Lecture Learning Objectives
Key Concepts and Terms:
Personality Style = deeply ingrained, pervasive
pattern of inner experience and interpersonal behavior that is relatively
stable from adolescence through adulthood = "who we are."
Cluster A (Avoidant):
Paranoid: chronic pattern of suspicion and distrust
of others WITHOUT JUSTIFICATION; interprets mistakes as malevolent; quick
to anger; reluctant to confide in others because of fear information will
be used to harm; doubts fidelity of significant other. Must differentiate
from schizophrenia and psychotic disorders; hint: paranoid personality
disorder has no hallucinations or frank delusions.
Personality Traits = characteristics of behaving,
interacting, and reacting that define our personality style. E.g.
vulnerability to criticism, entitlement, and difficulty with empathy.
Personality Disorder = collection of personality
traits that is markedly deviant from the individual's culture and that
leads to conflict or chaos in multiple life areas, such as regulation of
mood and impulses, ability to self-soothe, be in an intimate relationship,
hold a job, tolerate criticism or rejection, or defer gratification.
Schizoid: SOCIAL WITHDRAWAL and
paucity of interpersonal relationships because of NO DESIRE for this
contact (v. anxiety disorders or avoidant personality disorder, in which
social contact is desired, but FEARED). NOT psychotic or bizarre;
make excellent night watchmen and librarians. HAS NOTHING TO DO WITH
Schizotypal: ODD and BIZARRE with strange
beliefs (e.g. ideas of reference, paranoid ideation, overelaborate or stereotyped
speech), lack of close friends because of strangeness or paranoia.
Maybe associated with schizophrenia.
Cluster B (Boisterous):
Antisocial: pervasive pattern of
disregard for rights of others, beginning before age 16; classical behaviors:
firestarting, animal torture, criminality (stealing, assaulting); LACK
OF REMORSE (no conscience) is a critical feature; usually "smooth operators,"
pleasant and manipulative. Rule out substance abuse, narcissistic
p.d., major psychiatric disorder. Estimated prevalence: 1-3%
of men, 1% of women.
Borderline: remember RABID:
Relationships are stormy; Affect is unstable and they have trouble self-soothing;
Boundaries (interpersonal) are poorly defined and maintained; severe Identity
disturbance (a chronic inner emptiness is the core of their problem); and
they engage in self-Destructive behaviors (suicidal gestures more than
attempts, as well as SELF-MUTILATION (wrist-cutting, burning is classic)).
Histrionic: remember Scarlett
O'Hara; craves attention, is inappropriately sexually seductive or provocative,
has shallow and shifting emotions, uses physical appearance to draw attention
to self, very impressionistic speech, theatrical and dramatic, considers
relationships to be more intimate than they are. Sometimes difficult
to distinguish from borderline.
Narcissistic: critical features
are LACK OF EMPATHY for the suffering of others, SENSE OF ENTITLEMENT to
things they haven't earned, and extreme SENSITIVITY TO CRITICISM (as well
as its flipside: being overly dependent on external validation such
as grades, money, public acclaim to feel whole). Like the borderline,
narcissists have profound inner emptiness. Unlike the antisocial,
narcissists usually have tremendous inner pain (the antisocial is usually
cool, pleasant, and collected [unless caught!]).
Cluster C (Clinging):
Avoidant: avoids any relationship
unless acceptance is guaranteed; feels inadequate or inept especially socially;
fears public ridicule or criticism (but unlike the narcissist would react
with self-reproach, not rage). Usually shy, quiet, and
self-deprecating. Need to differentiate from anxiety disorders (which
have a high response rate to antidepressant medications).
Dependent: fears being alone,
will do anything to maintain a relationship that gives some support, even
if unpleasant; cannot make everyday decisions without excessive advice
from others; exaggerated fears of being unable to care for self.
Very similar to the borderline's fear of abandonment (without the other
Obsessive-compulsive personality disorder:
rigid, obsessed with rules and regulations, often missing the "big picture",
may spend more time planning than doing; often judgmental, unpleasant people.
Can become paranoid under pressure. Unlike OBSESSIVE-COMPULSIVE DISORDER,
obsessive-compulsive PERSONALITY disorder has NO frank obsessions or compulsions
(e.g. handwashing) and the behavior is EGO SYNTONIC (does not appear ridiculous
or disturbing to the patient, as it does in O.C.D.).
Diagnostic and Statistical Manual of Mental Disorders, Fourth
Edition (DSM-IV), pp. 629 - 634: gives a good overview and discussion
of personality disorders in general; pp. 645-650: good description
of antisocial personality disorder; pp. 650-654: borderline personality
disorder; 658-661: narcissistic personality disorder; 669-673: obsessive
compulsive personality disorder.