PERSONALITY DISORDERS:Paranoid Personality, Schizoid Personality, The Diagnosis

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Abnormal Psychology PSY404

Lesson 35

PERSONALITY DISORDERS

Personality refers to enduring patterns of thinking and behavior that define the person and distinguish

him or her from other people.

These enduring patterns are ways of expressing emotion as well as patterns of thinking about ourselves

and other people. When enduring patterns of behavior and emotion bring the person into repeated

conflicts with others, and when they prevent the person from maintaining close relationships with

others, an individual's personality may be considered disordered. Personality disorders are among the

most controversial categories in the diagnostic system for mental disorders.

1- They are difficult to identify reliably, their etiology is poorly understood, and there is relatively little

evidence to indicate that they can be treated successfully.

2- Although they are difficult to define and measure, but personality disorders are important in the field

of psychopathology.

Several observations support this argument.

· First, personality disorders are associated with significant social and occupational impairment.

· Second, the presence of pathological personality traits during adolescence is associated with an

increased risk for the subsequent development of other mental disorders.

· Third, in some cases, personality disorders actually represent the beginning stages of the onset of a

more serious form of psychopathology.

· Fourth, the presence of a co-morbid personality disorder can interfere with the treatment of a

disorder such as depression.

· The specific symptoms that are used to define personality disorders represent maladaptive

variations in several of the building blocks of personality.

· These include

1- Motives

2- Cognitive perspectives regarding the self and others

3- Temperament and personality traits.

· The authors of DSM-IV-TR have organized ten specific forms of personality disorder into three

clusters on the basis of broadly defined characteristics.

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The behavior of people who fit the subtypes in cluster A is typically odd, eccentric, or asocial. All

three types share similarity with the symptoms of schizophrenia.

The close association with schizophrenia, they are sometimes called schizophrenia spectrum disorders.

1- Paranoid Personality

· Paranoid personality disorder is characterized by the pervasive tendency to be inappropriately

suspicious of other people's motives and behaviors.

· Paranoid people do not trust anyone; they have trouble maintaining relationships with friends and

family members.

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Example

Client A was frequently complaining about her boss, co-workers, teachers, father and friends. She

watched everyone closely, did not accept food or medicine from anyone for the fear that it would

contain poison. She did not go out with friends and co-workers that they might kill her.

2- Schizoid Personality

· Schizoid personality disorder is defined in terms of a pervasive pattern of indifference to other

people, coupled with a diminished range of emotional experience and expression.

· These people are loners; they prefer social isolation to interactions with friends or family.

Example

Client B would follow her class mates to school but would hurry back to her hostel room where she

would stay alone most of the time and was completely uninterested in others.

3- Schizotypal Personality

Schizotypal personality disorder centers on peculiar patterns of behavior rather than on the

emotional restriction and social withdrawal that are associated with schizoid personality disorder.

People with this disorder may report bizarre fantasies and unusual perceptual experiences.

Example

Client A was a young man with vague complaints of stuttering, feeling of indifference towards one's

self and wanted to study stars. He had peculiar, odd language and perceptual experiences.

The cluster B includes Antisocial, Borderline, Histrionic, and Narcissistic Personality

disorders.

According to DSM-IV-TR, the cluster B disorders are characterized by dramatic, emotional, or erratic

behavior, and all are associated with marked difficulty in sustaining interpersonal relationships.

4- Antisocial Personality

Antisocial personality disorder is defined in terms of a persistent pattern of irresponsible and antisocial

behavior that begins during childhood or adolescence and continues into the adult years.

The pattern shows disregard for, and violation of the rights of others.

Once the person has become an adult, these difficulties include persistent failure to perform

responsibilities that are associated with occupational and family roles.

Example

Client D is a young man who has just knocked out a man with his beer bottle because he thinks that he

was insulted.

The same client has history of being kicked out of school, fighting with neighbors and he does what

pleases him not what is right or wrong.

5- Borderline Personality

· Borderline personality disorder is a diffuse category whose essential feature is a pervasive

pattern of instability in mood and interpersonal relationships.

· People with this disorder find it very difficult to be alone.

· They form intense, unstable relationships with other people and are often seen by others as

being manipulative.

Example

Client C is a man who has been thrown out of his father's house because of bad temper and

undependability. He is depressed to the point of suicidal feelings.

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6- Histrionic personality

· Histrionic personality disorder is characterized by a pervasive pattern of excessive emotionality

and attention seeking behavior.

· People with this disorder thrive on being the center of attention and they want the spotlight on

them at all times.

· They are self-centered, vain, and demanding, and they constantly seek approval from others.

