assessing personality disorders with the mmpi-2-rf - 6-20...

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AssessingPersonalityDisorderswiththeMMPI-2-RF

Mar>nSellbom,PhDAssociateProfessor

DepartmentofPsychologyUniversityofOtago

Dunedin,NewZealand

Agenda

• Introduc>ontoPersonalityDisorders• MMPI-2-RFandPersonalityDisorderResearch• MMPI-2-RFScalesandPersonalityDisorderCriteria• Cases

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Cluster A

Paranoid Schizoid

Schizotypal

Cluster B

Antisocial Borderline Histrionic

Narcissistic

Cluster C

Avoidant Dependent Obsessive- Compulsive

CurrentSystem–DSM-5Sec>onII

• 10PDsorganizedintothreeclusters

Empirically-ValidatedConceptualModel

• MappingMMPI-2-RFscalesontoPDcriteria

• Tes>ngofhypothesesinaseriesofresearchstudies

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Journal of Personality Assessment, 1–7, 2013Copyright C⃝ Taylor & Francis Group, LLCISSN: 0022-3891 print / 1532-7752 onlineDOI: 10.1080/00223891.2013.825625

SPECIAL SECTION: The Personality Psychopathology Five (PSY–5) and DSM–5 TraitDimensional Diagnostic System for Personality Disorders: Emerging Convergence

Mapping the Personality Psychopathology Five Domains OntoDSM–IV Personality Disorders in Dutch Clinical and Forensic

Samples: Implications for DSM–5

MARTIN SELLBOM,1 WINEKE SMID,2 HILDE DE SAEGER,3 NAOMI SMIT,4 AND JAN H. KAMPHUIS4

1Department of Psychology, The University of Alabama2Van der Hoeven Kliniek, Utrecht, The Netherlands

3De Viersprong, Halsteren, The Netherlands4Department of Psychology, University of Amsterdam, The Netherlands

The Personality Psychopathology Five (PSY–5) model represents 5 broadband dimensional personality domains that align with the originallyproposed DSM–5 personality trait system, which was eventually placed in Section III for further study. The main objective of this study was toexamine the associations between the PSY–5 model and personality disorder criteria. More specifically, we aimed to determine if the PSY–5 domainscales converged with the alternative DSM–5 Section III model for personality disorders, with a particular emphasis on the personality trait profilesproposed for each of the specific personality disorder types. Two samples from The Netherlands consisting of clinical patients from a personalitydisorder treatment program (n = 190) and forensic psychiatric hospital (n = 162) were used. All patients had been administered the MMPI–2 (fromwhich MMPI–2–RF PSY–5 scales were scored) and structured clinical interviews to assess personality disorder criteria. Results based on Poissonor negative binomial regression models showed statistically significant and meaningful associations for the hypothesized PSY–5 domains for eachof the 6 personality disorders, with a few minor exceptions that are discussed in detail. Implications for these findings are also discussed.

It is widely acknowledged that the current conceptualizationof personality disorders (PDs) outlined in past and currenteditions of the Diagnostic and Statistical Manual of MentalDisorders (DSM) is associated with substantial limitations thathinder progress in elaborating on epidemiology, etiology, andtreatment (Regier et al., 1998; Skodol, 2012). These limitationsinclude (but are not limited to) inadequate coverage of personal-ity psychopathology variance, excessive comorbidity, excessivewithin-diagnosis heterogeneity across patients, marked tempo-ral instability, no clear boundary between normal and patholog-ical personality, and poor convergent and discriminant validityacross diagnostic categories (e.g., Skodol, 2012; Skodol et al.,2011; Widiger & Trull, 2007). Many of these challenges haveled scholars to call for a dimensional system of PDs (Widiger& Trull, 2007).

