1. Comer, Abnormal Psychology, 6e – Chapter 16 1 Chapter 16 Personality Disorders Slides & Handouts by Karen Clay Rhines, Ph.D. Seton Hall University

2. 2Comer, Abnormal Psychology, 6e – Chapter 16 Personality What is personality? What is personality? Personality is a unique and long-term pattern of inner experience and outward behavior Personality is a unique and long-term pattern of inner experience and outward behavior Personality tends to be consistent and is often described in terms of “traits” Personality tends to be consistent and is often described in terms of “traits” These traits may be inherited, learned, or both These traits may be inherited, learned, or both Personality is also flexible, allowing us to adapt to new environments Personality is also flexible, allowing us to adapt to new environments For those with personality disorders, however, that flexibility is usually missing For those with personality disorders, however, that flexibility is usually missing

3. 3Comer, Abnormal Psychology, 6e – Chapter 16 Personality Disorders What is a personality disorder? What is a personality disorder? An inflexible pattern of inner experience and outward behavior An inflexible pattern of inner experience and outward behavior This pattern is seen in most interactions, differs from the experiences and behaviors usually expected, and continues for years This pattern is seen in most interactions, differs from the experiences and behaviors usually expected, and continues for years

4. 4Comer, Abnormal Psychology, 6e – Chapter 16 Classifying Personality Disorders A personality disorder is diagnosed only when it causes impairments in social or occupational functioning, or when it causes personal distress A personality disorder is diagnosed only when it causes impairments in social or occupational functioning, or when it causes personal distress Personality disorders typically become recognizable in adolescence or early adulthood Personality disorders typically become recognizable in adolescence or early adulthood Generally, the affected person does not regard his or her behavior as undesirable or problematic Generally, the affected person does not regard his or her behavior as undesirable or problematic It has been estimated that 9% to 13% of all adults may have a personality disorder It has been estimated that 9% to 13% of all adults may have a personality disorder

5. 5Comer, Abnormal Psychology, 6e – Chapter 16 Classifying Personality Disorders Personality disorders are diagnosed on Axis II of the DSM-IV-TR Personality disorders are diagnosed on Axis II of the DSM-IV-TR Those diagnosed with personality disorders are often also diagnosed with an Axis I disorder Those diagnosed with personality disorders are often also diagnosed with an Axis I disorder This relationship is called “comorbidity” This relationship is called “comorbidity” Axis II disorders may predispose people to develop an Axis I disorder, or Axis I disorders may set the stage for Axis II disorders, or some biological condition may set the stage for both! Axis II disorders may predispose people to develop an Axis I disorder, or Axis I disorders may set the stage for Axis II disorders, or some biological condition may set the stage for both! Whatever the reason, research indicates that the presence of a personality disorder complicates and reduces a person’s chances for a successful recovery Whatever the reason, research indicates that the presence of a personality disorder complicates and reduces a person’s chances for a successful recovery

6. 6Comer, Abnormal Psychology, 6e – Chapter 16 Classifying Personality Disorders The DSM-IV-TR identifies ten personality disorders and separates these into three categories or “clusters”: The DSM-IV-TR identifies ten personality disorders and separates these into three categories or “clusters”: Odd or eccentric behavior Odd or eccentric behavior Paranoid, schizoid, and schizotypal personality disorders Paranoid, schizoid, and schizotypal personality disorders Dramatic, emotional, or erratic behavior Dramatic, emotional, or erratic behavior Antisocial, borderline, narcissistic, and histrionic personality disorders Antisocial, borderline, narcissistic, and histrionic personality disorders Anxious or fearful behavior Anxious or fearful behavior Avoidant, dependent, and obsessive-compulsive personality disorders Avoidant, dependent, and obsessive-compulsive personality disorders

7. 7Comer, Abnormal Psychology, 6e – Chapter 16 Classifying Personality Disorders The various personality disorders overlap each other so much that it can be difficult to distinguish one from another The various personality disorders overlap each other so much that it can be difficult to distinguish one from another The frequent lack of agreement between clinicians and diagnosticians has raised concerns about the validity and reliability of these categories The frequent lack of agreement between clinicians and diagnosticians has raised concerns about the validity and reliability of these categories

8. 8Comer, Abnormal Psychology, 6e – Chapter 16 “Odd” Personality Disorders The cluster of “odd” personality disorders includes: The cluster of “odd” personality disorders includes: Paranoid personality disorder Paranoid personality disorder Schizoid personality disorder Schizoid personality disorder Schizotypal personality disorder Schizotypal personality disorder

9. 9Comer, Abnormal Psychology, 6e – Chapter 16 “Odd” Personality Disorders People with these disorders display behaviors similar to, but not as extensive as, schizophrenia People with these disorders display behaviors similar to, but not as extensive as, schizophrenia Behaviors include extreme suspiciousness, social withdrawal, and peculiar ways of thinking and perceiving things Behaviors include extreme suspiciousness, social withdrawal, and peculiar ways of thinking and perceiving things Such behaviors leave the person isolated Such behaviors leave the person isolated Some clinicians believe that these disorders are actually related to schizophrenia, and thus call them “schizophrenia- spectrum disorders” Some clinicians believe that these disorders are actually related to schizophrenia, and thus call them “schizophrenia- spectrum disorders”

10. 10Comer, Abnormal Psychology, 6e – Chapter 16 “Odd” Personality Disorders Clinicians have learned much about the symptoms of odd personality disorders but little about effective treatment for these disorders Clinicians have learned much about the symptoms of odd personality disorders but little about effective treatment for these disorders In fact, people with these disorders rarely seek treatment In fact, people with these disorders rarely seek treatment

11. 11Comer, Abnormal Psychology, 6e – Chapter 16 Paranoid Personality Disorder This disorder is characterized by deep suspicion or mistrust of others This disorder is characterized by deep suspicion or mistrust of others Although inaccurate, the suspicion is usually not “delusional” Although inaccurate, the suspicion is usually not “delusional” As a result of their mistrust, people with paranoid personality disorder often avoid relationships As a result of their mistrust, people with paranoid personality disorder often avoid relationships

12. 12Comer, Abnormal Psychology, 6e – Chapter 16 Paranoid Personality Disorder Other symptoms can include hypersensitivity, vigilance, and caution when dealing with others Other symptoms can include hypersensitivity, vigilance, and caution when dealing with others Between 0.5% and 3% of adults are believed to experience this disorder, apparently more men than women Between 0.5% and 3% of adults are believed to experience this disorder, apparently more men than women

