• Odd, eccentric
• Paranoid, Schizoid, Schizotypal

• Dramatic and eratic behaviour
• Antisocial, Borderline, Histrionic, Narcissistic

• Anxious and fearful
• Avoidant, Dependent, Obsessive Compulsive

• They are very different

• Categories and criterion

• They cause distress that is general, vague, and indistinct

• Appear in all stages of life
• Usually try not to diagnose children too early
• Must be 18 or older for Antisocial diagnosis

• They predispose individuals to mental disorders
• They affect the presentation and direction of other mental disorders
• They impact treatment success of mental disorders

•       Locates the problem “inside” the person; damaging to sense of self 

•       Are descriptive not explanatory. PD labels do not provide any information about how an individual came to feel or behave as they do

•       PDs are highly stigmatizing (misunderstood by public at large)       

• Prejudice with mental health field itself around PDs leads to refusal of services, insufficient support and erroneous clinical assessments

•       enable one to locate a specialist and secure much needed help

• It is usually a combination of both, where the person has the disordered personality traits, but they are aggravated by personal events and societal factors

• Premorbid PDs
• Psychiatric disorders
• Substance abuse

•       Role of Cultural and moral standards and expectations in shaping individual judgments about “normal” and disordered behavior

• Impossible to assess "appropriateness" of response to past experiences
• Involvement of political and social realties in creation & maintenance of disorders

1. The individual’s personality meets the general criteria for a PD and traits of several different Personality Disorders, but the criteria for any specific 1 are not met
2. The individual’s personality meets the general criteria for PD, but the individual is considered to have a PD that is not included in the Classification (e.g. passive aggressive personality disorder)

• Minorities are more likely to have PD diagnosis
• Women are more likely to be diagnosed with Borderline; considered modern day form of hysteria

• Criterion A. Deviates markedly from the experiences of one’s culture in at least two areas (cognition, affectivity, interpersonal functioning, and/or impulse control).
• Criterion B. Is pervasive and inflexible.
• Criterion C. Has an onset in adolescence or early adulthood; Has to be present for at least 1-2 years;
• Criterion D. Is stable over time. 
• Criterion E. Leads to significant distress or impairment.

• child custody
• employment
• health insurance
• right to make decisions about one’s legal affairs, health care, etc.
•  freedom      
• Keep in mind social/cultural component of diagnosis in real world

•       Need to have bias self-awareness

• the working out of the MOST LIKELY explanations insofar as one can tell of the causes or perpetuating factors of the person’s behavior
• More static approach

• Consider the effects of their diagnoses on client’s lives outside of treatment

• Consider treatment implications of giving a client one diagnosis rather than another

• Record rule outs and other diagnoses considered

• Be willing to write letters, make statements to minimize deleterious effects of diagnosis in various areas of a client’s life

• Follow ethical standards of the profession

• Seek legal advice when indicated to protect self and client

• Fully inform clients of the dx, rationale, benefits & potential risks, what clinician can do to protect the client, why you have to diagnose

• Stay informed about the various potential & active positive and negative consequences of diagnoses; stay educated

• Keep public informed

• Women's deviation from social norms caused by pressure to simultaneously conform and non-conform to expected gender roles
• In past called witchcraft or hysteria
• Now some would say that Borderline does this

·      Female survivors are looked at as a societal problem regarding power structure in our society

• Colorblind racism
• Stress from racial discrimination

1. Religious or Spiritual Problem
2. Acculturation problem
3. Partner relational problem
4. Parent-Child Relational Problem

• ·      Client has a disorder and it is related to a given V code
• ·      Client has a mental disorder that unrelated to V code but Vcode is significant/important
• ·      Client does not have a mental disorder but the particular Vcode appears to be focus of clinical attention

•       When a therapist fails to consider the effects of social factors on an individual’s behaviors & attitudes

 looks at how BPD was developed as a diagnostic category and how it gets used present day; how disorder was constructed

•       explains the prevalence of women in BPD category as products of power, resources, coping styles & risk for sexual abuse &violence; gives the cause on the disorder from this feminist viewpoint

• the process of cultural and psychological change that results following meeting between cultures; occurs in levels

• overt acts of discrimination by individuals on the basis of skin color that cause death, injury, destruction of property, or denial of services or opportunity.

• societal beliefs and customs that promote the assumption that the products of a given dominant culture, including the language and traditions of that culture are superior to those of other cultures.(Assumption White is the norm & is superior)

• polices, practices, and procedures of institutions that have a disproportionately negative effect on racial minorities’ access to and quality of goods, services, and opportunities.

• the extent to which an individual endorses and manifests the cultural traditions and practices of a particular group

• A cultural response style based on experiences of racism and oppression in White-dominant society; a reasonable and adaptive cultural mistrust exhibited by members of minority cultures
• Not to be confused with PPD

• Genetics
• Social Learning (self-reinforcement)

• Rooted in temperamental abnormalities
• Families with loose, inconsistent or nonexistent rules/structure
• Loose social structure
• Low social support 

• Rooted in traits of impulsivity and affective instability
•  § exaggerated with psychosocial stressors
• Family breakdown
• Unclear or unavailable social roles
• Detached social networks 

• rooted in narcissistic traits
• § exaggerated with psychosocial stressors 
• Detached social networks
• Individualism = highly valued & rewarded
• Technology is self-focused & self-promoted

• rooted in anxious traits
• overprotective parenting
• unclear social roles
• detached social networks

1. Manipulating environment (creating better person-environment fit)
2. Edication and trait modification
3. Help establish social roles and ties (purple/belonging)

