2.7 Personality Disorders

Summary: Core Features of Personality Disorders

Personality disorders involve enduring patterns of behavior, emotion, and thought that deviate from cultural expectations and cause difficulties in various areas of life. Below are the four core features common to all personality disorders:

1. Distorted Thinking Patterns

• Individuals interpret themselves and the world in extreme or distorted ways.

• Examples include:

  • Black-or-white thinking.

  • Idealizing and then devaluing others.

  • Suspicious and distrustful thoughts.

  • Odd or culturally inappropriate beliefs.

2. Problematic Emotional Responses

• Emotional responses are inflexible and extreme, leading to issues such as:

  • Emotional sensitivity and intensity.

  • Emotional numbness or detachment.

  • Inconsistent regulation of emotions (over-regulated or under-regulated).

• Healthy personalities show flexibility and appropriateness in emotional expression based on the situation.

3. Over or Under-Regulated Impulse Control

• Problems manifest as:

  • Over-control: Inhibition, avoidance of risk, excessive conscientiousness.

  • Under-control: Recklessness, risky behaviors, drug use, or self-injury.

• Healthy personalities balance impulse control, adapting to circumstances.

4. Interpersonal Difficulties

• Relationships are significantly impacted due to issues with thoughts, emotions, and behaviors.

• Experts categorize interpersonal dynamics along two dimensions:

  • Need for Power (Y-axis): Dominance ↔ Submission.

  • Need for Relationship (X-axis): Affiliation ↔ Detachment.

• Healthy personalities adjust their interpersonal approach based on context, displaying flexibility.

Key Notes on Diagnosis

• To diagnose a personality disorder, significant and enduring difficulties must be evident in at least two of the four core areas.

• Personality disorders are rarely diagnosed in children because they must represent enduring patterns over time.

Exam Preparation Tips

Focus on understanding the following:

1. The four core features and how they present.

2. The differences between healthy and disordered patterns of thought, emotion, impulse control, and interpersonal relationships.

3. The need for flexibility as a hallmark of a healthy personality.

4. How personality disorders impact relationships through the power and relationship dimensions.

5. Diagnostic criteria, particularly the requirement for enduring issues in at least two areas.

Clusters of Personality Disorders

1. Cluster A (Odd, Eccentric):

   • Key Traits: Social awkwardness, withdrawal, distorted thinking.

   • Disorders:

     • Paranoid Personality Disorder:

       • Persistent mistrust and suspicion of others without evidence.

       • Traits: Aloof, emotionally distant, sarcastic, unable to accept criticism.

       • Possible causes: Childhood humiliation, parental rage, or genetic factors.

     • Schizoid Personality Disorder:

       • Detachment from social relationships and restricted emotional expression.

       • Traits: Lack of desire for relationships, emotional constriction.

       • Rarely seek treatment unless for associated issues (e.g., depression).

     • Schizotypal Personality Disorder:

       • Social discomfort, cognitive distortions, and eccentric behavior.

       • Traits: Ideas of reference, peculiar behavior, potential link to schizophrenia.

2. Cluster B (Dramatic, Emotional, Erratic):

   • Key Traits: Impulse control issues, emotional dysregulation.

   • Disorders:

     • Borderline Personality Disorder:

       • Instability in relationships, self-image, and emotions.

       • Traits: Splitting (idealizing or devaluing others), impulsivity, rage.

       • Challenges for clinicians due to attachment-related maladaptive behaviors.

     • Narcissistic Personality Disorder:

       • Grandiosity, need for admiration, lack of empathy.

       • Traits: Vulnerable self-esteem, rage or depression when slighted.

       • Seeks clinical help due to depression after failures or rejections.

     • Histrionic Personality Disorder:

       • Excessive emotionality and attention-seeking behavior.

       • Traits: Dramatic, seductive, focus on being fetching rather than forming intimate connections.

     • Antisocial Personality Disorder:

       • Disregard for others' rights, lack of guilt or remorse.

       • Traits: Impulsive, manipulative, often engage in criminal behavior.

3. Cluster C (Anxious, Fearful):

   • Key Traits: High anxiety levels, need for control or reassurance.

   • Disorders:

     • Avoidant Personality Disorder:

       • Social inhibition and hypersensitivity to criticism.

       • Traits: Fear of rejection, limited social circle, low self-esteem.

     • Dependent Personality Disorder:

       • Excessive need to be cared for, fear of separation.

       • Traits: Clinging, reliance on others, difficulty making decisions.

       • Must consider cultural context and differentiate from learned dependence (e.g., due to abuse).

     • Obsessive-Compulsive Personality Disorder:

       • Preoccupation with orderliness, perfectionism, control.

       • Traits: Inflexibility, inefficiency due to focus on details, emotionally cold.

       • Differs from OCD, which involves rituals and intrusive thoughts.