1. Personality Disorders
• Personality Disorders refer to long-standing,
pervasive and inflexible patterns of behavior
– Depart from cultural expectations
– Impair social and occupational functioning
– Cause emotional distress
• Personality disorders are coded on Axis II of the
DSM
– Personality disorders can be a co-morbid condition for
an Axis I disorder
Ch 13.1

2. Personality Disorders: Facts and
Statistics
• Prevalence of Personality Disorders
– About 0.5% to 2.5% of the general population
– Rates are higher in inpatient and outpatient settings
• Origins and Course of Personality Disorders
– Thought to begin in childhood
– Tend to run a chronic course if untreated
• Co-Morbidity Rates are High
• Gender Distribution and Gender Bias in Diagnosis
– Gender bias exists in the diagnosis of personality disorders
– Such bias may be a result of criterion or assessment gender bias

3. Personality Disorder Clusters
• Personality disorders fall into three general
clusters:
– Persons in cluster A seem odd or eccentric
• Paranoid, schizoid, schizotypal
– Persons in cluster B seem dramatic, emotional
or erratic
• Antisocial, borderline, histrionic, narcissistic
– Persons in cluster C appear as anxious or
fearful
• Avoidant, dependent, obsessive-compulsive
Ch 13.2

4. Odd/Eccentric Cluster
• Paranoid personality disorder (PD) involves
suspicion of others, hostility, jealousy
– No hallucinations and no full-blown delusions
are present in paranoid PD
• Paranoid PD occurs more frequently in men
than in women
• Lifetime prevalence is about 1 percent
Ch 13.3

5. Odd/Eccentric Cluster
• Schizoid personality disorder (PD) involves
– Reduced social relations and few friends
– Reduced sexual desire and few pleasurable
activities
– Indifference to praise or criticism
– Lonely life style
• Prevalence of schizoid PD is less than 1
percent and occurs more commonly in men
than women
Ch 13.4

6. Odd/Eccentric Cluster
• Schizotypal personality disorder (PD) involves
– An attenuated form of schizophrenia
• Odd beliefs and magical thinking
• Recurrent illusions (things not present)
• Ideas of reference (hidden meaning)
• Behavior and appearance is eccentric
• Prevalence of schizotypal PD is about 3 percent
and occurs slightly more commonly in men than
women
Ch 13.5

7. Paranoid Personality
Disorder
Pervasive distrust and suspiciousness, sees
motives of others as malevolent. Four or more of
the following:
(1) suspects, without sufficient basis, that others
are exploiting, harming, or deceiving him or her
(2) preoccupied with unjustified doubts about the
loyalty or trustworthiness of friends or associates
(3) reluctant to confide in others b/c lack of trust

8. (4) persistently bears grudges, i.e., is
unforgiving of insults, injuries, or slights
(5) reads hidden demeaning or
threatening meanings into benign
remarks/events
(6) Perceives attacks on character or
reputation that are not apparent to
others and responds with
counterattacks
(7) has recurrent suspicions, without
justification, regarding fidelity of spouse
or sexual partner

9. Characteristics of Paranoid
Personality Disorder
•Aloof, emotionally cold
•Unjustified suspiciousness, hostility
•Hypersensitivity to slights, jealousy
•Rigid, unforgiving, sarcastic, litigious
•Prevalence: 1-2%; M>F
•Therapy, including meds, of little value – trusting
relationship is key but hard to come by b/o ‘self-
fulfilling prophecy’

10. Schizoid Personality
Disorder
Pervasive detachment from social
relationships and a restricted range of
emotional expression interpersonally.
Four or more of the following:
(1) neither desires nor enjoys close
relationships, including being part of a
family
(2) almost always chooses solitary
activities

11. (3) little interest in having sexual
experiences with another person
(4) takes pleasure in few, if any,
activities
(5) lacks close friends or
confidants
(6) appears indifferent to the
praise or criticism of others
(7) emotionally cold, detached

12. Characteristics of Schizoid
Personality Disorder
•Can perform well in solitary activities (computers, night
watchman)
•Limited emotional range, detached, daydream a lot
•NO increased risk for schizophrenia but many may
actually suffer from autism-spectrum disease
•“Loners” not necessarily schizoid, unless functioning
impaired (traits vs disorder)
•Treatment of little help
•Prevalence 2%; M>F