13. 13Comer, Abnormal Psychology, 6e – Chapter 16 How Do Theorists Explain Paranoid Personality Disorder? The proposed explanations of this disorder, like those of most other personality disorders, have received little systematic research The proposed explanations of this disorder, like those of most other personality disorders, have received little systematic research Psychodynamic theorists trace the pattern back to early interactions with demanding parents Psychodynamic theorists trace the pattern back to early interactions with demanding parents Cognitive theorists suggest that maladaptive assumptions such as “People are evil and will attack you if given the chance” are to blame Cognitive theorists suggest that maladaptive assumptions such as “People are evil and will attack you if given the chance” are to blame Biological theorists propose genetic causes and have looked at twin studies to support this model Biological theorists propose genetic causes and have looked at twin studies to support this model

14. 14Comer, Abnormal Psychology, 6e – Chapter 16 Treatments for Paranoid Personality Disorder People with paranoid personality disorder do not typically see themselves as needing help People with paranoid personality disorder do not typically see themselves as needing help Few come to treatment willingly Few come to treatment willingly Those who are in treatment often distrust and rebel against their therapists Those who are in treatment often distrust and rebel against their therapists As a result, therapy for this disorder, as for most of the other personality disorders, has limited effect and moves slowly As a result, therapy for this disorder, as for most of the other personality disorders, has limited effect and moves slowly

15. 15Comer, Abnormal Psychology, 6e – Chapter 16 Treatments for Paranoid Personality Disorder Object relations therapists try to see past the patient’s anger and work on the underlying wish for a satisfying relationship Object relations therapists try to see past the patient’s anger and work on the underlying wish for a satisfying relationship Behavioral and cognitive therapists try to help clients control anxiety and improve interpersonal skills Behavioral and cognitive therapists try to help clients control anxiety and improve interpersonal skills Cognitive therapists also try to restructure clients’ maladaptive assumptions and interpretations Cognitive therapists also try to restructure clients’ maladaptive assumptions and interpretations Drug therapy is of limited help Drug therapy is of limited help

16. 16Comer, Abnormal Psychology, 6e – Chapter 16 Schizoid Personality Disorder This disorder is characterized by persistent avoidance of social relationships and limited emotional expression This disorder is characterized by persistent avoidance of social relationships and limited emotional expression Withdrawn and reclusive, people with this disorder are not interested in relationships with others Withdrawn and reclusive, people with this disorder are not interested in relationships with others People with schizoid personality disorder focus mainly on themselves and are often seen as flat and cold People with schizoid personality disorder focus mainly on themselves and are often seen as flat and cold The disorder is estimated to affect fewer than 1% of the population The disorder is estimated to affect fewer than 1% of the population It is slightly more likely to occur in men than in women It is slightly more likely to occur in men than in women

17. 17Comer, Abnormal Psychology, 6e – Chapter 16 How Do Theorists Explain Schizoid Personality Disorder? Many psychodynamic theorists, particularly object relations theorists, link schizoid personality disorder to an unsatisfied need for human contact Many psychodynamic theorists, particularly object relations theorists, link schizoid personality disorder to an unsatisfied need for human contact The parents of those with the disorder are believed to have been unaccepting or abusive of their children The parents of those with the disorder are believed to have been unaccepting or abusive of their children

18. 18Comer, Abnormal Psychology, 6e – Chapter 16 How Do Theorists Explain Schizoid Personality Disorder? Cognitive theorists propose that people with schizoid personality disorder suffer from deficiencies in their thinking Cognitive theorists propose that people with schizoid personality disorder suffer from deficiencies in their thinking Their thoughts tend to be vague and empty, and they have trouble scanning the environment for cues Their thoughts tend to be vague and empty, and they have trouble scanning the environment for cues

19. 19Comer, Abnormal Psychology, 6e – Chapter 16 Treatments for Schizoid Personality Disorder Their extreme social withdrawal prevents most people with this disorder from entering therapy unless some other disorder makes treatment necessary Their extreme social withdrawal prevents most people with this disorder from entering therapy unless some other disorder makes treatment necessary Even then, patients are likely to remain emotionally distant from the therapist Even then, patients are likely to remain emotionally distant from the therapist

20. 20Comer, Abnormal Psychology, 6e – Chapter 16 Treatments for Schizoid Personality Disorder Cognitive therapists have sometimes been able to help people with this disorder experience more positive emotions and more satisfying social interactions Cognitive therapists have sometimes been able to help people with this disorder experience more positive emotions and more satisfying social interactions Behavioral therapists have had some success in teaching social skills Behavioral therapists have had some success in teaching social skills Group therapy is apparently useful when it offers a safe environment for social contact Group therapy is apparently useful when it offers a safe environment for social contact Drug therapy is of little benefit Drug therapy is of little benefit

21. 21Comer, Abnormal Psychology, 6e – Chapter 16 Schizotypal Personality Disorder This disorder is characterized by a range of interpersonal problems, odd (even bizarre) ways of thinking and perceiving, and behavioral eccentricities This disorder is characterized by a range of interpersonal problems, odd (even bizarre) ways of thinking and perceiving, and behavioral eccentricities These symptoms may include ideas of reference and/or bodily illusions These symptoms may include ideas of reference and/or bodily illusions People with the disorder often have great difficulty keeping their attention focused; conversation is typically digressive and vague People with the disorder often have great difficulty keeping their attention focused; conversation is typically digressive and vague

22. 22Comer, Abnormal Psychology, 6e – Chapter 16 Schizotypal Personality Disorder Socially withdrawn, people with schizotypal personality disorder seek isolation and have few friends Socially withdrawn, people with schizotypal personality disorder seek isolation and have few friends It has been estimated that 2% to 4% of all people (slightly more males than females) may have the disorder It has been estimated that 2% to 4% of all people (slightly more males than females) may have the disorder

23. 23Comer, Abnormal Psychology, 6e – Chapter 16 How Do Theorists Explain Schizotypal Personality Disorder? Because the symptoms of schizotypal personality disorder so often resemble those of schizophrenia, researchers have hypothesized that similar factors are at work in both disorders Because the symptoms of schizotypal personality disorder so often resemble those of schizophrenia, researchers have hypothesized that similar factors are at work in both disorders Schizotypal symptoms are often linked to poor family communication and to psychological disorders in parents Schizotypal symptoms are often linked to poor family communication and to psychological disorders in parents Researchers have also begun to link schizotypal personality disorder to some of the same biological factors found in schizophrenia Researchers have also begun to link schizotypal personality disorder to some of the same biological factors found in schizophrenia The disorder has also been linked to mood disorders The disorder has also been linked to mood disorders

