CHAPTER :8

Personality Disorders
LECTURE OUTLINE

I. WHAT IS PERSONALITY?
A. Personality is a set of uniquely expressed characteristics that influence our
behaviors, emotions, thoughts, and interactions
B. Particular characteristics—called traits—lead us to react in fairly predictable
ways as we move through life
C. Personality also is flexible, allowing us to learn and adapt to new environments
1. For those with personality disorders, however, that flexibility usually is missing

II. WHAT IS A PERSONALITY DISORDER?

A. It is an enduring, rigid pattern of inner experience and outward behavior that
impairs sense of self, emotional experience, goals, and capacity for empathy
and/or intimacy
1. The rigid traits of people with personality disorders often lead to psychological
pain for the individual or others
B. Classifying personality disorders
1. A personality disorder typically becomes recognizable in adolescence or early
adulthood
a. These are among the most difficult psychological disorders to treat
b. Many sufferers are not even aware of their personality problems
2. It has been estimated that between 9 and 13 percent of all adults may have a
personality disorder
3. It is common for a person with a personality disorder to also suffer from another
disorder, a relationship called comorbidity
a. Whatever the reason for this relationship, research indicates that the
presence of a personality disorder complicates and reduces a person’s
chances for a successful recovery from other psychological problems
4. DSM-5 identifies 10 personality disorders separated into three groups or “clusters”:
a. Odd or eccentric behavior
(a) Paranoid, schizoid, and schizotypal
b. Dramatic, emotional, or erratic behavior
(a) Antisocial, borderline, narcissistic, and histrionic
c. Anxious or fearful behavior
(a) Avoidant, dependent, and obsessive-compulsive
5. This DSM listing is called a categorical approach
a. It assumes that:
(a) Problematic personality traits are either present or absent
(b) A personality disorder is either displayed or not
(c) A person who suffers from a personality disorder is not markedly
troubled by personality traits outside of that disorder

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 b. It turns out, however, that these assumptions are frequently contradicted in
clinical practice
6. In fact, the symptom of the personality disorders overlap each other so much
that it can be difficult to distinguish one from another (See Figure 16-1 on text
p. 521.)
a. In addition, diagnosticians sometimes determine that particular individuals
have more than one personality disorder
7. This lack of agreement has raised concerns about the validity (accuracy) and
reliability (consistency) of these categories
8. As a result, many theorists have challenged the use of a categorical approach
a. They believe that these disorders differ more in degree than in type of
dysfunction—called a dimensional approach
b. In a dimensional approach, each trait is seen as varying along a continuum
extending from nonproblematic to extremely problematic
9. Given the inadequacies of a categorical approach and the enthusiasm for a
dimensional one, the framers of DSM-5 initially proposed significant changes
a. This proposal was met with enormous concern and criticism in the clinical
field, leading to a reversion back to the categorical approach
b. The newly proposed dimensional approach is now assigned “for further study”

III. “ODD” PERSONALITY DISORDERS

A. People with these disorders display behaviors similar to but not as extensive as
schizophrenia, including extreme suspiciousness, social withdrawal, and peculiar
ways of thinking and perceiving things
1. Such behaviors leave the person isolated
2. Some clinicians believe that these disorders are actually related to
schizophrenia and thus call them schizophrenia-spectrum disorders
B. Clinicians have learned much of the symptoms but little of their causes or how to
treat them
1. In fact, people with these disorders rarely seek treatment
C. The cluster of “odd” personality disorders includes:
1. Paranoid personality disorder
a. This disorder is characterized by deep distrust and suspicion of others
(a) Although inaccurate, this suspicion usually is not delusional—the ideas
are not so bizarre or so firmly held as to clearly remove the individuals
from reality
b. As a result of their mistrust, people with paranoid personality disorder often
remain cold and distant
c. They are critical of weakness and fault in others, particularly at work
(a) They are unable to recognize their own mistakes and are extremely
sensitive to criticism
(b) They often blame others for the things that go wrong in their lives, and
they repeatedly bear grudges
d. Between 0.5 and 3 percent of adults are believed to experience this disorder,
apparently more men than women
e. How do theorists explain paranoid personality disorder?
(a) The proposed explanations of this disorder, like most of the personality
disorders, have received little systematic research
(b) Psychodynamic theories trace the pattern back to early interactions with
demanding parents
(c) Cognitive theorists suggest that maladaptive assumptions such as

