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Chapter 17

Personality, Mental Health, and Physical Health

Objectives

Discuss personality disorders: what they are, how they are diagnosed, characteristics of the major disorders, and some potential negative outcomes of labeling disorders
Discuss how personality is related to physical health

People Are Different

Personality psychology addresses how and why people are different
This is a good thing
Consequences for mental and physical health

This is a good thing: makes life more interesting, allows people to survive and thrive in different environments, necessary for evolution

Personality Disorders

Some traits are socially undesirable
There is not an exact point that differentiates between normal and disordered personality

Personality disorders definition: patterns of thought, feeling, and behavior beyond the normal range of psychological variation

Personality Disorders

Diagnostic and Statistical Manual (DSM)
First edition: 1952
Controversy
Current edition: DSM-5 in 2013
Two systems for personality disorders
Purposes
Make diagnosis more objective
Insurance billing

First edition: included a list and description of personality disorders and other psychological afflictions

Controversy: over how to define many things, including personality disorders; experienced clinicians versus researchers and empirical data

Two systems for personality disorders: old system with list of mental disorders and symptoms; new system that is more scientifically grounded

Make diagnosis more objective: ensures a common vocabulary for describing problems, which should make discussions and analyses more useful; especially important for research

Insurance billing: so care for the patient will be reimbursed

Defining Personality Disorders

Unusually extreme personality attributes
In terms of cultural context
Denial or distortion of reality
Problematic
For the person: anxiety, depression, confusion
Or for others

Five general characteristics

Defining Personality Disorders

Affect social relationships and interactions
Stable over time
Can begin in adolescence or childhood
Difficult to change with therapy or other means
Ego-syntonic
Symptoms are seen as normal and valued aspects of personality
They think others are the ones with a problem

Affect social relationships: other people are required for the symptoms (inflexible, deceitful) to be expressed

Stable over time: disorders are about as stable as personality itself

Ego-syntonic: The people who have them do not think anything is wrong; only applies to some personality disorders

The Major Personality Disorders

Old system
10 major disorders in three clusters
Cluster A: odd and eccentric patterns of thinking
Cluster B: impulsive and erratic patterns of behavior
Cluster C: anxious and avoidant emotional styles
New system
6 major disorders (4 deleted), no clusters

Cluster B disorders tend to be the most stable

Four disorders deleted: not sufficiently coherent, common, or distinct from the other disorders; schizoid, histrionic, dependent, and paranoid

The Major Personality Disorders

Schizotypal personality disorder
Extremely odd thoughts, strange ideas, unconventional behavior, superstitious beliefs, difficulty in close relationships
Prevalence: 0.6–4.6%

Schizotypal personality disorder: an extreme pattern of odd beliefs and behaviors and difficulties relating to others

Similar to schizophrenia at its extreme

The Major Personality Disorders

Narcissistic personality disorder (NPD)
Belief that one is superior
Expects and needs recognition from others
Expects special treatment and feels entitled
Lack of empathy
Hitler, Mussolini, Stalin
Difficult or impossible to treat

Narcissistic personality disorder (NPD): an extreme pattern of arrogant, exploitative behavior combined with a notable lack of empathy

Belief that one is superior: even against evidence

Expects special treatment and feels entitled: does not think rules apply to them; feels justified in taking advantage of others

Up to 6.2% prevalence

Activities: Narcissistic Personality Disorder and Charles Manson, Case History of Hitler

The Major Personality Disorders

Antisocial personality disorder
Illegal activities
Impulsive and risky behaviors
Irritable, aggressive, and irresponsible
Problems caused to others do not bother them
Ted Bundy
Associated with low economic status and urban settings

Antisocial personality disorder: an extreme pattern of deceitful, manipulative, and sometimes dangerous behavior

Illegal activities: such as vandalism, theft, and drug dealing

Impulsive and risky behaviors: such as reckless driving, drug abuse, and dangerous sexual practices

0.2–3.3% prevalence

More common in men

The Major Personality Disorders

Borderline personality disorder (BPD)
Most severe personality disorder
Hallmark symptom: emotional instability
Suicide attempts are common
Self-mutilation
Identity disturbance
Interpersonal relationships are confusing, chaotic, noisy, unpredictable, and unstable
Partly due to splitting