24. 24Comer, Abnormal Psychology, 6e – Chapter 16 Treatments for Schizotypal Personality Disorder Therapy is as difficult in cases of schizotypal personality disorder as in cases of paranoid and schizoid personality disorders Therapy is as difficult in cases of schizotypal personality disorder as in cases of paranoid and schizoid personality disorders Most therapists agree on the need to help clients “reconnect” and recognize the limitations of their thinking and powers Most therapists agree on the need to help clients “reconnect” and recognize the limitations of their thinking and powers Cognitive therapists further try to teach clients to objectively evaluate their thoughts and perceptions Cognitive therapists further try to teach clients to objectively evaluate their thoughts and perceptions Antipsychotic drugs appear to be helpful in reducing certain thought problems Antipsychotic drugs appear to be helpful in reducing certain thought problems

25. 25Comer, Abnormal Psychology, 6e – Chapter 16 “Dramatic” Personality Disorders The cluster of “dramatic” personality disorders includes: The cluster of “dramatic” personality disorders includes: Antisocial personality disorder Antisocial personality disorder Borderline personality disorder Borderline personality disorder Histrionic personality disorder Histrionic personality disorder Narcissistic personality disorder Narcissistic personality disorder

26. 26Comer, Abnormal Psychology, 6e – Chapter 16 “Dramatic” Personality Disorders The behaviors of people with these disorders are so dramatic, emotional, or erratic that it is almost impossible for them to have relationships that are truly giving and satisfying The behaviors of people with these disorders are so dramatic, emotional, or erratic that it is almost impossible for them to have relationships that are truly giving and satisfying These personality disorders are more commonly diagnosed than the others These personality disorders are more commonly diagnosed than the others Only antisocial and borderline personality disorders have received much study Only antisocial and borderline personality disorders have received much study The causes of the disorders are not well understood The causes of the disorders are not well understood

27. 27Comer, Abnormal Psychology, 6e – Chapter 16 Antisocial Personality Disorder Sometimes described as “psychopaths” or “sociopaths,” people with antisocial personality disorder persistently disregard and violate others’ rights Sometimes described as “psychopaths” or “sociopaths,” people with antisocial personality disorder persistently disregard and violate others’ rights Aside from substance-related disorders, this is the disorder most linked to adult criminal behavior Aside from substance-related disorders, this is the disorder most linked to adult criminal behavior The DSM-IV-TR requires that a person be at least 18 years of age to receive this diagnosis The DSM-IV-TR requires that a person be at least 18 years of age to receive this diagnosis Most people with an antisocial personality disorder displayed some patterns of misbehavior before they were 15 years old Most people with an antisocial personality disorder displayed some patterns of misbehavior before they were 15 years old

28. 28Comer, Abnormal Psychology, 6e – Chapter 16 Antisocial Personality Disorder People with the disorder are likely to lie repeatedly, be reckless, sexually promiscuous, and impulsive People with the disorder are likely to lie repeatedly, be reckless, sexually promiscuous, and impulsive They have a disregard for other individuals, and can be cruel, sadistic, reckless, and violent They have a disregard for other individuals, and can be cruel, sadistic, reckless, and violent

29. 29Comer, Abnormal Psychology, 6e – Chapter 16 Antisocial Personality Disorder Surveys indicate that up to 3.5% of people in the U.S. meet the criteria for this disorder Surveys indicate that up to 3.5% of people in the U.S. meet the criteria for this disorder Caucasians are somewhat more likely to be diagnosed than are African Americans Caucasians are somewhat more likely to be diagnosed than are African Americans The disorder is four times more common in men than women The disorder is four times more common in men than women Because people with this disorder are often arrested, researchers frequently look for people with antisocial patterns in prison populations Because people with this disorder are often arrested, researchers frequently look for people with antisocial patterns in prison populations Studies indicate higher rates of alcoholism and other substance-related disorders among this group Studies indicate higher rates of alcoholism and other substance-related disorders among this group

30. 30Comer, Abnormal Psychology, 6e – Chapter 16 Antisocial Personality Disorder Children with a conduct disorder and an accompanying attention-deficit hyperactivity disorder apparently have a heightened risk of developing antisocial personality disorder Children with a conduct disorder and an accompanying attention-deficit hyperactivity disorder apparently have a heightened risk of developing antisocial personality disorder

31. 31Comer, Abnormal Psychology, 6e – Chapter 16 How Do Theorists Explain Antisocial Personality Disorder? Psychodynamic theorists propose that this disorder begins with an absence of parental love, leading to a lack of basic trust Psychodynamic theorists propose that this disorder begins with an absence of parental love, leading to a lack of basic trust Many behaviorists have suggested that antisocial symptoms may be learned through modeling or reinforcement Many behaviorists have suggested that antisocial symptoms may be learned through modeling or reinforcement

32. 32Comer, Abnormal Psychology, 6e – Chapter 16 How Do Theorists Explain Antisocial Personality Disorder? The cognitive view says that people with the disorder hold attitudes that trivialize the importance of other people’s needs The cognitive view says that people with the disorder hold attitudes that trivialize the importance of other people’s needs A number of studies suggest that biological factors may play a role A number of studies suggest that biological factors may play a role Findings suggest that people with antisocial personality disorder have lower levels of anxiety and arousal, leading them to be more likely than others to take risks and seek thrills Findings suggest that people with antisocial personality disorder have lower levels of anxiety and arousal, leading them to be more likely than others to take risks and seek thrills

33. 33Comer, Abnormal Psychology, 6e – Chapter 16 Treatments for Antisocial Personality Disorder About 25% of all people with antisocial personality disorder receive treatment for it, yet no treatment appears to be effective About 25% of all people with antisocial personality disorder receive treatment for it, yet no treatment appears to be effective A major problem is the individual’s lack of conscience or desire to change A major problem is the individual’s lack of conscience or desire to change Most have been mandated to treatment Most have been mandated to treatment Some cognitive therapists try to guide clients to think about moral issues and the needs of other people Some cognitive therapists try to guide clients to think about moral issues and the needs of other people Hospitals have attempted to create therapeutic communities Hospitals have attempted to create therapeutic communities Generally, most of today’s treatment approaches have little or no impact on the disorder Generally, most of today’s treatment approaches have little or no impact on the disorder

