Transcript Personality Disorders - Francis Marion University

Personality Disorders
William P. Wattles, Ph.D.
Francis Marion University
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Personality Disorders are generalized, inflexible
patterns of inner experience and behavior of
long-standing.
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Personality Disorders are long-term,
maladaptive patterns of perception, emotional
regulation, anxiety, and impulse control.
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Personality
• 1.The enduring pattern
of inner experiences
and outward behavior
that is unique to each
individual.
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Personality Disorders
• Enduring pattern of inner experience
• Deviates markedly from the expectations of
the person’s society
• Pervasive and inflexible
• Onset in adolescence or early adulthood
• Is stable over time
• Leads to distress or impairment.
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Personality Traits
• Enduring patterns of perceiving, relating to
and thinking about the environment and
oneself exhibited over a wide range of
social and personal contexts. Stable across:
– Time
– Place
– Situation
• Only disorders if maladaptive
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Personality disorder
• Involves long-term functioning
–
–
–
–
difficult to assess in one interview
not organic, substance-induced or situational
must go back at least to early adulthood
may be ego-syntonic
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PD’s frequently overlooked
• Client may express more concern with Axis I
Problems
• Personality styles often hidden and must be
inferred
• Can be difficult to distinguish between state
(clinical) elevations and trait (personality)
scales.
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Cluster A
• Individuals appear odd
or eccentric
– Paranoid
– Schizoid
– Schizotypal
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Cluster B
• Individuals appear
dramatic, emotional or
erratic
–
–
–
–
Antisocial
Borderline
Histrionic
Narcissistic
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Cluster C
• Individuals appear
anxious or fearful
– Avoidant
– Dependent
– Obsessive-Compulsive
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Paranoid Personality Disorder
• Pervasive distrust
and
suspiciousness of
others such that
their motives are
interpreted as
malevolent.
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Paranoid Personality Disorder
• Four of:
– Suspects others
exploiting, harming or
deceiving
– preoccupied with
unjustified doubts of
loyalty of friends and
associates
– Reluctant to confide in
others
– Reads hidden
demeaning of
threatening meanings
into benign events
– persistently bears
grudges
– perceives attacks not
apparent to others
– recurrent suspicions
w/o cause regarding
fidelity of partner
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Paranoid P.D.
• Overreact to minor
slights
• Hold grudges
• Constantly vigilant
• Quick to counterattack
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Dichotomy
Normal
Paranoid
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Points on Continuum
Paranoid
Traits
Normal
Gullible
Paranoid P. D.
Delusional
Disorder
Paranoid
Schizophrenic
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Delusional Disorder
• Persecutory Type
• Central theme of being conspired against,
cheated, spied on, followed, poisoned
Maligned, harassed, or obstructed. May
engage in repeated attempts to get
satisfaction by appeal to courts and
government agencies
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Delusions
• Erroneous beliefs that usually involve
misinterpretation of perceptions or
experiences.
– Vapor trails
• Delusions are deemed bizarre is they are
clearly implausible.
– Thought broadcasting
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Delusional Disorder vs
Schizophrenia
• Bizarre versus nonbizarre delusions
• Bizarre if clearly implausible, not
understandable, not derived from ordinary
life experience.
• Nonbizarre involves thing that can occur in
real life: being followed, poisoned loved at
a distance, deceived by one’s spouse.
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Schizophrenia
• Paranoid type
• Preoccupation with prominent delusions or
hallucinations
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Schizoid Personality Disorder
• Pervasive pattern of
detachment from
social relationships
and a restricted range
of expression of
emotions.
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Schizoid Personality Disorder
• Four of:
– neither desires nor
enjoys close
relationships
– Usually chooses
solitary activities
– Has little interest in sex
with another person
– Take pleasure in few if
any activities.
– Lacks close friend or
confidants
– appears indifferent to
praise or criticism
– shows emotional
coldness and flat affect
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Schizotypal Personality Disorder
• Pervasive pattern of
social and
interpersonal deficits
marked by acute
discomfort with close
relationships as well as
by cognitive or
perceptual distortions
and eccentricities of
behavior.
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Schizotypal Personality Disorder
• Five of:
– Ideas of reference
– odd beliefs
– unusual perceptual
experiences
– odd thinking and
speech
– suspiciousness or
paranoid ideation
– Inappropriate or
constricted affect
– odd behavior or
appearance
– lack of close friends or
confidants
– excessive social
anxiety based on
paranoid ideation
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Antisocial Personality Disorder
• The essential feature is
a pervasive pattern of
disregard for the
violation of the rights
of others.
