Abnormal Psychology

Personality Disorders 571

Moreover, as just noted, personality disorders can fl uctuate over time. Thus, the

reasons for putting personality disorders on a separate axis have not been borne out

by research.

However, symptoms of personality disorders do contrast with those of Axis I

disorders, in that they can be diffi cult to diagnose in a fi rst interview, largely be-

cause patients may not be aware of the symptoms. In many cases, people who have

a personality disorder are so familiar with their lifelong pattern of emotional re-

sponses, behavioral tendencies, and mental processes and contents that the ways in

which this pattern is maladaptive may not be apparent to them. In fact, most people

with a personality disorder identify otherpeople or situations as being the problem,

not something about themselves.

Assessing Personality Disorders

Given that many people with personality disorders are not aware of the nature of

their problems, clinicians may diagnose a patient with a personality disorder based

both on what the patient says and on patterns in the way he or she says it (Skodol,

2005). For instance, Sarah, in Case 13.1, probably had specifi c complaints about

her co-workers, but the key information lies in the pattern of her complaints—in her

claim that most of her co-workers, in various companies, were hostile and reject-

ing. More patient visits may be required to identify such a pattern and to diagnose

a personality disorder than to diagnose an Axis I disorder. And more so than with

other diagnoses, clinicians must make inferences about the patient in order to diag-

nose a personality disorder. However, clinicians must be careful not to assume that

their inferences are correct without further corroboration; for example, a clinician

should not assume that Sarah’s problems with her co-workers were Sarah’s fault

without obtaining further information (Skodol, 2005).

To help assess personality disorders, clinicians and researchers may have

patients complete personality inventories or questionnaires. To diagnose a per-

sonality disorder, the clinician may also talk with someone in the patient’s life,

such as a family member—who often describes the patient very differently than

does the patient (Clark, 2007; Clifton, Turkehimer, & Oltmanns, 2004). The

picture that emerges of someone with a personality disorder is a pattern of chronic

interpersonal diffi culties or chronic problems with self, such as a feeling of empti-

ness (Livesley, 2001).

According to DSM-IV-TR, when clinicians assess personality disorders, they

should take into account the individual’s culture, ethnicity, and social background.

For instance, a woman who appears unable to make any decisions independently

(even about what to make for dinner) and constantly defers to family members might

have a personality disorder. However, for some immigrants, this pattern of behavior

may be within a normal range for their ethnic or religious group.

When immigrants have problems that are related to the chal-

lenges of adapting to a new culture or that involve behaviors

or a worldview that is typical of people with their background,

a personality disorder shouldn’t be diagnosed. A clinician who

isn’t familiar with a patient’s background should get more in-

formation from other sources. Sometimes it may not be obvi-

ous that a person is an immigrant, and sometimes the children

of immigrants have incorporated a different set of social norms

than those of the mainstream culture. If at all possible, clini-

cians should assess a patient’s level of acculturation to deter-

mine whether he or she values and follows mainstream cultural

norms—and if not, which norms he or she values and follows.

DSM-IV-TR Personality Clusters

DSM-IV-TR lists ten personality disorders, divided into three

clusters. Each cluster of personality disorders shares a common

Although an individual may exhibit a pattern of

problems that indicates a personality disorder,

clinicians should take into consideration the

individual’s ethnicity, social background, and

culture. If the individual’s pattern of thoughts,

feelings, and behaviors are characteristic of

people from his or her background, a diagnosis of

a personality disorder is not warranted.

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