Disorders of Personality
• Chapter 19
LECTURE OUTLINE
• Building Blocks of Personality Disorders
• Concept of Disorder
• What is Abnormal?
• What is Personality Disorder?
• Culture, Age, Gender: Effect of Context
• Varieties of Personality Disorder
• Cluster A
• Cluster B
• Cluster C
• Prevalence of Personality Disorders
• Gender Differences in Personality Disorders
• DSM-5 Hybrid View of Personality Disorders
• Causes of Personality Disorders
Building Blocks of Personality Disorders
• Personality disorders:
• Maladaptive variations or combinations of normal personality traits
• Symptoms of PDs: maladaptive variations within domains of traits, emotions, cognitions,
motives, interpersonal behaviour and self-concept
• Disturbed or maladaptive social relationships
• Some PDs:
• Distortion in perception of other people and altered social cognition
• Several PDs:
• Maladaptive variations in common motives, esp. need for power and intimacy
• Extreme variations in experienced emotion
• Most PDs: some distortion in self-concept
• Biology forms building block of several personality disorders
• PDs can provide insight into normal workings of personality
Concept of Disorder
Psychological disorder:
• Pattern of behaviour or experience that is distressing and painful to person
• Leads to disability or impairment in important life domains
• Associated with increased risk of further suffering, loss of function, death or
confinement
Abnormal psychology/psychopathology:
• Study of mental disorders, including thought disorders, emotional disorders
and personality disorders
What Is Abnormal?
Statistical definition: Whatever is rare, not frequent
Social definition: Behaviours society deems unacceptable
Statistical and social definitions are tentative simply because society changes
Psychologists thus look within persons, inquiring about feelings and thoughts
Diagnostic and Statistical Manual of Widely accepted system for diagnosing and describing
Mental Disorders, 5th ed. (DSM-5): mental disorders
Personality disorders only small part of list of possible psychopathologies
What Is Personality Disorder?
DSM-5: Enduring and inflexible way of thinking and experiencing emotions that significantly and
negatively affects an individual’s daily functioning
Usually Thoughts, feelings
manifested in
more than one of How person gets along with others
following aspects:
Ability to control own behaviour
Pattern of Rigid and displayed across variety of situations, leading to distress in important areas in
behaviour: life
Typically has long history in person’s life
Must not be attributable to drug abuse, medication or or medical condition
Culture, Age and Gender: Effect of Context
Must consider person’s social, cultural and ethnic background before judging that
behaviour is symptom of personality disorder
Age and gender are also relevant to judgements about personality disorder
Varieties of Personality Disorder
DSM-5 lists 10 personality disorders, classified into three groups:
Cluster A Cluster B Cluster C
Odd and erratic Dramatic, emotional Anxious or fearful
A. Eccentric Cluster: Ways of Being Different
Mostly to do Schizoid: Extreme disinterest in others
with how person
interacts with
others
Schizotypal: Extreme discomfort with others
Paranoid: Extreme suspicion of others
Schizoid Personality Disorder
Some similarity with more severe schizophrenia
Detached/withdrawn from normal social relationships
Obtains little pleasure from bodily or sensory experiences
Appears inept or socially clumsy
Passive in face of unpleasant events
Can come across as eccentric
Schizotypal Personality Disorder
Anxious in social situations, not just indifferent like schizoid personality; withdraws completely
Suspicious/mistrust of others
Has odd or eccentric beliefs, such as in ESP or magic/special powers
May have unusual perceptions and experiences
Cognitively disorganized
Do not understand impact of their behaviour on others
Odd or rambling speech
Flat or limited emotional range
Paranoid Personality Disorder
Extremely distrustful of others
Misinterprets social events as threatening
Holds resentments towards others
Prone to pathological jealousy
Argumentative, quick to anger, hostile
Can develop depression, anxiety disorders
B. Dramatic or Emotional Cluster
Consists of four Antisocial
personality
disorders:
Borderline
Histrionic
Narcissistic
Antisocial Personality Disorder
Lack of conformity to social norms
Repeated lying
Impulsivity
Easily irritated and aggressive
Recklessness and irresponsibility
Lack of remorse
Antisocial personality disorder is similar to psychopathy but emphasises observable behaviours
rather than subjective characteristics
Antisocial term should only be used when behaviour pattern is indicative of dysfunction and not
simply response to immediate social context
Borderline Personality Disorder
Instability of relationships, emotions and self-image
Fears of abandonment
Aggressiveness
Self-mutilating behaviour
Shifting views of self
Strong emotions
Can experience stress-related paranoia and lose touch with reality for few minutes/hours
Histrionic Personality Disorder
Excessive attention seeking and emotionality
Sexually provocative
Opinions are shallow
Displays strong emotions in public
Suggestible, easily swayed
Strong need for attention, being center of attention
Fleeting moods, opinions, beliefs
Narcissistic Personality Disorder
Need to be admired
Strong sense of self-importance
Lack of insight into other people’s feelings or needs
Sense of entitlement and superiority
Self-esteem appears strong, but is fragile
Envious of others
Arrogant, boastful, pretentious
See others as inferior; belittle/have contempt for others
C. Anxious Cluster
Nervous, fearful or distressed
Patterns of behaviour focused on avoiding anxiety
Neurotic Although behaviour pattern solves one problem, it may create or
paradox: maintain another equally or more severe problem
Why/how?
