Personality D isorders John Oldham MD Past APA president member Personality Disorders Work Group 1 from the beginning of the development process for DSM5 the personality disorders were identified as a place where we needed to move beyond the categorical diagnostic system of d ID: 1036679
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1. Personality
2. Chapter 18: Personality DisordersJohn Oldham, M.D.Past APA president, member Personality Disorders Work Group1. “from the beginning of the development process for DSM-5, the personality disorders were identified as a place where we needed to move beyond the categorical diagnostic system of discrete disorders in DSM-IV toward a more dimensional system”2. “personality types, traits, and disorders are on a continuous spectrum, much like blood pressure and hypertension.3. “too much of a useful, adaptive trait may become a problem”2
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5. Everyone has personality Everyone has STUFF.That’s why we start with the personalitystuff, and we’ll add in other disorders as we go.
6. Kluckhorn and Murray’s 1950 model of personality Universal (We are all alike in some ways) Group (Everyone in my group is alike in some ways--but different from non-group) Individual (We are each unique in some ways)
7. Personality as a set of skillsEach style represents a skill to be able to take on a particular persona, assume a particular role, mask, or face. It’s important to have several of these from which to choose. Don’t need all of themGenetically, we are more comfortable taking on a subset of styles
8. Problems related to personality Failing to switch to a more role-appropriate style In a situation that calls for an extroverted role, you need to be able to do that
9. Problems related to personalityProblem 1: Lack of available styles (lack of personality skill sets)Problem 2: Inflexibilityunwillingness or inability to move out of a specific style
10. Personality DifferentiationCategorical ModelpregnantDescriptivefrom DSM III onDimensional Model- tall/short- hypertension- Big 5Interpretive- assumes causes
11. Big 5 Personality DimensionsOpenness to ExperienceConscientiousnessExtraversionAgreeablenessNeuroticism
12. The Golden Mean of AristotleFalls equidistant between the extremesPreferred alternative to panicnot fearlessness, but prudence
13. Normalizing the MMPIScaleScale nameUnderlying DimensionNegativePositiveHsHypochondriasisconservationdependent, irritable, complaining, bodily preoccupationsconscientious, careful, considerate, sincereDDepressionevaluationcritical, anxious, depressed, pessimisticdeliberate, objective, contemplative, realisticHyHysteriaexpressiondenial, psychosomatic reactions, suggestible, overreactiveempathetic, responsive, sensitive, optimisticPdPsychopathic Devianceassertionhostile, manipulative, impulsive, antisocialenergetic, enterprising, venturesome, socialMfMasculinity-Femininityrole-flexibilityself-recrimination, sex-role deviancy, identity confusion, unconventionalcolorful, dilettante, interestingPaParanoiainquiringgrandiose, hypersensitive, suspicious, distrustfulinvestigative, curious, questioning, discriminatoryPtPsychastheniaorganizationrigid, compulsive, obsessive, ritualisticmethodical, systematic, convergent thinker, organizedScSchizophreniaimaginationbizarre, irrational, confused, idiosyncraticspontaneous, creative, imaginative, divergent thinkerMahypoManiazesthyper, ineffectual, disorganized, agitatedenthusiastic, eager, wholehearted, exuberantSiSocial Introversionautonomyreclusive, asocial, alienatedindependent, self-reliant, free lance
14. Ivey’s Developmental Personality Styles
15. Nancy McWilliams’ Developmental Dimensions of Personality
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17. Personality Style and Disorder Clusters Cluster A (overlap with psychotic disorders) Vigilant style & Paranoid personality disorder Solitary style & Schizoid personality disorder Idiosyncratic style & Schizotypal personality disorder Cluster B (overlap with depression and impulse-control disorders) Adventurous style & Antisocial personality disorder Mercurial style & Borderline personality disorder Dramatic style & Histrionic personality disorder Self-Confident style & Narcissistic personality disorder Cluster C (overlap with anxiety disorders) Sensitive style & Avoidant personality disorder Devoted style & Dependent personality disorder Conscientious style & Obsessive-compulsive personality disorder (Leisurely style & Passive Aggressive personality disorder) Others Aggressive style & Sadistic personality disorder Self-Sacrificing style & Self-Defeating personality disorder Serious style & Depressive personality disorder
18. National online NPSP Sample
19. DSM-5 criteria for Personality Disorders Diagnosis of a personality disorder must satisfy the following general criteria in addition to the specific criteria listed under the specific personality disorder under consideration. A. An enduring pattern of inner experience and behavior that deviates markedly from the expectations of the individual's culture. This pattern is manifested in two (or more) of the following areas: cognition (perception and interpretation of self, others and events) affectivity (the range, intensity, lability, and appropriateness of emotional response) interpersonal functioning impulse control B. The enduring pattern is inflexible and pervasive across a broad range of personal and social situations. C. The enduring pattern leads to clinically significant distress or impairment in social, occupational, or other important areas of functioning.D. The pattern is stable and of long duration and its onset can be traced back at least to adolescence or early adulthood. E. The enduring pattern is not better explained as a manifestation or consequence of another mental disorder. F. The enduring pattern is not attributable to the physiological effects of a substance (a drug of abuse, a medication) or another medical condition (e.g., head trauma).
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27. PRE890 Top Personality Styles2011200920072005ConscientiousConscientiousConscientiousConscientiousDramaticDramaticDramaticDramaticSeriousSeriousVigilantDevotedSensitiveSensitiveLeisurelySolitarySelf SacrificingDevotedSeriousSelf SacrificingVigilantSelf SacrificingSelf SacrificingLeisurely
28. NPSP for EPSY 890 2017
29. TK 2013
30. TK 2007
31. Personality Self Portrait Exercise1. List things about the personality style that you would consider STRENGTHS. For example, my highest score is on the Conscientious style, and some things about that style that come in handy include things like: Being capable of immense, single-minded effort. Whenever they commit to a task, they do the job completely and thoroughly. When a problem arises, they work tirelessly until it is solved. 2. List things about the personality style that, if unchecked, might get you into trouble. Again, going with the Conscientious style, things that might apply to me would include: Many Conscientious people find it difficult to relax and experience pleasure.They expect the same thoroughness and devotion from others, which may not always be appropriate. Sometimes lack skills required for top managerial positions such as making quick decisions, setting priorities, and delegating responsibility. 3. Finally, list things you might not do easily because of your style, but things you would do well to consider doing more of BECAUSE OF your style. For the Conscientious style, those might include: Concentrate on relaxing and enhancing your leisure time. When you have difficulty making a decision, always keep in mind that it often makes no difference which decision you make, as long as you do something. To manage your time more efficiently at work, aim for results that are good enough and not necessarily perfect.
32. Personality Self Portrait Exercise1. How does this style relate to others?2. How does this style go about achieving their goals?3. How does this style cope with stress? 4. What does this style look like at work?5. How should I best interact with this style at work? 6. What does this style look like in a close relationship?7. How should I best interact with this style in a close relationship? 8. As a therapist, how might I LIKE to respond to this personality disorder?9. How might I most therapeutically respond to this personality disorder? 10. What cultural / gender / age considerations might be relevant to this style?
33. At issue is not whether we attend to normal or abnormal, or that we focus on strengths or weaknesses, but that we tell the human story from a hopeful and instrumental perspective: even our inevitable failings can be accepted – integrated – managed – lived. We (counselors and counseling psychologists) present a perspective that allows – even demands – soul.TK.
34. The debate should not be about where the line is between normal and abnormal, not about the field’s focus on strengths vs. pathology, but on our commitment to embracing, in a hopeful and positive way, the whole of the human experience. TK