4.2 Personality Disorders
Contents
Week 1:
- Lecture 1: Personality Disorders
- Lecture 2: Personality Disorders (2)
Week 2:
- Lecture 3: Personality Organization
- Lecture 4: Personality Assessment
Week 3:
- Lecture 5: Individual Treatment
- Lecture 6: Suicide Prevention
Week 4:
- Lecture 7: Stigma
- Lecture 8: Group Therapy
Week 5:
- Lecture 9: Arts & Psychomotor Therapy
- Exam: 50 MC questions
1
,Week 1
Lecture 1: Personality Disorders
Personality disorder: an enduring pattern of inner experience and behavior 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 or impairment
<Thoughts, feelings and behavior>
<All of us on a bad day>
PD criteria:
- Enduring pattern of inner experience and behavior
- Debates from expectations of the individual’s culture
- Inflexible and pervasive
- Clinically significant distress
- Stable and of long duration
- Not better explained by other mental disorder, medical condition or drugs
3 Ps: persistent, pervasive, pathological
Always signs in early teens / adulthood
Ethiology
The Diathesis-Stress Model:
- Diathesis: vulnerability to psychological disorders
- Genes
- Abnormalities of brain structure or functioning
- Neurotransmitters
- Stressors:
- Noxious physical stressors
- Tauma, abuse, neglect
- Relationships - loss, turbulence
- Culture-related stressors
→ Psychological disorders
Prevalence: 10.5% overall
- Cluster A: 3.6%
- Cluster B: 4.5%
- Cluster C: 2.8%
Problem: a lot of overlap / comorbidity
Clusters of PDs:
A. Odd / eccentric (Atypical) - 3
- Paranoid Personality Disorder
- Schizoid Personality Disorder
- Schizotypal Personality Disorder
B. Big emotions - 4
- Antisocial Personality Disorder
- Borderline Personality Disorder
2
, - Histrionic Personality Disorder
- Narcissistic Personality Disorder
C. Control / anxiety - 3
- Avoidant Personality Disorder
- Dependent Personality Disorder
- Obsessive-Compulsive Personality Disorder
Cluster A: Odd / Eccentric / Atypical (3)
Paranoid Personality Disorder: paranoid (careful, caring)
- Distress, suspicious
- Expect / assume that people’s intentions are not good
- Paranoia always present
- Affects every professional and personal relationships - unlikely to trust and share
- Small social circle
- Example: Stalin
Schizoid Personality Disorder: loners (independent, autonomous)
- Very little emotions going on (not a lot of feelings) - things just happen
- Lack of social contact
- Detachment from other people and yourself
- “Loners” or “cold”
- Lack of desire / interest (+ lack of desire to change it)
- Lack of sexual interest
- Simple cognitions
- Often causes the network more distress than the person themself
- Often don’t seek therapy
- Stereotype: librarian
Schizotypal Personality Disorder: eccentric (unique)
- Uneasiness in social relationships (difficulties)
- Most eccentric / special emotions, cognitions, behaviors, speech / vocabulary
- Difficulties interpreting social relationships (not knowing if we are friends or not)
- Often feeling that they’re friends when they’re not, or they’re not when they are
- Often random events are very meaningful
- Desire is there
- Magical thinking (hallucinations)
- See patterns and coincidences
- Most similar to schizophrenia (genetics)
- Biggest difference: the stress is not part of it, also more mild, but there all the time
(hallucinations don’t change depending on stress levels)
- Mood disorders quite frequent
- Difference with autism: autism is a developmental disorder, schizotypal is interpersonal -
a lot more tension when conversing
- Example: Willa Wonka
3
,Lecture 2: Personality Disorders (2)
Cluster B - Big (4)
Antisocial Personality Disorder: antisocial (own agenda)
- Early onset or signs in childhood
- Confident, arrogant, self-opinionated, cocky (just don’t care if they come off rude, not
particularly the goal)
- Similar traits in psychopathy (but you can have one and not the other)
- No regard for what is right or wrong
- Difficulty forming and maintaining relationships
- Little remorse or guilt
- Stereotype: businessman
- Example: Ted Bundy
Borderline Personality Disorder: dramatic (sensitive)
- Very big emotions: pattern of instability (relationships, self-image, affect)
- Impulsivity
- Example: Amy Winehouse, Angelina Jolie, Princess Diana, Britney Spears
Histrionic Personality Disorder: attention seeking (flair)
- “Hysteria”, “hysterical neurosis”
- Excessive emotionality and attention seeking
- More drama: more happiness, but also more sadness
- Can be difficult when people don’t exclusively focus on you
- Provocative / seductive behavior
- Cannot diagnose before 18 (can’t diagnose in puberty)
- Stereotype: aspiring actors
- Example: Megan Fox, Regina George, Kayne, Kim Kardashian
Narcissistic Personality Disorder: me, myself and I (special, unique)
- “Anal” (restricted)
- Pattern of grandiosity, need for admiration and praise and lack of empathy
- At the end of the conversation it needs to be obvious that they are better or on top
- Believe they are special or unique, and superior
- Deserve more, their problems feel more complicated
- Are you putting me on a pedestal for me or for you?
