Personality disorders
Contents
Chapter 1....................................................................................................................................1
Cluster A = odd, eccentric cluster..........................................................................................2
Alternative model of personality disorders (AMPD).............................................................7
Lecture 2...................................................................................................................................12
Lecture 3...................................................................................................................................16
Chapter 8..................................................................................................................................23
Lecture 4...................................................................................................................................24
Article (slides) on pro-lsocial behaviour..............................................................................27
Lecture 5 BPD..........................................................................................................................29
Dialectical behavioural therapy............................................................................................35
Lecture 6 narcissistic and histrionic.........................................................................................37
Lecture 7 Cluster A..................................................................................................................42
Lecture 8 mentalization based treatment..................................................................................49
Chapter 1
Personality = our usual tendencies to think, feel, react and behave in different situations > we
all have a personality > abnormal personality is the inability of persons to react flexibly and
appropriately to life’s challenges (in reference to the individual’s culture / a certain baseline)
> personality disorders are ego-syntonic = they experience it as something belonging to them
and being part of them (while other clinical disorders such as depression are often ego-
dystonic; it’s something that does not belong to them and the symptoms disturb their living in
some way)
DSM classification
A. An enduring pattern of inner experience and behavior that deviates markedly from the
expectations of the individual's culture. This pattern is manifested in two (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, liability, 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 (functional impairment and distress).
D. The pattern is stable and of long duration, and its onset can be traced back at least to
adolescence or early adulthood.
E. The enduring pattern is not better accounted for as a manifestation or consequence of
another mental disorder.
F. The enduring pattern is not due to the direct physiological effects of a substance (e.g., a
drug abuse, a medication) or a general medical condition (e.g., head trauma)
Cluster A = odd, eccentric cluster
Paranoid p.d.
A. Pervasive distrust and suspiciousness of others such that their motives are interpreted as
malevolent, beginning in early adulthood and present in a variety of contexts. Indicated by
four (or more) of the following criteria:
(1) suspects, without sufficient basis, that others are exploiting, harming, or deceiving
(2) is preoccupied with unjustified doubts about the loyalty or trustworthiness of
friends and associates
(3) is reluctant to confide in others because of unwarranted fear that the information
will be used maliciously against him or her
(4) reads hidden demeaning or threatening meanings into benign remarks or events
(5) persistently bears grudges, i.e. is unforgiving of insults, injuries, or slights
(6) perceives attacks on his or her character or reputation that are not apparent to
others and is quick to react angrily or to counterattack
(7) has recurrent suspicions, without justification, regarding fidelity of spouse or
sexual
partner.
B. Does not occur exclusively during the course of schizophrenia, bipolar disorder,
depressive disorder with psychotic features, psychotic disorder, not attributable to the direct
physiological effects of another medical condition
Schizoid personality disorder
,A. A pervasive pattern of detachment from social relationships and a restricted range of
expression of emotions in interpersonal settings, beginning by early adulthood and present
in a variety of contexts, indicated by four (or more) of the following:
(1) neither desires nor enjoys close relationships, including being part of a family
(2) almost always chooses solitary activities
(3) has little, if any, interest in having sexual experiences with another person
(4) takes pleasure in few, if any, activities
(5) lacks close friends or confidants other than first-degree relatives
(6) appears indifferent to the praise or criticism of others
(7) shows emotional coldness, detachment, or flattened affectivity.
B. Does not occur exclusively during the course of schizophrenia, a bipolar disorder,
depressive disorder with psychotic features, psychotic disorder, or autism spectrum disorder
and is not attributable to the physiological effects of another medical condition.
Schizotypal
A. Pervasive pattern of social and interpersonal deficits marked by acute discomfort with, and
reduced capacity for, close relationships as well as by cognitive or perceptual distortions and
eccentricities of behavior, beginning by earlyadulthood and present in a variety of contexts,
as indicated by five (or more) of the following:
(1) ideas of reference (excluding delusions of reference)
(2) odd beliefs or magical thinking that influences behavior and is inconsistent with
subcultural norms (e.g.superstitiousness, belief in clairvoyance, telepathy, or “sixth
sense”; in children and adolescents,bizarre fantasies or preoccupations)
(3) unusual perceptual experiences, including bodily illusions
(4) odd thinking and speech (e.g. vague, circumstantial, metaphorical, overelaborate,
or stereotyped)
(5) suspiciousness or paranoid ideation
(6) inappropriate or constricted affect
(7) behavior or appearance that is odd, eccentric, or peculiar
(8) lack of close friends or confidants other than first-degree relatives
(9) excessive social anxiety that does not diminish with familiarity and tends to be
associated with paranoid fears rather than negative judgements about self.