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 “People are evil and will attack you if given the chance” are to blame
(d) Biological theorists propose genetic causes and have looked at twins
studies to support this model
f. Treatments for paranoid personality disorder
(a) People with paranoid personality disorder do not typically see
themselves as needing help
(i) Few come to treatment willingly
(b) Those who are in treatment often distrust and rebel against their therapists
(i) As a result, therapy for this disorder, as for most of the other
personality disorders, has limited effect and moves slowly
(c) Object relations therapists try to see past patient anger and work on the
underlying wish for a satisfying relationship
(d) Behavioral and cognitive therapists try to help clients control anxiety
and improve interpersonal skills
(e) Cognitive therapists also try to restructure client’s maladaptive
assumptions and interpretations
(f) Drug therapy is of limited help
2. Schizoid personality disorder
a. This disorder is characterized by persistent avoidance of social
relationships and limited emotional expression
b. People with this disorder do not have close ties with other people; they
genuinely prefer to be alone
(a) People with schizoid personality disorder focus mainly on themselves
and often are seen as flat, cold, humorless, or dull
c. The prevalence of the disorder is not known, but it is estimated to affect
fewer than 1 percent of the population
(a) It is slightly more likely to occur in men than in women
d. How do theorists explain schizoid personality disorder?
(a) Many psychodynamic theorists, particularly object relations theorists,
link schizoid personality disorder to an unsatisfied need for human
contact
(i) The parents of those with the disorder are believed to have been
unaccepting or abusive of their children
(b) Cognitive theorists propose that people with schizoid personality
disorder suffer from deficiencies in their thinking
(i) Their thoughts tend to be vague and empty, and they have trouble
scanning the environment for accurate perceptions
e. Treatments for schizoid personality disorder
(a) Their social withdrawal prevents most people with this disorder from
entering therapy unless some other disorder makes treatment
necessary
(i) Even then, patients are likely to remain emotionally distant from the
therapist, seem not to care about treatment, and make limited
progress at best
(b) Cognitive-behavioral therapists have sometimes been able to help
people with this disorder experience more positive emotions and more
satisfying social interactions
(i) The cognitive end focuses on thinking about emotions
(ii) The behavioral end focuses on the teaching of social skills
(c) Group therapy apparently is useful when it offers a safe environment for
social contact
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 (d) Drug therapy is of little benefit
3. Schizotypal personality disorder
a. This disorder is characterized by a range of interpersonal problems, marked
by extreme discomfort in close relationships, odd (even bizarre) ways of
thinking, and behavioral eccentricities
(a) These symptoms may include ideas of reference and/or bodily illusions
b. People with the disorder often have great difficulty keeping their attention
focused; conversation is typically digressive and vague, even sprinkled
with loose associations
a. They tend to drift aimlessly and lead an idle, unproductive life, choosing
undemanding jobs in which they are not required to interact with other
people
(a) It has been estimated that 2 to 4 percent of all people (slightly more males
than females) may have schizotypal personality disorder
b. How do theorists explain schizotypal personality disorder?
(b) Because the symptoms of this personality disorder so often resemble
schizophrenia, researchers have hypothesized that similar factors are at
work in both disorders
(i) They often have found that schizotypal symptoms are linked to family
conflicts and to psychological disorders in parents
(c) Researchers also have begun to link schizotypal personality disorder to
some of the same biological factors found in schizophrenia, such as high
dopamine activity
(d) The disorder also has been linked to mood disorders, especially
depression
c. Treatments for schizotypal personality disorder
(e) Therapy is as difficult in cases of schizotypal personality disorder as in
cases of paranoid and schizoid personality disorders
(f) Most therapists agree on the need to help clients “reconnect” and to
recognize the limits of their thinking and powers
(g) Cognitive-behavioral therapists further try to teach clients to objectively
evaluate their thoughts and perceptions and provide speech lessons and
social skills training
(h) Antipsychotic drugs also have been given, and they appear to be
somewhat helpful in reducing certain thought problems

