Personality Disorders in Modern Life Jamie Dyce人格障礙在現(xiàn)代生活的杰米戴斯

1)Biological2)Psychoanalytic3)Cognitive4)Interpersonal5)Evolutionary6)Statistical-Trait7)Descriptive-DSMPerspectivesRecap1)Biological2)Psychoanalytic3)Cognitive4)Interpersonal5)Evolutionary6)Statistical-Trait7)Descriptive-DSMPerspectivesInterpersonalPerspectiveInterpersonalPerspectiveLifeisaboutrelationshipsCooleyandMeadLookingGlassSelfOursenseofselfisdeterminedbythefeedbackthatothersprovideHarryStackSullivanPersonalityisthe“recurrentsetofinterpersonalsituationswhichcharacterizedaperson’slife”Wearenotself-containedentitiesSomeformsofmentalillnessareinterpersonalLeary’sCircumplexKieslerWiggin’sCircumplexPrinciple1–InterpersonalStylePrinciples2–VectorlengthAPrinciple2–VectorlengthABA=fluidB=rigidWiggin’sCircumplexA+DComplementaryADWiggin’sCircumplexA+DComplementaryADBCBandCcomplementaryWiggin’sCircumplexA+BAnticomplementaryADBCCandDAnticomplementaryDominanceIntrovertedArroganceUnassumingExtravertedWarmColdSubmissiveNARANTPARSZDAVDDEPHIST1=therapistpositionstartC=avoidantclientT2=therapistpositionendoftherapyPersonalityDisordersC=clientT1=therapistpositionstartoftherapyT2=therapistpositionatendoftherapyEvolutionaryPersonologyThe“Millon”InventoriesMCMI-III(disorders,18+)MIPS(personalitystyles,18+)MACI(disorders,ages13-19)PACL(Strack,1991)AdjectivebasedmeasureofnormalpersonalityEarlyTheory–BiosocialLearningTheoryActivePassivedetached

dependentindependentambivalentSourceofreinforcementCopingstrategyEarlyTheoryActivePassivedetachedAvoidant(AVD)Schizoid(SZD)AVD=hypersensitive,inadequate,sociallyinhibitedSZD=emotionless,extremelyintrovertedEarlyTheoryActivePassivedetachedSchizotypalSZTSZT=eccentric,odd,“mildschizophrenia”,anxiousEarlyTheoryActivePassivedependentHistrionicHSTDependentDEPHST=attentionseeking,excessivelyemotionalDEP=submissive,clingy,indecisive,insecurelyattachedEarlyTheoryActivePassivedependentBorderlineBDLBDL=unstablerelationships,moodsandidentity,impulsiveHistoryActivePassive

