Personality Disorder Mnemonics (Memorable Psychiatry Lecture)

Summary

This script delves into the concept of personality and personality disorders, explaining the 'Big Five' traits (OCEAN) that define human behavior. It highlights how extreme, inflexible, and disabling traits can lead to personality disorders, affecting social and occupational functioning. The video clarifies misconceptions, discusses the challenges in diagnosis, and emphasizes the importance of treatment, particularly psychotherapy, for improvement.

Takeaways

• 😃 Personality is a consistent pattern of behavior, thought, and emotion that varies among individuals.
• 🤔 Personality disorders are characterized by inflexible and maladaptive traits causing distress and dysfunction.
• 📚 Historically, personality has been categorized into types like the four humors and the Myers-Briggs Type Indicator.
• 🌟 The 'Big Five' personality traits (OCEAN) are widely accepted as a reliable and valid model for describing personality.
• 🔄 Openness to Experience, Conscientiousness, Extraversion, Agreeableness, and Neuroticism are the five key traits in the OCEAN model.
• 🚫 Personality disorders are not simply an extreme presence or absence of traits but rather traits that become rigid and disabling.
• 🔗 The acronym TIED (Inflexible, Disabling, Extreme) helps to identify traits that may lead to personality disorders.
• 📉 Personality disorders are common, affecting around 10% of the population, and often under-diagnosed.
• 👥 They affect both men and women, although the prevalence varies by disorder.
• 🔁 While personality disorders are chronic, evidence suggests that personality can change and improve over a person's lifespan.
• 💡 Effective treatment for personality disorders primarily involves psychotherapy, with some specific therapies showing promise.

Q & A

What is the definition of personality?

Personality is the consistent, enduring pattern of behavior, thought, and emotion that a person shows throughout their life. It's how someone acts, thinks, and feels when interacting with the world.

What are personality disorders?

Personality disorders are conditions where certain personality traits become inflexible, maladaptive, causing distress, disability, and dysfunction.

How are personality types historically categorized?

Historically, personality types have been categorized using various methods, such as the four humors theory which divides people into sanguine, choleric, melancholic, and phlegmatic types.

What is the Myers-Briggs Type Indicator and how does it categorize personality?

The Myers-Briggs Type Indicator is a personality assessment tool that attempts to group people into 16 distinct categories based on their preferences in four dichotomies.

Why are personality traits best described using dimensional traits rather than categorical types?

Personality traits are best described using dimensional traits because personalities exist on a spectrum with most people falling somewhere in the middle, rather than fitting neatly into categorical buckets.

What are the Big Five personality traits?

The Big Five personality traits, also known as the Five Factor Model, include Openness to Experience, Conscientiousness, Extraversion, Agreeableness, and Neuroticism.

What does the acronym OCEAN stand for in relation to the Big Five personality traits?

OCEAN is an acronym for the Big Five personality traits: Openness to Experience, Conscientiousness, Extraversion, Agreeableness, and Neuroticism.

How do personality disorders emerge according to the script?

Personality disorders emerge when specific personality traits become inflexible, disabling, and extreme, leading to significant social and occupational dysfunction.

What is the DSM and how is it used to categorize personality disorders?

The DSM (Diagnostic and Statistical Manual of Mental Disorders) is a widely used classification system in the United States for categorizing mental disorders, including personality disorders.

What are the three clusters of personality disorders in the DSM and what do they represent?

The three clusters of personality disorders in the DSM are Cluster A (the 'weird' cluster), Cluster B (the 'wild' cluster), and Cluster C (the 'worried' cluster). They are based on superficial resemblances and traditional groupings rather than shared pathological processes.

How common are personality disorders and at what age do they typically develop?

Personality disorders are relatively common, with a base rate in the population around 10 percent. They tend to develop early in life, often showing signs by the teenage years.

What is the current understanding of the treatability of personality disorders?

While personality disorders were once considered incurable, recent evidence suggests that personality is malleable over the entire lifespan, and many patients may see a natural leveling off of severity as they age. Effective treatments include psychotherapy and psycho-education.