• Since age 15
• Sociopathy,
psychopathy
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Antisocial Personality Disorder
– Failure to conform to
social norms
– deceitfulness, lying
aliases conning.
– Impulsivity and failure
to plan ahead
– irritability and
aggressiveness
– reckless disregard for
the safety of self and
others
– consistent
irresponsibility
– lack of remorse
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Borderline Personality Disorder
• Pervasive pattern of
instability of
interpersonal
relationships, selfimage, and affects.
Marked impulsivity
• KM
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Borderline Personality Disorder
– Frantic efforts to avoid
abandonment
– unstable and intense
relationships
– identity disturbance
– impulsivity: sex,
substance abuse,
reckless driving, binge
eating.
– Recent suicidal
behavior or threats
– affective instability
– chronic feelings of
emptiness
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Histrionic Personality Disorder
• Pervasive Pattern of
excessive emotionality
and attention-seeking
behavior.
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Histrionic Personality Disorder
– Uncomfortable if not
the center of attention.
– Inappropriate sexually
seductive or
provocative behavior.
– Rapidly shifting and
shallow emotions
– Uses physical
appearance to draw
attention.
– Speech is excessively
impressionistic and
lacking in detail
– Self-dramatization,
theatricality and
exaggerated expression
of emotion
– Suggestible
– Considers shallow
relationships intimate
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Narcissistic Personality Disorder
• Pervasive pattern of
grandiosity, need for
admiration and lack of
empathy that begins
by early adulthood
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Narcissistic Personality Disorder
– Grandiose sense of
self-importance
– Preoccupied with
fantasies of unlimited
success
– Believes he or she is
special
– requires excessive
admiration
– Sense of entitlement
– interpersonally
exploitative
– lacks empathy
– envious
– arrogant behavior and
attitudes
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Narcissistic Personality Disorder
• Baughman article
• Sense of entitlement
• Lack of empathy or
conscience
• No lack of intelligence
• No lack of social skills
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Uconn President
• …spending in hard times. There was the
$170,000 inauguration with regal fireworks,
the half-million-dollar office renovation, the
decision to have the state pay $49,000 in
rent on a house near campus rather than live
in the recently restored presidential mansion
(the reason cited was health issues related to
mold), and the $3,500 for six life-size
cutouts of him around campus.”
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Avoidant Personality Disorder
• Pervasive pattern of
social inhibition,
feelings of inadequacy
and hypersensitivity to
negative evaluation.
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Avoidant Personality Disorder
– Avoids jobs with social
contact or evaluation
– Unwilling to get
involved unless sure of
being liked
– Restraint in intimate
relationships
– Preoccupied with being
criticized or rejected
– Inhibited in new
situations due to
inadequacy
– view self as socially
inept
– reluctant to take risks
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Dependent Personality Disorder
• Pervasive need to be
taken care of that leads
to submissive and
clinging behavior and
fears of separation.
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Dependent Personality Disorder
– Difficulty making
decisions
– Needs other to take
responsibility for life
– Difficulty expressing
disagreement
– Problems with
initiative
– Excessive need for
nurturing
– Feels uncomfortable or
helpless alone
– Urgently seeks new
relationship when one
ends.
– Fears of being left to
care for self
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Obsessive-Compulsive
Personality Disorder
• Preoccupation with
orderliness,
perfectionism and
mental and
interpersonal control.
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Obsessive-Compulsive
Personality Disorder
– Preoccupied with
details, rules, lists,
order.
– Perfectionism that
interferes with task
– Excessively devoted to
work and productivity
– Rigid and stubborn
– Overconscientious
about matters of
morality, ethics or
values.
– Unable to discard
worthless objects
– Reluctant to delegate
– Miserly
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Millon Clinical Multiaxial Inventory
MCMI-III
•
•
•
•
•
Standardized
Self-report
Adults
8th grade reading level
Focus on Personality Disorders
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Millon Clinical Multiaxial Inventory
MCMI-III
• 175 items
• 28 Scales
• Closely aligned with Millon’s theory and
DSM-IV
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MCMI-III
• Can be used instead of or in addition to
MMPI.
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Theoretical Considerations
• Millon’s Theory
• Core Principle Polarities of:
– Pleasure-pain
– Active-passive
– Self-other
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Interpretation
• BR base rate scores
– Used instead of T scores and norm-referencing.
– Distribution of scores varies from one
personality scale to the next.
– MCMI uses criterion referencing rather than
norm referencing.