IV. “DRAMATIC” PERSONALITY DISORDERS

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A. The behaviors of people with these problems are so dramatic, emotional, or erratic
that it is almost impossible for them to have relationships that are truly giving and
satisfying
B. These personality disorders are more commonly diagnosed than the others
1. Only antisocial and borderline personality disorders have received much study
C. The causes of the disorders are not well understood
D. Treatments range from ineffective to moderately effective
E. The cluster of “dramatic” personality disorders includes:
1. Antisocial personality disorder
a. Sometimes described as “psychopaths” or “sociopaths,” people with
antisocial personality disorder persistently disregard and violate others’
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 rights
b. Aside from substance-related disorders, this is the disorder most linked to
adult criminal behavior
c. The DSM-5 stipulates that a person must be at least 18 years of age to
receive this diagnosis
d. Most people with the antisocial personality disorder displayed some
patterns of misbehavior before they were 15 years old
e. People with the disorder are likely to lie repeatedly, be reckless, and impulsive
(a) They have little regard for other individuals, and can be cruel, sadistic,
aggressive, and violent
f. Surveys indicate that 2 to 3.5 percent of people in the United States meet
criteria for this disorder
(a) The disorder is four times more common in men than women
g. Because people with this disorder are often arrested, researchers frequently
look for people with antisocial patterns in prison populations
(a) Studies indicate higher rates of alcoholism and other substance use
disorders among this group
h. Children with a conduct disorder and an accompanying attention-
deficit/hyperactivity disorder may have a heightened risk of developing
antisocial personality disorder
i. How do theorists explain antisocial personality disorder?
(a) Explanations come from the major models:
(i) Psychodynamic theorists propose that this disorder begins with an
absence of parental love, leading to a lack of basic trust
(ii) Many behaviorists have suggested that antisocial symptoms may be
learned through modeling or unintentional reinforcement
(iii) The cognitive view states that people with the disorder hold
attitudes that trivialize the importance of other people’s needs
(iv) A number of studies suggest that biological factors may play a role:
1. Lower levels of serotonin, impacting impulsivity and aggression
2. Deficient functioning in the frontal lobes of the brain
3. Lower levels of anxiety and arousal, leading them to be more likely
than other people to take risks and seek thrills
j. Treatments for antisocial personality disorder
(a) Treatments are typically ineffective
(b) A major obstacle is the individual’s lack of conscience or desire to change
(i) Most have been forced to come to treatment
(c) Some cognitive therapists try to guide clients to think about moral issues
and the needs of other people
(d) Hospitals and prisons have attempted to create therapeutic communities
(e) Atypical antipsychotic drugs also have been tried, but systematic studies
are still needed
2. Borderline personality disorder
a. People with this disorder display great instability, including major shifts in
mood, an unstable self-image, and impulsivity
(a) Interpersonal relationships also are unstable
b. People with this disorder are prone to bouts of anger, which sometimes result
in physical aggression and violence
(a) Just as often, however, they direct their impulsive anger inward and harm
themselves
c. Many of the patients who come to mental health emergency rooms are

