Personality Disorders

Assessment & Diagnosis

SW 593

Introduction These disorders are listed on Axis II. Refers to a pervasive, persistent, relatively

inflexible personality trait that leads to functional impairment or subjective distress.

The pattern in question should be stable across a broad range of situations, be established by early adulthood, and not be due to another Axis I disorder, general medical condition, or substance usage.

Introduction Clinicians are encouraged to be extremely

circumspect in applying these labels with young people.

Problematic personality traits exhibited in early years will often not persist into adulthood.

In any event, for these diagnoses to be applied to persons under the age of 18, the behaviors need to have been present for at least one year.

Introduction Diagnoses are divided into three “clusters” based

on similarities in symptom presentation. Cluster A: odd and eccentric Cluster B: dramatic and emotional Cluster C: fearful and anxious

An individual warranting a diagnosis of a particular personality disorder will exhibit traits related to other diagnoses within the same cluster.

Introduction An individual may exhibit a grouping of

traits related to a particular cluster of personality disorders without fully meeting any specific diagnosis.

Clinicians may simply list such personality traits on Axis II, particularly if their presence is deemed to have relevance to treating a coexisting Axis I disorder.

Cluster A Refers to a pattern of behavior that is

generally viewed as odd or eccentric. Tend to isolate themselves and/or be

suspicious. Pattern of social isolation can be traced into

childhood. Seldom seek treatment.

Paranoid Pervasive mistrust and/or suspiciousness of

others. They may suspect others of having malevolent

motives; Be preoccupied with concerns about others; Be reluctant to confide in others; Be extremely sensitive to perceived criticisms

and/or bear grudges against others.

Schizoid Characterized by a general detachment

from social relationships. Restricted range of emotional expressions. Consistently prefer isolation to social

relationships, generally have few interests. Seldom engage in intimate relationships. Described as cold or emotionless.

Schizotypal Restricted interpersonal relationships Marked peculiarities in thinking and

perception. Similar but not as severe as one diagnosed

with schizophrenia. Ideas of reference vs. delusions of

reference.

Cluster B A pattern of behavior that is viewed as

dramatic or emotional. Often display erratic or impulsive behaviors. There is generally a marked self-absorption

that results in a diminished capacity for empathy.

Antisocial This diagnosis is not given to clients under the

age of 18. Usually engage in illegal activities; Routinely practice deceit; Often aggressive and violent; Typically irresponsible Generally ignore the rights and feelings of others. Rarely show remorse

Borderline Typically demonstrate erratic interpersonal

relationships; Fluctuating self-image and/or affect; Marked impulsivity. Frequently engage in suicidal or self-

mutilating behaviors. Noted for extremes in affect and in

judgment.

Borderline They rarely see themselves or others in a

balanced way. These clients are the most likely of people

with personality disorders to seek treatment.

Histrionic Characterized by emotionality and attention

seeking. Are only comfortable when they are the

“center of attention”. Will use physical appearance, speech, and

emotions to command others’ attention.

Narcissistic A grandiose sense of self-importance; A need for attention A reduced capacity for empathy Often seem to have an exaggerated sense

of entitlement; Expect to be admired and obeyed by others. Usually seeks treatment when frustrated by

others.

Cluster C Includes patterns of behaviors that are

essentially fearful and/or anxious. Tend to be perfectionistic or rigid in

standards or expectations for themselves or others.

Relatively unlikely to seek treatment.

Avoidant Demonstrate marked feelings of inadequacy that

are associated with hypersensitivity to negative feedback and/or social inhibition.

Seldom put themselves in “risky” or even new situations in which they may perform poorly.

Seldom develop intimate interpersonal relationships.

May constrain occupational choices based on fear of negative judgments.

Dependent Seek someone to take care of them, even

to the extent of being submissive, clinging, and fearful of separation.

Avoid decisive action and encourage others to make decisions for them.

Subservience makes it quite difficult to express disagreement, even when asked to undertake unpleasant activities.

Dependent Fear being alone and quickly substitute a

new relationship if an old one is lost. They systematically underestimate

themselves and their ability to function independently.

Obsessive-Compulsive Have well-controlled perfectionistic patterns of

behavior at the expense of spontaneity, flexibility, and even efficiency.

There is often such preoccupation with planning and details that tasks are not completed.

Difficulty delegating responsibilities and tend to work long hours in order to meet their own standards regarding productivity.

Obsessive-Compulsive Tend to collect and hoard things even when

those things have little value. Unlike obsessive-compulsive disorder,

individuals with OCPD do not necessarily have obsessions or compulsions.

Tendency is to be rigid in their actions and thinking, adhering to strict and controlled patterns of thought and behaviors.

Assessment Detailed and thorough histories are necessary for

the diagnosis of a Personality Disorder. Often the level of detail needed to substantiate a

pattern of persistent and pervasive personality traits is not obtained when the clinical focus is on an Axis I mental disorder.

A number of psychometric tools are available: MMPI-2 Millon Clinical Multiaxial Inventory Coolidge Axis II Inventory

Cultural Considerations Judgments about persistent and pervasive

personality traits cannot be made without consideration of a person’s cultural background.

Always use caution!!!!!!!!!! Particular care should be exercised in

diagnosing members of a minority group with Paranoid Personality Disorder.

Cultural Considerations Men are much more likely to be diagnosed

with Antisocial PD. Women are much more likely to be

diagnosed with Borderline, Histrionic, and Dependent PD.