PERSONALITY DISORDERS LECTURE NOTES
LECTURE 1
Personality disorders
Definition
- enduring pattern of inner experience and behavior that deviates from the
expectations from the person’s culture, that is pervasive and inflexible, onset in
adolescence and early adulthood, stable over time and leads to distress or
impairment
- PD criteria in general (similar to above definition), not explained by another mental
disorder, medical condition or drugs
- no differences in DSM4, DSM5 and DSM5-TR
- 3Ps pervasive, persistent, pathological
Etiology
- research is very new
- Diathesis-stress model diathesis (some type of predisposition, genes,
abnormalities in brain structure, neurotransmitters etc.) + stressors (trauma, abuse,
relationships, culture related stressors, noxious physical stressors etc.) results in
PDs
- heritability element (OCD and narcissism are high in heritability)
Clusters
- Cluster A, B and C
- different prevalence for clusters
o A: 5.7% (seen less in clinical practice, bc these people keep to themselves)
o B: 1.5%
o C: 6%
o PD in general: 9.1% personality disorders come in duos or trios
- Cluster A: (atypical, odd behavior)
o Paranoid PD
distress in suspiciousness all the time, expect bad intentions from
everyone in across all situations), everyone is out to get you all the
time
o Schizoid PD
detachment from emotions and social relationships, restricted
emotional range, lack of desire for interpersonal relationship, loners,
more observant than participants, not interested in sex or intimacy
o Schizotypal PD
discomfort in social relationships, odd thoughts feelings and
behaviors, few if any close relationships, causal experiences that they
link to themselves, misinterpret random events, closest to SCZ but this
doesn’t have psychosis, different patterns from SCZ as it’s more stable
- Cluster B: (boohoo, a lot of drama)
o Antisocial PD
, disregard for other people’s feelings wishes laws rules etc., behavior
that gets people arrested is a common byproduct, little or no
empathy, usually begins in childhood (compared to other PDs this is a
little bit earlier), referred as conduct disorder in childhood, a lot of
serial killers are known to have an antisocial PD, it’s different from
psychopaths (not everyone with an antisocial PD is a psychopath, but
most psychopaths probably also have an antisocial PD)
o Borderline PD
pattern of instability in interpersonal relationships self-image affect
etc., impulsivity, self-harm or self-destructive behavior (usually why or
when they come into therapy is bc of self-destructive behavior),
feelings of emptiness
o Histrionic PD
used to be referred as hysteria or hysterical neurosis, excessive
emotionality and lots of attention seeking, feel best when they’re the
center of attention, this is when they feel seen and that people value
them, eccentric behavior maybe in sexual behavior,
seductive/provocative behavior, people in reality tv shows?
o Narcissistic PD
most common in academia, need for grandiosity and admiration, lack
of empathy (byproduct with being involved with yourself), important
to be important in everybody else’s life, snobbish, patronizing attitude,
people wanting to feel special in therapy and they also treat you as a
therapist also very special (what special person wants to be treated by
an ordinary person)
- Cluster C: (control of anxiety, anxiety at the core, all 3 PDs control anxiety in
different ways)
o Avoidant PD
social inhibition, feel inadequate and small, sensitive to negative
feedback and what other people think about you, avoid work or school
and not interact with people, labeled shy and timid, but in reality they
do desire social interaction but it’s just very risky for them, some say
Covid created all of us to be a bit more avoidant, different than anxiety
disorders bc those are short-term and more localized and related
more to stress, avoidant PD is more long-term and wide-spread and
has more interpersonal consequences
o Dependent PD
opposite of avoidant PD, clinging, submissive behavior, “I need to be
taking care of to be okay”, “if you’re not there my anxiety with rise”,
elicit behavior that requires people to take care of them, low self-
esteem, will see criticism as proof of how worthy they are, they can’t
live their lives without these people to take care of them
o Obsessive compulsive PD
patterns of rigid orderliness, lots of control, getting really upset or
angry if other people don’t stick with the rules, rigid in bending rules,
difficulty in giving priority to tasks, different from OCD rules for
“you” to stick to, with OCPD getting upset when “other people”
, don’t stick to the rules with you, they identify with their rules and are
happy and cool with their rules (with OCD the rule is pushed upon
you)
From a different perspective:
Criticism on DMS 5:
- western perspective
- lack of non-psychiatrist input (very much medicine based unfortunately)
- potential bias (depending on who writes on and it’s controversial regarding previous
diagnosis e.g. homosexuality, gender identity etc.)