Outlines

00:00

🌟 Understanding Personality and Disorders

This paragraph introduces the concept of personality as a consistent pattern of behavior, thought, and emotion that varies among individuals. It explains that personality disorders are characterized by inflexible and maladaptive traits causing distress and dysfunction. The paragraph also discusses the historical attempts to categorize personalities, such as the four humors and the Myers-Briggs Type Indicator, and critiques these methods for their oversimplification. It then introduces the 'Big Five' personality traits, also known as the Five Factor Model (OCEAN), which includes Openness, Conscientiousness, Extroversion, Agreeableness, and Neuroticism. These traits are considered reliable and valid across cultures and age groups, providing a more nuanced understanding of personality.

05:01

🔗 From Personality Traits to Disorders

The second paragraph delves into how personality disorders develop when traits become inflexible, disabling, and extreme, forming the acronym TIED. It clarifies that no trait is inherently good or bad, and even positive traits can be problematic if they're extreme. The paragraph discusses the importance of flexibility in personality traits and how inflexibility can lead to issues in social and occupational functioning. It also touches on how personality disorders are often under-diagnosed and misunderstood, with people seeking help for related issues like depression or anxiety rather than for their personality disorder itself.

10:02

📚 DSM Classification of Personality Disorders

This section critiques the Diagnostic and Statistical Manual of Mental Disorders (DSM) for its outdated and somewhat arbitrary classification of personality disorders. It explains that the DSM categorizes personality disorders into three clusters: Cluster A (the 'weird'), Cluster B (the 'wild'), and Cluster C (the 'worried'), which are based more on tradition than on scientific evidence. The paragraph also discusses the challenges in diagnosing personality disorders and the importance of understanding them despite their complex and varied nature.

15:02

🌐 Prevalence and Treatment of Personality Disorders

The final paragraph addresses the prevalence of personality disorders, noting they are common, affecting around 10% of the population, with higher rates in certain settings. It discusses the early development of these disorders and the reluctance to diagnose them before the age of 18 due to the belief that personality is still developing. The paragraph also highlights that personality disorders are not lifelong, unchangeable conditions and that evidence suggests personality can change throughout life. It emphasizes the importance of diagnosis for appropriate treatment and the role of psychotherapy as the primary treatment modality, with specific therapies like DBT being effective for certain disorders.

Keywords

💡Personality

Personality refers to the consistent and enduring pattern of behavior, thought, and emotion that a person shows throughout their life. In the video, it is described as how someone acts, thinks, and feels when interacting with the world. The concept is foundational to understanding personality disorders as it sets the stage for discussing variations and disorders.

💡Personality Disorders

Personality disorders are characterized as inflexible and maladaptive traits that cause distress, disability, and dysfunction. The video explains that these disorders emerge when personality traits become extreme, leading to significant social and occupational impairment. It is a central theme as the video aims to demystify these disorders and their impact on individuals.

💡Normal Personality

Normal personality is used in the video to contrast with personality disorders, emphasizing that before discussing disorders, it's important to understand what constitutes a 'normal' range of personality traits. It provides a baseline against which personality disorders are identified as deviations.

💡Four Humors

The Four Humors is an ancient classification system mentioned in the video, dividing people into sanguine, choleric, melancholic, and phlegmatic types based on humoral balance. It illustrates early attempts to categorize personality, which the video contrasts with modern dimensional models like the Big Five.

💡Myers-Briggs Type Indicator

The Myers-Briggs Type Indicator is a modern personality typing system that attempts to categorize individuals into 16 personality types. The video critiques such categorical approaches, arguing that they oversimplify the complexity and spectrum of human personality traits.

💡Big Five Personality Traits

Also known as the Five Factor Model, the Big Five traits (OCEAN) are widely accepted for describing personality dimensions. The video uses OCEAN (Openness, Conscientiousness, Extraversion, Agreeableness, Neuroticism) to explain how personality is best understood along a spectrum rather than in distinct types.

💡Openness to Experience

Openness to Experience is one of the Big Five traits, describing a person's willingness to try new things and their imaginativeness. The video uses this trait to show how people scoring high on this dimension are more likely to seek novelty, contrasting with those who score low and prefer conventionality.

