Personality Disorders
All
of the disorders we have considered so far are included on Axis I of the DSM. Each involves a specific syndrome
with a well-defined set of signs and symptoms. DSM’s Axis II diagnoses, in contrast, are characterized by much
broader patterns ofbehaviors and problems that are much more consistent across
the lifespan (Clark, 2009). These diagnoses are concerned with traits or habits
that characterize almost everything a person does, and so are disorders, in
essence, in someone’s personality.
Of
course, people differ widely in their personalities , and, because of these
variations, some people are easier to be with than others, and some have a
smoother path through life than others. In some cases, though, a person’s
personality is so maladaptive that it creates considerable distress both for
that person and for those around her and impairs the person’s day-to-day
functioning. Someone with these dif-ficulties may well be diagnosed as having
one or another of the personality
disorders.
The
DSM recognizes 10 personality
disorders. These are paranoid personality
disorder (in which a person shows widespread suspiciousness and mistrust of
others); schizoidpersonality disorder (in
which a person shows a striking detachment from others); schizo-typal personality disorder (in which a person shows a
discomfort with close relationships,cognitive or perceptual distortions, and
odd behavior); antisocial personality
disorder (in which a person shows consistent disregard for—and violation
of—others’ rights); borderline
personality disorder (in which a person shows impulsive behavior and
markedinstability in relationships, self-concept, and affect); histrionic personality disorder (in
which a person shows an unusual degree of attention seeking and emotionality); narcissistic personality disorder (in
which a person is grandiose, lacks empathy, and needsthe attention and
admiration of others); avoidant
personality disorder (in which a person shows social inhibition and social
insecurity); dependent personality disorder
(in which a person shows an excessive need to be taken care of by others); and obsessive-compulsivepersonality disorder (in
which a person is preoccupied with orderliness, perfection, andcontrol). Each
of these disorders, and indeed all of the Axis II personality disorders, are
difficult to diagnose, and disagreements about diagnosis are common (L. A.
Clark & Harrison, 2001; Livesley, 2001).
Part
of the difficulty is that the definitions of these disorders tell us what a
clear-cut and “pure” case of the disorder might look like. In reality, though,
an individual’s traits are likely only to approximate this prototype, and many
people have traits that leave them resembling more than one of the prototypes
(Shea, 1995). This obviously makes diagnosis complicated. In addition, each of
these disorders can be thought of as merely the extreme of some ordinary
pattern (Livesley, 2001; Widiger & Sanderson, 1995). Many people, for
example, are vain, and it is therefore a judgment call whether some-one’s vanity
is so powerful that it signals a narcissistic personality disorder. Likewise,
many people are shy, and it is sometimes difficult to decide whether someone’s
shyness is consistent with avoidant personality disorder. Clinicians often
disagree in these judgments, increasing the uncertainty of the Axis II
diagnoses.
These
diagnostic problems have in turn been difficult for researchers, because it is
obviously hard to study a group that cannot be accurately identified (Clark,
2007). Despite this limitation, investigators have made impressive progress in
understanding several of the personality disorders. For example, the diagnosis
of antisocial personal-ity disorder (and the closely related diagnosis of
psychopathy) is a powerful predictor of whether someone will slide into crime
again after a period of imprisonment (Hare, Cooke, & Hart, 1999; Hemphill,
Hare, & Wong, 1998) and so can be an important source of information in
making parole decisions about a prisoner. Similarly, the diag-nosis of
borderline personality disorder predicts compromised social cognition, as
evi-denced in neuroimaging findings that show that people with borderline
personality disorder fail to discriminate between situations in which another
person signaled that they trusted the
diagnosed individual and situations in which the other person signaled no trust (King-Casas, Sharp,
Lomax-Bream, Lohrenz, Fonagy, & Montague, 2008;Meyer-Lindenberg, 2008).
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