B. Does not occur exclusively during the course of schizophrenia, a bipolar disorder,
depressive disorder with psychotic features, another psychotic disorder, or autism spectrum
disorder
, Antisocial p.d.
A. A pervasive pattern of disregard for and violation of the rights of others, occurring since
age 15 years, as indicated by three (or more) of the following:
(1) failure to conform to social norms with respect to lawful behaviors as indicated by
repeatedly performing acts that are grounds for arrest
(2) deceitfulness, as indicated by repeated lying, use of aliases, or conning others for
personal profit or pleasure
(3) impulsivity or failure to plan ahead
(4) irritability and aggressiveness, as indicated by repeated physical fights or assaults
(5) reckless disregard for safety of self or others
(6) consistent irresponsibility, as indicated by repeated failure to sustain consistent
work behavior or honor financial obligations
(7) lack of remorse, as indicated by being indifferent to or rationalizing having hurt,
mistreated, orstolen from another
B. The individual is at least age 18 years.
C. There is evidence of conduct disorder with onset before age 15 year.
D. The occurrence of antisocial behavior is not exclusively during the course of
schizophrenia or bipolar disorder
Borderline p.d.
Pervasive pattern of instability of interpersonal relationships, self-image, and affects, and
marked impulsivity beginning by early adulthood and present in a variety of contexts, as
indicated by five (or more) of the following:
(1) frantic efforts to avoid real or imagined abandonment.
(2) a pattern of unstable and intense interpersonal relationships characterized by
alternating between extremes of idealization and devaluation
(3) identity disturbance: markedly and persistently unstable self-image or sense of self
(4) impulsivity in at least two areas that are potentially self-damaging (e.g. spending,
sex, substance abuse, reckless driving, binge eating).
(5) recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior
(6) affective instability due to a marked reactivity of mood (e.g. intense episodic
dysphoria, irritability, or anxiety usually lasting a few hours and only rarely more than
a few days)
(7) chronic feelings of emptiness
Contents
Chapter 1....................................................................................................................................1
Cluster A = odd, eccentric cluster..........................................................................................2
Alternative model of personality disorders (AMPD).............................................................7
Lecture 2...................................................................................................................................12
Lecture 3...................................................................................................................................16
Chapter 8..................................................................................................................................23
Lecture 4...................................................................................................................................24
Article (slides) on pro-lsocial behaviour..............................................................................27
Lecture 5 BPD..........................................................................................................................29
Dialectical behavioural therapy............................................................................................35
Lecture 6 narcissistic and histrionic.........................................................................................37
Lecture 7 Cluster A..................................................................................................................42
Lecture 8 mentalization based treatment..................................................................................49
Chapter 1
Personality = our usual tendencies to think, feel, react and behave in different situations > we
all have a personality > abnormal personality is the inability of persons to react flexibly and
appropriately to life’s challenges (in reference to the individual’s culture / a certain baseline)
> personality disorders are ego-syntonic = they experience it as something belonging to them
and being part of them (while other clinical disorders such as depression are often ego-
dystonic; it’s something that does not belong to them and the symptoms disturb their living in
some way)
DSM classification
A. An enduring pattern of inner experience and behavior that deviates markedly from the
expectations of the individual's culture. This pattern is manifested in two (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, liability, 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 (functional impairment and distress).
D. The pattern is stable and of long duration, and its onset can be traced back at least to
adolescence or early adulthood.
E. The enduring pattern is not better accounted for as a manifestation or consequence of
another mental disorder.
F. The enduring pattern is not due to the direct physiological effects of a substance (e.g., a
drug abuse, a medication) or a general medical condition (e.g., head trauma)
Cluster A = odd, eccentric cluster
Paranoid p.d.
A. Pervasive distrust and suspiciousness of others such that their motives are interpreted as
malevolent, beginning in early adulthood and present in a variety of contexts. Indicated by
four (or more) of the following criteria:
(1) suspects, without sufficient basis, that others are exploiting, harming, or deceiving
(2) is preoccupied with unjustified doubts about the loyalty or trustworthiness of
friends and associates
(3) is reluctant to confide in others because of unwarranted fear that the information
will be used maliciously against him or her
(4) reads hidden demeaning or threatening meanings into benign remarks or events
(5) persistently bears grudges, i.e. is unforgiving of insults, injuries, or slights
(6) perceives attacks on his or her character or reputation that are not apparent to
others and is quick to react angrily or to counterattack
(7) has recurrent suspicions, without justification, regarding fidelity of spouse or
sexual
partner.
