Personality Disorders

"Personality disorder, also called character disorder, mental disorder that is marked by deeply ingrained and lasting patterns of inflexible, maladaptive, or antisocial behaviour. A personality disorder is an accentuation of one or more personality traits to the point that the trait significantly impairs an individual's social or occupational functioning. Personality disorders are not, strictly speaking, illnesses, since they need not involve the disruption of emotional, intellectual, or perceptual functioning. In many cases, persons with a personality disorder do not seek psychiatric treatment for such unless they are pressured to by relatives or by a court" — Encyclopedia Britannica.

Core Beliefs in Personality Disorder

A Note on a Theory of Personality Disorder

Idols of the Types

From Karen Horney and Character Disorder by Irving Solomon:

"Karen Horney's (1950) theory of neurosis, really character disorders, recognizes the influence of culture while viewing neurosis as a constellation of defenses designed to deal with basic anxiety. She concentrates on character structure rather than early childhood psychosexual experiences. Neurosis for Horney is essentially a character disorder, a way of life in which the patient is compulsively driven by conflicting "shoulds," claims, idealized images, alienation from the self and implicit and/or explicit self-hate" (pg. 109).

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Karen Horney: Intrapsychic Strategies of Defense

The ruling principle governing this work is that the personality disorders are ideal types (Cf., Schwartz, Wiggins & Norko, pp. 417-432). Specifically, they are ideal types of bad character.

"Personality disorders are seen by the American Psychiatric Association as an enduring pattern of inner experience and behaviour that deviates markedly from the expectations of the culture of the individual who exhibits it. These patterns are inflexible and pervasive across many situations. The onset of the pattern can be traced back at least to the beginning of adulthood. To be diagnosed as a personality disorder, a behavioural pattern must cause significant distress or impairment in personal, social, and/or occupational situations." - Wikipedia.org

Fifteen of the sixteen personality disorders that form the basis of the PTypes Typology appear, or have appeared, in the Diagnostic and Statistical Manual of Mental Disorders published by the American Psychiatric Association.

Summary of the personality disorders

The Perspectives of Psychiatry

• Introduction
• Disease
• Dimensional
• Behavior
• Life Story

Introduction

Reforming Psychiatry's DSM - Johns Hopkins, August 23, 2001.

Modern psychiatry has become mired in a system of disease classification that defines mental disorders by the way they look and not on biological or psychological processes, according to Paul R. McHugh, M.D., Henry Phipps Professor and chair of the Department of Psychiatry and Behavioral Sciences at the Johns Hopkins University.

Notably, McHugh's criticism and his proposed solution are featured in the current issue of Psychiatric Research Report, a publication of the American Psychiatric Association's Division of Research. [Source: Psychiatric Research Report, Summer 2001]

. . . .

McHugh proposes that the fifth edition of the DSM, slated for 2007, incorporate a conceptual structure for psychiatry that seeks to identify the essence of mental disorders as expressions of psychological life in a context of pathology and misdirection. This approach, used at Hopkins for over 20 years, is based on four explanatory methods or perspectives: disease, dimension or psychological variation, behavior and life story.

The Perspectives of Psychiatry [42K] by Paul R. McHugh M.D.

A Structure For Psychiatry At The Century's Turn: The View From Johns Hopkins

[E]veryone knows that disease is not an appropriate term for all distress or difficulty. To teach that all disorders are kinds of disease will misconstrue matters of importance in practice and research, implying as it does that neuroscience will provide an anomalous neuron for every anomalous thought.

200.328 Theory and Methods in Clinical Psychology - Department of Psychology, Johns Hopkins University.

Syllabus

This course is an introduction to the methods of applied clinical psychology. Traditionally, abnormal psychology courses focus on what different kinds of theorists think about different kinds of abnormal mental life. We will focus on how we think more than on what we think at any given point in time. What we think depends on our methods of observing and understanding (not to mention fashion and political correctness), but also influences our choice of those methods. Consequently, the how and what are intertwined, and we can only examine one in the context of the other.

We will focus on four basic methods of reasoning in psychology and psychiatry: the disease method , the dimensional method , the behavioral method , and the life-story method . We will examine the fundamental assumptions inherent in each method, the kind of logic by which each proceeds, and the strengths and weaknesses of each method.

Methods - A simplified reference table for the Perspectives of Psychiatry
Diagnostic flow chart

The Disease Perspective

From Treatments of Psychiatric Disorders:

Biologic Psychiatry

[T]he growth of biologic psychiatry has directed attention to issues of heritability and temperament in the pathogenesis of personality disorders and has helpfully encouraged exploration of biologic therapies. There is currently a growing number of efforts to test the possible utility of pharmacotherapies for personality disordered patients--tests that would have been considered fruitless, a priori, a decade ago. A more nonspecific effect on treatment from the biogenetic advance will probably be felt in years ahead. It is likely to set the stage for more methodologically rigorous treatment evaluations. (Gunderson, pg. 2635)

The Dimensional Perspective

From The Perspectives of Psychiatry:

Temperament, Affective Dimensions, and Personality Disorders

The dimensional perspective thus encompasses those individuals who deviate to an extreme in their affective disposition (temperament) and who often suffer and turn for psychiatric assistance because of the emotional and behavioral problems evoked by challenging circumstances. We are applying, now in the affective domain, the same logic we used to explain how problems can emerge from life's challenges in individuals who deviate downward in their cognitive disposition (intelligence).

