Personality Disorders

Carolyn R. Fallahi, Ph. D.

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  High controversy surrounding the personality disorders.
  
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  Problems with boundaries between various p.d. & their diagnostic criteria. Examples.
  

Theories of Personality

Psychodynamic Models:

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  “Character pathologies”. Character = the ability to bring harmony to the tasks presented by the internal demands and by the external world.
  
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  Freud’s explanation.
  
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  Karl Abraham (1927) used Freud’s psychosexual stages to associate personality traits with the stages. For example: oral period = oral-sucking phase & oral-biting phase becomes oral-dependent & aggressive oral tendencies that we see traits for in adulthood. Anal characters : anal-expulsive or anal-retentive period.
  
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  Kernberg (1996) psychosexual types are only of value for the less severe p.d. More severe = see aspects from all stages. Oral conflicts = masochistic personality; anal conflicts = obsessive-compulsive personality. Borderline personality = paranoid, antisocial, narcissistic personalities = all stages.
  
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  Prior to 1950: borderline stages = psychotic characters = ambulatory psuedoneurotic schizophrenics. The issue of splitting.
  
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  Kernberg – borderline & schizoid form the basic personalities of the borderline level of organization. Similarities & differences?
  

Behavioral Theories of Personality

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  Watson & classical conditioning.
  
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  Mid 1980s reinterpretations of traditional assessments – clinically applied behavioral approaches on Axis I.
  
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  Recently … applying systematic approach to personality.
  
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  Staats (19986): systematic approach & adds a behavioral & developmental dimension arguing that “basic behavioral repertoires” begin at birth and proceed hierarchically.
  

Interpersonal Models

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  Personality = social product of interactions with significant others.
  
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  Harry Stack Sullivan – father of interpersonal perspective. Reaction against the medical model & intrapsychic mode of Freud’s.
  
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  Sullivan = pathology is created & perpetuated through maladaptive patterns of interactions between people.
  

Cognitive Models

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  Very popular b/c most all clinical syndromes have cognitive elements.
  
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  Example: Five-factor model.
  
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  Aaron Beck: successful therapies for a wide range of Axis I diagnoses.
  
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  Beck & Freeman (1990): cognitive theory of personality pathology. Dysfunctional and distorting schemas give rise to maladaptive interaction strategies which in turn trigger automatic thoughts and make the individual susceptible to repetitive and pervasive life difficulties.
  

Neurobiological & Temperament models

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  Temperament = basic biological foundation of personality.
  
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  Hippocrates 4^th C B.C. – diseases stem from an excess of or imbalance of yellow bile, black bile, blood, & phlegm.
  
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  1920s Kretschmer – classification system based on thin, muscular, and obese types of physiques & linked them to psychopathology.
  
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  Sheldon – ectomorphy, mesomorphy, and endomorphy.
  
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  Cloninger (1987): interrelationship of 3 genetic neurobiological trait dispositions & associated them with a different NT system.
  

Schizoid & Avoidant Personality Disorders

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  Similarity = interpersonal detachment.
  
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  Schizoids appear emotionally bland & unresponsive & insensitive.
  
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  Avoidants experience social interactions as aversive owing to their propensity for self=criticism.
  
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  Distinction = motivation for the attachment. Schizoid lack the desire or ability to form social relationships; Avoidants desire interpersonal contact, but avoid out of fear of rejection & humiliation.
  
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  Millon (1981) passive (schizoid) versus active (avoidant) detachment.
  
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  Issue with the separation of these 2 disorders.
  
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  Similar issues between schizoid & schizotypal p.d. Share interpersonal and affective features, especially social isolation & odd/inappropriate affect, similar to “negative” symptoms of Schizophrenia.
  
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  Similar issues with avoidant and dependent p.d. Dependent p.d. = interpersonal submission, neediness, & fears of separation. Avoidant = shunts interpersonal intimacy, while dependent seeks it. Both = low self-esteem & lack of self-assertion.
  
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  Other issues: Avoidant p.d. resembles social phobia.
  
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  Symptoms of Schizoid p.d.
  
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  Symptoms of Avoidant p.d.
  
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  Issues with differential diagnosis.
  
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  Case Study Example
  
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  Comorbidity Issues: Avoidant & Schizotypal = 53%; 38% of schizotypals = schizoid; lesser degrees of comorbidity with paranoid, antisocial, borderline, passive-aggressive, dependent.
  
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  Question: Are Schizoid & Avoidant discrete disorders? Overholser (1989) could not differentiate a sample on measures of anxiety, depression, psychosis, or introversion.
  
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  Trull et al (1987) could distinguish avoidant p.d. on measures of anxiety, somatization, dysthymia.
  
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  Issues with Avoidant & Dependent p.d.
  
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  Trull et al (1987) symptoms highly correlated.
  
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  Reich (1990) minor differences between avoidant & dependent on a variety of psychological tests.
  
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  Schizoid & Avoidant also show comorbidity on Axis I disorders, especially social phobia. Herbert et al (1992) study found high correlation between avoidant p.d. & social phobia. Turner et al (1986) found social phobics have considerable distress & avoidance, but greater impairment found with avoidant p.d.
  

Historical Issues

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  Eugene Bleuler (1924)
  
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  Kretschmer (1925): anesthetic (e.g. insensitive) and hyperaesthetic (e.g. hypersensitive) = schizoid versus avoidant.
  
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  Melanie Klein (1996): nurturing and depriving aspects of caregiving figure = splitting.
  
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  Fairburn (1952) caregiver issues.
  
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  Guntrip: schizoids are starved for love.
  
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  Millon (1981) introduced avoidant p.d. Issues with this diagnosis.
  

Contemporary Views:

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  Psychoanalytic
  
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  Kernberg (1984)
  
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  Torgersen (1985)
  
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  Millon (1981)
  
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  Kagan (1989)
  
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  Stravyniski et al (1989)