, Lecture 2
Personality organization
- when we talk about foundations for personality, we have a spectrum
- personality organization is a continuum to identify the severity of mental illnesses
- neurotic, psychotic, and borderline 3 divisions
- different aspects (defense identity integration, reality testing, observing ego, primary
conflict, counter/transference)
- neurotic personality organization: (healthy, normal end)
o defense: mature
o identity integration: yes (to what extent are you a coherent person, behaviors
are in line with each other)
o reality testing: intact (being in touch with reality)
o observing ego: yes (to what extent do you have an ego that can observe itself,
being aware of yourself, 3rd person perspective)
o primary conflict: oedipal (jobs, life, goals, more substantial problems
discussed in therapy)
o counter/transference: good working alliance (what we feel in relation to our
client/therapist)
- borderline personality organization (in the middle)
o defense: immature (especially splitting, key aspect to borderline)
o identity integration: no (full of inconsistencies, a lot of black and white, yes
and no, not balanced or nuanced, not as existential as psychotic but still not
clear, more switching)
o reality testing: intact (but only intact in really high stressful moments, but not
entirely in line with reality, still questionable)
o observing ego: limited (mentalization ability is affected in both psychotic and
borderline)
o primary conflict: separation-individuation (being close to people is tricky but
being alone is also not nice, uncertainty, not appreciating close friends but
also not able to go without them)
o counter/transference: all good/bad (either super good or really bad, can
fluctuate within sessions or from session to session, easier to work as a group
of professionals in treatment)
- psychotic personality organization (far other end, unhealthy):
o defense: immature (denial, splitting, projection etc.)
o identity integration: no (more in their own world, subjective ideas to
surroundings, bubble of who they are is thin where a lot of things come in but
they’re not sure about it, no boundaries)
o reality testing: no (difficult to get a sense of whether they are living in the
“real” world)
o observing ego: no (difficult and couples with identity formation, if you don’t
have a good sense of who you are it’s also difficult to observe yourself)
LECTURE 1
Personality disorders
Definition
- enduring pattern of inner experience and behavior that deviates from the
expectations from the person’s culture, that is pervasive and inflexible, onset in
adolescence and early adulthood, stable over time and leads to distress or
impairment
- PD criteria in general (similar to above definition), not explained by another mental
disorder, medical condition or drugs
- no differences in DSM4, DSM5 and DSM5-TR
- 3Ps pervasive, persistent, pathological
Etiology
- research is very new
- Diathesis-stress model diathesis (some type of predisposition, genes,
abnormalities in brain structure, neurotransmitters etc.) + stressors (trauma, abuse,
relationships, culture related stressors, noxious physical stressors etc.) results in
PDs
- heritability element (OCD and narcissism are high in heritability)
Clusters
- Cluster A, B and C
- different prevalence for clusters
o A: 5.7% (seen less in clinical practice, bc these people keep to themselves)
o B: 1.5%
o C: 6%
o PD in general: 9.1% personality disorders come in duos or trios
- Cluster A: (atypical, odd behavior)
o Paranoid PD
distress in suspiciousness all the time, expect bad intentions from
everyone in across all situations), everyone is out to get you all the
time
o Schizoid PD
detachment from emotions and social relationships, restricted
emotional range, lack of desire for interpersonal relationship, loners,
more observant than participants, not interested in sex or intimacy
o Schizotypal PD
discomfort in social relationships, odd thoughts feelings and
behaviors, few if any close relationships, causal experiences that they
link to themselves, misinterpret random events, closest to SCZ but this
doesn’t have psychosis, different patterns from SCZ as it’s more stable
- Cluster B: (boohoo, a lot of drama)
o Antisocial PD
, disregard for other people’s feelings wishes laws rules etc., behavior
that gets people arrested is a common byproduct, little or no
empathy, usually begins in childhood (compared to other PDs this is a
little bit earlier), referred as conduct disorder in childhood, a lot of
serial killers are known to have an antisocial PD, it’s different from
psychopaths (not everyone with an antisocial PD is a psychopath, but
most psychopaths probably also have an antisocial PD)
o Borderline PD
pattern of instability in interpersonal relationships self-image affect
etc., impulsivity, self-harm or self-destructive behavior (usually why or
when they come into therapy is bc of self-destructive behavior),
feelings of emptiness
o Histrionic PD
used to be referred as hysteria or hysterical neurosis, excessive
emotionality and lots of attention seeking, feel best when they’re the
center of attention, this is when they feel seen and that people value
them, eccentric behavior maybe in sexual behavior,
seductive/provocative behavior, people in reality tv shows?
