PERSONALITY DISORDERS
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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."
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.
Personality Disorders:
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.
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 SCHIZOPHRENIA.
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 disruptive
features).
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.).
DSM-IV Criteria for
Narcissistic Personality Disorder
A pervasive pattern of grandiosity (in fantasy or behavior), need for admiration, and lack of empathy, beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following:
(1) has a grandiose sense of self-importance (e.g., exaggerates achievements and talents, expects to be recognized as superior without commensurate achievements)
(2) is preoccupied with fantasies of unlimited success, power, brilliance, beauty, or ideal love
(3) 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)
(4) requires excessive admiration
(5) has a sense of entitlement, i.e., unreasonable expectations of especially favorable treatment or automatic compliance with his or her expectations
(6) is interpersonally exploitative, i.e., takes advantage of others to achieve his or her own ends
(7) lacks empathy: is unwilling to recognize or identify with the feelings and needs of others
(8) is often envious of others or believes that others are envious of him or her
(9) shows arrogant,
haughty behaviors or attitudes
- American Psychiatric Association. (1994).
Diagnostic and statistical manual of mental disorders, fourth edition.
Optional
- 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 (see below for sample criteria); 669-673:
obsessive compulsive personality disorder.
- Personality Disorders and Culture: Clinical and Conceptual Interactions by Renato D. Alarcon, Edward F. Foulks, Mark Vakkur. June 1998, John Wiley & Sons, pp. 60-68: "Personalities and Personality Disorders in World Politics" explores Lenin, Hitler, and Stalin from a personality disorder perspective, highlighting the interplay between cultural and individual pathology.