Personality Disorders

• personality disorders:
• types of personality disorders:
  • "odd, eccentric" cluster:
    • paranoid
    • schizoid
    • schizotypal
  • "extravert" cluster:
    • antisocial
    • borderline
    • histrionic
    • narcissistic
  • "neurotic" cluster:
    • avoidant
    • dependent
    • obsessive-compulsive
• see also:
  • Evolution of human sexuality
  • Human behaviour
  • Learning & human brain development
  • Motivation
  • Personality
  • Personality disorders
  • Drug-induced sexual dysfunction
  • The potentially suicidal patient

Personality disorders:

• personality disorders are pervasive chronic psychological disorders which can greatly affects a person's life, usually having a negative affect on one's work, family & social life.
• they exist on a continuum of both severity (mild-severe) and type 
• while most people with mild personality disorders (or personality traits) can live pretty normal lives, during times of increased stress or external pressures, the symptoms of the disorder will gain strength & begin to seriously interfere with their emotional & psychological functioning
• such people possess several distinct psychological features including disturbances of:
  • self-image
  • ability to have successful interpersonal relationships
  • appropriateness of range of emotion
  • ways of perceiving themselves, others & the world
  • ability to possess proper impulse control
• these disturbances come together to create a pervasive pattern of behaviour & inner experience that is quite different from the norms of the individual's culture & that often tend to be expressed in behaviours that appear more dramatic than what society considers usual.
• there are many causes of personality disorders including:
  • parental upbringing
  • personality & social development
  • genetic & biologic factors
• The DSM-IV lists several criterion that underlie all personality disorders as follows:
  • An enduring pattern of inner experience and behaviour that deviates considerably from the expectations of society. This pattern is manifested in two or more of the following ways:

  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 functions
  4. Impulse control

  • The enduring pattern is inflexible and pervasive across a broad range of personal and social situations.
  • The pattern leads to clinically significant distress or impairment in social, occupational, or other important areas of function.
  • The pattern is stable and of long duration. Onset can usually be traced back to adolescence.
  • The enduring pattern is not in any way linked to another mental disorder.
  • The enduring pattern is not do to the use of controlled substances, or a general medical condition.
• When learning about personality disorders it is extremely important to remember that the only diagnosis is done by professionals with considerable knowledge and exposure to personality disorders. 
• It is quite easy for one to develop fourth year med school student syndrome. This is a term referring to one's tendency to diagnose serious diseases and disorders because they have a little information of the subject and they see a few of the symptoms. All people have personality flaws; some might be shy, some aggressive, some unable to deal with stress... this does not mean that person has a personality disorder.
• Only people with extreme cases of persistent, maladaptive, and dysfunctional personality traits that affect their lives meet the criteria for personality disorders.

Types of personality disorders:

• there are 10 basic types of personality disorders which can be grouped into 3 clusters:
  • "odd, eccentric, psychotic" cluster:
    • Paranoid
      • Paranoid personality disorder is characterized by a distrust of others and a constant suspicion that people around you have sinister motives. People with this disorder tend to have excessive trust in their own knowledge and abilities and usually avoid close relationships with others. They search for hidden meanings in everything and read hostile intentions into the actions of others. They are quick to challenge the loyalties of friends and loved ones and often appear cold and distant to others. They usually shift blame to others and tend to carry long grudges.
      • SUSPECT (4 criteria).
        • S: Spouse fidelity suspected
          U: Unforgiving (bears grudges)
          S: Suspicious of others
          P: Perceives attacks (and reacts quickly)
          E: "Enemy or friend" (suspects associates, friends)
          C: Confiding in others feared
          T: Threats perceived in benign events
    • Schizoid
      • People with schizoid personality disorder avoid relationships and do not show much emotion. They genuinely prefer to be alone and do not secretly wish for popularity. They tend to seek jobs that require little social contact. Their social skills are often weak and they do not show a need for attention or acceptance. They are perceived as humourless and distant and often are termed "loners."
      • DISTANT (4 criteria).
        • D: Detached (or flattened) affect
          I: Indifferent to criticism and praise
          S: Sexual experiences of little interest
          T: Tasks (activities) done solitarily
          A: Absence of close friends
          N: Neither desires nor enjoys close relations
          T: Takes pleasure in few activities
    • Schizo typal
      • Many believe that schizo typal personality disorder represents mild schizophrenia. The disorder is characterized by odd forms of thinking and perceiving, and individuals with this disorder often seek isolation from others. They sometimes believe to have extra sensory ability or that unrelated events relate to them in some important way. They generally engage in eccentric behavior and have difficulty concentrating for long periods of time. Their speech is often over elaborate and difficult to follow.
      • ME PECULIAR (5 criteria).
        • M: Magical thinking or odd beliefs
          E: Experiences unusual perceptions
        • P: Paranoid ideation
          E: Eccentric behaviour or appearance
          C: Constricted (or inappropriate) affect
          U: Unusual (odd) thinking and speech
          L: Lacks close friends
          I: Ideas of reference
          A: Anxiety in social situations
          R: Rule out psychotic disorders and pervasive developmental disorder
  • "extravert" cluster:
    • Antisocial
      • A common misconception is that antisocial personality disorder refers to people who have poor social skills. The opposite is often the case. Instead, antisocial personality disorder is characterized by a lack of conscience. People with this disorder are prone to criminal behaviour, believing that their victims are weak and deserving of being taken advantage of. They tend to lie and steal. Often, they are careless with money and take action without thinking about consequences. They are often aggressive and are much more concerned with their own needs than the needs of others.
      • CORRUPT (3 criteria).
        • C: Conformity to law lacking
          O: Obligations ignored
          R: Reckless disregard for safety of self or others
          R: Remorse lacking
          U: Underhanded (deceitful, lies, cons others)
          P: Planning insufficient (impulsive)
          T: Temper (irritable and aggressive)
    • Borderline
      • Borderline personality disorder is characterized by mood instability and poor self-image. People with this disorder are prone to constant mood swings and bouts of anger. Often, they will take their anger out on themselves, causing themselves injury. Suicidal threats and actions are not uncommon. They think in very black and white terms and often form intense, conflict-ridden relationships. They are quick to anger when their expectations are not met. Most are females.
      • AM SUICIDE (5 criteria).
        • A: Abandonment
          M: Mood instability (marked reactivity of mood)
        • S: Suicidal (or self-mutilating) behaviour
          U: Unstable and intense relationships
          I: Impulsivity (in two potentially self-damaging areas)
          C: Control of anger
          I: Identity disturbance
          D: Dissociative (or paranoid) symptoms that are transient and stress-related
          E: Emptiness (chronic feelings of)
    • Histrionic
      • People with histrionic personality disorder are constant attention seekers. They need to be the centre of attention all the time, often interrupting others in order to dominate the conversation. They use grandiose language to describe everyday events and seek constant praise. They may dress provocatively or exaggerate illnesses in order to gain attention. They also tend to exaggerate friendships and relationships, believing that everyone loves them. They are often manipulative.
      • PRAISE ME (5 criteria).
        • P: Provocative (or sexually seductive) behaviour
          R: Relationships (considered more intimate than they are)
          A: Attention (uncomfortable when not the center of attention)
          I: Influenced easily
          S: Style of speech (impressionistic, lacks detail)
          E: Emotions (rapidly shifting and shallow)
        • M: Made up (physical appearance used to draw attention to self)
          E: Emotions exaggerated (theatrical)
      • 5 or more of the following (Am.Psych. Assoc. 1994):