- “When it’s not about me, it feels less relevant”
- Seek treatment often because they are “not appreciated enough” at work
- Stereotype: careers high on the ladder (CEO)
- Example: Kanye, Kim Kardashian, Trump
Cluster C - Control / anxiety (3)
Other people struggle with their behavior
Avoidant Personality Disorder: shy
- Trying to avoid things that you feel will make you feel worse
4
, - Feeling of inadequacy
- Hypersensitive to negative evaluations
- Very preoccupied with the idea that people are watching / judging them
- Social inhibition: affects private life, work, school
- Shy, introverted, timid
- Desire affection and acceptance
- Example: Whoopi Goldberg (actress - not typical)
Dependent Personality Disorder: clingy (loyal, people-person)
- Pattern of submissive and clingy behavior
- Need to be checked and reassured
- Don’t know if they can handle life themselves
- Elicit caregiving in others
- Low self-esteem
- Can’t live without help of others
Obsessive-Compulsive Personality Disorder: controlling (perfectionistic, conscientious)
- Orderliness, perfectionism, control
- Creating structure to thing gives control and calmness
- Inflexible to having rules and norms change
- Difficulty deciding what takes priority
- Passive aggressive, not direct
- Genuine need for control
- Don’t just expect myself to follow the rules, but everyone else too
- Example: Steve Jobs
Difference with OCD: the rules that they initiate, adhere to or point out are "useful" (more
egosyntonic), in OCD they don’t enjoy their behaviors, OCD covers less ground
Controversies in PDs: some argue they should be called interpersonal disorders
5
,DSM-5: Personality Disorders
Personality disorders are included in both section II and III
Prevalence: 9.1% for any PD → frequent co-occurrence of disorders from different clusters
- 15% of U.S. adults have at least 1 PD
PDs in the chapter:
Cluster A: odd or eccentric (5.7%) - PPD, SPD, STPD
- Paranoid personality disorder: distrust and suspiciousness such that others' motives
are interpreted as malevolent
- Schizoid personality disorder: detachment from social relationships and a restricted
range of emotional expression
- Schizotypal personality disorder: acute discomfort in close relationships, cognitive or
perceptual distortions, and eccentricities of behavior
Cluster B: dramatic, emotional, erratic (1.5%)
- Antisocial personality disorder: disregard for, and violation of, rights of others
- Borderline personality disorder: instability in interpersonal relationships, self-image,
and affects, and marked impulsivity
- Histrionic personality disorder: excessive emotionality and attention seeking
- Narcissistic personality disorder: grandiosity, need for admiration and lack of empathy
Cluster C: anxious or fearful (6%)
- Avoidant personality disorder: social inhibition, feelings of inadequacy, and
hypersensitivity to negative evaluation
- Dependent personality disorder: submissive and clinging behavior related to an
excessive need to be taken care of
- Obsessive-compulsive personality disorder: preoccupation with orderliness,
perfectionism and control
Personality change due to another medical condition is a persistent personality disturbance that
is judged to be due to the direct physiological effects of a medical condition (frontal lobe lesion)
Other specified PD and unspecified PD is a category provided for two situations:
1. The individual's personality pattern meets the general criteria for a PD, and traits of
several different PDs are present, but the criteria for any specific PD are not met
2. The individual's personality pattern meets the general criteria for a PD, but the individual
is considered to have a PD that is not included in the DSM-5 classification
(passive-aggressive PD)
DSM-5 placement
- Section II: categorical model (10 PDs, updated DSM-IV-TR)
- Section III: dimensional research model (trait-based, alternative view)
Models
- Categorical: PDs = qualitatively distinct syndromes
- Dimensional: PDs = maladaptive variants of normal traits, on spectrum
6
, General PD:
A. An enduring pattern of inner experience and behavior that deviates markedly from the
expectations of the individual’s culture, 2 or more of the following areas:
1. Cognition (i.e., ways of perceiving and interpreting self, other people, and events)
2. Affectivity (i.e., the range, intensity, lability, and appropriateness of emotional response)
3. Interpersonal functioning
4. Impulse control