To address these concerns, the DSM–5 Workgroup on Person-ality and Personality Disorders (P&PD) originally proposed anew hybrid system for PDs that would include a combination ofa dimensional personality trait system and ratings of functionalimpairment across self- (identity, self-direction) and interper-

Received January 20, 2013; Revised April 4, 2013.Martin Sellbom is now at The Australian National University, Canberra,

ACT, Australia.Address correspondence to Martin Sellbom, Research School of Psychol-

ogy, The Australian National University, Building 39, Canberra, ACT, 0200,Australia; Email: martin.sellbom@anu.edu.au

sonally oriented (empathy, intimacy) domains (American Psy-chiatric Association, 2011, 2013). The dimensional personalitytraits are organized into five broad domains of antagonism, de-tachment, disinhibition, negative affectivity, and psychoticism(American Psychiatric Association, 2013; Krueger et al., 2011;Skodol, 2012). Furthermore, each of these domains has three(psychoticism) to seven (negative affectivity) facets that are usedto specify the personality trait criteria for each of the PDs pro-posed for inclusion in DSM–5. In addition, the P&PD workgroupproposed seven categorical PD diagnoses for the DSM–5: anti-social, avoidant, borderline, narcissistic, obsessive–compulsive,schizotypal, and personality disorder: trait specified (Skodol,2012). These were proposed primarily to maintain continuityfrom DSM–IV–TR to DSM–5 and will be defined specificallyby facet trait profiles as well as specific self and interpersonalimpairment tailored to each disorder (Skodol et al., 2011). Per-sonality disorder: trait specified is the only diagnosis that is notdefined by a particular trait profile, but rather considers all possi-ble configurations that do not match one of the specific disordertypes just listed. Furthermore, the personality profiles proposedfor the specific DSM–5 Section III PDs are based on matchingspecific trait facets with original DSM–IV criteria (AmericanPsychiatric Association, 2011), as well as empirical researchconducted with other dimensional personality trait models andDSM–IV PDs (Skodol, 2012; Skodol et al., 2011). Ultimately,the American Psychiatric Association Board of Trustees de-cided not to incorporate the proposal into Section II of DSM–5

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Diagnos>cCriteriafor301.0ParanoidPersonalityDisorder

Apervasivedistrustandsuspiciousnessofotherssuchthattheirmo>vesareinterpretedasmalevolent,beginningbyearlyadulthoodandpresentinavarietyofcontexts,asindicatedbyfour(ormore)ofthefollowing:

– Suspects,withoutsufficientbasis,thatothersareexploi>ng,harming,ordeceivinghimorher

– Preoccupiedwithunjus>fieddoubtsabouttheloyaltyortrustworthinessoffriendsorassociates

– Reluctanttoconfideinothersbecauseofunwarrantedfearthattheinforma>onwillbeusedmaliciouslyagainsthimorher

– Readshiddendemeaningorthreateningmeaningsintobenignremarksorevents

– Persistentlybearsgrudges,i.e.,isunforgivingofinsults,injuries,orslights

– Perceivesa^acksonhisorhercharacterorreputa>onthatarenotapparenttoothersandisquicktoreactangrilyortocountera^ack

– Recurrentsuspicions,withoutjus>fica>on,regardingfidelityofspouseorsexualpartner

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ParanoidPersonalityDisorderApervasivedistrustandsuspiciousnessofotherssuchthattheirmo3vesareinterpretedasmalevolent,

beginningbyearlyadulthoodandpresentinavarietyofcontexts…

• Suspects,withoutsufficientbasis,thatothersareexploi>ng,harming,ordeceivinghimorher;– MMPI-2-RF:PSYC,RC6

• Ispreoccupiedwithunjus>fieddoubtsabouttheloyaltyortrustworthinessoffriendsorassociates;Isreluctanttoconfideinothers;hasrecurrentsuspicions,withoutjus>fica>on,regardingfidelityofspouseorsexualpartner– MMPI-2-RF:PSYC,RC6,NEGE,RC7,(RC3)

• Readshiddendemeaningorthreateningmeaningsintobenignremarksorevents;Persistentlybearsgrudges,i.e.,isunforgivingofinsults,injuries,orslights;Perceivesa^acksonhisorhercharacterorreputa>onthatarenotapparenttoothersandisquicktoreactangrilyortocountera^ack– MMPI-2-RF:PSYC,AGGR,ANP(RC4,RC9)

Diagnos>cCriteriafor301.20SchizoidPersonalityDisorder

Apervasivepa^ernofdetachmentfromsocialrela>onshipsandarestrictedrangeofexpressionofemo>onsininterpersonalsedngs,beginningbyearlyadulthoodandpresentinavarietyofcontexts,asindicatedbyfour(ormore)ofthefollowing:

