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Personality Disorder - a working guide |
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The following pages are loosely based on the training which we offer, and illustrate our assumptions about personality disorder and how it relates to other mental health problems.
DEFINITIONS OF PERSONALITY DISORDER Much debate rages around so-called categorical definitions of PD and dimensional definitions. The former are seen as having an either-you-have-it-or-you-don't approach, allocating people to diagnostic categories based on whether or not they display sufficient symptoms of the disorder to warrant inclusion. The latter can be seen as more flexible (and therefore more sensitive at the cost of losing the clarity of categorical approaches.) People have degrees of personality disorder which shade imperceptibly down into personality styles and traits which are not so problematic. THE CATEGORICAL APPROACH: THE DSM-IV DEFINITION OF PERSONALITY DISORDER A. An enduring pattern of inner experience and behaviour that deviates markedly from the expectations of the individual's culture. This pattern is manifested in two (or more) of the following areas: Cognition (ie. ways of perceiving and interpreting self, other people and events)
The enduring pattern is inflexible and pervasive across a broad range of personal and social situations. C. The enduring pattern leads to clinically significant distress or impairment in social, occupational or other important areas of functioning D. The pattern is stable and of long duration and its onset can be traced back to at least adolescence or early adulthood E. The enduring pattern is not better accounted for as a manifestation of consequence of another mental disorder F. The enduring pattern is not due to the direct physiological effects of a substance (eg. a drug of abuse, a medication) or a general medical condition eg. head trauma CLUSTER A, B AND C OF THE DSM-IV PERSONALITY DISORDERS Personality traits are enduring patterns of perceiving, relating to, and thinking about the environment and oneself exhibited in a wide range of social and personal contexts. Only when these are inflexible and maladaptive and cause significant functional impairment or distress do they constitute personality disorders. Cluster A: The Odd, Bizarre, Eccentric Group PARANOID Personality Disorder = a pattern of distrust and suspiciousness such that others' motives are interpreted as malevolent. SCHIZOID Personality Disorder = a pattern of detachment from social relationships and a restricted range of emotional expression. SCHIZOTYPAL Personality Disorder = a pattern of acute discomfort in close relationships, cognitive or perceptual distortions, and eccentricities of behaviour. Cluster B: The Dramatic, Erratic Group BORDERLINE Personality Disorder = a pattern of instability in interpersonal relationships, self-image, and affects, and marked impulsivity. NARCISSlSTIC Personality Disorder = a pattern of grandiosity, need for admiration, and lack of empathy. HISTRIONIC Personality Disorder = a pattern of excessive emotionality and attention seeking. ANTISOCIAL Personality Disorder = a pattern of disregard for, and violation of, the rights of others. Cluster C: The Anxious, Fearful Group DEPENDENT Personality Disorder = a pattern of submissive and clinging behaviour related to an excessive need to be taken care of. AVOIDANT Personality Disorder = a pattern of social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation. OBSESSIVE-COMPULSIVE Personality Disorder = a pattern of pre-occupation with orderliness, perfectionism, and control. This emphasises the meaning and purpose of symptoms, not merely their presence or absence. This tends to be in the context of two-way relationships, rather than concentrating on the pathological individual. Elinor Greenberg uses the underlying dynamics, rather than the surface symptoms, to cluster the DSM-IV axis II disorders: Borderline processes: Borderline PD, Histrionic PD, Dependent PD Narcissistic processes: Narcissistic PD, Antisocial PD, Paranoid PD Schizoid processes: Schizoid PD, Schizotypal PD, Avoidant PD, Obsessive-Compulsive PD Lorna Benjamin also takes a dimensional approach to the DSM-IV, identifying four interpersonal axes in her Structural Analysis of Social Behaviour (SASB): IGNORE - PROTECT EMANCIPATE - CONTROL AFFIRM - BLAME ACTIVE LOVE - ATTACK Each DSM-IV PD (and every client) will have a unique, characteristic pattern across this circumplex model. Page last updated: 18/04/01 |
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