– Base rate or prevalence of disorder in the
psychiatric population
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BR scores
• For clinical scales:
– BR 75 indicates presence of a trait
– BR 85 indicates presence of a disorder
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1. Interpret Profile Validity
• Validity Scale-3 items, 1 is sign of absurd answer
• Disclosure Index- below 34 indicates defensive
unwillingness to disclose.
• Desirability Index –measure of defensive
responding. Scores above BR 75 suggest claims of
unusual moral, attractive stable organized.
• Debasement index-the extent to which a client
describes themselves in negative terms. Above BR
85 bad profile and/or cry for help.
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2. Interpret Personality Disorder
scales
• The primary focus for diagnosis is on the
Severe Personality Disorders.
– Unless elevations on others were high
compared to SPD
• Other personality pattern scales used to
elaborate on Severe Personality Disorder
Scale.
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3. Interpret Clinical Syndrome
Scales
• Precedence given to elevations on Severe
Clinical Syndrome scales
• All can be elevated
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Schizoid Scale 1
• Little or no interest in other people
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Avoidant Scale 2A
• A desire to be with other people that is
blocked by an intense fear of being rejected
or humiliated.
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Depressive Scale 2B
• Clients perceive themselves as worthless,
vulnerable, inadequate, unsuccessful, and
guilty. The frequently engage in selfcriticism and frame events in a defeatist
manner.
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Dependent Scale 3
• They feel incapable and incompetent of
functioning independently. They quickly
form alliances and give up responsibility for
decisions. See themselves as placating,
insecure, passive and immature.
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Histrionic Scale 4
• Histrionic persons are dramatic, colorful
and emotional. Tolerance for boredom is
low and they constantly seek novel
situations.
• Elevations of Histrionic are associated with
an above average number of positive life
events, low levels of distress and good
social adjustment.
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Narcissistic Scale 5
• Exaggerated sense of self-importance and
competence.
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Antisocial Scale 6A
• Competitiveness along with impulsive
acting-out of anti-social feelings.
Provocative, violent, vicious, self-centered,
dominant, dishonest, brutal an devious.
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Aggressive Scale 6B
• Competitive, energetic, hard-headed,
authoritarian and socially intolerant.
Predisposed toward aggressive outburst
with little sensitivity.
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Compulsive Scale 7
• Conformity, discipline, self-restraint,
formality. Strictly adhere to social norms.
Conscientious, well prepared, reghteous,
and meticulous.
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Passive-Aggressive Scale 8A
• Passive compliance combined with
resentment and opposition.
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Self-defeating 8B
• Present themselves as inferior,
nonindulgent, self-effacing, insecure. They
do not deserve pleasure.
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Schizotypal Scale S
• Eccentricity, disorganization and social
isolation.
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Bordeline Scale C
• Instability and unpredictability of mood and
behavior.
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Paranoid Scale P
• Suspicious and defensive
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Anxiety Scale A
• Tension, difficulty relaxing, indecisiveness,
and apprehension.
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Somatoform Scale H
• Somatic complaints in the for of generalized
pain, fatigue, multiple vague complaints,
preoccupation with health problems.
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Bipolar: Manic Scale N
• Moods swings that range from elation to
depression.
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Dysthymia Scale D
• Sadness, pessimism
• hopelessness, apathy, low self-esteem, guilt
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Alcohol Dependence Scale B
• A history of problem drinking.
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Drug Dependence Scale T
• Recurring difficulties with drug abuse
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Posttraumatic Distress Disorder
Scale R
• Extreme experience leading to fear,
helplessness and arousal.
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Thought Disorder SS
• Inconsistent, bizarre, fragmented and
disorganized thoughts.
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Major Depression Scale CC
• Severe depression-difficulty with effective
daily living.
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Delusional Disorder PP
• Irrational but interconnected delusions,
persecutory thoughts and grandiosity
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MCMI
• Commendable and innovative
• Generally a well-constructed psychometric
instrument
• Test-retest reliabilities moderate to high
• Factor analysis generally supports
organization of scales.
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MCMI problems
• No “gold standard” or benchmark to
validate scale.
• Low interdiagnostician agreement
• May over diagnose and over pathologize
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MCMI problems
• “Our ability to describe different personality
disorders has outstripped out ability to
diagnose them accurately in real-world
clinical settings.”
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MCMI
• Axis 1 State
• Axis 2 Trait
• MCMI frequently revised to keep it
consistent with the DSM
• Should be used only with clinical
populations
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The End
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