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 individuals with borderline personality disorder who have intentionally hurt
themselves
(a) Their impulsive, self-destructive behavior can include:
(i) Alcohol and substance abuse
(ii) Reckless behavior, including driving and unsafe sex
(iii) Self-injurious or self-mutilation behavior
(iv) Suicidal threats and actions
d. People with the disorder frequently form intense, conflict-ridden
relationships while struggling with recurrent fears of impending
abandonment
e. Between 1 and 2.5 percent of the general population are thought to suffer
from this disorder
(a) Close to 75 percent of those diagnosed are women
f. The course of the disorder varies
(a) In the most common pattern, the instability and risk of suicide reach a
peak during young adulthood and then gradually wane with advancing
age
g. How do theorists explain borderline personality disorder?
(a) Because a fear of abandonment tortures so many people with the
disorder, psychodynamic theorists look to early parental relationships
to explain the disorder
(b) Object-relations theorists propose a lack of early acceptance or
abuse/neglect by parents
(i) Research has found some support for this view, including a link to
early sexual abuse
(c) Some features of the disorder also have been linked to biological
abnormalities, such as an overly reactive amygdala and an underactive
prefrontal cortex
(i) In addition, sufferers who are particularly impulsive apparently have
lower brain serotonin activity
(ii) Close relatives of those with borderline personality disorder are five
times more likely than the general population to have the disorder
(d) A number of theorists currently use a biosocial theory, stating that the
disorder results from a combination of internal and external forces
(e) Some sociocultural theorists suggest that cases of borderline personality
disorder are particularly likely to emerge in cultures that change rapidly
h. Treatments for borderline personality disorder
(a) It appears that psychotherapy can eventually lead to some degree of
improvement for people with this disorder
(b) It is extraordinarily difficult, 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
(c) Contemporary psychodynamic therapy has been somewhat more
effective than traditional psychodynamic approaches when it focuses on
the patient’s central relationship disturbance, poor sense of self, and
pervasive loneliness and emptiness
(i) Over the past two decades, an integrative treatment approach, called
dialectical behavior therapy, has received more research support
than any other treatment for this disorder
(ii) This approach grows largely from the cognitive-behavioral treatment
model and borrows heavily from humanistic and psychodynamic
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 approaches
(iii) DBT is often supplemented by the clients' participation in social skill-
building groups
(d) Antidepressant, antibipolar, antianxiety, and antipsychotic drugs have
helped some individuals to calm their emotional and aggressive storms
(i) Given the numerous suicide attempts by these patients, their use of
drugs on an outpatient basis is controversial
(e) Many clients seem to have benefited from a combination of
psychotherapy and drug therapy
3. Histrionic personality disorder
a. People with histrionic personality disorder are extremely emotional and
continually seek to be the center of attention
(a) They often engage in attention-getting behaviors and are always “on
stage”
(b) Approval and praise are the lifeblood of these individuals
b. People with histrionic personality disorder often are described as vain, self-
centered, and demanding
(a) Some make suicide attempts, often to manipulate others
c. This disorder was once believed to be more common in women than in men
(a) However, research has revealed gender bias in past diagnoses
(b) The latest statistics suggest that approximately 2 to 3 percent of adults
have this personality disorder, with males and females equally affected
d. How do theorists explain histrionic personality disorder?
(a) The psychodynamic perspective was originally developed to explain
hysteria, and theorists have retained their interest in the disorder today
(i) Most psychodynamic theorists believe that, as children, people with
this disorder experienced unhealthy relationships in which cold
parents left them feeling unloved and afraid of abandonment
(ii) To defend against deep-seated fears of loss, the individuals learned
to behave dramatically, inventing crises that would require people to
act protectively
(b) Cognitive theorists look at the lack of substance and extreme
suggestibility seen in people with the disorder
(i) Some argue that people with histrionic personality disorder hold a
general assumption that they are helpless to care for themselves, so
they seek out others who will meet their needs
(c) Sociocultural and multicultural theorists believe the disorder is caused in
part by society’s norms and expectations
(i) The vain, dramatic, and selfish behavior may be an exaggeration of
femininity as our culture once defined it
e. Treatments for histrionic personality disorder
(a) Unlike people with most other personality disorders, those with histrionic
personality disorder are more likely to seek treatment on their own
(i) Working with them can be difficult because of their demands,
tantrums, seductiveness, and attempts to please the therapist
(b) Cognitive therapists try to change their patients’ belief that they are
helpless and to help them develop better, more deliberate ways of
thinking and solving problems
(c) Psychodynamic therapy and group therapy also have been applied to
help clients deal with their dependency
(d) Clinical case reports suggest that each of the approaches can be useful
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 (e) Drug therapy is less successful, except as a means of relieving the
depression experienced by some patients
4. Narcissistic personality disorder
a. People with narcissistic personality disorder are generally grandiose, need
much admiration, and feel no empathy with others
b. People with this disorder exaggerate their achievements and talents and
often appear arrogant
c. People with this disorder are seldom interested in the feelings of others
(a) Many take advantage of others to achieve their own ends
d. Approximately 1 percent of adults display narcissistic personality disorder,
and up to 75 percent of them are men
(a) This type of behavior is common among normal teenagers and does not
usually lead to adult narcissism
e. How do theorists explain narcissistic personality disorder?
(a) Psychodynamic theorists more than others have theorized about this
disorder, focusing on cold, rejecting parents
(i) Object-relations theorists interpret the grandiose self-presentation
seen in people with the disorder as a way to convince themselves that
they are self-sufficient and without need of warm relationships
(ii) In support of this theory, research has found increased risk for
developing the disorder among abused children and those who lost
parents through adoption, divorce, or death
(b) Cognitive-behavioral theorists propose that the disorder may develop
when people are treated too positively rather than too negatively in
early life
(i) Those with the disorder have been taught to “overvalue their self-
worth”
(c) Finally, many sociocultural theorists see a link between narcissistic
personality disorder and “eras of narcissism” in society
f. Treatments for narcissistic personality disorder
(a) Narcissistic personality disorder is one of the most difficult personality
patterns to treat
(b) Clients who consult therapists usually do so because of a related
disorder, most commonly depression
(c) Once in treatment, the individuals may try to manipulate the therapist
into supporting their sense of superiority
(d) None of the major treatment approaches has had much success