Consists of: Avoidant
Dependent
Obsessive-compulsive
Avoidant Personality Disorder
Feelings of inadequacy
Nervousness, fearfulness
Hypersensitive to criticism, disapproval
Intense fear of humiliation, rejection
Restricts activities to avoid embarrassments
Avoids taking risks
Low self-esteem
Dependent Personality Disorder
Excessive need to be taken care of
Fear of being abandoned; can show clingingness
Acts in submissive ways
Seeks reassurance from others
Rarely takes initiative
Avoids disagreements
Lack of self-confidence
Does not work well independently
May tolerate extreme circumstances to obtain others’ reassurance and support
Frequently asks for reassurance
Obsessive–Compulsive Personality Disorder
Preoccupied with order
Strives for perfection
Devoted to work at expense of leisure and friendship
Inflexible about ethics and morals
Frequently miserly or stingy
Rigid, inflexible and stubborn
Often confused with obsessive–compulsive disorder
OCD is characterized by presence of ritualistic behaviours whilst OCPD involves collection of traits,
such as excessive need for order or extremely high conscientiousness
Prevalence of Personality Disorders
• Prevalence
• Total number of cases present in given population during specific period of time
• Global overall prevalence of any personality disorder: 7.8%
• Cluster A personality disorders relatively common in high-income countries (4.2%) and LMICs
(3.4%).
• Mattia and Zimmerman (2001)
• Obsessive–compulsive PD: most common (about 4% prevalence)
• Next most common: dependent, histrionic, schizotypal (about 2%)
• Narcissistic least common (about 0.2 per cent)
• Volkert et al. (2018)
• Prevalence of having at least one personality disorder is about 11-13%
• Oltmanns and Emery (2004)
• Comorbidity
• 25-50% of people who meet criteria for diagnosis on one personality disorder will also meet
criteria for diagnosis on another personality disorder
Prevalence of Personality Disorders
South Africa: Prevalence of Personality
Disorders
Gender Differences in Personality Disorders
Overall prevalence fairly equal in men and women
Oltmanns and Higher prevalence rate for antisocial personality disorder in men (4.5%)
Emery (2004) compared to women (0.8%)
Borderline and dependent disorders: may be somewhat more prevalent in women than men, but
evidence is not strong
Be aware of gender biases in diagnoses (e.g. criteria for dependent personality disorder are based
on feminine stereotypes, which makes it easier for women to meet criteria for this diagnosis)
Must consider gender biases in diagnoses, and how stereotypes affect diagnoses
DSM-5: Hybrid Model of Personality Disorders
Categorical view Either person does or does not have personality disorder
Disorders are viewed as distinct and qualitatively different from normal
extremes on each trait
Dimensional view PD seen as continuum ranging from normality to severe disability or
disturbance
Distinctions between normal personality traits & disorders are i.t.o. extremity,
rigidity and maladaptiveness
DSM-5: hybrid dimensional-categorical model for diagnosing PDs
Causes of Personality Disorders
Both biological and environmental factors can contribute to development of personality disorders
Genetic factors: Little role in borderline personality disorder
Bigger role in schizotypal personality disorder
But: most research is descriptive or correlational
So: evidence needs to be interpreted with caution
Something as complicated as human personality and its disorder has multiple causes