34. 34Comer, Abnormal Psychology, 6e – Chapter 16 Borderline Personality Disorder People with this disorder display great instability, including major shifts in mood, an unstable self-image, and impulsivity People with this disorder display great instability, including major shifts in mood, an unstable self-image, and impulsivity Interpersonal relationships are also unstable Interpersonal relationships are also unstable People with borderline personality disorder are prone to bouts of anger, which sometimes result in physical aggression and violence People with borderline personality disorder are prone to bouts of anger, which sometimes result in physical aggression and violence Just as often, however, they direct their impulsive anger inward and harm themselves Just as often, however, they direct their impulsive anger inward and harm themselves

35. 35Comer, Abnormal Psychology, 6e – Chapter 16 Borderline Personality Disorder Research indicates that as many as 10% of outpatients and 20% of inpatients may meet the diagnostic criteria for the disorder Research indicates that as many as 10% of outpatients and 20% of inpatients may meet the diagnostic criteria for the disorder Many of the patients who come to mental health emergency rooms are individuals with the disorder who have intentionally hurt themselves Many of the patients who come to mental health emergency rooms are individuals with the disorder who have intentionally hurt themselves Their impulsive, self-destructive behavior can include: Their impulsive, self-destructive behavior can include: Alcohol and substance abuse Alcohol and substance abuse Reckless behavior, including driving and unsafe sex Reckless behavior, including driving and unsafe sex Cutting themselves Cutting themselves Suicidal actions and threats Suicidal actions and threats

36. 36Comer, Abnormal Psychology, 6e – Chapter 16 Borderline Personality Disorder Between 1.5% and 2.5% of the general population are thought to suffer from this disorder Between 1.5% and 2.5% of the general population are thought to suffer from this disorder Close to 75% of those diagnosed are women Close to 75% of those diagnosed are women The course of the disorder varies The course of the disorder varies In the most common pattern, the instability and risk of suicide reach a peak during young adulthood and then gradually lessen with advancing age In the most common pattern, the instability and risk of suicide reach a peak during young adulthood and then gradually lessen with advancing age

37. 37Comer, Abnormal Psychology, 6e – Chapter 16 How Do Theorists Explain Borderline Personality Disorder? Because a fear of abandonment tortures so many people with the disorder, psychodynamic theorists look to early parental relationships to explain the disorder Because a fear of abandonment tortures so many people with the disorder, psychodynamic theorists look to early parental relationships to explain the disorder Object-relations theorists propose a lack of early acceptance by parents Object-relations theorists propose a lack of early acceptance by parents Research has found some support for this view Research has found some support for this view

38. 38Comer, Abnormal Psychology, 6e – Chapter 16 How Do Theorists Explain Borderline Personality Disorder? Some features of the disorder have also been linked to biological abnormalities Some features of the disorder have also been linked to biological abnormalities Sufferers who are particularly impulsive apparently have lower brain serotonin activity Sufferers who are particularly impulsive apparently have lower brain serotonin activity Close relatives of those with borderline personality disorder are five times more likely than the general population to have the disorder Close relatives of those with borderline personality disorder are five times more likely than the general population to have the disorder A number of theorists currently use a biosocial theory, stating that the disorder results from a combination of internal and external forces A number of theorists currently use a biosocial theory, stating that the disorder results from a combination of internal and external forces Some sociocultural theorists suggest that cases of borderline personality disorder are particularly likely to emerge in cultures that change rapidly Some sociocultural theorists suggest that cases of borderline personality disorder are particularly likely to emerge in cultures that change rapidly

39. 39Comer, Abnormal Psychology, 6e – Chapter 16 Treatments for Borderline Personality Disorder It appears that psychotherapy can eventually lead to some degree of improvement for people with this disorder It appears that psychotherapy can eventually lead to some degree of improvement for people with this disorder It is not easy, though, for a therapist to strike a balance between empathizing with a patient’s dependency and anger and challenging his or her way of thinking It is not easy, though, for a therapist to strike a balance between empathizing with a patient’s dependency and anger and challenging his or her way of thinking Furthermore, termination of therapy is often incredibly difficult Furthermore, termination of therapy is often incredibly difficult

40. 40Comer, Abnormal Psychology, 6e – Chapter 16 Treatments for Borderline Personality Disorder Contemporary psychodynamic therapy has been somewhat effective when it focuses on the patient’s central relationship disturbance, poor sense of self, and pervasive loneliness Contemporary psychodynamic therapy has been somewhat effective when it focuses on the patient’s central relationship disturbance, poor sense of self, and pervasive loneliness Over the past two decades, an integrative treatment approach, called “dialectical behavior therapy,” has received growing research support and is now considered the treatment of choice in many clinical circles Over the past two decades, an integrative treatment approach, called “dialectical behavior therapy,” has received growing research support and is now considered the treatment of choice in many clinical circles Group therapy has also been of some help Group therapy has also been of some help

41. 41Comer, Abnormal Psychology, 6e – Chapter 16 Treatments for Borderline Personality Disorder Antidepressant, antibipolar, antianxiety, and antipsychotic drugs have helped some individuals to calm their emotional and aggressive storms Antidepressant, antibipolar, antianxiety, and antipsychotic drugs have helped some individuals to calm their emotional and aggressive storms Given the high risk of suicide attempts by these patients, their use of drugs on an outpatient basis is controversial Given the high risk of suicide attempts by these patients, their use of drugs on an outpatient basis is controversial Some patients have benefited from a combination of drug therapy and psychotherapy Some patients have benefited from a combination of drug therapy and psychotherapy

42. 42Comer, Abnormal Psychology, 6e – Chapter 16 Histrionic Personality Disorder People with histrionic personality disorder are extremely emotional and continually seek to be the center of attention People with histrionic personality disorder are extremely emotional and continually seek to be the center of attention They often engage in attention-getting behaviors They often engage in attention-getting behaviors Approval and praise are the lifeblood of these individuals Approval and praise are the lifeblood of these individuals People with histrionic personality disorder are often described as vain, self-centered, and demanding People with histrionic personality disorder are often described as vain, self-centered, and demanding Some make suicide attempts, often to manipulate others Some make suicide attempts, often to manipulate others

43. 43Comer, Abnormal Psychology, 6e – Chapter 16 Histrionic Personality Disorder This disorder was once believed to be more common in women than in men This disorder was once believed to be more common in women than in men However, research has revealed gender bias in past diagnoses However, research has revealed gender bias in past diagnoses The latest statistics suggest that around 2% of adults have this personality disorder, with males and females equally affected The latest statistics suggest that around 2% of adults have this personality disorder, with males and females equally affected

