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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

Paranoid

Normal

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Points on Continuum

Gullible

Delusional Disorder

Paranoid P. D.

Paranoid Traits

Paranoid Schizophrenic

Normal

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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, self-image, 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

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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• 175 items

• 28 Scales

• Closely aligned with Millon’s theory and DSM-IV

Millon Clinical Multiaxial Inventory MCMI-III

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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 self-criticism 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