V. “ANXIOUS” PERSONALITY DISORDERS

A. People with these disorders typically display anxious and fearful behavior
B. Although many of the symptoms are similar to those of anxiety and depressive
disorders, researchers have found no direct links between those personality
disorders and those diagnoses
C. As with most of the personality disorders, research is very limited, but treatments
for this cluster appear to be modestly to moderately helpful—considerably better
than for other personality disorders
D. The cluster of “anxious” personality disorders includes:
1. Avoidant personality disorder
a. People with avoidant personality disorder are very uncomfortable and
inhibited in social situations, overwhelmed by feelings of inadequacy, and
extremely sensitive to negative evaluation
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 (a) They believe themselves unappealing or inferior and often have few
close friends
b. The disorder is similar to social anxiety disorder, and many people with one
disorder experience the other
(a) Similarities between the two disorders include a fear of humiliation and
low self-confidence
(b) A key difference is that people with social anxiety disorder mainly fear
social circumstances, while people with the personality disorder tend to
fear close social relationships
c. As many as 1 and 2 percent of adults have avoidant personality disorder, men
as frequently as women
d. How do theorists explain avoidant personality disorder?
(a) Theorists often assume that avoidant personality disorder has the same
causes as anxiety disorders, including:
(i) Early trauma
(ii) Conditioned fears
(iii) Upsetting beliefs
(iv) Biochemical abnormalities
(b) Research has not directly tied the personality disorder to the anxiety
disorders
(c) Psychodynamic theorists focus mainly on the general sense of shame
felt by people with avoidant personality disorder
(i) Some trace the shame back to early toileting experiences
(d) Cognitive theorists believe that harsh criticism and rejection in early
childhood may lead people to assume that their environment will always
judge them negatively
(i) In several studies, individuals reported memories that supported both
the psychodynamic and cognitive theories
(e) Behavioral theorists suggest that people with this disorder typically fail
to develop normal social skills
e. Treatments for avoidant personality disorder
(a) People with avoidant personality disorder come to therapy seeking
acceptance and affection
(b) Keeping them in therapy can be challenging because they soon begin
to avoid sessions
(c) A key task of the therapist is to gain the individual’s trust
(d) Beyond trust building, therapists tend to treat the disorder as they treat
social phobia and anxiety
(i) These treatments have had modest success
(e) Group therapy formats, especially those that follow cognitive-
behavioral principles, also help by providing practice in social
interactions
(f) Antianxiety and antidepressant drugs are also sometimes helpful
2. Dependent personality disorder
a. People with dependent personality disorder have a pervasive, excessive
need to be taken care of
(a) As a result, they are clinging and obedient, fearing separation from
their loved ones
(b) They rely on others so much that they cannot make the smallest
decision for themselves
b. The central feature of the disorder is a difficulty with separation