💡Conscientiousness

Conscientiousness from the Big Five refers to a person's tendency to be organized, responsible, and goal-oriented. The video explains how highly conscientious individuals may be successful but also rigid, while those scoring low might be more spontaneous but less reliable.

💡Extroversion

Extroversion is highlighted in the video as a trait that focuses on external environments and social interaction. It contrasts extroverts, who gain energy from others, with introverts, who prefer solitude to recharge, underscoring the spectrum on which this trait varies.

💡Agreeableness

Agreeableness is described as the tendency to prioritize social harmony. People high in agreeableness are seen as helpful and kind, but the video notes they might be susceptible to groupthink. Those scoring low may be less interested in social harmony and more skeptical of others' motives.

💡Neuroticism

Neuroticism refers to the tendency to experience negative emotions. The video explains that individuals high in neuroticism often focus on the negative, worry, and feel upset, while those low in neuroticism are less emotionally reactive, not necessarily being in a positive mood but avoiding persistent negative moods.

💡Inflexible

Inflexible in the context of the video refers to personality traits that become rigid and do not adapt to different situations. This inflexibility is a key characteristic of personality disorders, leading to the disabling and extreme nature of these conditions.

💡Disabling

Disabling is used to describe how personality disorders not only cause personal distress but also significantly impair social and occupational functioning. The video emphasizes that these disorders often hinder an individual's ability to form lasting relationships or maintain stable employment.

💡Extreme

Extreme in the video refers to the fact that individuals with personality disorders often exhibit traits at the poles of the personality spectrum, which contributes to their inflexibility and disability. It contrasts with the typical human experience where most people fall somewhere in the middle of these dimensions.

Highlights

Personality is defined as the consistent pattern of behavior, thought, and emotion.

Personality disorders are characterized by inflexible and maladaptive traits causing distress and dysfunction.

Understanding 'normal' personality is crucial before discussing personality disorders.

Personality types like the four humors and Myers-Briggs are oversimplified and not entirely accurate.

Personalities exist on a spectrum rather than fitting into distinct categories.

The Big Five personality traits (OCEAN) are a widely accepted model for describing personality.

Openness to experience reflects a person's interest in novelty and imaginativeness.

Conscientiousness is about acting according to personal and societal expectations.

Extroversion vs. Introversion describes a person's focus on external environment vs. internal state.

Agreeableness indicates how much a person prioritizes social harmony.

Neuroticism refers to the tendency to experience negative emotions.

Personality disorders emerge when traits become inflexible, disabling, and extreme.

The DSM's classification of personality disorders is criticized for being outdated and not based on the OCEAN model.

Personality disorders are categorized into Cluster A (weird), B (wild), and C (worried).

Cluster B disorders are linked by a common underlying pathology.

Personality disorders are common, affecting around 10% of the population.

Personality disorders often go undiagnosed due to stigma and the chronic nature of the condition.

Personality disorders can improve with age, and are not lifelong conditions.

Effective treatment for personality disorders is lacking, but psychotherapy is generally more effective than medication.

A personality disorder diagnosis can provide a framework for understanding multiple symptoms.

Working with personality disorders can be challenging but rewarding as patients make progress.

