates in relatives of people with schizophrenia and delusional disorder, people with schizophrenia are at increased risk for this disorder. Dramatic/erratic cluster: diagnoses: borderline, histrionic, narcissistic, and anti-social pds. Etiology of borderline personality disorder: views concerning causes of bpd: object-relations theory, biological research, and linehan"s diathesis-stress theory.