– Neitherdesiresnorenjoyscloserela>onships,includingbeingpartofafamily– Almostalwayschoosessolitaryac>vi>es– hasli^le,ifany,interestinhavingsexualexperienceswithanotherperson– Takespleasureinfew,ifany,ac>vi>es– Lacksclosefriendsorconfidantsotherthanfirst-degreerela>ves– Appearsindifferenttothepraiseorcri>cismofothers– Showsemo>onalcoldness,detachment,orfla^enedaffec>vity

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SchizoidPersonalityDisorder“Apervasivepa;ernofdetachmentfromsocialrela3onshipsandarestrictedrangeofexpressionofemo3onsin

interpersonalse<ngs,beginningbyearlyadulthoodandpresentinavarietyofcontexts…”

• Neitherdesiresnorenjoyscloserela>onships,includingbeingpartofafamily;Almostalwayschoosessolitaryac>vi>es;Lacksclosefriendsorconfidantsotherthanfirst-degreerela>ves

– MMPI-2-RF:INTR,SAV,DSF

• Hasli^le,ifany,interestinhavingsexualexperienceswithanotherperson;Takespleasureinfew,ifany,ac>vi>es

– MMPI-2-RF:INTR,RC2;(LowRC9,lowACT)

• Appearsindifferenttothepraiseorcri>cismofothers– MMPI-2-RF:Lookfornon-elevatedscoreonNEGE,RC7,andSHYtodifferen>atefromAvoidantPD

• Showsemo>onalcoldness,detachment,orfla^enedaffec>vity

– MMPI-2-RF:INTR,DSF

Note:Sellbom&Smith,2017–poten>alconcernswithdiscriminantvalidity

Diagnos>cCriteriafor301.22SchizotypalPersonalityDisorder

Apervasivepa^ernofsocialandinterpersonaldeficitsmarkedbyacutediscomfortwith,andreducedcapacityfor,closerela>onshipsaswellasbycogni>veorperceptualdistor>onsandeccentrici>esofbehavior,beginningbyearlyadulthoodandpresentinavarietyofcontexts,asindicatedbyfour(ormore)ofthefollowing:

– Ideasofreference(excludingdelusionsofreference)– Oddbeliefsormagicalthinkingthatinfluencesbehaviorandisinconsistentwithsubculturalnorms(e.g.,supers>>ousness,beliefinclairvoyance,telepathy,or"sixthsense";inchildrenandadolescents,bizarrefantasiesorpreoccupa>ons)– Unusualperceptualexperiences,includingbodilyillusions– Oddthinkingandspeech(e.g.,vague,circumstan>al,metaphorical,overelaborate,orstereotyped)– Suspiciousnessorparanoididea>on– Inappropriateorconstrictedaffect– Behaviororappearancethatisodd,eccentric,orpeculiar– Lackofclosefriendsorconfidantsotherthanfirst-degreerela>ves– Excessivesocialanxietythatdoesnotdiminishwithfamiliarityandtendstobeassociatedwithparanoidfearsratherthannega>vejudgmentsaboutself

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SchizotypalPersonalityDisorder“Apervasivepa;ernofsocialandinterpersonaldeficitsmarkedbyacutediscomfortwith,andreducedcapacityfor,closerela3onshipsaswellasbycogni3veorperceptualdistor3onsandeccentrici3esofbehavior,beginningbyearly

adulthoodandpresentinavarietyofcontexts…”

• Ideasofreference(excludingdelusionsofreference);Oddbeliefsormagicalthinking;Unusualperceptualexperiences,includingbodilyillusions;oddthinkingandspeech;Inappropriateorconstrictedaffect;Behaviororappearancethatisodd,eccentric,orpeculiar

– MMPI-2-RF:THD,PSYC,RC8,NUC

• Suspiciousnessorparanoididea>on– MMPI-2-RF:PSYC,RC6

• Lackofclosefriendsorconfidantsotherthanfirst-degreerela>ves

– MMPI-2-RF:SAV,INTR,RC2,DSF

• Excessivesocialanxiety– MMPI-2-RF:NEGE,RC7,SHY– Differen>atesfromAvPDbasedonPSYC;AvPDalsolikelyhigheronSHY

Diagnos>cCriteriafor301.7An>socialPersonalityDisorder

Thereisapervasivepa^ernofdisregardforandviola>onoftherightsofothersoccurringsinceage15years,asindicatedbythree(ormore)ofthefollowing:

– Failuretoconformtosocialnormswithrespecttolawfulbehaviors

– Deceimulness– Impulsivityorfailuretoplanahead

– Irritabilityandaggressiveness– Recklessdisregardforsafetyofselforothers– Consistentirresponsibility– Lackofremorse

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An>socialPersonalityDisorder”Apervasivepa;ernofdisregardforandviola3onoftherightsofothers…”

• Failuretoconformtosocialnormswithrespecttolawfulbehaviors;Irresponsibility;Impulsivityorfailuretoplanahead;Recklessdisregardforsafetyofselforothers– MMPI-2-RF:BXD,DISC,RC4,JCP,SUB

• Deceimulness,Conning/Manipula>ve– MMPI-2-RF:AGGR,RC9;lowIPP,lowSHY

• Irritabilityandaggressiveness– MMPI-2-RF:RC9,ANP,AGG

• Lackofremorse– MMPI-2-RF:AGGR,RC9,DSF;lowRC7

Diagnos>cCriteriafor301.83BorderlinePersonalityDisorderApervasivepa^ernofinstabilityofinterpersonalrela>onships,self-image,andaffects,andmarkedimpulsivitybeginningbyearlyadulthoodandpresentinavarietyofcontexts,asindicatedbyfive(ormore)ofthefollowing:

– Fran>ceffortstoavoidrealorimaginedabandonment.Note:Donotincludesuicidalorself-mu>la>ngbehaviorcoveredinCriterion5.– Apa^ernofunstableandintenseinterpersonalrela>onshipscharacterizedbyalterna>ngbetweenextremesofidealiza>onanddevalua>on– Iden>tydisturbance:markedlyandpersistentlyunstableself-imageorsenseofself– Impulsivityinatleasttwoareasthatarepoten>allyself-damaging(e.g.,spending,sex,substanceabuse,recklessdriving,bingeea>ng).Note:Donotincludesuicidalorself-mu>la>ngbehaviorcoveredinCriterion5.– Recurrentsuicidalbehavior,gestures,orthreats,orself-mu>la>ngbehavior– Affec>veinstabilityduetoamarkedreac>vityofmood(e.g.,intenseepisodicdysphoria,irritability,oranxietyusuallylas>ngafewhoursandonlyrarelymorethanafewdays)– Chronicfeelingsofemp>ness– Inappropriate,intenseangerordifficultycontrollinganger(e.g.,frequentdisplaysoftemper,constantanger,recurrentphysicalfights)– Transient,stress-relatedparanoididea>onorseveredissocia>vesymptoms

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BorderlinePersonalityDisorder“Apervasivepa;ernofinstabilityofinterpersonalrela3onships,self-image,andaffects,andmarkedimpulsivity

beginningbyearlyadulthoodandpresentinavarietyofcontexts…”

• Fran>ceffortstoavoidrealorimaginedabandonment;Apa^ernofunstableandintenseinterpersonalrela>onshipscharacterizedbyalterna>ngbetweenextremesofidealiza>onanddevalua>on– MMPI-2-RF:EID,NEGE,RC7,FML

• Iden>tydisturbance:markedlyandpersistentlyunstableself-imageorsenseofself– MMPI-2-RF:NEGE,RC7,SFD

• Impulsivityinatleasttwoareasthatarepoten>allyself-damaging(e.g.,spending,sex,substanceabuse,recklessdriving,bingeea>ng)– MMPI-2-RF:BXD,DISC,RC4,SUB

• Recurrentsuicidalbehavior,gestures,orthreats,orself-mu>la>ngbehavior– MMPI-2-RF:NEGE,RCd,SUI

BorderlinePersonalityDisorder“Apervasivepa;ernofinstabilityofinterpersonalrela3onships,self-image,andaffects,andmarkedimpulsivity

beginningbyearlyadulthoodandpresentinavarietyofcontexts…”

• Affec>veinstabilityduetoamarkedreac>vityofmood– MMPI-2-RF:EID,NEGE,RC7,RCd,STW,AXY,ANP

• Chronicfeelingsofemp>ness– MMPI-2-RF:INTR,RC2

• Inappropriate,intenseangerordifficultycontrollinganger(e.g.,frequentdisplaysoftemper,constantanger,recurrentphysicalfights)– MMPI-2-RF:NEGE,RC7,ANP,AGG

• Transient,stress-relatedparanoididea>onorseveredissocia>vesymptoms– MMPI-2-RF:THD,PSYC,RC8,RC6