This chapter aims to describe methods that reveal affective dispositional dimensions and to identify their clinical implications. In particular, we shall describe how the concept of disorder emerges from assessments about the affective constitution of an individual--documenting again how the "emotive paradigm" directs diagnosis, prognosis, and treatment. (McHugh & Slavney, pg. 127)

The Behavior Perspective

From Treatments of Psychiatric Disorders:

Behavior therapy

Individuals with personality disorders are noted for unusual or maladaptive behaviors that adversely affect others. Although these individuals experience emotional pain at times, many aspects of their psychopathology are ego-syntonic and are viewed as the only possible response to an unforgiving world. Behavior therapy may be useful in modifying some maladaptive responses, including behaviors (e.g., aggressiveness and disturbances in complex social role functioning), cognitive beliefs, and affects (including anger). Because learning theory forms the basis for behavior therapy, this approach may be especially useful for individuals with histories of learning difficulties or deficits in social skills due to poor social role models. (Perry & Flannery, pg. 2649)

The Life Story Perspective

Childhood

A Christian Approach to Character Disorder

The universal character disorder is a typological representation of the universal "solution" to the problem of anxiety; that is, of the universal strategy to alleviate anxiety. The objects of desire and pleasure listed below are limited goods pridefully turned to for security when we fail to trust God. They are analogous to Karen Horney's "neurotic needs."

"Even when we deeply value ourselves, the anxiety built into finitude will tempt us to find our source of security in some strategy rather than a trust in God" (Cooper, pg. 163).

Idols
Compulsive Attachments	Compulsive Aversions
life health wealth possessions pleasure strength physical beauty intelligence status reputation noble birth relationships security	death sickness poverty lack of possessions pain weakness ugliness dim-wittedness lack of status low reputation ignoble birth few relationships lack of security

Cognitive Effects

From the Comprehensive Textbook of Psychiatry/VI:

Cognitive Therapy

A complete elaboration of cognitive therapy for the personality disorders has been published, and at least three outcome trials are underway (for avoidant, dependent, and obsessive-compulsive personality disorders). The focus of treatment is directed at formulating the patient's basic beliefs (for example, "Since I am helpless, I need to have a stronger person available at all times") and showing how those beliefs feed into the patient's dysfunctional behavior.

In contrast to the treatment of such Axis I disorders as depressive disorder and anxiety disorders, the therapy for personality disorders requires a long period of therapeutic work--often one or more years. Also, much more therapeutic concentration deals with transference issues, exploring childhood patterns, and even revivifying pathogenic childhood experiences. In that respect, cognitive therapy has an increasing convergence with psychodynamic therapy. The major differences are that the cognitive therapist is more active and directive, the therapeutic sessions are more structured, the content is based on exploring and testing cognitive distortions and basic beliefs, and the patient is expected to carry out homework assignments. (Beck & Rush, pg. 1854)

Beck's Cognitive Therapy for Personality Disorders

Beck, Aaron T. and Rush, A. John (1995). Cognitive Therapy. Comprehensive Textbook of Psychiatry/VI, Vol. 2. Eds. Harold I. Kaplan and Benjamin J. Sadock. Baltimore: Williams & Wilkins.

Cooper, Terry D. (2003). Sin, Pride, and Self-Acceptance: The Problem of Identity in Theology and Psychology. Downers Grove, IL: InterVarsity Press.

Gunderson, John G. (1989). Personality Disorders: Introduction. Treatments of Psychiatric Disorders, Vol. 3. American Psychiatric Association. Task Force on Treatments of Psychiatric Disorders. Washington, DC : American Psychiatric Association.

Horney, Karen (1950). Neurosis and Human Growth. New York: W. W. Norton.

McHugh, Paul R. and Slavney, Phillip R. (1998). Perspectives of Psychiatry, 2nd ed. Baltimore: Johns Hopkins UP.

Perry, J. Christopher and Flannery, Raymond B. (1989). Personality Disorders: Behavior Therapy. Treatments of Psychiatric Disorders, Vol. 3. American Psychiatric Association. Task Force on Treatments of Psychiatric Disorders. Washington, DC : American Psychiatric Association.

Schwartz, M. A., Wiggins, O. P. & Norko, M. A., (1995). Prototypes, ideal types, and personality disorders: the return to classical phenomenology. In Livesley, W. John, (Ed.), The DSM-IV Personality Disorders. New York: Guilford.

Solomon, Irving (2006). Karen Horney and Character Disorder: A Guide for the Modern Practitioner. New York: Springer.

Personality Disorder Links

• BehaveNet� Clinical Capsule�: DSM-IV-TR Classification
• Mental Health Net - All About Personality Disorders
• Cognitive Therapy for Personality Disorders by Judith S. Beck, Ph.D. - Psychiatric Times.
• The Dual Diagnosis Pages: Personality Disorders and Addiction
• Bibliography: Dual Diagnosis and the Personality Disorders
• The Official Website of Theodore Millon
• The Millon Fifteen Personality Styles/Disorders and Subtypes - Theodore Millon.
• PsychNet-UK - Personality Disorder Index
• The Merck Manual of Diagnosis and Therapy Section 15. Psychiatric Disorders Chapter 191. Personality Disorders
• Personality Disorders General - PsychNet-UK.
• Great Ideas in Personality--Personality Disorders - G. Scott Acton.
• Chapter 7 -- Personality Disorders - National Library of medicine.
• Personality Disorders Foundation Materials - CounsellingResource.com.
• LookSmart's Personality Disorders: General Information - Sites
• Google Directory - Health > Mental Health > Disorders > Personality

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