Millon Clinical Multiaxial InventoryIn

One of the most widely acclaimed leaders in the personality disorder field is Theodore Millon who in the late 1970s began developing one of the first standardized self-report measures of personality disorders called the Millon Clinical Multiaxial Inventory (MCMI Millon, 1983). The MCMI was created to evaluate personality disorders according to Millon's own theory of personality psychopathology, but it was generally consistent with DSM-III conceptualizations of personality disorders. The MCMI...

Community and Psychiatric Samples

Surveys conducted in the 1980s found prevalence rates for personality disorders in the older adult community ranging from as low as 2.8 to as high as 11.0 (Cohen, 1990). Agronin (1994) presented a review of some early epidemi-ological studies in various European older adult communities and described prevalence rates of 1.8 to 6.0 . However, he noted that many of the diagnoses would not conform to modern DSM-IV personality disorder criteria. Weissman (1993) presented somewhat higher estimates of...

The Case of Toby Dependent Personality Disorder

Toby L.'s husband called the psychologist to schedule an appointment. I don't know if you want to see us together or just my wife. She's driving me absolutely crazy. I love her, but I'm really at the end of my rope here. She's crying in the next room even while I'm calling you. An appointment was set for the couple to come in. The clinician intended to meet with them together to identify if this would become a couples therapy case or an individual case, and, if so, who would be the identified...

NEO Personality Inventory Revised

A famous historical and current debate in psychology concerns the number of dimensions that most accurately describe the broadest themes in individual differences in personality. For example, famous psychologists Raymond B. Cattell (1946) derived 16 primary dimensions from factor analytical techniques, whereas Hans Eysenck (1960) proposed that trait descriptors can be subsumed under two ubiquitous factors he called Neu-roticism and Extraversion. A competing and popular model of personality...

Info

Institutional Example A Prototypical Skilled Nursing Facility Three dominant personality traits are suggested as being central to what defines the ideal nursing home resident. These traits address (a) the degree of the resident's characteristic dependency (b) how much he or she reflects what is usual and expectable for a person of that age, gender, and location and (c) how comfortable that person is functioning as a member of a highly interactive community. The fit to that system can be...

Semi Structured Clinical Interviews

Over the past 3 decades, numerous structured and semi-structured diagnostic interviews have been created to assist with the differential diagnosis of all standard Axis II personality disorders and all major Axis I clinical syndromes. During such an interview, diagnostic criteria are comprehensively assessed through a consistently applied set of questions and responses that are coded in a replicable fashion. Structured and semi-structured interviews have become widely used in clinical, research,...

Course and Prognosis for the Personality Disorders

In general, we would not expect a dramatic diminution of personality disorders over time because personality disorders, de facto, are robust and not expected to change greatly. Given recent evidence for their heritability (Coolidge, Thede, et al., 2001 Torgersen et al., 2000) and the DSM-IV-TR definition of personality disorders as enduring patterns of inner experience and external behaviors that are pervasive, inflexible, and stable over time, their chronicity is not surprising. Much more has...

Diagnostic Interview for Dsmiv Personality Disorders

The Diagnostic Interview for DSM-IV Personality Disorders (DIPD-IV Zanarini, Frankenburg, Sickel, & Yong, 1996) is a semi-structured interview designed to assess the presence or absence of the 10 standard DSM-IV personality disorders as well as Passive-Aggressive Personality Disorder and Depressive Personality Disorder in the DSM-IV appendix. Before personality assessment, a full screening for Axis I disorders is recommended. Additionally, an assessment of the respondent's general...

Avoidant Personality Disorder

This disorder manifests itself as a pervasive pattern of social inhibition or intense shyness, coupled with a longing for relationships. People with Avoidant Personality Disorder are extremely sensitive about how others perceive them, and they are especially preoccupied with and afraid of social criticism or rejection. As a consequence, they typically avoid entering into social situations in which they might be scrutinized or rejected. Cogni-tively, they tend to exaggerate the risks associated...

Application to Schizoid Schizotypal and Avoidant Personality Disorders

Individuals with Schizoid Personality Disorder are highly detached from nearly all social relationships and have a restricted range of emotions in interpersonal interactions. A schizoid person is the quintessential loner, who appears aloof, cold, and remote to others. Even when pressed into relationships, they do not appear to enjoy them, including sexual interactions. Individuals with Schizotypal Personality Disorder share two of the same criteria as the Schizoid Personality Disorder (1)...

