text:
Personality disorder
Personality disorders | |
Classification and external resources | |
DiseasesDB | 9889 |
MedlinePlus | 000939 |
MeSH | D010554 |
Personality disorders |
Cluster A (odd) |
Cluster B (dramatic) |
Cluster C (anxious) |
Not specified |
Personality disorders are a class of mental disorders characterised by enduring maladaptive patterns of behavior, cognition and inner experience, exhibited across many contexts and deviating markedly from those accepted by the individual's culture. These patterns develop early, are inflexible and are associated with significant distress or disability.[1] The definitions may vary some according to other sources.[2][3]
Official criteria for diagnosing personality disorders are listed in the Diagnostic and Statistical Manual of Mental Disorders, published by the American Psychiatric Association, and in the mental and behavioral disorders section of the International Statistical Classification of Diseases and Related Health Problems, published by the World Health Organization. The DSM-5 published in 2013 now lists personality disorders in exactly the same way as other mental disorders, rather than on a separate 'axis' as previously.[4]
Personality, defined psychologically, is the set of enduring behavioral and mental traits that distinguish human beings. Hence, personality disorders are defined by experiences and behaviors that differ from societal norms and expectations. Those diagnosed with a personality disorder may experience difficulties in cognition, emotiveness, interpersonal functioning or control of impulses. In general, personality disorders are diagnosed in 40–60 percent of psychiatric patients, making them the most frequent of all psychiatric diagnoses.[5]
These behavioral patterns in personality disorders are typically associated with substantial disturbances in some behavioral tendencies of an individual, usually involving several areas of the personality, and are nearly always associated with considerable personal and social disruption. A person is classified as having a personality disorder if their abnormalities of behavior impair their social or occupational functioning. Additionally, personality disorders are inflexible and pervasive across many situations, due in large part to the fact that such behavior may be ego-syntonic (i.e. the patterns are consistent with the ego integrity of the individual) and are, therefore, perceived to be appropriate by that individual. This behavior can result in maladaptive coping skills, which may lead to personal problems that induce extreme anxiety, distress or depression.[6] These patterns of behavior typically are recognized in adolescence and the beginning of adulthood and, in some unusual instances, childhood.[1]
There are many issues with classifying a personality disorder.[7] There are many categories of definition,[clarification needed] some mild and some extreme.[7] Because the theory and diagnosis of personality disorders stem from prevailing cultural expectations, their validity is contested by some experts on the basis of invariable subjectivity. They argue that the theory and diagnosis of personality disorders are based strictly on social, or even sociopolitical and economic considerations.[8][9][10][11]
- 1 Classification
- 2 Signs and symptoms
- 3 Diagnosis
- 4 Causes
- 5 Epidemiology
- 6 Comorbidity
- 7 Management
- 8 History
- 9 Children
- 10 Five Factor Model
- 11 References
- 12 Further reading
- 13 External links
The two major systems of classification, the ICD and DSM, have deliberately merged their diagnoses to some extent, but some differences remain. For example, ICD-10 does not include narcissistic personality disorder as a distinct category, while DSM-5 does not include enduring personality change after catastrophic experience or after psychiatric illness. ICD-10 classifies the DSM-5 schizotypal personality disorder as a form of schizophrenia rather than as a personality disorder. There are accepted diagnostic issues and controversies with regard to distinguishing particular personality disorder categories from each other.[12] ICD classifies Transsexualism as a personality disorder;[13] while DSM-5 addresses Gender dysphoria.[14]
World Health Organization[edit]
The ICD-10 section on mental and behavioral disorders includes categories of personality disorder and enduring personality changes. They are defined as ingrained patterns indicated by inflexible and disabling responses that significantly differ from how the average person in the culture perceives, thinks and feels, particularly in relating to others.[15]
The specific personality disorders are: paranoid, schizoid, dissocial, emotionally unstable (borderline type and impulsive type), histrionic, anankastic, anxious (avoidant) and dependent.[16]
There is also an 'Others' category involving conditions characterized as eccentric, haltlose (derived from "haltlos" (German) = drifting, aimless and irresponsible),[17] immature, narcissistic, passive-aggressive or psychoneurotic. An additional category is for unspecified personality disorder, including character neurosis and pathological personality.