44. 44Comer, Abnormal Psychology, 6e – Chapter 16 How Do Theorists Explain Histrionic Personality Disorder? The psychodynamic perspective was originally developed to explain cases of hysteria and theorists have retained their interest in the disorder today The psychodynamic perspective was originally developed to explain cases of hysteria and theorists have retained their interest in the disorder today Most psychodynamic theorists believe that, as children, people with this disorder experienced unhealthy relationships in which cold parents left them feeling unloved Most psychodynamic theorists believe that, as children, people with this disorder experienced unhealthy relationships in which cold parents left them feeling unloved To defend against deep-seated fears of loss, the individuals learned to behave dramatically, inventing crises that would require people to act protectively To defend against deep-seated fears of loss, the individuals learned to behave dramatically, inventing crises that would require people to act protectively

45. 45Comer, Abnormal Psychology, 6e – Chapter 16 How Do Theorists Explain Histrionic Personality Disorder? Cognitive theorists look at the lack of substance and the extreme suggestibility found in people with the disorder Cognitive theorists look at the lack of substance and the extreme suggestibility found in people with the disorder Some propose that people with histrionic personality disorder hold a general assumption that they are helpless to care for themselves Some propose that people with histrionic personality disorder hold a general assumption that they are helpless to care for themselves Sociocultural theorists believe the disorder is caused in part by society’s norms and expectations Sociocultural theorists believe the disorder is caused in part by society’s norms and expectations The vain, dramatic, and selfish behavior may be an exaggeration of femininity as defined by our culture The vain, dramatic, and selfish behavior may be an exaggeration of femininity as defined by our culture

46. 46Comer, Abnormal Psychology, 6e – Chapter 16 Treatments for Histrionic Personality Disorder Unlike people with most other personality disorders, those with histrionic personality disorder often seek treatment on their own Unlike people with most other personality disorders, those with histrionic personality disorder often seek treatment on their own Working with them can be difficult because of their demands, tantrums, seductiveness, and attempts to please the therapist Working with them can be difficult because of their demands, tantrums, seductiveness, and attempts to please the therapist

47. 47Comer, Abnormal Psychology, 6e – Chapter 16 Treatments for Histrionic Personality Disorder Cognitive therapists try to help people with this disorder change their belief that they are helpless and try to help them develop better, more deliberate ways of thinking and solving problems Cognitive therapists try to help people with this disorder change their belief that they are helpless and try to help them develop better, more deliberate ways of thinking and solving problems Psychodynamic therapy and group therapy have also been applied Psychodynamic therapy and group therapy have also been applied Clinical case reports suggest that each of the approaches can be useful Clinical case reports suggest that each of the approaches can be useful Drug therapy is less successful, except as a means of relieving the depression experienced by some patients Drug therapy is less successful, except as a means of relieving the depression experienced by some patients

48. 48Comer, Abnormal Psychology, 6e – Chapter 16 Narcissistic Personality Disorder People with narcissistic personality disorder are generally grandiose, need much admiration, and feel no empathy for others People with narcissistic personality disorder are generally grandiose, need much admiration, and feel no empathy for others Convinced of their own great success, power, or beauty, they expect constant attention and admiration from those around them Convinced of their own great success, power, or beauty, they expect constant attention and admiration from those around them People with this disorder exaggerate their achievements and talents, and often appear arrogant People with this disorder exaggerate their achievements and talents, and often appear arrogant

49. 49Comer, Abnormal Psychology, 6e – Chapter 16 Narcissistic Personality Disorder People with this disorder are seldom interested in the feelings of others People with this disorder are seldom interested in the feelings of others Many take advantage of others to achieve their own ends Many take advantage of others to achieve their own ends Less than 1% of adults display narcissistic personality disorder Less than 1% of adults display narcissistic personality disorder Up to 75% of these are men Up to 75% of these are men This type of behavior is common among normal teenagers and does not usually lead to adult narcissism This type of behavior is common among normal teenagers and does not usually lead to adult narcissism

50. 50Comer, Abnormal Psychology, 6e – Chapter 16 How Do Theorists Explain Narcissistic Personality Disorder? Psychodynamic theorists more than others have theorized about this disorder, focusing on cold, rejecting parents Psychodynamic theorists more than others have theorized about this disorder, focusing on cold, rejecting parents Object-relations theorists interpret the grandiose self- presentation as a way for people with this disorder to convince themselves that they are self-sufficient and without need of warm relationships Object-relations theorists interpret the grandiose self- presentation as a way for people with this disorder to convince themselves that they are self-sufficient and without need of warm relationships In support of this theory, research has found increased risk for developing the disorder among abused children and those from divorced families In support of this theory, research has found increased risk for developing the disorder among abused children and those from divorced families

51. 51Comer, Abnormal Psychology, 6e – Chapter 16 How Do Theorists Explain Narcissistic Personality Disorder? Behavioral and cognitive theorists propose that narcissistic personality disorder may develop when people are treated too positively rather than too negatively in early life Behavioral and cognitive theorists propose that narcissistic personality disorder may develop when people are treated too positively rather than too negatively in early life Those with the disorder have been taught to “overvalue their self-worth” Those with the disorder have been taught to “overvalue their self-worth” In support of this explanation, first-born and only children score higher on measures of narcissism In support of this explanation, first-born and only children score higher on measures of narcissism Finally, many sociocultural theorists see a link between narcissistic personality disorder and “eras of narcissism” in society Finally, many sociocultural theorists see a link between narcissistic personality disorder and “eras of narcissism” in society

52. 52Comer, Abnormal Psychology, 6e – Chapter 16 Treatments for Narcissistic Personality Disorder This disorder is one of the most difficult personality patterns to treat This disorder is one of the most difficult personality patterns to treat Clients who consult therapists usually do so because of a related disorder, most commonly depression Clients who consult therapists usually do so because of a related disorder, most commonly depression Once in treatment, the individuals may try to manipulate the therapist into supporting their sense of superiority Once in treatment, the individuals may try to manipulate the therapist into supporting their sense of superiority None of the major treatment approaches have had much success None of the major treatment approaches have had much success

53. 53Comer, Abnormal Psychology, 6e – Chapter 16 “Anxious” Personality Disorders The cluster of “anxious” personality disorders includes: The cluster of “anxious” personality disorders includes: Avoidant personality disorder Avoidant personality disorder Dependent personality disorder Dependent personality disorder Obsessive-compulsive personality disorder Obsessive-compulsive personality disorder

