perfectionism traits and perfectionistic self-presentation · perfectionism traits and...

Personality Disorders


• When behaviour patterns become inflexible and maladaptive to the point of causing distress or social/occupation impairment can say have Personality Disorder


• Don’t stem from reactions to stress but from gradual development of inflexible and distorted personality

• Maladaptive ways of perceiving, thinking, relating to world


• Excessively rigid patterns of behaviour or ways to relating to others that prevents people from adjusting to external demands and, thus, become self-defeating.

• Have always been there for an individual


• Mild: Function reasonably well, viewed as troublesome, eccentric, etc.

• Severe: Extreme or unethical behaviour, may be incarcerated.

Quote From Lorna Benjamin (1996)

“A great way to come down with a case of “medical student disease (syndrome)” is to read a survey of personality disorders”

Some Trait Pattern Example

• Suspiciousness

• Excessive Self-regard

• Fear of Rejection

• Come to dominate reactions to new situations

• Repetitive maladaptive behaviour

Difference between DSM’s Clinical Syndromes & PD

• Clinical Syndrome specific symptom clusters, time limited, ego-distonic (viewed as separate from self, unacceptable, objectionable and alien)• E.g., depression, anxiety disorders, psychotic disorders

Continued

Personality Disorder Individual with PD are perceived as ego-syntonic (e.g., personality issues are acceptable, unobjectionable and part of the self). Tend to blame others for problems in their lives.

Difficulties with Diagnosis of Personality Disorder

• Need to infer traits to make diagnosis, do not have specific behaviours clinician can judge

• Disorders and criteria are relatively new, therefore not as much research has been done on them

• Great deal of overlap among the disorders

• Hard to draw a line between disorder and normal behaviour

DSM & PDM

• PDM includes all DSM personality disorders

• Adds others:• Depressive Personality Disorder, Sadistic and Sadomasochistic Personality

Disorders, Masochistic (Self-Defeating) Personality Disorders, Somatizing Personality Disorders

Personality Disorder Clusters

• Cluster One: Odd-Eccentric: • Behaviours similar to schizophrenia, suspiousness, withdrawal, peculiar

thinking

The Odd Eccentric PD Group

1. Paranoid Personality Disorder

2. Schizoid Personality Disorder

3. Schizotypal Personality Disorder

Paranoid Personality Disorder

Reverend Jim JonesPeople’s Temple

Paranoid Personality Disorder

• suspicious of other’s motives

• interprets actions of others as deliberately demeaning/threatening

•expectation of being exploited

•see hidden messages in benign comments

•easily insulted/ bears grudges

•appear cold and serious

Paranoid Personality Disorder Example

• Undergraduate student/patient who followed

Psychodynamic Diagnostic Manual Paranoid Personality Disorder

•Constitutional/Maturational Patterns:• Possibly irritable/aggressive

• Central Tension/Preoccupation:• Attacking and being attacked by humiliating others

• Central Affects:• Fear, rage, shame, contempt

Psychodynamic Diagnostic Manual Paranoid Personality Disorder

•Characteristic Pathogenic Self-Belief:• Hatred, aggression, and dependency are dangerous

• Characteristic Pathogenic Other-Belief:• World is full of potential attackers and users

• Central Ways of Defending:• Projection, projective identification, denial, reaction formation

Schizoid Personality Disorder

Theodore Kaczynski: Unabomber

Schizoid

• indifferent to relationships

• limited social range (some are hermits)

•aloof, detached, called loners

•no apparent need of friends, sex

•solitary activities

•seem to be missing the “human part”

Psychodynamic Diagnostic Manual Schizoid Personality Disorder

•Constitutional/Maturational Patterns:• Highly Sensitive, shy, easily overstimulated

• Central Tension/Preoccupation:• Fear of closeness/longing for closeness

• Central Affects:• Emotional pain when overstimulated, powerful affects that are suppressed


•Characteristic Pathogenic Self-Belief:• Dependency and love are dangerous

• Characteristic Pathogenic Other-Belief:• Social world is impinging and dangerously engulfing

• Central Ways of Defending:• Withdrawal, physically and into fantasy, and idiosyncratic preoccupations.