B. The enduring pattern is inflexible and pervasive across a broad range of personal and
social situations
C. The enduring pattern leads to clinically significant distress or impairment in social,
occupational, or other important areas of functioning
D. The pattern is stable and cf long duration, and Its onset can be traced back at least to
adolescence or early adulthood
E. The enduring pattern is not better explained as a manifestation or consequence of another
mental disorder
F. The enduring pattern is not attributable to the physiological effects of a substance (a drug of
abuse, a medication) or another medical condition (head trauma)
Personality traits are diagnosed as a PD only when they are inflexible, maladaptive, and
persisting and cause significant functional impairment or distress
Diagnosis of PDs: evaluation of long-term patterns of functioning, particular personality features
must be evident by early adulthood
- The personality traits that define these disorders must also be distinguished, assess the
stability of personality traits over time and across situations
- Can be complicated: the characteristics that define a PD may not be considered
problematic by the individual (traits are often ego-syntonic)
For a PD to be diagnosed in younger than 18 years, the features must have been present for at
least 1 year
- Exception: ASPD → must be over 18
A PD should be diagnosed only when the defining characteristics appeared before early
adulthood
Some PDs (ASPD, BPD) may lessen with age, others (OCPD, STPD) remain stable
Culture / gender
Must account for ethnic, cultural, social background (avoid mistaking culturally normative
behaviors)
Gender differences: risk of bias from gender stereotypes
- Antisocial → more males
- Borderline, Histrionic, Dependent → more females
Differential diagnosis: distinguish PDs from
- Other mental disorders (esp. persistent mood / psychotic disorders)
- Personality traits not severe enough for PD
7
Contents
Week 1:
- Lecture 1: Personality Disorders
- Lecture 2: Personality Disorders (2)
Week 2:
- Lecture 3: Personality Organization
- Lecture 4: Personality Assessment
Week 3:
- Lecture 5: Individual Treatment
- Lecture 6: Suicide Prevention
Week 4:
- Lecture 7: Stigma
- Lecture 8: Group Therapy
Week 5:
- Lecture 9: Arts & Psychomotor Therapy
- Exam: 50 MC questions
1
,Week 1
Lecture 1: Personality Disorders
Personality disorder: an enduring pattern of inner experience and behavior 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 or impairment
<Thoughts, feelings and behavior>
<All of us on a bad day>
PD criteria:
- Enduring pattern of inner experience and behavior
- Debates from expectations of the individual’s culture
- Inflexible and pervasive
- Clinically significant distress
- Stable and of long duration
- Not better explained by other mental disorder, medical condition or drugs
3 Ps: persistent, pervasive, pathological
Always signs in early teens / adulthood
Ethiology
The Diathesis-Stress Model:
- Diathesis: vulnerability to psychological disorders
- Genes
- Abnormalities of brain structure or functioning
- Neurotransmitters
- Stressors:
- Noxious physical stressors
- Tauma, abuse, neglect
- Relationships - loss, turbulence
- Culture-related stressors
→ Psychological disorders
Prevalence: 10.5% overall
- Cluster A: 3.6%
- Cluster B: 4.5%
- Cluster C: 2.8%
Problem: a lot of overlap / comorbidity
Clusters of PDs:
A. Odd / eccentric (Atypical) - 3
- Paranoid Personality Disorder
- Schizoid Personality Disorder
- Schizotypal Personality Disorder
B. Big emotions - 4
- Antisocial Personality Disorder
- Borderline Personality Disorder
2
, - Histrionic Personality Disorder
- Narcissistic Personality Disorder
C. Control / anxiety - 3
- Avoidant Personality Disorder
- Dependent Personality Disorder
- Obsessive-Compulsive Personality Disorder
Cluster A: Odd / Eccentric / Atypical (3)
Paranoid Personality Disorder: paranoid (careful, caring)
- Distress, suspicious
- Expect / assume that people’s intentions are not good
- Paranoia always present
- Affects every professional and personal relationships - unlikely to trust and share
- Small social circle
- Example: Stalin
Schizoid Personality Disorder: loners (independent, autonomous)
- Very little emotions going on (not a lot of feelings) - things just happen
- Lack of social contact
- Detachment from other people and yourself
- “Loners” or “cold”
- Lack of desire / interest (+ lack of desire to change it)
- Lack of sexual interest
- Simple cognitions