Borderline personality disorder (BPD): an extreme and sometimes dangerous pattern of emotional instability, emotional emptiness, confused identity, and tendencies toward self-harm

Hallmark symptom: emotional instability: emotions cannot be stopped

Self-mutilation: cutting

Identity disturbance: they do not know who they are (values, goals, sexual identity) or how they appear to others; do not understand own behaviors

Partly due to splitting: seeing people as all good or all bad

The Major Personality Disorders

Borderline personality disorder (BPD)
Possible origins
Treatment: dialectical behavioral therapy

Possible origins: genetic risk factor combined with early family environment that doesn’t teach children how to understand and regulate emotions; problems with the endogenous opioid system that regulates natural painkillers

Dialectical behavioral therapy: teaches skills for emotional self-control

About 2.0% prevalence

More common in women

Activity: Thoughts from a Man with Borderline Personality Disorder

The Major Personality Disorders

Avoidant personality disorder
Expect the absolute worst from others
Need constant reassurance of uncritical acceptance
Active inhibition of emotional expression
Deep cravings for affection and social acceptance

Avoidant personality disorder: fear of failure, criticism, or rejection leads to avoidance of normal activities

Expect the absolute worst from others: criticism, contempt, rejection

Deep cravings for affection and social acceptance: but they inhibit emotional expression toward others and others cannot get close to them

About 2.4% prevalence

Similar prevalence in men and women

Activity: Thoughts from a Woman with Avoidant Personality Disorder

The Major Personality Disorders

Obsessive-compulsive personality disorder (OCPD)
Bound by rituals and rules
Lacks a sense of proportion
Workaholism
Inability to throw things away
Can be ego-syntonic
Not the same as obsessive compulsive disorder

Obsessive-compulsive personality disorder (OCPD): an extreme pattern of rigidly conscientiousness behavior, including an anxious and inflexible adherence to rules and rituals, perfectionism, and a stubborn resistance to change

Lacks a sense of proportion: so unable to determine when rules don’t apply or details are not important

Workaholism: work long hours but don’t get much done

Inability to throw things away: they think they might need it later

Can be ego-syntonic: for some symptoms but not others; some of these characteristics may be useful

Not the same as obsessive compulsive disorder: less severe because it does not include specific compulsions, but OCPD may affect more areas of life and be harder to treat

2.1–7.9% prevalence (one of the most common disorders)

Personality Disorders

Organizing disorders with the DSM-5
New way of organization
The Bad Five
Negative affectivity
Detachment
Antagonism
Disinhibition
Psychoticism

New way of organization: doesn’t use clusters and tries to move beyond use of discreet categories; recognizes that psychological maladjustment is more a matter of degree than kind

The Bad Five: trait domains that are used to organize personality disorders; correspond to extremes of the Big Five; highlights that the difference between normal and abnormal is on a continuum

Negative affectivity: tendency to feel negative emotions

Detachment: tendency to withdraw from and avoid emotional contacts with others

Antagonism: including deceitfulness, grandiosity, callousness, and manipulativeness

Disinhibition: lack of self-control that leads to impulsive behavior

Psychoticism: tendency to have bizarre thoughts or experiences; eccentric behavior

Personality Disorders

Diagnosing disorders with the new section of the DSM-5
Follow three steps

Assess whether functioning is seriously impaired and rate degree of dysfunction

Assess whether at least one of the personality disorders is present

Assess degree of the five maladaptive personality traits

No sorting into a single diagnostic bin

New way of organization: doesn’t use clusters and tries to move beyond use of discreet categories; recognizes that psychological maladjustment is more a matter of degree than kind

No sorting into a single diagnostic bin, which was how the old system worked

Personality and Disorder

Pathologizing
Do all bad people have personality disorders?
Should we refrain from punishing socially undesirable, illegal, or immoral behavior because people suffer from antisocial personality disorder?
Describing behavior as the result of mental illness is too easy

Pathologizing behaviors: describing behaviors as the result of mental illness; there are disadvantages to describing so many behaviors as pathological

Describing behavior as the result of mental illness is too easy because there is a diagnosis for almost everything.