•Constitutional/Maturational Patterns:• Highly Sensitive, shy, easily overstimulated

• Central Tension/Preoccupation:• Fear of closeness/longing for closeness

• Central Affects:• Emotional pain when overstimulated, powerful affects that are suppressed

Schizotypal

• peculiar patterns of thinking and behaviour

• perceptual and cognitive disturbances

• magical thinking

• not psychotic

• perhaps a distant “cousin” of schizophrenia

Psychodynamic Diagnostic Manual Schizotypal Personality Disorder

•Characteristic Pathogenic Self-Belief:• Dependency and love are dangerous

• Characteristic Pathogenic Other-Belief:• Social world is impinging and dangerously engulfing

• Central Ways of Defending:• Withdrawal, physically and into fantasy, and idiosyncratic preoccupations.

PDM Does Not Include Schizotypal


• Cluster Two: Dramatic-Emotional: • Behaviours are so dramatic, emotional, or erratic that it is almost impossible

to have truly giving and satisfying relationships

• More commonly diagnosed than other PD’s

The Dramatic-Emotional PD Group

1. Antisocial Personality Disorder (Dissocial)

2. Borderline Personality Disorder

3. Histrionic Personality Disorder

4. Narcissistic Personality Disorder

Antisocial Personality Disorder

• pattern of irresponsibility, recklessness, impulsivity beginning in childhood or adolescence (e.g., lying, truancy)

• adulthood: • criminal behaviour• little adherence to societal norms,

• little anxiety• conflicts with others

• callous/exploitive

• Difficulties in establishing secure identity

• Distrust

• Impulsive and self-destructive behavior

• Difficulty in controlling anger and other emotions

Narcissistic Personality Disorder

•grandiose, sense of self-importance

• lack of empathy

•hyper-sensitive to criticism

•exaggerate accomplishments/ abilities

•special and unique• entitlement

• below surface is fragile self-esteem

PDM: Narcissistic

1. Characteristic Pathogenic Self-Belief: I need to be perfect to feel ok

2. Characteristic Pathogenic Other-Belief: Others enjoy beauty, riches, power, fame and the more I have of those the better I feel.

3. Central Ways of Defending: Idealization, Devaluation

4. Constitutional/Maturational Patterns: No Clear Data

5. Central Tension/Preoccupation: Inflation/Deflation of Self-Esteem

6. Central Affects: Shame, Contempt, Envy

Armand Hammer

• “There has never been anyone like me, and my likes will never be seen again.”

Armand Hammer - Again

“The brilliance of my mind can only be described as dazzling. Even I am impressed by it.”

Histrionic Personality Disorder

•excessive emotional displays/ dramatic behaviour

•attention-seeking, victim stance

•seek re-assurance, praise

•shallow emotions, flamboyant, self-centred

•very seductive, “life of the party”


• Cluster Three: Anxious-Fearful: • Display anxiety and fear typically

• Similar to anxiety and depressive disorders but no real connection

The Anxious-Fearful Group

1. Avoidant Personality Disorder

2. Dependent Personality Disorder

3. Obsessive-Compulsive Personality

Disorder

Avoidant Personality Disorder

•over-riding sense of social discomfort

•easily hurt by criticism

•always need emotional support

•occasionally try to socialize •so distressing they retreat into loneliness

Dependent Personality Disorder

•submissive, clingy behaviour

•fear of separation

•easily hurt by criticism

PDM: Dependent

1. Characteristic Pathogenic Self-Belief: I am inadequate, needy, impotent

2. Characteristic Pathogenic Other-Belief: Others are powerful and I need their care.

3. Central Ways of Defending: Regression, avoidance

4. Constitutional/Maturational Patterns: Placidity

5. Central Tension/Preoccupation: Keeping/Losing Relationships

6. Central Affects: Pleasure when securely attached; sadness/fear when alone

Obsessive Compulsive Personality Disorder

•excessive control and perfectionism

•inflexible

•preoccupied with trivial details

•judgmental/moralistic

•workaholic/ignore family members

•often humourless

PDM Additional Personality Disorders

• Depressive Personality Disorder • Sadistic and Sadomasochistic PD• Masochistic (Self-defeating) PD• Somatizing PD