- Often causes the network more distress than the person themself
- Often don’t seek therapy
- Stereotype: librarian
Schizotypal Personality Disorder: eccentric (unique)
- Uneasiness in social relationships (difficulties)
- Most eccentric / special emotions, cognitions, behaviors, speech / vocabulary
- Difficulties interpreting social relationships (not knowing if we are friends or not)
- Often feeling that they’re friends when they’re not, or they’re not when they are
- Often random events are very meaningful
- Desire is there
- Magical thinking (hallucinations)
- See patterns and coincidences
- Most similar to schizophrenia (genetics)
- Biggest difference: the stress is not part of it, also more mild, but there all the time
(hallucinations don’t change depending on stress levels)
- Mood disorders quite frequent
- Difference with autism: autism is a developmental disorder, schizotypal is interpersonal -
a lot more tension when conversing
- Example: Willa Wonka
3
,Lecture 2: Personality Disorders (2)
Cluster B - Big (4)
Antisocial Personality Disorder: antisocial (own agenda)
- Early onset or signs in childhood
- Confident, arrogant, self-opinionated, cocky (just don’t care if they come off rude, not
particularly the goal)
- Similar traits in psychopathy (but you can have one and not the other)
- No regard for what is right or wrong
- Difficulty forming and maintaining relationships
- Little remorse or guilt
- Stereotype: businessman
- Example: Ted Bundy
Borderline Personality Disorder: dramatic (sensitive)
- Very big emotions: pattern of instability (relationships, self-image, affect)
- Impulsivity
- Example: Amy Winehouse, Angelina Jolie, Princess Diana, Britney Spears
Histrionic Personality Disorder: attention seeking (flair)
- “Hysteria”, “hysterical neurosis”
- Excessive emotionality and attention seeking
- More drama: more happiness, but also more sadness
- Can be difficult when people don’t exclusively focus on you
- Provocative / seductive behavior
- Cannot diagnose before 18 (can’t diagnose in puberty)
- Stereotype: aspiring actors
- Example: Megan Fox, Regina George, Kayne, Kim Kardashian
Narcissistic Personality Disorder: me, myself and I (special, unique)
- “Anal” (restricted)
- Pattern of grandiosity, need for admiration and praise and lack of empathy
- At the end of the conversation it needs to be obvious that they are better or on top
- Believe they are special or unique, and superior
- Deserve more, their problems feel more complicated
- Are you putting me on a pedestal for me or for you?
- “When it’s not about me, it feels less relevant”
- Seek treatment often because they are “not appreciated enough” at work
- Stereotype: careers high on the ladder (CEO)
- Example: Kanye, Kim Kardashian, Trump
Cluster C - Control / anxiety (3)
Other people struggle with their behavior
Avoidant Personality Disorder: shy
- Trying to avoid things that you feel will make you feel worse
4
, - Feeling of inadequacy
- Hypersensitive to negative evaluations
- Very preoccupied with the idea that people are watching / judging them
- Social inhibition: affects private life, work, school
- Shy, introverted, timid
- Desire affection and acceptance
- Example: Whoopi Goldberg (actress - not typical)
Dependent Personality Disorder: clingy (loyal, people-person)
- Pattern of submissive and clingy behavior
- Need to be checked and reassured
- Don’t know if they can handle life themselves
- Elicit caregiving in others
- Low self-esteem
- Can’t live without help of others
Obsessive-Compulsive Personality Disorder: controlling (perfectionistic, conscientious)
- Orderliness, perfectionism, control
- Creating structure to thing gives control and calmness
- Inflexible to having rules and norms change
- Difficulty deciding what takes priority
- Passive aggressive, not direct
- Genuine need for control
- Don’t just expect myself to follow the rules, but everyone else too
- Example: Steve Jobs
Difference with OCD: the rules that they initiate, adhere to or point out are "useful" (more
egosyntonic), in OCD they don’t enjoy their behaviors, OCD covers less ground
Controversies in PDs: some argue they should be called interpersonal disorders
5
,DSM-5: Personality Disorders
Personality disorders are included in both section II and III
Prevalence: 9.1% for any PD → frequent co-occurrence of disorders from different clusters
- 15% of U.S. adults have at least 1 PD
PDs in the chapter:
Cluster A: odd or eccentric (5.7%) - PPD, SPD, STPD