independentAntisocialANTNarcissisticNARANT=interpersonallycallous,impulsive,recklessNAR=entitled,arrogant,lackingempathyHistoryActivePassiveindependentParanoidPAR=mistrusting,suspicious,interpretsmotivesofothersasmalevolentHistoryActivePassiveambivalentNegativisticNEGCompulsiveCOMNegativistic=oppositional,resisting,stubbornCompulsive=controlling,orderly,perfectionisticHistoryActivePassiveambivalentBorderlineHistoryActivePassivedetachedavoidantschizoiddependenthistrionicdependentindependentantisocialnarcissisticambivalentnegativisticcompulsiveMCMI-I(1983)Loevinger(1957)TestConstructionProcedure1)Theoretical2)Internal–structural(reliability)3)External(validity)MCMI-II(1987)DSM-III-R(1987)11officialPDs2unofficialPDs(sadistic,self-defeating)Sadistic=enjoysinflictingpain,cruel,demeaningSelf-defeating=goodthingsdon’tlast,don’tdeservegoodthingsActivePassivedetachedavoidantschizoiddependenthistrionicdependentindependentantisocialnarcissisticambivalentnegativisticcompulsivediscordantsadisticself-defeatingBiosocialTheoryRevisedMCMI-IIIMCMI-IIIThreepolaritiesExistentialAim:Pleasure-PainCopingStyle:Modify-AccommodateReplicationStrategy:Self-OtherAllPDsablendofthesepolarities.SchizoidversusAvoidantMCMI-IIITheodoreMillon(1994)175items(20-30minutes)1ValidityIndex3ModifyingIndices14Pdscales(11mild,3severe)10clinicalsyndromes(7mild,3severe)ages18+Statistical-TraitApproaches1)ExaminecorrelatesofpersonalitydisordersNomotheticRelationshipbetweenPDsandBigFive2)ExaminesingleprofileIdeographicInferpersonalitydisorderfrom“spikes”MMPIMMPI-2MinnesotaMultiphasicPersonalityInventory-2MMPI-2StarkeHathawayamedicalpsychologistJovianMcKinleyaneuropsychiatristUniversityofMinnesotaHospitals“tobeusedlocally”“Finishedby1956”MMPIEightoriginalscales:HypochondriasisDepressionHysteriaPsychopathicDeviantParanoiaPsychastheniaSchizophreniaHypomaniaEmpiricalKeyingnormaldiagnosticgroupItemAnalysisComparisonofMMPIandMMPI-2MMPI566totalitems16repeateditems4validityscales10clinicalscalesStandardizedon724individualswithmeaneducationalof8thgrade.WhitesonlyMMPI-2(1989)567totalitemsnorepeateditems7validityscales10clinicalscalesStandardizedon2,600individualswithmeaneducationof13yearsRepresentativeofgender,ethnicity,andSESlevelDonotcopy/studyInterpretationTscores,M=50,SD=10ahighscoreisabove65TTof65orgreater,8%ofpopulationMMPIInterpretationSingleSpikeTwopointcodes(verycommon)e.g.,2-7codetypeTriadse.g.,1,2,3(neurotictriad)e.g.,6,7,8(psychotictriad)ContentScales,HarrisLingoes,Supplemental,etc.CriticalItemsGeneralScaleInterpretationsPositiveslopepoorday-to-dayfunctioningNegativeslopeemotionalturmoilanddissatisfactionwithlifeBasicClinicalScalesScale1-Hypochondriasispoorphysicalhealthgastrointestinaldifficulties

Scale2-Depressiondepression,poormorale,lackofhopegeneraldissatisfactionwithone'slifegeneralapathy,physicalsymptoms(sleepdisturbances,gastrointestinal)excessivesensitivity,lackofsociabilityScales3-Hysteria1)adenialofproblemsorvulnerabilities2)complaintsofreasonablyspecificsomaticproblemsScale4–PsychopathicDeviateangryrebelliousnessagainstruleshostileinterpersonalrelationshipsinabilitytoprofitfromexperience

angeratfamilyScale5–Masculinity-Femininityvocationalandavocationalinterestsaestheticpreferences,activity-passivitypersonalsensitivityScale6:PgnosisintherapyispoortendtoexternalizeScale7:Psychastheniageneraldiscontentwiththeworldobsessionalconcernsanxietyindecision,poorconcentration,self-devaluationScale8:SchizophreniaconfusedthoughtprocesseshallucinationssocialandinterpersonalalienationdepressionanddissatisfactionScale9:HypomaniahighenergyoutputdistractibilityandlackofpersistenceextroversionandstimulationseekinggrandiosityamoralityScale0:SocialIntroversionhighscoresindicateintroversionlowscoresindicateextraversionCaseStudy-JeffreyDahmer1960-1994Milwaukee/OhioareaSentencedto957years17malemurdervictimsSerialkillerCaseStudyJeffreyDahmerLink1Link2Link3Link4Link5DescriptiveDSMDSMPDsCalledmanythings…Charactertypes–FreudNeuroticstyles–ShapiroCharacterdisorders–HorneyPersonalitydisorders–DSM-III(1980)DefinedAPersonalityDisordersisanenduring

patternofinnerexperienceandbehaviorthatdeviatesmarkedlyfromtheexpectationsofanindividual’sculture,ispervasiveandinflexible,hasanonsetinadolescenceorearlyadulthood,isstableovertime,andleadstodistressorimpairment.(p.629)MultiaxialSystemScanp.6anddiscussAxialRelationshipsAxisI=AxisII*AxisIVExample:Depression=dependent*divorceMeasurementQuestion1)Interview2)StructuredInterview(SCID)3)PersonalityInventor