Week 1: Learning Goals
Lecture 1: Learning Objectives
1. To identify the characteristics of a personality disorder (PD)
A personality disorder – is (1) an enduring pattern of inner experience and behavior that (2)
deviates markedly from the expectations of the individual’s culture, (3) is pervasive and
inflexible, (4) has onset in adolescence – or early adulthood – is (5) stable over time and
leads to (6) distress or impairment
General Personality Disorder
Diagnostic Criteria 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: (1) cognition –
i.e., ways of perceiving and interpreting self, others, and events, (2) affectivity –
i.e., the range, intensity, lability, and appropriateness of emotional response, (3)
interpersonal functioning, and/or (4) impulse control
The enduring pattern is inflexible and pervasive across broad range of personal and
social situations
The enduring pattern leads to clinically sig distress or impairment in social,
occupational, or other important areas of functioning
The pattern is stable and of long duration – and its onset can be traced back at least
to adolescence or early adulthood
The enduring pattern is NOT better explained as a manifestation or consequences of
another mental disorder
The enduring pattern is NOT attributable to the physiological effects of a substance
– e.g., drug of abuse, medication – or another medical condition – e.g., head trauma
Development and Some types of PD – i.e., antisocial and borderline PDs – tend to become less
Course evident or remit with age
Other types – e.g., OCPD – do not remit with age
In order to diagnose PD in a person younger than 18yo – the features of PD must be
, present for at least 1 year
Antisocial PD cannot be diagnosed in individuals younger than 18yo
PDs may be exacerbated following (1) the loss of sig supporting persons such as a
spouse – or (2) the loss of previously stabilizing social situations such as a job
The development of a change in personality in middle adulthood to later life –
warrants careful evaluation to determine possible presence of PD due to another
medical condition – or unrecognized SUD
Gender-Related Careful not to over- or underdiagnose certain PDs in females or males due to social
Diagnostic Issues
stereotypes about typical gender roles and behaviors
Certain PDs – e.g., ASPD – are diagnosed more frequently in males
Others – e.g., BPD, histrionic, and dependent PD – are diagnosed more frequently in
females
Differential Diagnosis
Other Mental Disorders Many of the specific criteria for PDs describe features – e.g., suspiciousness,
and Personality
dependency, insensitivity – that are also characteristic of episodes of other mental
Traits
disorders
A PD should only be diagnosed when the defining characteristics (1) appeared
before early adulthood, (2) are typical of the individual’s long-term functioning,
and (3) do NOT occur exclusively during episode of another mental disorder
PDs must be distinguished from personality traits that do NOT reach the threshold
for a PD
Psychotic Disorders For the three PDs that may be related to psychotic disorders – i.e., paranoid,
schizoid, schizotypal – there is an exclusion criterion
The exclusion criterion states that the pattern of behavior must NOT have occurred
exclusively during the course of SZ, a bipolar or depressive disorder with psychotic
features, or another psychotic disorder
When one has a persistent mental disorder that was preceded by a preexisting PD –
the PD should also be recorded – followed by “premorbid” in parentheses
Anxiety Disorders Caution when diagnosis PDs during an episode of a depressive disorder or anxiety
disorder
These conditions may have cross-sectional symptom features that mimic
personality traits – and make it more difficult to evaluate retrospectively the
, individual’s long-term patterns of functioning
PTSD When personality changes emerge and persist after one has been exposed to
extreme stress – a diagnosis of PTSD should be considered
SUDs When one has a SUD – important NOT to make a PD diagnosis based solely on
behaviors that are (1) consequences of substance intoxication or withdrawal or (2)
are associated with activities in the service of sustaining substance use – e.g.,
antisocial behavior
Personality Change due When enduring changes in personality arise as a result of physiological effects of
to Another Medical
another medical condition – e.g., brain tumor – a diagnosis of personality change
Condition
due to another medical condition should be considered
2. To distinguish between personality traits vs. personality disorders
Personality Traits – are enduring patterns of (1) perceiving, (2) relating to, and (3) thinking
about the environment and oneself – exhibited in a wide range of social and personal
contexts
Only when personality traits are (1) inflexible, (2) maladaptive, and (3) persisting – and (4)
cause sig functional impairment or subjective distress – do they constitute personality
disorders
- Personality disorders must be distinguished from personality traits that do NOT