54. 54Comer, Abnormal Psychology, 6e – Chapter 16 “Anxious” Personality Disorders People with these disorders typically display anxious and fearful behavior People with these disorders typically display anxious and fearful behavior Although many of the symptoms are similar to those of anxiety and depressive disorders, researchers have found no links between this cluster and those Axis I diagnoses Although many of the symptoms are similar to those of anxiety and depressive disorders, researchers have found no links between this cluster and those Axis I diagnoses As with most of the personality disorders, research is limited As with most of the personality disorders, research is limited But treatments for this cluster appear to be modestly to moderately helpful, considerably better than for the other personality disorders But treatments for this cluster appear to be modestly to moderately helpful, considerably better than for the other personality disorders

55. 55Comer, Abnormal Psychology, 6e – Chapter 16 Avoidant Personality Disorder People with avoidant personality disorder are very uncomfortable and inhibited in social situations, overwhelmed by feelings of inadequacy, and extremely sensitive to negative evaluation People with avoidant personality disorder are very uncomfortable and inhibited in social situations, overwhelmed by feelings of inadequacy, and extremely sensitive to negative evaluation They believe themselves unappealing or inferior and often have few close friends They believe themselves unappealing or inferior and often have few close friends

56. 56Comer, Abnormal Psychology, 6e – Chapter 16 Avoidant Personality Disorder The disorder is similar to social phobia, and many people with one disorder experience the other The disorder is similar to social phobia, and many people with one disorder experience the other Similarities between the two disorders include a fear of humiliation and low self-confidence Similarities between the two disorders include a fear of humiliation and low self-confidence A key difference is that people with social phobia mainly fear social circumstances, while people with avoidant personality disorder tend to fear close social relationships A key difference is that people with social phobia mainly fear social circumstances, while people with avoidant personality disorder tend to fear close social relationships Between 1% and 2% of adults have avoidant personality disorder, men as frequently as women Between 1% and 2% of adults have avoidant personality disorder, men as frequently as women

57. 57Comer, Abnormal Psychology, 6e – Chapter 16 How Do Theorists Explain Avoidant Personality Disorder? Theorists often assume that avoidant personality disorder has the same causes as anxiety disorders, including: Theorists often assume that avoidant personality disorder has the same causes as anxiety disorders, including: Early trauma Early trauma Conditioned fears Conditioned fears Upsetting beliefs Upsetting beliefs Biochemical abnormalities Biochemical abnormalities Research has not directly tied the personality disorder to the anxiety disorders Research has not directly tied the personality disorder to the anxiety disorders

58. 58Comer, Abnormal Psychology, 6e – Chapter 16 How Do Theorists Explain Avoidant Personality Disorder? Psychodynamic theorists focus mainly on the general sense of shame felt by people with avoidant personality disorder Psychodynamic theorists focus mainly on the general sense of shame felt by people with avoidant personality disorder Some trace the shame back to early toilet training experiences Some trace the shame back to early toilet training experiences

59. 59Comer, Abnormal Psychology, 6e – Chapter 16 How Do Theorists Explain Avoidant Personality Disorder? Cognitive theorists believe that harsh criticism and rejection in early childhood may lead people to assume that others will always judge them negatively Cognitive theorists believe that harsh criticism and rejection in early childhood may lead people to assume that others will always judge them negatively In several studies, individuals reported memories that supported both the psychodynamic and cognitive theories In several studies, individuals reported memories that supported both the psychodynamic and cognitive theories

60. 60Comer, Abnormal Psychology, 6e – Chapter 16 Treatments for Avoidant Personality Disorder People with avoidant personality disorder come to therapy seeking acceptance and affection People with avoidant personality disorder come to therapy seeking acceptance and affection Keeping them in therapy can be challenging because they often begin to avoid sessions Keeping them in therapy can be challenging because they often begin to avoid sessions A key task of the therapist is to gain the individual’s trust A key task of the therapist is to gain the individual’s trust Beyond building trust, therapists tend to treat the disorder as they treat social phobia and anxiety Beyond building trust, therapists tend to treat the disorder as they treat social phobia and anxiety These treatments have had modest success These treatments have had modest success Drug therapy may also be useful Drug therapy may also be useful

61. 61Comer, Abnormal Psychology, 6e – Chapter 16 Dependent Personality Disorder People with dependent personality disorder have a pervasive, excessive need to be taken care of People with dependent personality disorder have a pervasive, excessive need to be taken care of As a result, they are clinging and obedient, fearing separation from their loved ones As a result, they are clinging and obedient, fearing separation from their loved ones They rely on others so much that they cannot make the smallest decision for themselves They rely on others so much that they cannot make the smallest decision for themselves The central feature of the disorder is a difficulty with separation The central feature of the disorder is a difficulty with separation

62. 62Comer, Abnormal Psychology, 6e – Chapter 16 Dependent Personality Disorder Many people with this disorder feel distressed, lonely, and sad Many people with this disorder feel distressed, lonely, and sad Often they dislike themselves Often they dislike themselves They are at risk for depression and anxiety disorders and may be especially prone to suicidal thoughts They are at risk for depression and anxiety disorders and may be especially prone to suicidal thoughts The exact prevalence of the disorder is not known, but some studies estimate it at over 2% The exact prevalence of the disorder is not known, but some studies estimate it at over 2% Research suggests that men and women are affected equally Research suggests that men and women are affected equally

63. 63Comer, Abnormal Psychology, 6e – Chapter 16 How Do Theorists Explain Dependent Personality Disorder? Psychodynamic explanations for dependent personality disorder are very similar to those for depression Psychodynamic explanations for dependent personality disorder are very similar to those for depression Freudian theorists argue that unresolved conflicts during the oral stage of development can give rise to a lifelong need for nurturance Freudian theorists argue that unresolved conflicts during the oral stage of development can give rise to a lifelong need for nurturance Object-relations theorists say that early parental loss or rejection may prevent normal experiences of attachment and separation, leaving some children with lingering fears of abandonment Object-relations theorists say that early parental loss or rejection may prevent normal experiences of attachment and separation, leaving some children with lingering fears of abandonment Other theorists argue that parents were overinvolved and overprotective, increasing their children’s dependency Other theorists argue that parents were overinvolved and overprotective, increasing their children’s dependency

64. 64Comer, Abnormal Psychology, 6e – Chapter 16 How Do Theorists Explain Dependent Personality Disorder? Behaviorists propose that parents of those with dependent personality disorder unintentionally rewarded their children’s clinging and “loyal” behavior while punishing acts of independence Behaviorists propose that parents of those with dependent personality disorder unintentionally rewarded their children’s clinging and “loyal” behavior while punishing acts of independence Alternatively, some parents’ own dependent behaviors may have served as models for their children Alternatively, some parents’ own dependent behaviors may have served as models for their children