Note:Verysedngdependent–forensicvs.clinicalExternalizing+Emo>onallabilityvs.Psycho>cism

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Diagnos>cCriteriafor301.50HistrionicPersonalityDisorder

Apervasivepa^ernofexcessiveemo>onalityanda^en>onseeking,beginningbyearlyadulthoodandpresentinavarietyofcontexts,asindicatedbyfive(ormore)ofthefollowing

– Uncomfortableinsitua>onsinwhichheorsheisnotthecenterofa^en>on

– Interac>onwithothersisorencharacterizedbyinappropriatesexuallyseduc>veorprovoca>vebehavior

– Displaysrapidlyshiringandshallowexpressionofemo>ons

– Consistentlyusesphysicalappearancetodrawa^en>ontoself

– Styleofspeechthatisexcessivelyimpressionis>candlackingindetail

– Showsself-drama>za>on,theatricality,andexaggeratedexpressionofemo>on

– Sugges>ble,i.e.,easilyinfluencedbyothersorcircumstances

– Considersrela>onshipstobemorein>matethantheyactuallyare

HistrionicPersonalityDisorder“Apervasivepa;ernofexcessiveemo3onalityanda;en3onseeking,beginningbyearlyadulthoodandpresentin

avarietyofcontexts…”

• Isuncomfortableinsitua>onsinwhichheorsheisnotthecenterofa^en>on;Interac>onwithothersisorencharacterizedbyinappropriatesexuallyseduc>veorprovoca>vebehavior;Consistentlyusesphysicalappearancetodrawa^en>ontoself– MMPI-2-RF:LowINTR,lowRC2,lowSHY,lowSAV

• Displaysrapidlyshiringandshallowexpressionofemo>ons– MMPI-2-RF:NEGE,RC7

• Hasastyleofspeechthatisexcessivelyimpressionis>candlackingindetail;Showsself-drama>za>on,theatricality,andexaggeratedexpressionofemo>on;Considersrela>onshipstobemorein>matethantheyactuallyare– MMPI-2-RF:RC9,ACT,lowSAV

• Issugges>ble,i.e.,easilyinfluencedbyothersorcircumstances– MMPI-2-RF:LowRC3

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Diagnos>cCriteriafor301.81Narcissis>cPersonalityDisorder

Apervasivepa^ernofgrandiosity(infantasyorbehavior),needforadmira>on,andlackofempathy,beginningbyearlyadulthoodandpresentinavarietyofcontexts,asindicatedbyfive(ormore)ofthefollowing:

– Hasgrandiosesenseofself-importance(e.g.,exaggeratesachievementsandtalents,expectstoberecognizedassuperiorwithoutcommensurateachievements)– Preoccupiedwithfantasiesofunlimitedsuccess,power,brilliance,beauty,orideallove– Believesthatheorsheis"special"anduniqueandcanonlybeunderstoodby,orshouldassociatewith,otherspecialorhigh-statuspeople(orins>tu>ons)– Requiresexcessiveadmira>on– Hasasenseofen>tlement,i.e.,unreasonableexpecta>onsofespeciallyfavorabletreatmentorautoma>ccompliancewithhisorherexpecta>ons– Interpersonallyexploita>ve,i.e.,takesadvantageofotherstoachievehisorherownends– Lacksempathy:isunwillingtorecognizeoriden>fywiththefeelingsandneedsofothers– Orenenviousofothersorbelievesthatothersareenviousofhimorher– Showsarrogant,haughtybehaviorsoradtudes

Narcissis>cPersonalityDisorder“Apervasivepa;ernofgrandiosity(infantasyorbehavior),needforadmira3on,andlackofempathy,beginningby

earlyadulthoodandpresentinavarietyofcontexts…”

• Hasagrandiosesenseofself-importance(e.g.,exaggeratesachievementsandtalents,expectstoberecognizedassuperiorwithoutcommensurateachievements);Believesthatothersareenviousofhim/her

– MMPI-2-RF:AGGR,RC9,lowSFD

• Ispreoccupiedwithfantasiesofunlimitedsuccess,power,brilliance,beauty,orideallove;Believesthatheorsheis"special"anduniqueandcanonlybeunderstoodby,orshouldassociatewith,otherspecialorhigh-statuspeople(orins>tu>ons)