• Dissociative PD

Borderline Personality Disorder

• DSM Focus:• One type of borderline disorder

• PDM has spectrum and numerous personality disorders that reflect severe borderline personality disorganization:• Neurotic, Borderline, Psychotic

Neurotic Beh

-Anxiety-based-No distortions in reality-Recognizes problem-No great personality disorganization

Psychotic

-Gross distortions in reality (e.g., perception)-Some personality disorganization-Does not recognize problem

Bo r d e r l i n e


• marked instability of mood, relationships, self-image

• intense, unstable relationships

• uncertainty about sexuality

• everything is “good” or “bad”

• chronic feeling of “emptiness

• recurrent threats of self-harm/ “slashers”

• Single White Female (Jennifer Jason Leigh) or Fatal Attraction (Glen Close).

Good Depictions of BPD


• Therapist “killers” (not really killers)

• Very difficult to treat

• Tend to be avoided by many clinicians

• Takes lots of training and experience to treat effectively

• Lots of turmoil in treatment

Self-Destructive Behaviour

• Drug abuse

• Suicide threats

• Lots of promiscuity

Borderline Personality Disorder: Four Core Elements

• Difficulties in establishing secure self- identity

• Distrust & Splitting

• Impulsive and Self Destructive Behaviour

• Difficulty in controlling anger and other emotions

Borderline Examples: From Therapist

• Student’s First experience with BPD under my supervision

Identity Disturbance

• In terms of identity disturbance, she relied heavily on a sort of reflected identity from others and saw herself as she believed others saw her.

• With respect to her poor ego boundaries and the melding of her identity with my own, one particularly surprising thing she said to me was that she had googled my name on the internet and found out that I had won a presitious academic award. She said she felt really sad because she did not have an award herself.

Distrust and Splitting

•She vascillated quite wildly between idealizing me (including telling me that she loved me and at times wanted us to sit together on the couch so I could hold her) and devaluing me (lots of anger in session, and a fairly caustic email that said "Ain't it so nice and easy. Tell you what M***, go out and get ourself abused, loose that charming smile of yours and come back and tell me who's mentally ill", which was followed shortly after by an apologetic one.)

Continued

• It was difficult for me to predict from week to week whether she would tell me I was dirt or idealized. She was a good example of someone who used splitting defenses where she saw other people (me in particular) in all good or all bad terms and made rapid shifts between these two positions.

Affective Instability

• Affective instability (went along with the wild swings between this sort of coy, coquettish behavior and the pronounced anger in session), but also exhibited shallow affect and incongruent affect.

• For example, she often smiled or giggled when she told me about her difficulties and began to ocassionally exhibit sadness in session by crying. However, a little later in therapy she told me that in fact the tears were fake and that she was using them because she felt closer to me when I responded to her tears.

More on Distrust

•She had a long history of interpersonal problems and difficulty connecting with people. She was quite paranoid about what others thought of her and this was quite evident in her comments about her co-workers whom she felt were against her (and, frankly, she may have been right) and in her desire to see her chart in the hopes that it would finally reveal the intense dislike for her that she imagined I felt.

Termination: Always difficult

• We spent about 2 months preparing for and discussing termination and it still went poorly. She was angry and her parting gift to me was a plant that contained a set of tiny clay pots (sort a decorative thing) partially submerged in the soil. She gave the clinic secretary the same thing, but she was careful to say "this one is for the secretary, and this one is for you", when I looked at the two later, the one that she gave me had the tiny clay pots smashed, while Geraldine's were intact. A final parting message.

PDM: Passive Aggressive

1. Characteristic Pathogenic Self-Belief: I am inadequate, needy, impotent

2. Characteristic Pathogenic Other-Belief: Others are powerful and I need their care.

3. Central Ways of Defending: Regression, avoidance

4. Constitutional/Maturational Patterns: Not Known

5. Central Tension/Preoccupation: Keeping/Losing Relationships

6. Central Affects: Pleasure when securely attached; sadness/fear when alone

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