The Case of Lenore Borderline Personality Disorder

The consultation request came as a message left on the psychologist's answering machine, which began Hi, Doctor. This is Jane, the nurse over at Ashton Manor. There's a patient here whom I'd really like you to see. Her name is Lenore, and if you can't come and do something with her soon, I'll probably murder her. The psychologist was able to stop by the skilled nursing facility on her way home, intending to look over the resident's chart and to set up an appointment for the assessment and...

Horneys Interpersonal View of the Personality Personality Disorders and the Basic Conflict

Horney's major disagreement with traditional Freudian theory was over the Freudian concept of instincts in personality development and the genesis of psychopathology. Horney thought that environmental, social, and family relationships played a much stronger role in the development of the normal and abnormal personality than did Freud. Central to her thinking was the concept of a basic conflict or basic anxiety, which Horney (1945) defined as the feeling a child has of being isolated and...

Neuroses Psychoses and Personality Disorders

Freud called his earliest conception of neurosis neurasthenia, and he saw all neurasthenias as rooted in sexual difficulties. Later, he differentiated the neurasthenias into different types, such as anxiety, hysteria, melancholia, narcissistic, obsessional, sexual, and war neuroses. He maintained that neuroses had no specific etiologic factor but that their nucleus, regardless of neurotic type, was the Oedipal conflict (or presumably Electra conflict for women) during the phallic stage....

Dependent Personality Disorder

Individuals with this disorder have an excessive need to be taken care of by others. As such, they are characteristically submissive, clinging, and needy, ever fearful of being alone. They are reluctant to make even minor decisions, relinquishing this responsibility to others or only doing so after receiving excessive advice and reassurance. Chronically feeling inadequate, dependent individuals desperately need others to assume responsibility for them. They lack confidence in their abilities...

Psychoanalytic Theory and Aging

Freudian theory is preeminently a theory of early childhood, yet given many of Freud's adult life experiences, this is somewhat ironic. From about 4 years before the publication of Interpretation of Dreams in 1899, Freud began describing himself as old in letters to his friend Wilhelm Fliess (even though Freud was only 40 at the time). He became very depressed and remained so for years after the death of his aged father Jacob in 1896. Nearing the age of 60, Freud agonized over the fate of his...

The Case of Blanche Narcissistic Personality Disorder

Blanche E. is a 77-year-old woman who resides in a skilled nursing facility (SNF), where she has been living for the past year and a half. She is dependent on the staff for her full care. At this time, her only independent functions are those involving the use of her hands, with which she still has limited movement. She is cognitively intact, however, and able to use her mind and her verbal skills to reach far beyond the limited confines of her bed. Her sharp tongue has become her weapon, with...

Self Defeating Personality Disorder Dsmiiir Appendix A

The basic pattern of the Self-Defeating Personality Disorder involves behaviors that undermine the person's ability to be successful, happy, and healthy in a wide variety of contexts. Self-defeating people are habitually attracted to people who invariably disappoint them, hurt them, or make them suffer. They typically reject or avoid pleasurable experiences. They typically fail to accomplish tasks that are critical to their own success (despite the ability to be successful at such tasks) such...

Personality Disorders and Dementia

Perhaps the ultimate overarching task in late life is that of life review looking back over one's life, reflecting on it, and making meaning from the journey. Erik Erikson's (1963) influential developmental theory posited a conflict between ego integrity and despair, with the successful outcome being the achievement of wisdom. As clinicians, we recognize that there can be many hurdles along the way. Wisdom might be a possible outcome, but simply becoming old does not guarantee its achievement....

Structured Clinical Interview for Dsmiv Axis II Personality Disorders

The Structured Clinical Interview for DSM-IV Axis II Personality Disorders (SCID-II First, Gibbon, Spitzer, Williams, & Benjamin, 1997) was developed to complement the widely used Axis I version of the SCID (First, Spitzer, Gibbon, & Williams, 1997). The SCID-II has semi-structured format (like the Axis I version) but it covers the 10 standard DSM-IV Axis II personality disorders, as well as Personality Disorder Not Otherwise Specified, and Depressive Personality Disorder and...

The Case of Mickey Antisocial Personality Disorder

The ambulance doors opened, and the male figure on the stretcher was flailing and fighting the attendants as they attempted to wheel him into the emergency room. Lie still, Mister. You'll be okay. Everything will be okay. Just take it easy. You son of a bitch Get me the hell out of here Oh, crap, it hurts. My chest hurts like hell. The new ER (emergency room) admission, now a patient, is a 71-year-old man named Mickey H. He has been transported to this inner-city hospital from a nearby bar,...

