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12.5: Personality Disorders

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    Learning Objectives

    1. Categorize the different types of personality disorders and differentiate antisocial personality disorder from borderline personality disorder.
    2. Outline the biological and environmental factors that may contribute to a person developing a personality disorder.

    To this point in the chapter we have considered the psychological disorders that fall on Axis I of the Diagnostic and Statistical Manual of Mental Disorders (DSM) categorization system. In comparison to the Axis I disorders, which may frequently be severe and dysfunctional and are often brought on by stress, the disorders that fall on Axis II are longer-term disorders that are less likely to be severely incapacitating. Axis II consists primarily of personality disorders. A personality disorder is a disorder characterized by inflexible patterns of thinking, feeling, or relating to others that cause problems in personal, social, and work situations. Personality disorders tend to emerge during late childhood or adolescence and usually continue throughout adulthood (Widiger, 2006). The disorders can be problematic for the people who have them, but they are less likely to bring people to a therapist for treatment than are Axis I disorders.

    The personality disorders are summarized in Table 12.6 “Descriptions of the Personality Disorders (Axis II)”. They are categorized into three types: those characterized by odd or eccentric behavior, those characterized by dramatic or erratic behavior, and those characterized by anxious or inhibited behavior. As you consider the personality types described in Table 12.6 “Descriptions of the Personality Disorders (Axis II)”, I’m sure you’ll think of people that you know who have each of these traits, at least to some degree. Probably you know someone who seems a bit suspicious and paranoid, who feels that other people are always “ganging up on him,” and who really doesn’t trust other people very much. Perhaps you know someone who fits the bill of being overly dramatic—the “drama queen” who is always raising a stir and whose emotions seem to turn everything into a big deal. Or you might have a friend who is overly dependent on others and can’t seem to get a life of her own.

    The personality traits that make up the personality disorders are common—we see them in the people whom we interact with every day—yet they may become problematic when they are rigid, overused, or interfere with everyday behavior (Lynam & Widiger, 2001). What is perhaps common to all the disorders is the person’s inability to accurately understand and be sensitive to the motives and needs of the people around them.

    Table 12.6 Descriptions of the Personality Disorders (Axis II)

    Cluster Personality disorder Characteristics
    A. Odd/eccentric Schizotypal Peculiar or eccentric manners of speaking or dressing. Strange beliefs. “Magical thinking” such as belief in ESP or telepathy. Difficulty forming relationships. May react oddly in conversation, not respond, or talk to self. Speech elaborate or difficult to follow. (Possibly a mild form of schizophrenia.)
    Paranoid Distrust in others, suspicion that people have sinister motives. Apt to challenge the loyalties of friends and read hostile intentions into others’ actions. Prone to anger and aggressive outbursts but otherwise emotionally cold. Often jealous, guarded, secretive, overly serious.
    Schizoid Extreme introversion and withdrawal from relationships. Prefers to be alone, little interest in others. Humorless, distant, often absorbed with own thoughts and feelings, a daydreamer. Fearful of closeness, with poor social skills, often seen as a “loner.”
    B. Dramatic/erratic Antisocial Impoverished moral sense or “conscience.” History of deception, crime, legal problems, impulsive and aggressive or violent behavior. Little emotional empathy or remorse for hurting others. Manipulative, careless, callous. At high risk for substance abuse and alcoholism.
    Borderline Unstable moods and intense, stormy personal relationships. Frequent mood changes and anger, unpredictable impulses. Self-mutilation or suicidal threats or gestures to get attention or manipulate others. Self-image fluctuation and a tendency to see others as “all good” or “all bad.”
    Histrionic Constant attention seeking. Grandiose language, provocative dress, exaggerated illnesses, all to gain attention. Believes that everyone loves him. Emotional, lively, overly dramatic, enthusiastic, and excessively flirtatious.
    Narcissistic Inflated sense of self-importance, absorbed by fantasies of self and success. Exaggerates own achievement, assumes others will recognize they are superior. Good first impressions but poor longer-term relationships. Exploitative of others.
    C. Anxious/inhibited Avoidant Socially anxious and uncomfortable unless he or she is confident of being liked. In contrast with schizoid person, yearns for social contact. Fears criticism and worries about being embarrassed in front of others. Avoids social situations due to fear of rejection.
    Dependent Submissive, dependent, requiring excessive approval, reassurance, and advice. Clings to people and fears losing them. Lacking self-confidence. Uncomfortable when alone. May be devastated by end of close relationship or suicidal if breakup is threatened.
    Obsessive-compulsive Conscientious, orderly, perfectionist. Excessive need to do everything “right.” Inflexibly high standards and caution can interfere with his or her productivity. Fear of errors can make this person strict and controlling. Poor expression of emotions. (Not the same as obsessive-compulsive disorder.)

    Source: American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., text rev.). Washington, DC: Author.