reach the threshold for a PD
3. To compare and distinguish the different PDs and their characteristics, including:
Cluster A Personality Disorders – Odd, Eccentric
PARANOID
Description A pattern of distrust and suspiciousness such that others’ motives are interpreted as
malevolent
Diagnostic Criteria Onset by early adulthood and present in variety of contexts as indicated by four or
more of the following:
, Suspects – without sufficient basis – that others are exploiting harming or deceiving
him/her
Is preoccupied with unjustified doubts about the loyalty or trustworthiness of
friends and associates
Is reluctant to confide in others due to unwarranted fear that the info will be used
maliciously against him/her
Reads hidden meaning or threatening meanings into benign remarks or events
Persistently holds grudges – i.e., is unforgiving of insults, injuries, or slights
Perceives attacks on his/her character or reputation that are not apparent to others –
and is quick to react angrily or to counterattack
Has recurrent suspicious – without justification – regarding fidelity of spouse or
sexual partner
Does NOT occur exclusively during the course of SZ, bipolar disorder or depressive
disorder with psychotic features – or another psychotic disorder – and is not
attributable to the physiological effects of another medical condition
Associated Features Individuals with paranoid PD are generally (1) difficult to get along with and (2)
Supporting
have problems with close relationships
Diagnosis
Their excessive suspiciousness and hostility may be expressed in (1) overt
argumentativeness, (2) recurrent complaining, and (3) quiet, apparently hostile
aloofness
They are hypervigilant for potential threats – and may react in a guarded, secretive,
or devious manner – and appear to be cold or lacking in tender feelings
They may appear to be objective, rational, and unemotional – but often display a
labile range of affect with hostile, stubborn, and sarcastic expressions mostly
Their combative and suspicious nature may elicit hostile response in others which
serves to confirm their original expectations
Lack of trust in others – results in excessive need to be self-sufficient and a strong
sense of autonomy
High level of control over those around them – are often (1) rigid, (2) critical of
others, and (3) unable to collaborate
Great difficulty accepting criticism
Seek to confirm their preconceived negative notions about others they encounter –
attribute malevolent motivations to others that are projections of their own fears
Lecture 1: Learning Objectives
1. To identify the characteristics of a personality disorder (PD)
A personality disorder – is (1) an enduring pattern of inner experience and behavior that (2)
deviates markedly from the expectations of the individual’s culture, (3) is pervasive and
inflexible, (4) has onset in adolescence – or early adulthood – is (5) stable over time and
leads to (6) distress or impairment
General Personality Disorder
Diagnostic Criteria 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: (1) cognition –
i.e., ways of perceiving and interpreting self, others, and events, (2) affectivity –
i.e., the range, intensity, lability, and appropriateness of emotional response, (3)
interpersonal functioning, and/or (4) impulse control
The enduring pattern is inflexible and pervasive across broad range of personal and
social situations
The enduring pattern leads to clinically sig distress or impairment in social,
occupational, or other important areas of functioning
The pattern is stable and of long duration – and its onset can be traced back at least
to adolescence or early adulthood
The enduring pattern is NOT better explained as a manifestation or consequences of
another mental disorder
The enduring pattern is NOT attributable to the physiological effects of a substance
– e.g., drug of abuse, medication – or another medical condition – e.g., head trauma
Development and Some types of PD – i.e., antisocial and borderline PDs – tend to become less
Course evident or remit with age
Other types – e.g., OCPD – do not remit with age
In order to diagnose PD in a person younger than 18yo – the features of PD must be
, present for at least 1 year
Antisocial PD cannot be diagnosed in individuals younger than 18yo
PDs may be exacerbated following (1) the loss of sig supporting persons such as a
spouse – or (2) the loss of previously stabilizing social situations such as a job
The development of a change in personality in middle adulthood to later life –
warrants careful evaluation to determine possible presence of PD due to another
medical condition – or unrecognized SUD
Gender-Related Careful not to over- or underdiagnose certain PDs in females or males due to social
Diagnostic Issues
stereotypes about typical gender roles and behaviors
Certain PDs – e.g., ASPD – are diagnosed more frequently in males
Others – e.g., BPD, histrionic, and dependent PD – are diagnosed more frequently in
females
Differential Diagnosis
Other Mental Disorders Many of the specific criteria for PDs describe features – e.g., suspiciousness,