65. 65Comer, Abnormal Psychology, 6e – Chapter 16 How Do Theorists Explain Dependent Personality Disorder? Cognitive theorists identify two maladaptive attitudes as helping to produce and maintain this disorder: Cognitive theorists identify two maladaptive attitudes as helping to produce and maintain this disorder: “I am inadequate and helpless to deal with the world” “I am inadequate and helpless to deal with the world” “I must find a person to provide protection so I can cope” “I must find a person to provide protection so I can cope” Such thinking prevents sufferers of the disorder from making efforts to be autonomous Such thinking prevents sufferers of the disorder from making efforts to be autonomous

66. 66Comer, Abnormal Psychology, 6e – Chapter 16 Treatments for Dependent Personality Disorder In therapy, people with this disorder usually place all responsibility for their treatment on the clinician In therapy, people with this disorder usually place all responsibility for their treatment on the clinician A key task is to help patients accept responsibility for themselves A key task is to help patients accept responsibility for themselves Couple or family therapy can be helpful; both are often recommended Couple or family therapy can be helpful; both are often recommended

67. 67Comer, Abnormal Psychology, 6e – Chapter 16 Treatments for Dependent Personality Disorder Treatment can be at least modestly helpful Treatment can be at least modestly helpful Psychodynamic therapy focuses on many of the same issues as therapy for people with depression Psychodynamic therapy focuses on many of the same issues as therapy for people with depression Cognitive therapists try to help clients challenge and change their assumptions of incompetence and helplessness Cognitive therapists try to help clients challenge and change their assumptions of incompetence and helplessness Antidepressant drug therapy has been helpful for those whose disorder is accompanied by depression Antidepressant drug therapy has been helpful for those whose disorder is accompanied by depression Group therapy can be helpful because it provides clients an opportunity to receive support from a number of peers and because group members may serve as models for one another Group therapy can be helpful because it provides clients an opportunity to receive support from a number of peers and because group members may serve as models for one another

68. 68Comer, Abnormal Psychology, 6e – Chapter 16 Obsessive-Compulsive Personality Disorder People with obsessive-compulsive personality disorder are so preoccupied with order, perfection, and control that they lose all flexibility, openness, and efficiency People with obsessive-compulsive personality disorder are so preoccupied with order, perfection, and control that they lose all flexibility, openness, and efficiency They set unreasonably high standards for themselves and others and, fearing a mistake, may be afraid to make decisions They set unreasonably high standards for themselves and others and, fearing a mistake, may be afraid to make decisions These individuals tend to be rigid and stubborn These individuals tend to be rigid and stubborn They may have trouble expressing affection and their relationships are often stiff and superficial They may have trouble expressing affection and their relationships are often stiff and superficial

69. 69Comer, Abnormal Psychology, 6e – Chapter 16 Obsessive-Compulsive Personality Disorder Between 2% and 5% of the population has this disorder, with white, educated, married, and employed individuals receiving the diagnosis most often Between 2% and 5% of the population has this disorder, with white, educated, married, and employed individuals receiving the diagnosis most often Men are twice as likely as women to display the disorder Men are twice as likely as women to display the disorder Many clinicians believe that obsessive-compulsive personality disorder and obsessive-compulsive disorder (the anxiety disorder) are closely related Many clinicians believe that obsessive-compulsive personality disorder and obsessive-compulsive disorder (the anxiety disorder) are closely related While the disorders share similar symptoms, researchers have not found a specific link between them While the disorders share similar symptoms, researchers have not found a specific link between them

70. 70Comer, Abnormal Psychology, 6e – Chapter 16 How Do Theorists Explain Obsessive- Compulsive Personality Disorder? Most explanations of obsessive-compulsive personality disorder borrow heavily from those of obsessive-compulsive anxiety disorder, despite doubts concerning a link between the two Most explanations of obsessive-compulsive personality disorder borrow heavily from those of obsessive-compulsive anxiety disorder, despite doubts concerning a link between the two Psychodynamic explanations dominate and research is limited Psychodynamic explanations dominate and research is limited

71. 71Comer, Abnormal Psychology, 6e – Chapter 16 How Do Theorists Explain Obsessive- Compulsive Personality Disorder? Freudian theorists suggest that people with obsessive-compulsive personality disorder are anal regressive Freudian theorists suggest that people with obsessive-compulsive personality disorder are anal regressive Because of overly harsh toilet training, people become angry and remain fixated at this stage of psychosexual development Because of overly harsh toilet training, people become angry and remain fixated at this stage of psychosexual development To keep their anger under control, they resist both their anger and their instincts to have bowel movements To keep their anger under control, they resist both their anger and their instincts to have bowel movements As a result, they become extremely orderly and restrained As a result, they become extremely orderly and restrained

72. 72Comer, Abnormal Psychology, 6e – Chapter 16 How Do Theorists Explain Obsessive- Compulsive Personality Disorder? Cognitive theorists have little to say about the origins of the disorder, but they do propose that illogical thinking processes help maintain it Cognitive theorists have little to say about the origins of the disorder, but they do propose that illogical thinking processes help maintain it

73. 73Comer, Abnormal Psychology, 6e – Chapter 16 Treatments for Obsessive- Compulsive Personality Disorder People with obsessive-compulsive personality disorder do not usually believe there is anything wrong with them People with obsessive-compulsive personality disorder do not usually believe there is anything wrong with them They are therefore unlikely to seek treatment unless they also are suffering from another disorder, most frequently anxiety or depression They are therefore unlikely to seek treatment unless they also are suffering from another disorder, most frequently anxiety or depression

74. 74Comer, Abnormal Psychology, 6e – Chapter 16 Treatments for Obsessive- Compulsive Personality Disorder Although drug therapy and behavioral therapy have been effective for people with OCD (the anxiety disorder), people with the personality disorder often appear to respond better to psychodynamic or cognitive therapy Although drug therapy and behavioral therapy have been effective for people with OCD (the anxiety disorder), people with the personality disorder often appear to respond better to psychodynamic or cognitive therapy