Personality and Disorder

Mental health
Pathologizing tells us almost nothing about the nature of mental health
Improving mental health requires an understanding of normal personality

Pathologizing tells us almost nothing about the nature of mental health: Mental health means more than not having any of the symptoms listed in the DSM

Improving mental health requires an understanding of normal personality: not just mental illness and personality disorders; this is one motivator of positive psychology

Personality and Disorder

Labeling
Misleading
Can limit understanding
Not an explanation
Can be useful and are necessary

Misleading: sometimes a little, sometimes a lot; because no one fits the exact criteria for any category, people often have characteristics of several categories, and they are difficult to apply consistently and reliably

Can limit understanding: by leading to not taking the person’s feelings, outlook, and rights seriously and decreasing empathy

Can be useful: for knowing what characteristics and behaviors tend to go together

Necessary: for describing clients, for research purposes, for discussing disorders with precision

Personality and Disorder

Normal and abnormal
There is not a sharp dividing line
Having a mild degree of a few characteristics does not imply having a disorder
Disorders may be thought of as exaggerated versions of traits that are advantageous when in the normal range
Unusual, original and creative: schizotypal
Self-confident and proud: narcissistic

There is not a sharp dividing line: normal traits are associated with a range of psychopathologies

Personality and Physical Health

Research
Health is often assessed with self-report
Some items on personality tests and health assessments overlap
L data: medical records, death certificates
I-data
Two possible pathways: biological and behavioral

Health is often assessed with self-report: with all the advantages and disadvantages of S-data

I-data: friends’ ratings of personality can predict longevity better than self-reports; predictors were conscientiousness and openness for men, and emotional stability and agreeableness for women

Two possible pathways: between personality and health

Biological: predispositions to certain physical reactions

Behavioral: predispositions to certain behaviors that have health consequences

Personality and Physical Health

The “Type A” personality
Jittery, overreactive, hyper-competitive, hostile
Correlated with blood and cardiovascular indications of risk for heart disease
Little evidence of this link
Kernel of truth: hostility

Little evidence of this link: and the reverse seems to be true

Hostility: related to stress on the physical system; but ambition and hard work are not related to risk factors

Activity: Hostility and Health

Personality and Physical Health

Emotionality
Negative and positive
Related to extraversion and neuroticism
Negative emotionality is associated with poor physical health
The connection is likely not direct
Unclear direction of the relationship
The relationship is complicated

Negative emotionality is associated with poor physical health: but there are mixed finding, and this may be due at least in part to the connection between neuroticism and smoking

Unclear direction of the relationship: Does negative emotion cause illness, or does illness cause negative emotion? A longitudinal study found that health affected emotional experience but emotional experience did not affect health; moreover, mental health treatment lowers coronary heart disease events but does not affect death rate

Personality and Physical Health

Conscientiousness
Clear, positive relationship
Related to quality and length of life
Related to behaviors that make good health more likely
Related to employment

Related to behaviors that make good health more likely: persistence, self-control, long-term planning to protect health, less substance abuse

Related to employment: Unemployment has negative implications for health.

Personality and Physical Health

Prospects for improving health
Some possibility of changing personality
More direct routes are likely to be better

Some possibility of changing personality: increase positive emotionality and conscientiousness

More direct routes are likely to be better: smoke less, exercise more, promote engagement in work and being active and productive in old age (behaviors related to high conscientiousness)

Activity: Improving conscientiousness for health

The Healthy Personality

Mental
Complex, fully elaborated, and well-integrated psychological world
Mostly positive, volitional, and adaptive self-concept
Rich, broad, and appropriately regulated emotional life
Productive member of society
Reciprocal and fulfilling relationships

The Health Personality

Physical health
Ability to do things one wants to do
Feel good
Supportive social relationships
Productivity
Good memory and ability to make decisions
Stay alive

Clicker Question #1

Someone with a personality disorder

does not have any advantageous characteristics.

is likely to grow out of the disorder.

has thoughts, feelings, and/or behaviors that are beyond the normal range of variation.

can easily be given a specific diagnosis.

Correct answer: c

Clicker Question #2

People who have personality disorders

can and will always tell you about their symptoms.

might think that there is nothing wrong with them.

are incapable of forming relationships.

always wish to get rid of their symptoms.

Correct answer: b

Clicker Question #3

The relationship between personality and physical health is

due to only biological factors.

strongly driven by the relationship between Type A personality and negative outcomes.

complexly and likely to be indirect.

well-understood.

Correct answer: c; emphasize still a lot to learn about this relationship