– MMPI-2-RF:PSYC

• Requiresexcessiveadmira>on;Isorenenviousofothers– MMPI-2-RF:NEGE,RC7,SFD

• Hasasenseofen>tlement;Isinterpersonallyexploita>ve;lacksempathy– MMPI-2-RF:AGGR,RC9,lowIPP,AGG

• Showsarrogant,haughtybehaviorsoradtudes– MMPI-2-RF:AGGR,lowIPP

Note:Empiricaldatainforensicsedng;moregrandiosemanifesta>ons

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Diagnos>cCriteriafor301.82AvoidantPersonalityDisorder

Apervasivepa^ernofsocialinhibi>on,feelingsofinadequacy,andhypersensi>vitytonega>veevalua>on,beginningbyearlyadulthoodandpresentinavarietyofcontexts,asindicatedbyfour(ormore)ofthefollowing:

– Avoidsoccupa>onalac>vi>esthatinvolvesignificantinterpersonalcontact,becauseoffearsofcri>cism,disapproval,orrejec>on– Unwillingtogetinvolvedwithpeopleunlesscertainofbeingliked– Showsrestraintwithinin>materela>onshipsbecauseofthefearofbeingshamedorridiculed– Preoccupiedwithbeingcri>cizedorrejectedinsocialsitua>ons– Inhibitedinnewinterpersonalsitua>onsbecauseoffeelingsofinadequacy– Viewsselfassociallyinept,personallyunappealing,orinferiortoothers– Unusuallyreluctanttotakepersonalrisksortoengageinanynewac>vi>esbecausetheymayproveembarrassing

AvoidantPersonalityDisorder“Apervasivepa;ernofsocialinhibi3on,feelingsofinadequacy,hypersensi3vitytonega3veevalua3on…”

• Hypersensi>vitytocri>cism;Fearofnega>veevalua>onandrejec>on– MMPI-2-RF:NEGE,RC7,SHY

• Extremesocialwithdrawalandaliena>on– MMPI-2-RF:INTR,SAV,DSF

• Feelingsofinadequacyandinep>tude– MMPI-2-RF:NEGE,SFD,NFC

• Emo>onalindicators,suchasRCdandRC2arelikelytobecommonaswell,andsupportedbydata

• NEGEshouldbeviewedasdifferen>a>ngAvPDfromSchizoidPD

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Diagnos>cCriteriafor301.6DependentPersonalityDisorder

Apervasiveandexcessiveneedtobetakencareofthatleadstosubmissiveandclingingbehaviorandfearsofsepara>on,beginningbyearlyadulthoodandpresentinavarietyofcontexts,asindicatedbyfive(ormore)ofthefollowing:

– Difficultymakingeverydaydecisionswithoutanexcessiveamountofadviceandreassurancefromothers– Needsotherstoassumeresponsibilityformostmajorareasofhisorherlife– Difficultyexpressingdisagreementwithothersbecauseoffearoflossofsupportorapproval.– Difficultyini>a>ngprojectsordoingthingsonhisorherown(becauseofalackofself-confidenceinjudgmentorabili>esratherthanalackofmo>va>onorenergy)– Goestoexcessivelengthstoobtainnurturanceandsupportfromothers,tothepointofvolunteeringtodothingsthatareunpleasant– Feelsuncomfortableorhelplesswhenalonebecauseofexaggeratedfearsofbeingunabletocareforhimselforherself– Urgentlyseeksanotherrela>onshipasasourceofcareandsupportwhenacloserela>onshipends– Unrealis>callypreoccupiedwithfearsofbeinglertotakecareofhimselforherself

DependentPersonalityDisorder“Apervasiveandexcessiveneedtobetakencareofthatleadstosubmissiveandclingingbehaviorandfears

ofsepara3on,beginningbyearlyadulthoodandpresentinavarietyofcontexts…”

• Hasdifficultymakingeverydaydecisions;needsotherstoassumeresponsibilityformostmajorareasofhisorherlife;goestoexcessivelengthstoobtainnurturanceandsupportfromothers

– MMPI-2-RF:LowAGGR,NFC,IPP

• Hasdifficultyexpressingdisagreementwithothersbecauseoffearoflossofsupportorapproval

– MMPI-2-RF:LowAGGR;highNEGE,RC7,SHY,IPP

• Feelingsofinadequacy– MMPI-2-RF:LowAGGR;highNEGE,SFD

• Feelsuncomfortableorhelplesswhenalone;isunrealis>callypreoccupiedwithfearsofbeinglertotakecareofhimselforherself