Transcripts

personality is defined as the consistent

and enduring pattern of behavior thought

and emotion that a person shows

throughout their life

to put it in even simpler terms

personality is how someone acts thinks

and feels when interacting with the

world

while everyone's personality is

different some people have personality

traits that are inflexible and

maladaptive resulting in distress

disability and dysfunction

these people are said to have

personality disorders

before we can talk about personality

disorders though we must first

understand what is meant by normal

personality

humans have come up with various methods

to describe personality even going back

thousands of years

most of these schemes attempt to divide

people into distinct personality types

for example you may have heard of the

four humors including sanguin for social

extroverted and fun-loving people

cleric for hot-tempered decisive and

strong-willed people

melancholic for artistic introverted and

private people and phlegmatic for calm

easygoing and conflict-avoidant people

more recently the well-known

myers-briggs type indicator similarly

attempts to group people into 16

distinct categories

however while these personality types

seem to make sense on first glance they

actually do a pretty poor job of

accurately describing someone's behavior

thoughts and emotions in the long run

this is because personalities are not

distinct buckets that people either fit

into or not

instead personalities exist on a

spectrum with a few people fitting

neatly into categorical buckets but most

people falling somewhere in the middle

for this reason personality is best

described using dimensional traits

rather than categorical types

there are different ways of describing

personality traits but the most widely

accepted is known as the big five

personality traits also called the five

factor model

these traits have been shown in multiple

studies to be both reliable meaning that

they're stable over time and stay

consistent from childhood through

adulthood and even into old age

as well as valid meaning that someone's

self-assessment of these traits

generally agrees with reports from

outside observers like family or friends

these traits have also been observed in

different cultures around the world

suggesting that they are universal

patterns which are inherent to humanity

and not just reflective of any one

particular society

you can remember these traits using the

acronym ocean

first o is for openness to experience

people who score highly on openness to

experience are generally imaginative and

tend to be interested in novelty whether

that involves the arts travel or

innovative ideas

conversely those who score low on this

trait tend to be more conventional in

their outlook valuing perseverance and

practicality over new experiences

next c is for conscientiousness

conscientiousness is the tendency to act

according to both personal and societal

expectations including following rules

keeping things orderly and working to

meet goals

people who are highly conscientious tend

towards planned behaviors which can lead

to great accomplishments but they can

also be overly rigid when it comes to

following rules and schedules

in contrast people who are less

conscientious are more spontaneous and

free spirited though they may also risk

being impulsive or unreliable as a

result

next e is for extroversion

extroversion is a tendency to focus on

one's external environment with a

particular fondness for wanting to be

around other people

the opposite of extroversion is

introversion or the tendency to focus

instead on one's inner mental and

emotional state

the mark of an extrovert is that they

gain mental energy from interacting with

others while introverts tend to have

their mental energy depleted by being

around others and will often need time

alone in order to recharge

next a is for agreeableness

agreeableness refers to the priority

that one places on getting along with

other people

those with high agreeableness are seen

as helpful kind and trustworthy and tend

to put others interests ahead of their

own though they may be prone to peer

pressure and groupthink as a result

in contrast people who score low

unagreeableness are less interested in

social harmony and will put forth less

time and effort into helping others and

may even view others motives with

skepticism

finally n is for neuroticism neuroticism

refers to the tendency to experience

negative emotions such as anger sadness

and anxiety over positive emotions such

as happiness joy and contentment

people with high neuroticism tend to

spend more time focusing on negative

things in the present thinking of

mistakes from the past and worrying

about bad outcomes in the future

on the other hand people who score low

on neuroticism are less emotionally

reactive and tend to become upset less

often

it's important to note that low

neuroticism does not mean that these

people are in a perpetually positive

mood

rather they tend to have freedom from

persistent negative moods

so how do we get from the personality

traits and the ocean acronym to the

specific personality disorders listed in

the dsm

it's initially tempting to think that

it's the mere presence or absence of

specific traits that's problematic

for example you might think that

agreeableness is good and neuroticism is

bad so a personality disorder would

emerge when someone has too little

agreeableness or too much neuroticism

however this isn't necessarily the case

none of the ocean traits are inherently

good or bad and even seemingly positive

attributes like agreeableness or

conscientiousness can become problematic

as we'll see shortly

instead personality disorders emerge

when specific personality traits become

inflexible disabling and extreme