o Narcissistic PD
most common in academia, need for grandiosity and admiration, lack
of empathy (byproduct with being involved with yourself), important
to be important in everybody else’s life, snobbish, patronizing attitude,
people wanting to feel special in therapy and they also treat you as a
therapist also very special (what special person wants to be treated by
an ordinary person)
- Cluster C: (control of anxiety, anxiety at the core, all 3 PDs control anxiety in
different ways)
o Avoidant PD
social inhibition, feel inadequate and small, sensitive to negative
feedback and what other people think about you, avoid work or school
and not interact with people, labeled shy and timid, but in reality they
do desire social interaction but it’s just very risky for them, some say
Covid created all of us to be a bit more avoidant, different than anxiety
disorders bc those are short-term and more localized and related
more to stress, avoidant PD is more long-term and wide-spread and
has more interpersonal consequences
o Dependent PD
opposite of avoidant PD, clinging, submissive behavior, “I need to be
taking care of to be okay”, “if you’re not there my anxiety with rise”,
elicit behavior that requires people to take care of them, low self-
esteem, will see criticism as proof of how worthy they are, they can’t
live their lives without these people to take care of them
o Obsessive compulsive PD
patterns of rigid orderliness, lots of control, getting really upset or
angry if other people don’t stick with the rules, rigid in bending rules,
difficulty in giving priority to tasks, different from OCD rules for
“you” to stick to, with OCPD getting upset when “other people”
, don’t stick to the rules with you, they identify with their rules and are
happy and cool with their rules (with OCD the rule is pushed upon
you)
From a different perspective:
Criticism on DMS 5:
- western perspective
- lack of non-psychiatrist input (very much medicine based unfortunately)
- potential bias (depending on who writes on and it’s controversial regarding previous
diagnosis e.g. homosexuality, gender identity etc.)
, Lecture 2
Personality organization
- when we talk about foundations for personality, we have a spectrum
- personality organization is a continuum to identify the severity of mental illnesses
- neurotic, psychotic, and borderline 3 divisions
- different aspects (defense identity integration, reality testing, observing ego, primary
conflict, counter/transference)
- neurotic personality organization: (healthy, normal end)
o defense: mature
o identity integration: yes (to what extent are you a coherent person, behaviors
are in line with each other)
o reality testing: intact (being in touch with reality)
o observing ego: yes (to what extent do you have an ego that can observe itself,
being aware of yourself, 3rd person perspective)
o primary conflict: oedipal (jobs, life, goals, more substantial problems
discussed in therapy)
o counter/transference: good working alliance (what we feel in relation to our
client/therapist)
- borderline personality organization (in the middle)
o defense: immature (especially splitting, key aspect to borderline)
o identity integration: no (full of inconsistencies, a lot of black and white, yes
and no, not balanced or nuanced, not as existential as psychotic but still not
clear, more switching)
o reality testing: intact (but only intact in really high stressful moments, but not
entirely in line with reality, still questionable)
o observing ego: limited (mentalization ability is affected in both psychotic and
borderline)
o primary conflict: separation-individuation (being close to people is tricky but
being alone is also not nice, uncertainty, not appreciating close friends but
also not able to go without them)
o counter/transference: all good/bad (either super good or really bad, can
fluctuate within sessions or from session to session, easier to work as a group
of professionals in treatment)
- psychotic personality organization (far other end, unhealthy):
o defense: immature (denial, splitting, projection etc.)
o identity integration: no (more in their own world, subjective ideas to
surroundings, bubble of who they are is thin where a lot of things come in but
they’re not sure about it, no boundaries)
o reality testing: no (difficult to get a sense of whether they are living in the
“real” world)
o observing ego: no (difficult and couples with identity formation, if you don’t
have a good sense of who you are it’s also difficult to observe yourself)