and Personality
dependency, insensitivity – that are also characteristic of episodes of other mental
Traits
disorders
A PD should only be diagnosed when the defining characteristics (1) appeared
before early adulthood, (2) are typical of the individual’s long-term functioning,
and (3) do NOT occur exclusively during episode of another mental disorder
PDs must be distinguished from personality traits that do NOT reach the threshold
for a PD
Psychotic Disorders For the three PDs that may be related to psychotic disorders – i.e., paranoid,
schizoid, schizotypal – there is an exclusion criterion
The exclusion criterion states that the pattern of behavior must NOT have occurred
exclusively during the course of SZ, a bipolar or depressive disorder with psychotic
features, or another psychotic disorder
When one has a persistent mental disorder that was preceded by a preexisting PD –
the PD should also be recorded – followed by “premorbid” in parentheses
Anxiety Disorders Caution when diagnosis PDs during an episode of a depressive disorder or anxiety
disorder
These conditions may have cross-sectional symptom features that mimic
personality traits – and make it more difficult to evaluate retrospectively the
, individual’s long-term patterns of functioning
PTSD When personality changes emerge and persist after one has been exposed to
extreme stress – a diagnosis of PTSD should be considered
SUDs When one has a SUD – important NOT to make a PD diagnosis based solely on
behaviors that are (1) consequences of substance intoxication or withdrawal or (2)
are associated with activities in the service of sustaining substance use – e.g.,
antisocial behavior
Personality Change due When enduring changes in personality arise as a result of physiological effects of
to Another Medical
another medical condition – e.g., brain tumor – a diagnosis of personality change
Condition
due to another medical condition should be considered
2. To distinguish between personality traits vs. personality disorders
Personality Traits – are enduring patterns of (1) perceiving, (2) relating to, and (3) thinking
about the environment and oneself – exhibited in a wide range of social and personal
contexts
Only when personality traits are (1) inflexible, (2) maladaptive, and (3) persisting – and (4)
cause sig functional impairment or subjective distress – do they constitute personality
disorders
- Personality disorders must be distinguished from personality traits that do NOT
reach the threshold for a PD
3. To compare and distinguish the different PDs and their characteristics, including:
Cluster A Personality Disorders – Odd, Eccentric
PARANOID
Description A pattern of distrust and suspiciousness such that others’ motives are interpreted as
malevolent
Diagnostic Criteria Onset by early adulthood and present in variety of contexts as indicated by four or
more of the following:
, Suspects – without sufficient basis – that others are exploiting harming or deceiving
him/her
Is preoccupied with unjustified doubts about the loyalty or trustworthiness of
friends and associates
Is reluctant to confide in others due to unwarranted fear that the info will be used
maliciously against him/her
Reads hidden meaning or threatening meanings into benign remarks or events
Persistently holds grudges – i.e., is unforgiving of insults, injuries, or slights
Perceives attacks on his/her character or reputation that are not apparent to others –
and is quick to react angrily or to counterattack
Has recurrent suspicious – without justification – regarding fidelity of spouse or
sexual partner
Does NOT occur exclusively during the course of SZ, bipolar disorder or depressive
disorder with psychotic features – or another psychotic disorder – and is not
attributable to the physiological effects of another medical condition
Associated Features Individuals with paranoid PD are generally (1) difficult to get along with and (2)
Supporting
have problems with close relationships
Diagnosis
Their excessive suspiciousness and hostility may be expressed in (1) overt
argumentativeness, (2) recurrent complaining, and (3) quiet, apparently hostile
aloofness
They are hypervigilant for potential threats – and may react in a guarded, secretive,
or devious manner – and appear to be cold or lacking in tender feelings
They may appear to be objective, rational, and unemotional – but often display a
labile range of affect with hostile, stubborn, and sarcastic expressions mostly
Their combative and suspicious nature may elicit hostile response in others which
serves to confirm their original expectations
Lack of trust in others – results in excessive need to be self-sufficient and a strong
sense of autonomy
High level of control over those around them – are often (1) rigid, (2) critical of
others, and (3) unable to collaborate
Great difficulty accepting criticism
Seek to confirm their preconceived negative notions about others they encounter –
attribute malevolent motivations to others that are projections of their own fears