– MMPI-2-RF:NEGE,RC7,HLP,NFC,BRF

• LookforIntroversionindicators(INTR)aspoten>alfordifferen>aldiagnosisforAvPD• Emo>onalindicators,suchasEID,RCdarelikelytobecommonaswell

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Diagnos>cCriteriafor301.4Obsessive-CompulsivePersonalityDisorder

Apervasivepa^ernofpreoccupa>onwithorderliness,perfec>onism,andmentalandinterpersonalcontrol,attheexpenseofflexibility,openness,andefficiency,beginningbyearlyadulthoodandpresentinavarietyofcontexts,asindicatedbyfour(ormore)ofthefollowing:

– Preoccupiedwithdetails,rules,lists,order,organiza>on,orschedulestotheextentthatthemajorpointoftheac>vityislost– Showsperfec>onismthatinterfereswithtaskcomple>on(e.g.,isunabletocompleteaprojectbecausehisorherownoverlystrictstandardsarenotmet)– Excessivelydevotedtoworkandproduc>vitytotheexclusionofleisureac>vi>esandfriendships(notaccountedforbyobviouseconomicnecessity)– Overconscien>ous,scrupulous,andinflexibleaboutma^ersofmorality,ethics,orvalues(notaccountedforbyculturalorreligiousiden>fica>on)– Unabletodiscardworn-outorworthlessobjectsevenwhentheyhavenosen>mentalvalue– Reluctanttodelegatetasksortoworkwithothersunlesstheysubmittoexactlyhisorherwayofdoingthings– Adoptsamiserlyspendingstyletowardbothselfandothers;moneyisviewedassomethingtobehoardedforfuturecatastrophes– Showsrigidityandstubbornness

Obsessive-CompulsivePersonalityDisorder“Apervasivepa;ernofpreoccupa3onwithorderliness,perfec3onism,andmentaland

interpersonalcontrol,attheexpenseofflexibility,openness,andefficiency…”

• Ispreoccupiedwithdetails,rules,lists,order,organiza>on,orschedulestotheextentthatthemajorpointoftheac>vityislost;Showsperfec>onismthatinterfereswithtaskcomple>on

– MMPI-2-RF:LowDISC,lowRC4,RC7,COG

• Isexcessivelydevotedtoworkandproduc>vitytotheexclusionofleisureac>vi>esandfriendships

– MMPI-2-RF:SAV,DSF

• Isoverconscien>ous,scrupulous,andinflexibleaboutma^ersofmorality,ethics,orvalues;Showsrigidityandstubbornness

– MMPI-2-RF:LowDISC,lowRC4;NEGE,RC7,NFC

• Isunabletodiscardworn-outorworthlessobjectsevenwhentheyhavenosen>mentalvalue;Adoptsamiserlyspendingstyletowardbothselfandothers;Moneyisviewedassomethingtobehoardedforfuturecatastrophes

– MMPI-2-RF:RC7,NFC,STW

• Isreluctanttodelegatetasksortoworkwithothersunlesstheysubmittoexactlyhisorherwayofdoingthings

– MMPI-2-RF:NEGE,RC7,STW

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CASES

Case1• 40year-oldNZMaorimanseekingparole• Convictedofaggravatedmurderandaggravatedrobbery• Incarceratedfor19years

– Deniedparoleforpast9years

• Longhistoryofseverejuveniledelinquency• Numerousformalcita>onsformisconductinprison• Completedseveralprograms• Improvedoverthepast5years

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Case2

• 30yearoldWhitewomanchargedwithaDUI• Hitanothervehicleanddroveaway• Significanthistoryofphysicalandsexualabuse

– Biologicalfather(physical),stepfather(both)• Unstableroman>crela>onshiphistory

– Reportsbisexual;threeofherpreviousrela>onships,menandwomen,were“trueloves”

• Neverheldajobforlongerthantwoyears• Significantsuicidalidea>on,a^empts,andhospitaliza>onssince

age11– Ini>allyinresponsetosexualabuse

• Extensivealcoholandmarijuanausehistorysinceage18• Fourpreviousconvic>onsofDUI

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Thankyou!

QUESTIONS?

Dr.Mar>nSellbommsellbom@psy.otago.ac.nz