Example

Client C is an attractive woman with a lovely smile used by her to get the attention of people. Her habit

of trying to be the centre of attention is annoying to others. She is moody and seemed to over-

dramatize minor problems.

7- Narcissistic Personality

· The essential feature of narcissistic personality disorder is a pervasive pattern of grandiosity,

need for admiration, and inability to empathize with other people.

· Narcissistic people have a greatly exaggerated sense of their own importance.

· They are preoccupied with their own achievements and abilities.

Example

Client D is a lawyer of outward charm and good looks who has won the bar elections. He has written

books and has a media following. He is a man preoccupied by appearance, wealth, power and fame.

8- Avoidant Personality

· Avoidant personality disorder is characterized by a pervasive pattern of social discomfort, fear

of negative evaluation, and timidity.

· People with this disorder tend to be socially isolated when they are outside their own family

circle because they are afraid of criticism.

Example

Client D is a woman who has taken a job in night shift where she can have minimal contact. Off duty

she spends time alone, worrying less that she may behave stupidly.

9- Dependent Personality

· The essential feature of dependent personality disorder is a pervasive pattern of submissive and

clinging behavior.

· People with this disorder are afraid of separating from other people on whom they are

dependent for advice and reassurance.

· Often unable to make everyday decisions on their own, they feel anxious and helpless when

they are alone.

Example

Client A has lacked self confidence since childhood, relying on her mother to choose what to wear,

what friends to have, which courses and classes to study.

10- ObsessiveCompulsive Personality

· Obsessivecompulsive personality disorder (OCPD) is defined by a pervasive pattern of

orderliness, perfectionism, and mental and interpersonal control, at the expense of flexibility,

openness, and efficiency.

· People with this disorder set ambitious standards for their own performance that frequently are

so high as to be unattainable.

· The central features of this disorder may involve a marked need for control and lack of

tolerance for uncertainty.

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Obsessivecompulsive personality disorder should not be confused with obsessivecompulsive

disorder (OCD), a type of anxiety disorder. A pattern of intrusive, unwanted thoughts

accompanied by ritualistic behaviors is used to define OCD. The definition of obsessive

compulsive personality disorder, in contrast, is concerned with personality traits, such as

excessively high levels of conscientiousness.

Example

Client A has a reputation of being careful and conscientious and careful.

He works long hours and brings a lot of money to the firm but he is humorless but takes a lot time in

procedural details in staff meetings.

The common element in all three disorders is presumably anxiety or fearfulness.

This description fits most easily with the avoidant and dependent types. In contrast, obsessive

compulsive personality disorder is more accurately described in terms of preoccupation with rules and

with lack of emotional warmth than in terms of anxiety. Like people with avoidant personality disorder,

they are easily hurt by criticism, extremely sensitive to disapproval, and lacking in self confidence. One

difference between them is that people who are avoidant have trouble initiating a relationship (because

they are fearful). People who are dependent have trouble being alone or separating from other people

with whom they already have a close relationship.

The Diagnosis

The diagnosis of Personality Disorders is not an easy and simple task because

1-There are a lot of people with serious personality problems who do not fit the official DSM-IV-TR

subtypes.

2-Another frequent complaint about the description of personality disorders is the considerable overlap

among categories.

3-Many patients meet the criteria for more than one type.

Thus, for diagnosis of personality disorders many experts favor the proposal to use the five-factor

model of personality as the basic structure for a comprehensive description of personality

problems.

4-There is also extensive overlap between personality disorders and disorders that are diagnosed on

Axis I of DSM-IV-TR.

Approximately 75 percent of people who qualify for a diagnosis on Axis II also meet criteria for a

syndrome such as major depression, substance dependence, or an anxiety disorder.

Gender Differences

The overall prevalence of personality disorders is approximately equal in men and women.

Antisocial personality disorder is unquestionably much more common among men than among women.

Almost nothing is known about the extent of potential gender differences for the other types of

personality disorder.

Borderline personality disorder and dependent personality disorder may be somewhat more prevalent

among women than men, but the evidence is not strong.

Stability of Personality Disorders over Time

Temporal stability is one of the most important assumptions about personality disorders.

Evidence for the assumption that personality disorders appear during adolescence and persist into

adulthood has, until recently, been limited primarily to antisocial personality disorder.

The rate of personality disorders was relatively high in this sample: Seventeen percent of the

adolescents received a diagnosis of at least one personality disorder.

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Viewed from a dimensional perspective, the maladaptive traits that represent the core features of the

disorders remained relatively stable between adolescence and young adulthood.

Several studies have examined the stability of personality disorders among people who have received

professional treatment for their problems, especially those who have been hospitalized for schizotypal

or borderline disorders.

Recovery rates are relatively high among patients with a diagnosis of borderline personality disorder.

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