13. Schizotypal Personality
Disorder
(diagnostic criteria)
Little capacity for close relationships
accompanied by cognitive or perceptual
disturbances and eccentricities of behavior
(1) ideas of reference
(2) odd beliefs or magical thinking, inconsistent
with cultural norms
(3) unusual perceptual experiences, including
bodily illusions

14. (4) odd thinking and speech (e.g.,vague,
circumstantial,metaphorical,over
elaborate)
(5) suspiciousness or paranoid ideation
(6) inappropriate or constricted affect
(7) behavior or appearance that is odd,
eccentric, or peculiar
(8) lack of close friends or confidants
(9) excessive social anxiety r/t paranoid
fears

15. Characteristics of Schizotypal
Personality Disorder
•Isolated, anhedonic, aloof but also “peculiar”
•Strange intra-psychic experiences, odd and
magical beliefs
•Reason in odd ways (ideas of reference)
•Anxious, detached
•NOT psychotic proportions
•3% incidence; M=F

16. Etiology of the Odd/Eccentric
Cluster
• These disorders are linked to schizophrenia and
may represent a less severe form of the disorder
– Schizophrenia has clear genetic determinants
– Family studies reveal that relatives of schizophrenic
patients are at increased risk for developing schizotypal
PD as well as paranoid PD
• No clear pattern for schizoid PD
• Additional similarities for Schizotypal PD
– Have cognitive and neuropsychological problems
similar to those found in individuals with schizophrenia.
– Have enlarged ventricles and less temporal lobe gray
matter.
Ch 13.6

17. Dramatic/Erratic Cluster
• Borderline personality disorder (PD) involves
– Impulsivity (gambling, spending, sexual sprees)
– Instability in relationships, mood and self-image
– Borderline PD persons are argumentative and difficult
to live with
• Prevalence of Borderline PD is about 1-2 percent
and occurs more commonly in women than men
• Linehan’s diathesis-stress theory
– Difficulty controlling emotions (biological diathesis)
– Raised in “invalidating” family environment
Ch 13.7

18. Figure 13.1 Linehan’s Diathesis-Stress theory:
Etiology of borderline personality disorder
•Emotional dysregulation in child (diathesis) and a failure to
validate the child’s feelings by the parents (stress) leads to a
vicious cycle.
–The emotional dysregulation may be inadvertently
reinforced by parents if it becomes one of the only times the
child receives parental attention.

19. •
Etiologyplay aAntisocial PDof
Family issues may
of role in the development
antisocial PD
– Lack of affection
– Severe parental rejection
– Inconsistent (or no) discipline
• Twin studies show a greater concordance for antisocial PD
in MZ twins relative to DZ twins
• Adoption studies (e.g., Cadoret et al., 1995)
– Adverse adoptive environment may be the stressor triggering the
ASPD biological diathesis
• Psychopaths
– Have reduced gray matter in frontal lobes
– Perform more poorly on tests of frontal lobe functioning
– These findings are supportive of a key role for impulsivity in
psychopathy
Ch 13.11

20. Cluster B: Antisocial
Personality Disorder
Figure 12.2 Barlow/Durand, 3rd. Edition
Overlap and lack of overlap among antisocial personality disorder, psychopathy, and criminality

21. Dimensional Approach to Personality
Disorders
• Five-Factor Model (McRae & Costa, 1990)
– Neuroticism
– Extroversion/introversion
– Openness to experience
– Agreeableness/antagonism
– Conscientiousness
• Relationship of PDs to FFM (Widiger & Costa, 1994)
• Advantages of dimensional model
– Handles the comorbidity problem
– Makes a link between normal and abnormal personality
– Supported by behavior-genetic and statistical techniques

22. Therapies for Personality
Disorders
• Therapists treating PD patients are concerned about co-
morbid Axis I disorders
• Therapy modalities include:
– Antianxiety or antidepressant drugs
– Psychodynamic therapy aims to change the person’s
understanding of the childhood problems that underlie the PD
– Behavioral and cognitive therapy focuses on specific symptoms
and issues (e.g. social skills)
• Overall therapeutic goal: change the “disorder’ into a
“style”, except for ASPD (D&N, p.377)
– Recent meta-analysis show promising results with CBT for
younger psychopaths.
Ch 13.15

23. Complications:
1- depression
2- anxiety
3- schizophrenia
4- substance abuse.