Chapter 15 -- Personality Disorders

I. General Personality Disorder
A. Criteria: An enduring pattern of inner experience and behavior that deviates markedly from the individual's culture in two or more areas
1. Cognition (perceiving and interpreting self, others, and events)
2. Affectivity (the range, intensity, lability, and appropriateness of emotional responses)
3. Interpersonal functioning
4. Impulse control
B. Enduring pattern is inflexible and pervasive
C. Enduring pattern leads to significant distress or impairment

II. Cluster A (odd or eccentric)
A. Paranoid Personality Disorder - pervasive distrust and suspiciousness
B. Schizoid Personality Disorder - pervasive detachment from relationships and restricted emotional expression
C. Schizotypal Personality Disorder - pervasive interpersonal deficits, eccentric behavior

III. Cluster B (dramatic, emotional, or erratic)
A. Antisocial Personality Disorder - pervasive disregard for and violation of the rights of others
B. Borderline Personality Disorder - pervasive unstable relationships, self-image, affect, and impulsivity
C. Histrionic Personality Disorder - pervasive excessive emotionality and attention seeking
D. Narcissistic Personality Disorder - pervasive grandiosity, need for admiration, and lack of empathy

IV. Cluster C (anxious or fearful)
A. Avoidant Personality Disorder - pervasive social inhibition, hypersensitivity to negative evaluation
B. Dependent Personality Disorder - pervasive need to be taken care of that leads to submissive and clinging behavior
C. Obsessive-Compulsive Personality Disorder - pervasive pattern of orderliness and perfectionism

V. Dimensional Diagnostic Approach
A. Longstanding, pervasive, inflexible, extreme, and persistent patterns of behavior and inner experience
1. Disturbance in sense of self or identity
2. Unable to sustain close relationships
3. Rate the overall degree of impairment in the self and interpersonal functioning
0 = No impairment
1 = Mild impairment
2 = Moderate impairment
3 = Serious impairment
4 = Extreme impairment
B. Evaluation of 6 Personality Disorders
1. Obsessive-Compulsive
2. Narcissistic
3. Schizotypal
4. Avoidant
5. Antisocial
6. Borderline
C. At least one Pathological Personality trait, some correspondence to the Big 5 Personality Traits
1. Negative Affectivity similar to Neuroticism
2. Detachment opposite of Extroversion
3. Antagonism opposite of Agreeableness
4. Disinhibition opposite of Conscientiousness
5. Psychoticism different from Openness to Experience
D. Each domain is comprised of 3 to 7 facets (total 25), if no disorder type fits, a diagnosis of a Personality Disorder Trait Specified can occur

VI. Obsessive-Compulsive Personality Disorder
A.Diagnostic Criteria
1. Compulsivity with rigid perfectionism
2. Negative affectivity with perseveration
B. Prototype Description
1. Need for order
2. Intense concerns with time and rules
3. Sense of duty and obligation
4. Strong emotions are rarely expressed
C. Minimal Knowledge of Causes

VII. Narcissistic Personality Disorder
A.Diagnostic criteria
1. Antagonism characterized by grandiosity and attention seeking
B. Profile type
1. Self-centered, arrogant, lack of empathy
2. Sensitive to criticism
3. Seeks out high-status partners
C. Etiology
1. Low self-esteem
2. Parental coldness and focus on achievement
3. Relationships bolster self-esteem

VIII. Schizotypal Personality Disorder
A.Diagnostic Criteria
1. Psychoticism with eccentricity, cognitive and perceptual dysregulation, and unusual beliefs
2. Detachment with restricted affectivity and withdrawal
3. Negative affectivity with suspiciousness
B. Prototype Description
1. Few friends
2. Suspiciousness
3. Peculiar appearance
4. Odd beliefs
5. Sensory illusions

IX. Avoidant Personality Disorder
A. Diagnostic Criteria
1. Detachment with withdrawal, intimacy avoidance, and anhedonia
2. Negative affectivity with anxiousness
B. Prototype Description
1. Negative self and sense of inadequacy
2. Unrealistic high standards for self
3. Shyness and social avoidance
4. Few close friendships
5. Intimate relationships are avoided
6. Passive and unassertive about personal goals

X. Antisocial Personality Disorder
A.Diagnostic criteria
1. Antagonism with manipulativeness, deceitfulness, callousness, and hostility
2. Disinhibition with irresponsibility, impulsivity, and risk taking
B. Prototype description
1. Arrogance and entitlement
2. Motivated by self-serving goals
3. Little empathy for others
4. Little or no remorse or guilt if they harm others
5. Generally irresponsible about work or finances
6. Often have problems with authority figures
C.Etiology
1. Genetics - antisocial behavior heritable (40-50%)
2. Family environment - lack of warmth, high negativity, parental inconsistency, poverty, and exposure to violence
3. Fearlessness
4. Impulsivity
5. Deficits in empathy

XI. Borderline Personality Disorder
A.Diagnostic Criteria
1. Negative affectivity with emotional lability, anxiousness, separation insecurity, and depressivity
2. Disinhibition with impulsivity and risk taking
3. Antagonism with hostility
B. Prototype Description
1. Fragile self-concept disrupted by stress
2. Rapidly changing, unpredictable emotions
3. Intense fear of loss, abandonment, or rejection
4. May engage in acts of self-harm
5. Unstable relationships
C. Etiology
1. Genetic (80% heritable) impulsivity and emotional dysregulation
2. Decreased functioning of serotonin system
3. Increased activation of amygdala
4. Parental separation, emotional and verbal abuse
5. Family invalidates or discounts emotional experience
D. Treatment
1. Dialectical behavior therapy includes acceptance and empathy, CBT, emotion regulation, and social skills training
2. Mentalization-based therapy to think about own and other's feelings
3. Schema-focused cognitive therapy to identify maladaptive asssumptions that underlie thoughts
4. Antidepressants and mood stabilizers