        • is uncomfortable in situations in which he/she is not the centre of attention
        • interaction with others is often characterised by inappropriate sexually seductive or provocative behaviour
        • displays rapid shifting & shallow expression of emotions
        • consistently uses physical appearance to draw attention to self
        • has a style of speech that is excessively impressionistic & lacking in detail
        • shows self-dramatisation, theatricality & exaggerated expression of emotion
        • is suggestible. ie. easily influenced by others or circumstance
        • considers relationships to be more intimate than they actually are
    • Narcissistic
      • Narcissistic personality disorder is characterized by self-centeredness. Like histrionic disorder, people with this disorder seek attention and praise. They exaggerate their achievements, expecting others to recognize them as being superior. They tend to be choosy about picking friends, since they believe that not just anyone is worthy of being their friend. They tend to make good first impressions, yet have difficulty maintaining long-lasting relationships. They are generally uninterested in the feelings of others and may take advantage of them.
      • SPECIAL (5 criteria).
        • S: Special (believes he or she is special and unique)
          P: Preoccupied with fantasies (of unlimited success, power, brilliance, beauty, or ideal love)
          E: Entitlement
          C: Conceited (grandiose sense of self-importance)
          I: Interpersonal exploitation
          A: Arrogant (haughty)
          L: Lacks empathy
      • 5 or more of the following (Am.Psych. Assoc. 1994):
        • has a grandiose sense of self-importance (e.g., exaggerates achievements and talents, expects to be recognized as superior without commensurate achievements)
        • is preoccupied with fantasies of unlimited success, power, brilliance, beauty, or ideal love
        • believes that he or she is "special" and unique and can only be understood by, or should associate with, other special or high-status people (or institutions)
        • requires excessive admiration
        • has a sense of entitlement, i.e., unreasonable expectations of especially favourable treatment or automatic compliance with his or her expectations
        • is interpersonally exploitative, i.e., takes advantage of others to achieve his or her own ends
        • lacks empathy: is unwilling to recognize or identify with the feelings and needs of others
        • is often envious of others or believes that others are envious of him or her
        • shows arrogant, haughty behaviours or attitudes
  • "neurotic" cluster:
    • Avoidant
      • Avoidant personality disorder is characterized by extreme social anxiety. People with this disorder often feel inadequate, avoid social situations, and seek out jobs with little contact with others. They are fearful of being rejected and worry about embarassing themselves in front of others. They exaggerate the potential difficulties of new situations to rationalize avoiding them. Often, they will create fantasy worlds to substitute for the real one. Unlike schizoid personality disorder, avoidant people yearn for social relations yet feel they are unable to obtain them. They are frequently depressed and have low self-confidence.
      • CRINGES (4 criteria).
        • C: Certainty (of being liked required before willing to get involved with others)
          R: Rejection (or criticism) preoccupies one's thoughts in social situations
          I: Intimate relationships (restraint in intimate relationships due to fear of being shamed)
          N: New interpersonal relationships (is inhibited in)
          G: Gets around occupational activity (involving significant interpersonal contact)
          E: Embarrassment (potential) prevents new activity or taking personal risks
          S: Self viewed as unappealing, inept, or inferior
    • Dependent
      • Dependent personality disorder is characterized by a need to be taken care of. People with this disorder tend to cling to people and fear losing them. They may become suicidal when a break-up is imminent. They tend to let others make important decisions for them and often jump from relationship to relationship. They often remain in abusive relationships. They are overly sensitive to disapproval. They often feel helpless and depressed.
      • RELIANCE (5 criteria).
        • R: Reassurance required for decisions
          E: Expressing disagreement difficult (due to fear of loss of support or approval)
          L: Life responsibilities (needs to have these assumed by others)
          I: Initiating projects difficult (due to lack of self-confidence)
          A: Alone (feels helpless and discomfort when alone)
          N: Nurturance (goes to excessive lengths to obtain nurturance and support)
          C: Companionship (another relationship) sought urgently when close relationship ends
          E: Exaggerated fears of being left to care for self
    • Obsessive-Compulsive
      • Obsessive-Compulsive personality disorder is similar to obsessive-compulsive anxiety disorder. People with this disorder are overly focused on orderliness and perfection. Their need to do everything "right" often interferes with their productivity. They tend to get caught up in the details and miss the bigger picture. They set unreasonably high standards for themselves and others, and tend to be very critical of others when they do not live up to these high standards. They avoid working in teams, believing others to be too careless or incompetent. They avoid making decisions because they fear making mistakes and are rarely generous with their time or money. They often have difficulty expressing emotion.
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