75. 75Comer, Abnormal Psychology, 6e – Chapter 16 What Problems Are Posed by the DSM-IV-TR Categories? Most of today’s clinicians believe that personality disorders are important and troubling patterns Most of today’s clinicians believe that personality disorders are important and troubling patterns Yet these disorders are particularly hard to diagnose, easy to misdiagnose, and raise serious issues of reliability and validity Yet these disorders are particularly hard to diagnose, easy to misdiagnose, and raise serious issues of reliability and validity Several specific problems have been raised… Several specific problems have been raised…

76. 76Comer, Abnormal Psychology, 6e – Chapter 16 What Problems Are Posed by the DSM-IV-TR Categories? Some of the diagnostic criteria cannot be observed directly Some of the diagnostic criteria cannot be observed directly The diagnoses often rely heavily on the impressions of the individual clinician The diagnoses often rely heavily on the impressions of the individual clinician Similarly, clinicians differ widely in their judgments about when a normal personality style crosses the line and deserves to be called a disorder Similarly, clinicians differ widely in their judgments about when a normal personality style crosses the line and deserves to be called a disorder

77. 77Comer, Abnormal Psychology, 6e – Chapter 16 What Problems Are Posed by the DSM-IV-TR Categories? The similarity of disorders within a cluster or between clusters creates classification difficulties The similarity of disorders within a cluster or between clusters creates classification difficulties People with quite different personalities may be given the same diagnosis People with quite different personalities may be given the same diagnosis Individuals must meet a certain number of criteria to receive a given diagnosis, but no single feature is necessary for any diagnosis Individuals must meet a certain number of criteria to receive a given diagnosis, but no single feature is necessary for any diagnosis

78. 78Comer, Abnormal Psychology, 6e – Chapter 16 What Problems Are Posed by the DSM-IV-TR Categories? Because of these problems, diagnosticians keep changing the criteria used to assess the personality disorders Because of these problems, diagnosticians keep changing the criteria used to assess the personality disorders For example, DSM-IV-TR dropped a past category, passive- aggressive personality disorder For example, DSM-IV-TR dropped a past category, passive- aggressive personality disorder

79. 79Comer, Abnormal Psychology, 6e – Chapter 16 Are There Better Ways to Classify Personality Disorders? The leading criticism of DSM-IV-TR’s approach to personality disorders is that the classification system uses multiple categories that serve to dichotomize personality problems The leading criticism of DSM-IV-TR’s approach to personality disorders is that the classification system uses multiple categories that serve to dichotomize personality problems This method does not allow for variations in symptom presentation, including failure to meet all criteria necessary for a full diagnosis This method does not allow for variations in symptom presentation, including failure to meet all criteria necessary for a full diagnosis It has been estimated that as many as 60% of clients with personality problems are not diagnosable according to the DSM-IV-TR criteria It has been estimated that as many as 60% of clients with personality problems are not diagnosable according to the DSM-IV-TR criteria

80. 80Comer, Abnormal Psychology, 6e – Chapter 16 Are There Better Ways to Classify Personality Disorders? Given such difficulties, many theorists now believe that the DSM-IV-TR personality disorders actually differ more in degree than in type of dysfunction Given such difficulties, many theorists now believe that the DSM-IV-TR personality disorders actually differ more in degree than in type of dysfunction They have proposed that the disorders should be organized by the severity of certain key traits, or personality dimensions, rather than the presence or absence of specific traits They have proposed that the disorders should be organized by the severity of certain key traits, or personality dimensions, rather than the presence or absence of specific traits A growing number of these theorists suggest that a dimensional approach to classifying personality pathology would more accurately reflect the personality problems seen in people A growing number of these theorists suggest that a dimensional approach to classifying personality pathology would more accurately reflect the personality problems seen in people

81. 81Comer, Abnormal Psychology, 6e – Chapter 16 Are There Better Ways to Classify Personality Disorders? The “Big Five” Theory of Personality and Personality Disorders The “Big Five” Theory of Personality and Personality Disorders A large body of research conducted with diverse populations consistently suggests that the basic structure of personality may consist of five “supertraits” or factors – neuroticism, extroversion, openness to experience, agreeableness, and conscientiousness A large body of research conducted with diverse populations consistently suggests that the basic structure of personality may consist of five “supertraits” or factors – neuroticism, extroversion, openness to experience, agreeableness, and conscientiousness Each of these factors, collectively referred to as the “Big Five” consists of a number of subfactors Each of these factors, collectively referred to as the “Big Five” consists of a number of subfactors Theoretically, everyone’s personality can be summarized by a combination of these supertraits Theoretically, everyone’s personality can be summarized by a combination of these supertraits

82. 82Comer, Abnormal Psychology, 6e – Chapter 16 Are There Better Ways to Classify Personality Disorders? The “Big Five” Theory of Personality and Personality Disorders The “Big Five” Theory of Personality and Personality Disorders Many theorists have further considered how the “Big Five” model of personality might relate to the impairments seen across the DSM-IV-TR personality disorders Many theorists have further considered how the “Big Five” model of personality might relate to the impairments seen across the DSM-IV-TR personality disorders Research suggests that the majority of these disorders are characterized by high levels of neuroticism and low levels of agreeableness Research suggests that the majority of these disorders are characterized by high levels of neuroticism and low levels of agreeableness Many proponents of the five-factor model further argue that it would be best to describe all people with personality disorders as being high, low, or in-between on the five supertraits, and to drop the DSM-IV- TR’s current use of personality disorder categories altogether Many proponents of the five-factor model further argue that it would be best to describe all people with personality disorders as being high, low, or in-between on the five supertraits, and to drop the DSM-IV- TR’s current use of personality disorder categories altogether

83. 83Comer, Abnormal Psychology, 6e – Chapter 16 Are There Better Ways to Classify Personality Disorders? Alternative Dimensional Approaches Alternative Dimensional Approaches Although many clinical theorists now agree that a dimensional approach would reflect personality pathology more accurately than the categorical approach of DSM-IV-TR, not all of them believe that the “Big Five” model is the most useful dimensional approach Although many clinical theorists now agree that a dimensional approach would reflect personality pathology more accurately than the categorical approach of DSM-IV-TR, not all of them believe that the “Big Five” model is the most useful dimensional approach As such, a number of theorists have proposed alternative dimensional models As such, a number of theorists have proposed alternative dimensional models It is not yet certain where these proposed dimensional models of personality pathology will lead, although a number of influential theorists predict that the next edition of DSM (DSM-V) will use some such model rather than the categorical model currently in DSM-IV-TR It is not yet certain where these proposed dimensional models of personality pathology will lead, although a number of influential theorists predict that the next edition of DSM (DSM-V) will use some such model rather than the categorical model currently in DSM-IV-TR