Borderline Personality Disorder

In trying to understand Borderline Personality Disorder, one may wonder what is the border to which the name of the disorder refers. Historically, and from a primarily psychoanalytic perspective, people with the disorder were theorized to be on the bound-ary the borderline between neurosis and psychosis, reflecting the severe nature of the syndrome (Stern, 1938 1986). Borderline Personality Disorder has also been referred to as borderline personality organization (Kernberg, 1975),...

The Case ofThelma Histrionic Personality Disorder

Thelma E. swept into the office carrying a large blue shopping bag from Tiffany's in one hand and an oversized alligator handbag in the other. Her petite frame was dwarfed by them. With a great sigh, she unloaded her burden. Placing the bags on the floor, she scanned the office, trying to decide which seat to claim, finally deciding on a large recliner situated across from the therapist's chair. She proceeded to push the chair closer to the therapist's, sat down, pulled the lever to extend the...

Antisocial Personality Disorder

As the term antisocial implies, individuals with this disorder are against society. Indeed, the hallmark feature is a pervasive pattern of disregard for, and failure to comply with, societal norms. Among people with Antisocial Personality Disorder, the rights of others are never a consideration, and when individuals with this disorder hurt, deceive, manipulate, abuse, or victimize others, they fail to experience remorse, guilt, or shame. When caught, antisocial types may weep crocodile tears...

Guideposts for Treatment Planning and Goal Setting

One general guidepost is that the more severe the personality pathology and the more poorly the individual is functioning, the more appropriate it is that the therapy intervention be directed at the level of the environment. The obverse also bears stating. The more intact and highly functioning is the individual, the more appropriate are therapies directed at the deeper level of the individual, including the more psychodynamic therapies. When considering treatment planning, a seminal question...

Application to Antisocial Histrionic Narcissistic Dependent and Avoidant Personality Disorders

Evolutionary psychologists speculate that this seemingly disparate group of personality disorders might have developed in the ancestral environment because of varying ESS with regard to status hierarchies (which are characteristic of nearly all primates). A status hierarchy implies that organisms living in groups fall along a continuum from dominant to submissive. By evaluating the success of fighting or submitting, individuals maximize their outcomes for obtaining mates, food, or other...

The Case of Dom Schizoid Personality Disorder

Dom D. came to the United States as a young boy, together with his parents and two older brothers. They settled in a large metropolitan area where his father worked as a skilled laborer in a factory and his mother as a homemaker. Dom was an easy child for his overwhelmed mother to raise. While she counted on her older sons to ease her way in this new country, she relied on Dom to help her with domestic chores, which he did dutifully, if not willingly. He did not appear to anticipate or even to...

Comorbidity of Axis I and Axis II Disorders

Those with a personality disorder are selectively at greater risk of developing an Axis I disorder, especially mood, anxiety, and somatization disorders (Zweig, 2003). As discussed earlier, we know that Axis I and II disorders commonly coexist in about 20 to 75 of patients (DeLeo, Scocco, & Meneghel, 1999 Oldham, 2001 Widiger & Seidlitz, 2002). Comorbid depression is especially prevalent, with approximately 15 to 30 of older adults diagnosed with depression also having a comorbid...

Narcissistic Personality Disorder

The narcissistic personality is characterized by an exaggerated or grandiose sense of self-importance and an illusion of being unique or special that lead to feelings of entitlement. Such persons overestimate their abilities, popularity, and power, frequently coming across as self-centered, conceited, and boastful. They are typically preoccupied with themselves and their self-affirming fantasies of unlimited success, fame, intellectual sophistication, power, and beauty. Sadly, their excessive...

Somatic Treatments

In this section we examine biologically based interventions and discuss potential applications and issues with older adult patients. Electroconvulsive therapy (ECT) has been a highly controversial intervention for many years, but it is the treatment of choice for severe recalcitrant depression, which has not responded to psychological and pharmacological approaches. Electroconvulsive therapy may also be used in cases of severe depression where treatment must work quickly and when it cannot wait...

The Case of Doreen Schizotypal Personality Disorder

Doreen G. is a 68-year-old woman who has come to the attention of mental health professionals only twice in her life. The first time was early in high school when the teachers were concerned about the degree of her introversion and lack of connection to her classmates, and about her sometimes bizarre facial expressions, which did not seem to match the events going on around her. She was a bit peculiar and significantly withdrawn and detached. Her parents were called into school to discuss these...