- Paranoid personality disorder: distrust and suspiciousness such that others' motives
are interpreted as malevolent
- Schizoid personality disorder: detachment from social relationships and a restricted
range of emotional expression
- Schizotypal personality disorder: acute discomfort in close relationships, cognitive or
perceptual distortions, and eccentricities of behavior
Cluster B: dramatic, emotional, erratic (1.5%)
- Antisocial personality disorder: disregard for, and violation of, rights of others
- Borderline personality disorder: instability in interpersonal relationships, self-image,
and affects, and marked impulsivity
- Histrionic personality disorder: excessive emotionality and attention seeking
- Narcissistic personality disorder: grandiosity, need for admiration and lack of empathy
Cluster C: anxious or fearful (6%)
- Avoidant personality disorder: social inhibition, feelings of inadequacy, and
hypersensitivity to negative evaluation
- Dependent personality disorder: submissive and clinging behavior related to an
excessive need to be taken care of
- Obsessive-compulsive personality disorder: preoccupation with orderliness,
perfectionism and control
Personality change due to another medical condition is a persistent personality disturbance that
is judged to be due to the direct physiological effects of a medical condition (frontal lobe lesion)
Other specified PD and unspecified PD is a category provided for two situations:
1. The individual's personality pattern meets the general criteria for a PD, and traits of
several different PDs are present, but the criteria for any specific PD are not met
2. The individual's personality pattern meets the general criteria for a PD, but the individual
is considered to have a PD that is not included in the DSM-5 classification
(passive-aggressive PD)
DSM-5 placement
- Section II: categorical model (10 PDs, updated DSM-IV-TR)
- Section III: dimensional research model (trait-based, alternative view)
Models
- Categorical: PDs = qualitatively distinct syndromes
- Dimensional: PDs = maladaptive variants of normal traits, on spectrum
6
, General PD:
A. An enduring pattern of inner experience and behavior that deviates markedly from the
expectations of the individual’s culture, 2 or more of the following areas:
1. Cognition (i.e., ways of perceiving and interpreting self, other people, and events)
2. Affectivity (i.e., the range, intensity, lability, and appropriateness of emotional response)
3. Interpersonal functioning
4. Impulse control
B. The enduring pattern is inflexible and pervasive across a broad range of personal and
social situations
C. The enduring pattern leads to clinically significant distress or impairment in social,
occupational, or other important areas of functioning
D. The pattern is stable and cf long duration, and Its onset can be traced back at least to
adolescence or early adulthood
E. The enduring pattern is not better explained as a manifestation or consequence of another
mental disorder
F. The enduring pattern is not attributable to the physiological effects of a substance (a drug of
abuse, a medication) or another medical condition (head trauma)
Personality traits are diagnosed as a PD only when they are inflexible, maladaptive, and
persisting and cause significant functional impairment or distress
Diagnosis of PDs: evaluation of long-term patterns of functioning, particular personality features
must be evident by early adulthood
- The personality traits that define these disorders must also be distinguished, assess the
stability of personality traits over time and across situations
- Can be complicated: the characteristics that define a PD may not be considered
problematic by the individual (traits are often ego-syntonic)
For a PD to be diagnosed in younger than 18 years, the features must have been present for at
least 1 year
- Exception: ASPD → must be over 18
A PD should be diagnosed only when the defining characteristics appeared before early
adulthood
Some PDs (ASPD, BPD) may lessen with age, others (OCPD, STPD) remain stable
Culture / gender
Must account for ethnic, cultural, social background (avoid mistaking culturally normative
behaviors)
Gender differences: risk of bias from gender stereotypes
- Antisocial → more males
- Borderline, Histrionic, Dependent → more females
Differential diagnosis: distinguish PDs from
- Other mental disorders (esp. persistent mood / psychotic disorders)
- Personality traits not severe enough for PD
7
