Personality Disorder Mnemonics (Memorable Psychiatry Lecture)
Summary
TLDRThis 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
🌟 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.
🔗 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.
📚 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.
🌐 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.
Mindmap
Keywords
💡Personality
💡Personality Disorders
💡Normal Personality
💡Four Humors
💡Myers-Briggs Type Indicator
💡Big Five Personality Traits
💡Openness to Experience
💡Conscientiousness
💡Extroversion
💡Agreeableness
💡Neuroticism
💡Inflexible
💡Disabling
💡Extreme
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
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