Introduction to Personality Disorders and Aging

Frustrating. Confusing. Maddening. Exasperating These are just a few of the words clinicians commonly use to describe their interactions with patients who have a personality disorder. Now, on top of this already challenging clinical situation, add in the common stressors associated with aging physical declines, social losses, reduced independence, financial stressors, and cognitive declines. Adults with personality disorders are woefully ill prepared to meet...

The Fearful or Anxious Cluster C Personality Disorders and Aging

Cluster C Personality Disorders Avoidant, Dependent, and Obsessive-Compulsive The similarities of the three personality disorders in Cluster C include underlying pervasive nervousness, anxiety, or fearfulness. Compared with the erratic and impulsive personality disorders in Cluster B with their characteristic interpersonal chaos, the Cluster C personality disorders often present with debilitating indecision, social inhibition, and avoidance. Based on the anxious nature of these personality...

The Case of Louis Obsessive Compulsive Personality Disorder

Louis M. was referred to the psychologist by his internist who had cared for Louis and his wife for many years. The physician lived in the same town and knew Louis not only as a patient but also as an active resident of the community. Louis's name was frequently cited in the town's weekly newspaper. He was outspoken, relied on well-documented facts, and had served over the years as a town selectman and chairman of the town's project development committee. His civic activities were in addition...

Passive Aggressive Personality Disorder Dsmivtr Appendix B

The Passive-Aggressive Personality Disorder has been in the DSM since its inception in 1952. Only in 1994 with the advent of DSM-IV was the Passive-Aggressive Personality Disorder removed from Axis II and placed in an appendix. The reasons for its drop in diagnostic status are uncertain however, Appendix B of DSM-IV-TR is intended to foster research that may result in a refinement of the diagnosis and its criteria, so it is possible the type may reappear in revised form in future versions of...

The Debate about Stability versus Change for the Personality Disorders

Whereas the extant cross-sectional data suggest some tendency for personality disorders overall to be less prevalent in older persons, a different issue is the stability or change in personality disorder signs and symptoms across the life span. Definitive data are lacking about this issue, and in fact, there is some controversy in the geropsychological literature about whether personality disorders decline or mellow with advancing age (Coolidge et al., 1992 Molinari, Kunik, Snow-Turek, Deleon,...

Depressive Personality Disorder Dsmivtr Appendix B

The appearance of the Depressive Personality Disorder in DSM-IV was not unheralded (Coolidge & Segal, 1998). The DSM-II, published in 1968, had at least two personality disorders with many of the features of Depressive Personality Disorder. Whereas the cyclothymic personality included many of the same depressive symptoms as the current depressive personality, the symptoms alternated with periods of elation in the cyclothymic type. But the worry, pessimism, and general sense of futility are...

International Personality Disorder Examination

The International Personality Disorder Examination (IPDE Loranger, 1999) is an extensive-semi-structured diagnostic interview to evaluate personality disorders according to both the DSM-IV and International Classification of Diseases, 10th edition (ICD-10) classification systems. Impetus for the creation of the IPDE came from the World Health Organization and the U.S. Alcohol, Drug Abuse, and Mental Health Administration in their joint effort aimed at producing a standardized assessment...

Horneys Description of Types

Compliant Type (Moving toward People) Compliant types have a strong and compulsive need for affection, approval, belonging, and human intimacy. They need a partner on whom they can regularly rely for help, protection, and guidance. Their urge to satisfy these compulsions is so strong that they often forget what their own real feelings are because they become so sensitive to their partner's feelings. They become so unselfish and self-sacrificing that they have a warped view of their own needs...

Sadistic Personality Disorder Dsmiiir Appendix A

People with Sadistic Personality Disorder are pervasively cruel, demeaning, and verbally and physically aggressive in most of their relationships. The sadistic behavior is typically more evident when the sadistic individual is in a position of power, as in the role of a father, mother, or uncle, or in occupational settings as a boss or in any position where there are subordinates. In contrast, individuals with Sadistic Personality Disorder often manage to contain their behavior when they are in...

Cognitive Theories of Personality Disorders

It may be useful to define what is meant by the various terms cognitive theory, behaviorism, cognitive therapy, and cognitive-behavioral therapy CBT . Theories of cognition are as old as the original foundations of psychology. Cognitive psychology was originally the study of internal mental processes. Wilhelm Wundt, a German psychologist and arguably the founder of psychology, used a method, in 1879, called introspection in which his subjects would be asked to reflect inwardly on their thought...