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 (a) Many people with this disorder feel distressed, lonely, and sad
(b) Often they dislike themselves
c. They are at risk for depression, anxiety, and eating disorders and may be
especially prone to suicidal thoughts
d. Studies suggest that more than 2 percent of the population experience the
disorder
(a) Research suggests that men and women are affected equally
e. How do theorists explain dependent personality disorder?
(a) Psychodynamic explanations for this personality disorder are very
similar to those for depression
(i) Freudian theorists argue that unresolved conflicts during the oral
stage of development can give rise to a lifelong need for nurturance
(ii) 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
(iii) Other theorists argue that parents were overinvolved and
overprotective, increasing their children’s dependency
(b) Behaviorists propose that parents of those with dependent personality
disorder unintentionally rewarded their children’s clinging and “loyal”
behavior while punishing acts of independence
(i) Alternatively, some dependent behaviors seen in parents may have
acted as models
(c) Cognitive theorists identify two maladaptive attitudes as helping to
produce and maintain this disorder:
(i) “I am inadequate and helpless to deal with the world”
(ii) “I must find a person to provide protection so I can cope”
(i) Such thinking prevents sufferers of the disorder from making efforts
to be autonomous
f. Treatments for dependent personality disorder
(a) In therapy, people with this disorder usually place all responsibility for
their treatment and well-being on the clinician
(b) A key task is to help patients accept responsibility for themselves
(c) Couple or family therapy can be helpful and often is recommended
(d) Treatment can be at least modestly helpful
(i) Psychodynamic therapists focus on many of the same issues as therapy
for people with depression
(ii) Cognitive-behavioral therapists try to help clients challenge and
change their assumptions of incompetence and helplessness and
provide assertiveness training
(iii) Antidepressant drug therapy has been helpful for those whose
disorder is accompanied by depression
(iv) Group therapy also can be helpful because it provides clients an
opportunity to receive support from a number of peers, and group
members may serve as models for one another
3. Obsessive-compulsive personality disorder
a. People with obsessive-compulsive personality disorder are so preoccupied
with order, perfection, and control that they lose all flexibility, openness,
and efficiency
b. They set unreasonably high standards for themselves and others and, fearing
a mistake, may be afraid to make decisions
(a) These individuals tend to be rigid and stubborn

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 (b) They may have trouble expressing affection, and their relationships often
are stiff and superficial
c. As many as 1 and 2 percent of the population has this disorder, with white,
educated, married, and employed individuals receiving the diagnosis most
often
(a) Men are twice as likely as women to display the disorder
d. Many clinicians believe that obsessive-compulsive personality disorder and
obsessive-compulsive disorder (the anxiety disorder) are closely related
(a) While the disorders do share similar symptoms, researchers have not
found a specific link between them
e. How do theorists explain obsessive-compulsive personality disorder?
(a) Most explanations of obsessive-compulsive personality disorder borrow
heavily from those of obsessive-compulsive anxiety disorder, despite
the doubts concerning a link
(b) Psychodynamic explanations dominate and research is limited
(i) Freudian theorists suggest that people with obsessive-compulsive
personality disorder are anal regressive
1. Because of overly harsh toilet training, individuals become angry
and remain fixated at this stage of psychosexual development
2. To keep their anger under control, they resist both their anger
and their instincts to have bowel movements
3. As a result, they become extremely orderly and restrained
(ii) Cognitive theorists have little to say about the origins of the
disorder, but they do propose that illogical thinking processes help
maintain it
f. Treatments for obsessive-compulsive personality disorder
(a) People with obsessive-compulsive personality disorder do not usually
believe there is anything wrong with them
(b) They are therefore unlikely to seek treatment unless they also are
suffering from another disorder, most frequently anxiety or depression
(a) Individuals with this personality disorder often appear to respond well
to psychodynamic or cognitive therapy
(b) A number of clinicians report success with SSRIs