B. Does not occur exclusively during the course of schizophrenia, bipolar disorder,
depressive disorder with psychotic features, psychotic disorder, not attributable to the direct
physiological effects of another medical condition
Schizoid personality disorder
,A. A pervasive pattern of detachment from social relationships and a restricted range of
expression of emotions in interpersonal settings, beginning by early adulthood and present
in a variety of contexts, indicated by four (or more) of the following:
(1) neither desires nor enjoys close relationships, including being part of a family
(2) almost always chooses solitary activities
(3) has little, if any, interest in having sexual experiences with another person
(4) takes pleasure in few, if any, activities
(5) lacks close friends or confidants other than first-degree relatives
(6) appears indifferent to the praise or criticism of others
(7) shows emotional coldness, detachment, or flattened affectivity.
B. Does not occur exclusively during the course of schizophrenia, a bipolar disorder,
depressive disorder with psychotic features, psychotic disorder, or autism spectrum disorder
and is not attributable to the physiological effects of another medical condition.
Schizotypal
A. Pervasive pattern of social and interpersonal deficits marked by acute discomfort with, and
reduced capacity for, close relationships as well as by cognitive or perceptual distortions and
eccentricities of behavior, beginning by earlyadulthood and present in a variety of contexts,
as indicated by five (or more) of the following:
(1) ideas of reference (excluding delusions of reference)
(2) odd beliefs or magical thinking that influences behavior and is inconsistent with
subcultural norms (e.g.superstitiousness, belief in clairvoyance, telepathy, or “sixth
sense”; in children and adolescents,bizarre fantasies or preoccupations)
(3) unusual perceptual experiences, including bodily illusions
(4) odd thinking and speech (e.g. vague, circumstantial, metaphorical, overelaborate,
or stereotyped)
(5) suspiciousness or paranoid ideation
(6) inappropriate or constricted affect
(7) behavior or appearance that is odd, eccentric, or peculiar
(8) lack of close friends or confidants other than first-degree relatives
(9) excessive social anxiety that does not diminish with familiarity and tends to be
associated with paranoid fears rather than negative judgements about self.
B. Does not occur exclusively during the course of schizophrenia, a bipolar disorder,
depressive disorder with psychotic features, another psychotic disorder, or autism spectrum
disorder
, Antisocial p.d.
A. A pervasive pattern of disregard for and violation of the rights of others, occurring since
age 15 years, as indicated by three (or more) of the following:
(1) failure to conform to social norms with respect to lawful behaviors as indicated by
repeatedly performing acts that are grounds for arrest
(2) deceitfulness, as indicated by repeated lying, use of aliases, or conning others for
personal profit or pleasure
(3) impulsivity or failure to plan ahead
(4) irritability and aggressiveness, as indicated by repeated physical fights or assaults
(5) reckless disregard for safety of self or others
(6) consistent irresponsibility, as indicated by repeated failure to sustain consistent
work behavior or honor financial obligations
(7) lack of remorse, as indicated by being indifferent to or rationalizing having hurt,
mistreated, orstolen from another
B. The individual is at least age 18 years.
C. There is evidence of conduct disorder with onset before age 15 year.
D. The occurrence of antisocial behavior is not exclusively during the course of
schizophrenia or bipolar disorder
Borderline p.d.
Pervasive pattern of instability of interpersonal relationships, self-image, and affects, and
marked impulsivity beginning by early adulthood and present in a variety of contexts, as
indicated by five (or more) of the following:
(1) frantic efforts to avoid real or imagined abandonment.
(2) a pattern of unstable and intense interpersonal relationships characterized by
alternating between extremes of idealization and devaluation
(3) identity disturbance: markedly and persistently unstable self-image or sense of self
(4) impulsivity in at least two areas that are potentially self-damaging (e.g. spending,
sex, substance abuse, reckless driving, binge eating).
(5) recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior
(6) affective instability due to a marked reactivity of mood (e.g. intense episodic
dysphoria, irritability, or anxiety usually lasting a few hours and only rarely more than
a few days)
(7) chronic feelings of emptiness