handily these words form the acronym

tied which should be easy to link to the

word ocean let's look at each of these

in more detail

first i is for inflexible for most

people personality traits are stable

with someone experiencing similar

behaviors thoughts and emotions across

their entire life

however these traits are also flexible

and can adapt to different situations

for example someone who's extroverted

may be more likely to spend their friday

nights out partying than someone who is

introverted but that doesn't mean that

the extrovert never spends time alone or

that the introvert never goes out

in this way personality is

simultaneously both consistent and

flexible

in contrast problems can emerge when

traits become rigid and unbending

for example someone who is spontaneous

and free-spirited may bring joy to their

group of friends with their exciting and

fast-paced lifestyle

however they still need to be able to

rein in their impulsive side in

situations where this is necessary such

as being at work or giving testimony in

a court case

in contrast if this person had a

maladaptively inflexible level of

impulsivity they would be spontaneous

and careless in all areas of their life

which could make it difficult for them

to maintain relationships or hold a job

next d is for disabling

the problematic nature of the trait

scene and personality disorders are not

only distressing to the individual but

also aggravating to the people around

them resulting in significant social and

occupational dysfunction

in particular personality disorders tend

to impact one's ability to form lasting

and meaningful relationships leading

many to have chaotic or destructive

relationships with others in their lives

or conversely to shy away from seeking

connection altogether

because these problematic traits are

often a core part of one's identity

patients rarely seek medical attention

saying there's something wrong with my

personality rather most people with

personality disorders come in reporting

depression anxiety or stress due to the

effects of their personality such as

conflicts at work or lack of close

friends

finally the ease for extreme we

established earlier that personality

traits exist on a spectrum with most

people being somewhere in the middle

in contrast people with personality

disorders tend to live at the extremes

with either incredibly high or

incredibly low scores on measures of

openness conscientiousness extroversion

agreeableness and neuroticism

the extreme nature of these traits makes

it hard for them to operate in

situations that call for the other end

of the spectrum leading directly to the

inflexibility and disability that we've

talked about already

so that's the theoretical basis of how

personality disorders emerge

unfortunately making the jump from that

framework to the specific personality

disorders listed in the dsm is not a

straightforward process

this is because the current diagnostic

scheme for personality disorders in the

dsm is to be perfectly honest kind of a

mess

the dsm does not base its personality

disorder diagnoses on any specific

personality framework like the ocean

model

instead the personality disorders listed

in the dsm are based on old and frankly

outdated psychological theories

like a broken clock that happens to be

right a couple of times a day at times

the dsm's diagnostic scheme works with

some personality disorders mapping

neatly onto specific ocean traits for

other personality disorders however any

relationship with the ocean traits or

any other validated framework is scarce

or even non-existent

nevertheless the dsm remains the most

common way of categorizing mental

pathology in the united states so it's

still important to understand how it

attempts to characterize and describe

personality pathology

traditionally the dsm categorized

personality disorders into three

distinct groups cluster a the weird

cluster of paranoid schizoid and

schizotypal personality disorders

cluster b the wild cluster of borderline

antisocial narcissistic and histrionic

personality disorders and cluster c the

worried cluster of dependent

obsessive-compulsive and avoid in

personality disorders

for the most part these clusters are

based more on superficial resemblances

between the disorders than on actual

shared pathological processes

the main exception to this is cluster b

as the four disorders in this cluster do

appear to have a common underlying

pathology

for clusters a and c however any

similarities between the disorders are

only surface level with few shared

diagnostic patterns or underlying causes

to be found

so when learning about the personality

disorder clusters keep in mind that

these clusters are largely based on

tradition rather than science

regardless of their shaky scientific

foundations you may be asked to identify

disorders from each cluster so having a

mnemonic to group them can be helpful

you can remember these categories by

thinking of what would happen if you

were to invite people from each cluster

to a party

cluster a will want to pass on the

invitation as people with these

disorders tend to shy away from social

interaction

cluster b will come to the party but

they run the risk of being banned from

future parties for engaging in overly

emotional self-centered manipulative or

even aggressive behavior

finally cluster c will join as well but

the party will be doa or dead on arrival

given their tendency to drag down the

spirit of the event with their highly

anxious and neurotic behavior

these 10 disorders are a highly variable

group that are often more different than

they are alike because of this variation

we'll wait until we discuss each

personality disorder individually to

talk about the specific signs and

symptoms associated with each

for now we will focus primarily on the

