Abnormal Psychology

Personality Disorders 621

Follow-up on Rachel Reiland

We can say with certainty that Rachel Reiland suffered from borderline personal-

ity disorder. In addition, she displayed signifi cant elements of two other person-

ality disorders: histrionic personality disorder (her dramatic behaviors may have

been motivated by excessive emotional reactivity and a desire for attention) and

obsessive-compulsive personality disorder (her rigid thoughts and behaviors may

have been motivated by perfectionism). However, it is diffi cult to determine whether

these aspects of her personality met the criteria for the diagnosis of a comorbid

personality disorder. Her symptoms of borderline personality disorder were so pro-

nounced that they might have masked additional personality disorders.

If a clinician interviewing Reiland had sought to assess the presence of possible

comorbid personality disorders, he or she might have spoken with Reiland’s husband

for his perspective, asked Reiland specifi c questions related to the other personality

disorders under consideration, or asked her to complete a personality inventory or

questionnaire (described in Chapter 3).

What happened to Reiland? In her memoir, she notes that she was hospitalized

three times; the fi rst time because of signifi cant suicidal impulses. After discharge

from that fi rst hospitalization, she spent 4 years in intensive outpatient therapy with

a psychiatrist—three times a week during the fi rst 2 years of treatment. She was

hospitalized twice more over the course of her therapy and again developed an-

orexia for a period of time. Her symptoms were suffi ciently severe that her therapist

imposed strict limits on their interactions; for instance, he banned physical contact

of any kind. Although her therapist used psychodynamic therapy, he also incor-

porated elements of CBT and DBT into the treatment. For instance, the therapist

addressed Reiland’s black-and-white thinking and validated her experiences while

trying to help her accept her feelings without judging herself. In addition to the

Key Concepts and Facts About Fearful/Anxious Personality Disorders

• The hallmark of avoidant personality disorder is social inhibi-
  tion, which usually stems from feeling inadequate and being
  overly sensitive to negative evaluation. Although similar to so-
  cial phobia, avoidant personality disorder has criteria that are
  more pervasive and involve a more general reluctance to take
  risks. CBT methods that are used to treat social phobia can also
  be effective with avoidant personality disorder.


• Dependent personality disorder is characterized by submissive
  and clingy behaviors, based on fear of separation; these behav-
  iors are intended to elicit attention, reassurance, and decision
  making from other people. People with dependent personality
  disorder are chronically plagued by self-doubt and consistently
  underestimate their abilities; in fact, they may not know how to
  function independently.


• Obsessive-compulsive personality disorder is characterized by
  preoccupations with perfectionism, orderliness, and self-control
  and by low levels of fl exibility and effi ciency. These rigid person-
  ality traits may lead these people to have diffi culty prioritizing
  and making decisions, and they are often intolerant of emo-
  tional or “illogical” behavior in others.


• Psychological and social factors that contribute to social phobia
  also contribute to avoidant personality disorders.

Making a Diagnosis

• Reread Case 13.9 about Marcus, and determine whether or not
  his symptoms meet the criteria for avoidant personality disor-
  der. Specifically, list which criteria apply and which do not. If
  you would like more information to determine his diagnosis,
  what information—specifi cally—would you want, and in what
  ways would the information infl uence your decision?


• Reread Case 13.10 about Matthew, and determine whether or
  not his symptoms meet the criteria for dependent personality
  disorder. Specifi cally, list which criteria apply and which do not.
  If you would like more information to determine his diagnosis,
  what information—specifi cally—would you want, and in what
  ways would the information infl uence your decision?


• Reread Case 13.11 about Mr. V, and determine whether or not his
  symptoms meet the criteria for obsessive-compulsive personal-
  ity disorder. Specifi cally, list which criteria apply and which do
  not. If you would like more information to determine his diag-
  nosis, what information—specifi cally—would you want, and in
  what ways would the information infl uence your decision?