Ljh Personality Disorder

Psychotic Disorders Mood Disorders Anxiety Disorders Mood Disorders Somatoform Disorders Anxiety Disorders Passive-Aggressive Self-Defeating Avoidant Borderline years , we found that depression as measured by Beck's Depression Inventory and anxiety as measured by Spiel-berger's State-Trait Anxiety Scale were highly comorbid with personality disorders as an aggregate. We found that 18 of the sample met the criteria for at least one personality disorder self-report form of the CATI , 25 were...

For Designing a Treatment Plan

As we have highlighted in earlier chapters, older adults with personality disorders in general are likely to have problems fitting into formal institutions such as hospitals, rehabilitation facilities, and skilled nursing facilities. Generally, the more formal the institution, the more rigid the template defining the personality traits of those favored by the system. The staff working in these institutions also reflect this template for them to be valued by the system. Thus the GOF model can be...

Schizotypal Personality Disorder

Individuals with this disorder are characterized as bizarre or eccentric with odd perceptions and cognitions. Their eccentricities are typically not confined to an isolated area rather, schizotypal people often combine a peculiar style of dress or appearance, strange uses of language, unusual behaviors, and odd thought patterns. Their hygiene may be also poor. As such, schizotypal people are often identified easily and quickly by others, even nonclinicians. The schizotypal type is the classic...

Structured Interview for Dsmiv Personality

The Structured Interview for DSM-IV Personality SIDP-IV Pfohl, Blum, amp Zimmerman, 1997 covers 14 DSM-IV Axis II diagnoses, including the 10 standard personality disorders, Mixed Personality Disorder, as well as Self-Defeating, Depressive, and Negativistic Personality Disorders. Pfohl et al. 1997 recommend that prior to administering the SIDP-IV, a full evaluation of episodic clinical disorders is required. Interestingly, the SIDP-IV does not cover personality problems on a...

Obsessive Compulsive Personality Disorder

This disorder is characterized by a preoccupation with rules, details, organization, orderliness, and internal and external control. People with Obsessive-Compulsive Personality Disorder are highly perfectionistic, and they apply their overly strict standards to their own behavior and that of others. This preoccupation with details, lists, schedules, routines, organization, and perfectionism is so engrossing that the major point of the activity or project often becomes obscured, lost in the...

Coolidge Axis II Inventory

The Coolidge Axis II Inventory CATI Coolidge, 2000 Coolidge amp Merwin, 1992 is a 225-item, self-report inventory designed and revised to assess personality disorders and many clinical disorders according to the specific diagnostic criteria of DSM-IV-TR. Items are answered on a 4-point Likert scale ranging from strongly false to strongly true. The CATI measures all 10 personality disorders in the main text of the DSM-IV-TR but it also covers the Passive-Aggressive and Depressive Personality...

Inadequate Personality Disorder

The Inadequate Personality Disorder description in DSM-II included ineffectual responses to any physical, intellectual, social, or emotional demands placed on the individual. Despite the lack of any real physical or intellectual deficits, these patients appear poorly adapted to their environment, are inept, have poor judgment, are socially unstable, lack physical and emotional stamina, and chronically cannot cope with everyday stress and strain. Detailed, behaviorally specific criteria were not...

Chapter

Theories of Personality Disorders Evolutionary Evolutionary Theories of Personality Disorders 209 Basic Concepts of Evolutionary Theory 210 Application to Antisocial, Histrionic, Narcissistic, Dependent, and Avoidant Personality Disorders 212 Application to Borderline Personality Disorder 216 Application to Paranoid Personality Disorder 218 Application to Schizoid, Schizotypal, and Avoidant Personality Disorders 219 Neurobiological Theories of Personality Disorders 220 The Clinical Interview of...

Comorbidity General Issues

The comorbidity of personality disorders with other psychiatric disorders and with other personality disorders presents a special challenge and problem for clinicians and researchers. Since the multiaxial system was created, the DSM has inadvertently put personality disorders in a somewhat secondary status by placing them on Axis II, an afterthought to an Axis I assessment. It has even been suggested that clinicians have long been trained to focus on Axis I pathology, as if it is more important...

Histrionic Personality Disorder

The essential features of this personality disorder are excessive emotionality and attention-seeking behavior. These individuals are uncomfortable when not the center of attention and characteristically engage in overly dramatic, excessive, exaggerated, and affected emotional displays for which the primary goal is to secure attention and admiration from others. They may present themselves in a sexually seductive, flirtatious, and provocative manner and are concerned with their physical...