core features shared by all personality

disorders including who gets them what

happens once they do and what forms of

treatment are effective

personality disorders are common with a

relatively high base rate in the

population around 10 percent

in certain settings the rate is higher

still with even conservative estimates

suggesting that around a third or more

of patients in psychiatry clinics meet

criteria for personality disorder

this high prevalence combined with the

stigma that often accompanies these

diagnoses makes it so that personality

disorders are often under-diagnosed

compared to other mental disorders like

depression or bipolar disorder

the characteristic patterns of

personality disorders tend to develop

early in life with most people showing

signs by their teenage years if not even

earlier

despite this fact many clinicians are

reluctant to diagnose personality

disorders before the age of 18 as they

want to avoid giving such a permanent

and unchanging label at a time when

personality is thought to still be in

the process of developing

however while personality is more fluid

during development than during adulthood

many of the key patterns of personality

are still noticeable even from an early

age

while it's always wise to be cautious

and to allow for normal variations and

personality during childhood and

adolescence it does a disservice to our

patients to ignore clear signs of a

personality disorder when they're

present especially as some conditions

respond well to earlier intervention and

treatment

personality disorders as a whole are

found with roughly the same frequency in

both men and women

however the gender ratio varies from one

disorder to the next such as

narcissistic personality disorder being

more common in men and histrionic

personality disorder being more common

in women

you might expect that as with anything

related to personality the dysfunction

seen in personality disorders would be

chronic and enduring rather than

transient or episodic and to a large

extent this is true

however as we learn more about

personality disorders it's becoming

clearer that they are not lifelong

conditions in every case

just as personality is not completely

fluid during childhood it is also not

completely rigid as an adult

recent evidence suggests that while

changes are slower to happen after a

certain age personality remains

malleable over the entire lifespan

for people with personality disorders

there is often a natural leveling off of

severity that occurs as the patient

enters middle and later adulthood and in

many cases the patient may no longer

even meet criteria for the disorder even

if some of the core patterns remain

present to a certain extent

this means that personality disorders

are no longer a life sentence of

incurable and untreatable disability

even without treatment

speaking of which available evidence on

effective treatment of personality

disorders is severely lacking as they

are some of the most understudied

conditions in all of psychiatry

however the evidence that does exist

tends to suggest that personality

disorders are difficult to treat

because long-term change is hard work

for both the patient and their treatment

team many clinicians prefer not to work

with these patients or if they do to

focus on specific symptoms like insomnia

or anxiety that are seen as more easily

treatable using conventional treatments

like medications

however the presence of a personality

disorder is a major risk factor for

treatment failure when trying to manage

other conditions so providers taking

this approach often end up continuing a

cycle of failed trials and dashed

expectations

for this reason it is best to

thoughtfully but assertively address the

presence of a personality disorder and

work with the patient on managing it

rather than pretending that it doesn't

exist

in general psychotherapy should be the

primary form of treatment as it is

significantly more effective than

medications psycho-education about the

nature of the disorder is almost always

helpful if it is done empathically in a

way that does not further stigmatize the

patient

beyond that there are a few specific

forms of therapy that have been shown to

be effective for individual personality

disorders such as dialectical behavioral

therapy or dbt for borderline

personality disorder

we'll cover these when we talk about the

individual disorders in more detail

so that's personality disorders in a

nutshell while some clinicians believe

that they are doing patients a favor by

avoiding the potentially stigmatizing

diagnosis of a personality disorder the

fact of the matter is that doing so also

deprives them of the benefits of

diagnosis including providing

information about their prognosis

predicting their response to treatment

allowing for referrals to evidence-based

forms of therapy and relieving distress

through psychoeducation

for personality disorders in particular

a diagnosis often provides a helpful

unifying framework for why someone is

experiencing multiple different types of

symptoms at once

there's no doubt that working with

personality disorders can be challenging

however that doesn't erase the need to

provide care for our most vulnerable

patients and the cases that are

initially the most challenging often end

up being the most rewarding as you start

to see them make hard-won progress

towards a better life

and that's it thanks for watching this

video i hope it helped you to see

personality and personality disorders

from a different angle than you might

have previously

if you'd like to learn more about

personality disorders subscribe to my

channel to be notified when the next set

of videos is released you can also check

out my book memorable psychiatry on

amazon if you'd like to do a deeper dive

until next time bye for now