Personality disorders
Lecture 1
-PD’s are highly prevalent in clinical practice (40-60%) and interfere with treatment of clinical
disorders and
can be treated through evidence-based therapies.
Personality
refers to the enduring
characteristics and behavior that
comprise a person’s unique adjustment
to life, including major traits, interests,
drives, values, self-concept, abilities,
and emotional patterns.
According to the DSM5 , a personality disorders is :
-an enduring pattern of inner experience
and behavior that deviates from the
expectations of an individual’s culture, is
pervasive and inflexible, has an onset in
adolescence and early adulthood, is stable
over time, and leads to clinically significant
distress or impairment in social, occupational
or other areas of functioning.’
*PD are egosyntonic (vs ego dystonic clinical
disorders such as anxiety disorders) and
interfere with adaptive interpersonal
functioning.
*Pervasive , Persistent , Pathological
General criteria from the DSM5
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).
PD clusters
Cluster A -odd , Cluster B-dramatic , Cluster C -anxious , fearful ,
eccentric,weird emotional , unpredictable worried
Paranoid personality disorder Borderline personality Avoidant personality disorder
disorder
Schizoid personality disorder Antisocial personality Dependent personality
disorder disorder
Schizotypal personality Narcissistic personality Obsessive compulsive
didorder disorders personality disorder
Histrionic personality
disorder
Prevalence
PD in general population: 10.5 – 12%
,Cluster A: 4%
Cluster B: 3.5-4%
Cluster C: 3-9%
*check each diagnosis criteria from the printed slides
The alternative model for PD
• The Work Group for Personality and Personality Disorders reviewed the literature
and explored the possibility of developing a dimensional approach to classification
of personality disorders.
• The APA Board of Trustees then voted to sustain the DSM-IV diagnostic system for
personality disorders, virtually unchanged, in the main section of DSM-5 and to
include the proposed new model as an “alternative DSM-5 model for personality
disorders” in Section III of DSM-5, the section referred to as “Emerging measures
and models”
Suggestions of the alternative model
• Retain 6 of 10 PD with most empirical evidence
• Remove Paranoid PD, Schizoid PD, Histrionic PD, Dependent PD
• Revise the general definition/criteria for PD to impairments at
level of self and interpersonal functioning
• Scholars/therapists agree that the general core of PD = ‘failure to develop
coherent sense of self and chronic interpersonal dysfunction’
• Assess levels (i.e. severity such as ‘mild’ or extreme’) of self and
interpersonal functioning
• Disturbances in levels of self and interpersonal functioning
• Assess underlying pathological personality traits
• BIG-FIVE traits: negative affectivity, detachment, antagonism, disinhibition,
psychoticism.
• Add option to diagnose PD ‘ trait specified’
*when it comes to general criteria there is the inclusion of one or more pathological personality
traits so big five traits
, *check the exact criteria for each cluster from the printed slides
Problems with the current assessment of PD types
• Limited empirical evidence for validity for some
existing PD types
• Lack of specificity in general definition PDs
• Inadequate representation of PD severity
• Heterogeneity within types
• Arbitrary thresholds for diagnosis
• Excessive comorbidity among PDs
• Instability of current categorical personality disorder
criteria sets
• The majority of people has two or more PD diagnoses
• The PDNOS category is used very often in clinical practice
• High comorbidity of other clinical disorders (mood, anxiety, addiction etc).
-Inherent to the definition is pervasiveness and stability over time: PDs start early and are
chronic
Prevalence
● Point prevalence is a measure of the proportion of people in a
population who have a condition at a particular time/date
● Lifetime prevalence (LTP) is the proportion of individuals in a
population that at some point in their life (up to the time of
assessment) have experienced a condition
Lecture 1
-PD’s are highly prevalent in clinical practice (40-60%) and interfere with treatment of clinical
disorders and
can be treated through evidence-based therapies.
Personality
refers to the enduring
characteristics and behavior that
comprise a person’s unique adjustment
to life, including major traits, interests,
drives, values, self-concept, abilities,
and emotional patterns.
According to the DSM5 , a personality disorders is :
-an enduring pattern of inner experience
and behavior that deviates from the
expectations of an individual’s culture, is
pervasive and inflexible, has an onset in
adolescence and early adulthood, is stable
over time, and leads to clinically significant
distress or impairment in social, occupational
or other areas of functioning.’
*PD are egosyntonic (vs ego dystonic clinical
disorders such as anxiety disorders) and
interfere with adaptive interpersonal
functioning.
*Pervasive , Persistent , Pathological
General criteria from the DSM5
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).
PD clusters
Cluster A -odd , Cluster B-dramatic , Cluster C -anxious , fearful ,
eccentric,weird emotional , unpredictable worried
Paranoid personality disorder Borderline personality Avoidant personality disorder
disorder
Schizoid personality disorder Antisocial personality Dependent personality
disorder disorder
Schizotypal personality Narcissistic personality Obsessive compulsive
didorder disorders personality disorder
Histrionic personality
disorder
Prevalence
PD in general population: 10.5 – 12%
,Cluster A: 4%
Cluster B: 3.5-4%
Cluster C: 3-9%
*check each diagnosis criteria from the printed slides
The alternative model for PD
• The Work Group for Personality and Personality Disorders reviewed the literature
and explored the possibility of developing a dimensional approach to classification
of personality disorders.
• The APA Board of Trustees then voted to sustain the DSM-IV diagnostic system for
personality disorders, virtually unchanged, in the main section of DSM-5 and to
include the proposed new model as an “alternative DSM-5 model for personality
disorders” in Section III of DSM-5, the section referred to as “Emerging measures
and models”
Suggestions of the alternative model
• Retain 6 of 10 PD with most empirical evidence
• Remove Paranoid PD, Schizoid PD, Histrionic PD, Dependent PD
• Revise the general definition/criteria for PD to impairments at
level of self and interpersonal functioning
• Scholars/therapists agree that the general core of PD = ‘failure to develop
coherent sense of self and chronic interpersonal dysfunction’
• Assess levels (i.e. severity such as ‘mild’ or extreme’) of self and
interpersonal functioning
• Disturbances in levels of self and interpersonal functioning
• Assess underlying pathological personality traits
• BIG-FIVE traits: negative affectivity, detachment, antagonism, disinhibition,
psychoticism.
• Add option to diagnose PD ‘ trait specified’
*when it comes to general criteria there is the inclusion of one or more pathological personality
traits so big five traits
, *check the exact criteria for each cluster from the printed slides
Problems with the current assessment of PD types
• Limited empirical evidence for validity for some
existing PD types
• Lack of specificity in general definition PDs
• Inadequate representation of PD severity
• Heterogeneity within types
• Arbitrary thresholds for diagnosis
• Excessive comorbidity among PDs
• Instability of current categorical personality disorder
criteria sets
• The majority of people has two or more PD diagnoses
• The PDNOS category is used very often in clinical practice
• High comorbidity of other clinical disorders (mood, anxiety, addiction etc).
-Inherent to the definition is pervasiveness and stability over time: PDs start early and are
chronic
Prevalence
● Point prevalence is a measure of the proportion of people in a
population who have a condition at a particular time/date
● Lifetime prevalence (LTP) is the proportion of individuals in a
population that at some point in their life (up to the time of
assessment) have experienced a condition