VI. MULTICULTURAL FACTORS: RESEARCH NEGLECT

A. Given the enormous interest in personality disorders, it is striking how little
multicultural research has been conducted
1. Clinical theorists have suspicions, but no compelling evidence, that cultural
differences exist or that such differences are important to the field’s
understanding and treatment of personality disorders
B. The lack of multicultural research is of special concern with regard to borderline
personality disorder
1. Theorists are convinced that gender and other cultural differences may be
particularly important in both the development and diagnosis of the disorder

VII. ARE THERE BETTER WAYS TO CLASSIFY PERSONALITY DISORDERS?

A. Most of today’s clinicians believe that personality disorders represent important
and troubling patterns
1. Yet, these disorders are particularly hard to diagnose, easy to misdiagnose,
and raise serious issues of reliability and validity
2. Several specific problems have been raised:

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 a.Some of the diagnostic criteria cannot be observed directly
(a) The diagnoses often rely heavily on the impressions of the individual
clinician
b. Similarly, clinicians differ widely in their judgments about when a normal
personality style crosses the line and deserves to be called a disorder
c. The personality disorders often are very similar
d. People with quite different personalities may be given the same diagnosis
B. The leading criticism of DSM-5’s approach to personality disorders is that the
classification system uses categories—rather than dimensions—of personality
1. A growing number of theorists now believe that personality disorders actually
differ more in degree than in type of dysfunction
a. They propose 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
b. In such an approach, each key trait would be seen as varying along a
continuum in which there is no clear boundary between normal and
abnormal
c. Some theorists believe that they should rely on the dimensions identified in
the “Big Five” theory of personality
C. The “Big Five” theory of personality and personality disorders
1. A large body of research conducted with diverse populations consistently
suggests that the basic structure of personality may consist of five factors or
“supertraits”—neuroticism, extroversion, openness to experiences,
agreeableness, and conscientiousness
a. Each of these factors, collectively referred to as the “Big Five,” consists of a
number of subfactors
b. Theoretically, everyone’s personality can be summarized by a combination
of these supertraits
2. Many proponents of the five-factor model further argue that it would be more
useful to describe all people with personality disorders as either high, low, or
in- between on the five supertraits and to drop the use of personality disorder
categories altogether
D. “Personality Disorder Trait Specified”: Another Dimensional Approach
1. The “Big Five” approach to personality disorders is currently receiving
considerable study
2. DSM-5 framers have designed their own dimensional approach for possible use
in future editions
a. This approach begins with the notion that individuals whose traits
significantly impair their functioning should receive a diagnosis called
“personality disorder—trait specified (PDTS)”
b. When assigning this diagnosis, clinicians would further identify and list
problematic traits and rate the severity of impairment caused
c. According to the proposal, five groups of problematic traits would be
eligible for a diagnosis of PDTS:
(a) Negative Affectivity
(b) Detachment
(c) Antagonism
(d) Disinhibition
(e) Psychoticism
d. According to this dimensional approach, when clinicians assign a diagnosis,
they must also rate the degree of dysfunction caused by each of the person’s
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 traits, using a four-point scale ranging from “minimally descriptive”
(Rating
= 0) to “maximally descriptive” (Rating = 3)
3. This dimensional approach to personality disorders may indeed prove superior
to DSM-5’s current categorical approach
a. Thus far, however, it has caused its own stir in the clinical community
b. Many clinicians believe the proposed changes give too much latitude to
diagnosticians
c. Still others worry that the proposals are too cumbersome or complicated
4. Only time and research will determine whether the alternative system is
indeed a useful approach to the classification and diagnosis of personality
disorders

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