• Identify when&where traits are maladaptive
• Observe emotionalstates that lead to problematic behaviour
• Experiment with more effective alternatives
• Practice new strategy and observe results

• Phenomenology
• Vulnerability Level
• Net Stress Engagement
• Reactive Coping Stretegies
• Emergent Identities
• Life Stage Outcomes

Self-organization determined by context & by the phenomenological experience of race, gender, physical status and many other potential

factors

Factors that pose challenges to an individual at any life stage

• Risk contributors
• Protective factors

Net effect between challenges experienced by the individual in contrast to the total support provided them

• Challenges
• Social support

Coping methods individuals use in the moment when faced with personal, interpersonal, and environmental challenges

• Maladaptive
• Adaptive

Sum total of coping strategies

• Unproductive
• Productive

Productive or adverselife outcomes based on summation of earlier identity choices

• Negative
• Positive

• PD’s increase the likelihood of impoverishment and the need for social welfare
• Poverty increases the likelihood of the development of PD’s
• A bi-directional relationship with moderating variables that pertains to poverty and PD’s 

Divides personality into categories of “normal” and “abnormal.”  Members of each diagnostic group share the same features, based on categories and descriptions

Personality traits differ along a continuum of normal to abnormal.  The levels of expression of a characteristic determine psychology pathology

• Individuals whose personality functioning or trait pattern is substantially different from that of any of the 6 specific disorders should be diagnosed with PD-TS
• Difficulties in 2 or more orders of self-functioning
• 1 or more traits from Criterion B

1. Overlapping categories
2. Heterogeneity among clients w/same disorder
3. Lack of clear boundary between normality & abnormality
4. “Catch-all” –default category – Personality Disorder-NOS
5. Disconnect with findings from normal personality research
6. Lack of diagnostic stability over time
7. Arbitrary selection of thresholds to define PDs (i.e. some will diagnose w 3 traits and some w 4)

•       Personality Disorders are well-established as a phenomenon – no longer need  a separate category requiring clinicians to consider

• Categorical model
• Number of Personality Disorders
• Names of the Diagnoses
• 3 cluster approach
• Diagnostic thresholds
• Consideration of Personality Disorders as distinct from other disorders

• OCEAN
• DAPP/SNAP

Adds two new critereon

• Criterion A: 4 assessment levels of impairment
• Criterion B: Pathological personality traits

• Self-functioning (identity & self-direction)
• Interpersonal functioning (intimacey and empathy)

• Negative affectivity (vs. emotional stability)
• Detachment (vs. extroversion)
• Antagonism (vs. agreeableness)
• Disinhibition (vs. concientiousness)
• Psychotism (vs. lucidity)

• Paranoid
• Dependent
• Schizoid
• Histrionic

•      Inform most useful treatment type, intensity & prognosis

•       An acute episode of major depression in the context of a chronic characterological depression

1. Protection and validation of an insufficient identity

2. Avoidance of the internal emptiness
3. Distraction from one’s deficiencies
4. Justification of inappropriate behavior
5. The creation of “drama”

1. To be flexible and adaptive (appropriate; produce positive consequences; handle unexpected turns in life)
2. To improve one’s results (observe mistakes, take corrected action)
3. When facing something in life, engage in Problem Solving

1. Cognitive/perceptual organization
2. Impulsivity/aggression
3. Affective stability/instability
4. Anxiety/inhibition

•       Adult personality may be the product of “goodness of fit” between child’s predispositions & vulnerabilities and caretaker’s resources & demands

BIPOLAR DISORDER and Personality Disorders

If affective instability + absence of significant & mature Interpersonal relations + instability in work +/or self-image, then likely PD

Suicidality and Personality Disorders

If suicidal gestures are acute or chronic + under conditions of emotional agitation or acute frustrations, then likely PD

Major Depressive Disorder & Personality Disorders

If symptoms accompanied with rageful reactions, are rapidly shifting, less severe in intensity and closely tied to social circumstances, then likely PD

PTSD and Personality Disorder (Borderline)

If symptoms develop or remain many years after the trauma event and include somatization symptoms + emotional immaturity + chronic interpersonal difficulties, then likely PD

ADHD and Personality Disorders  (i.e.. Borderline, Narcisstic)

If symptoms (not necessarily from early childhood) + history of poor adjustment to social aspects of school + marked difficulties at home with parents or siblings + identity disturbance, then likely PD

•       Allow pathological traits and behaviors to become more ingrained and unchallenged

The etiology of any disorder is the result of :

• •       Influence of the social environment
• •       Biological vulnerability
• •       Psychological impact of life experiences

       Trait variability becomes maladaptive only when underlying traits are amplified (more intense) and are used under inappropriate circumstances

•       Biological markers (brain scans, blood tests, etc)

•       Abnormal parenting

• Social conditions
• Social disintegration

1. More likely to engage in use at earlier age and polysubstance abuse with greater frequency (impulse difficulties, poor relationships)
2. More vulnerable to having a compulsive and rigid use pattern
3. More likely to develop dependence
4. More likely to relapse
5. Have more difficult time keeping effective therapy relationships

1. Both are ways to sustain maladaptive patterns of behavior & escape the pain of life
2. Both entail use of defense strategies- denying, minimizing, hiding
3. Both can be seen on a continuum from normal to pathological
4. Both exist in multiple form (polysubstance abuse; polypersonality disorder)

•       Effect of chronic use of drugs or alcohol on personality functioning is marked by impulsivity, decreased frustration tolerance, self-centeredness( stubbornness, lack of empathy), grandiosity, passivity, and affect tolerance