There is also a category for Mixed and other personality disorders, defined as conditions that are often troublesome but do not demonstrate the specific pattern of symptoms in the named disorders. Finally there is a category of Enduring personality changes, not attributable to brain damage and disease. This is for conditions that seem to arise in adults without a diagnosis of personality disorder, following catastrophic or prolonged stress or other psychiatric illness.
American Psychiatric Association[edit]
The Diagnostic and Statistical Manual of Mental Disorders (currently the DSM-5) provides a definition of a General personality disorder that stress such disorders are an enduring and inflexible pattern of long duration that lead to significant distress or impairment and are not due to use of substances or another medical condition. DSM-5 lists ten personality disorders, grouped into three clusters. The DSM-5 also contains three diagnoses for personality patterns that do not match these ten disorders, but nevertheless exhibit characteristics of a personality disorder.[18]
Cluster A (odd disorders)[edit]
- Paranoid personality disorder: characterized by a pattern of irrational suspicion and mistrust of others, interpreting motivations as malevolent
- Schizoid personality disorder: lack of interest and detachment from social relationships, and restricted emotional expression
- Schizotypal personality disorder: a pattern of extreme discomfort interacting socially, distorted cognitions and perceptions
Cluster B (dramatic, emotional or erratic disorders)[edit]
- Antisocial personality disorder: a pervasive pattern of disregard for and violation of the rights of others, lack of empathy
- Borderline personality disorder: pervasive pattern of instability in relationships, self-image, identity, behavior and affects often leading to self-harm and impulsivity
- Histrionic personality disorder: pervasive pattern of attention-seeking behavior and excessive emotions
- Narcissistic personality disorder: a pervasive pattern of grandiosity, need for admiration, and a lack of empathy
Cluster C (anxious or fearful disorders)[edit]
- Avoidant personality disorder: pervasive feelings of social inhibition and inadequacy, extreme sensitivity to negative evaluation
- Dependent personality disorder: pervasive psychological need to be cared for by other people.
- Obsessive-compulsive personality disorder (not the same as obsessive-compulsive disorder): characterized by rigid conformity to rules, perfectionism and control
Other personality disorders[edit]
- Personality change due to another medical condition – is a personality disturbance due to the direct effects of a medical condition
- Other specified personality disorder – symptoms characteristic of a personality disorder but fails to meet the criteria for a specific disorder, with the reason given
- Personality disorder not otherwise specified
Some types of personality disorder were in previous versions of the diagnostic manuals but have been deleted. This includes two types that were in the DSM-III-R appendix as "Proposed diagnostic categories needing further study" without specific criteria, namely Sadistic personality disorder (a pervasive pattern of cruel, demeaning and aggressive behavior) and Self-defeating personality disorder (masochistic personality disorder) (characterised by behaviour consequently undermining the person's pleasure and goals).[19] The psychologist Theodore Millon and others consider some relegated diagnoses to be equally valid disorders, and may also propose other personality disorders or subtypes, including mixtures of aspects of different categories of the officially accepted diagnoses.[20]
Personality disorder diagnoses in each edition of American Psychiatric Association's Diagnostic Manual[21] | |||||
DSM-I | DSM-II | DSM-III | DSM-III-R | DSM-IV(-TR) | DSM-V Proposals |
Personality | |||||
Pattern disturbance: | |||||
Inadequate | Inadequate | ||||
Schizoid | Schizoid | Schizoid | Schizoid | Schizoid | |
Cyclothymic | Cyclothymic | ||||
Paranoid | Paranoid | Paranoid | Paranoid | Paranoid | |
Schizotypal | Schizotypal | Schizotypal | Schizotypal* | ||
Personality | |||||
Trait disturbance: | |||||
Emotionally unstable | Hysterical | Histrionic | Histrionic | Histrionic | |
Borderline | Borderline | Borderline | Borderline | ||
Compulsive | Obsessive-compulsive | Compulsive | Obsessive-compulsive | Obsessive-compulsive | Obsessive-compulsive |
Passive-aggressive: | |||||
Passive-depressive subtype | Dependent | Dependent | Dependent | ||
Passive-aggressive subtype | Passive-aggressive | Passive-aggressive | Passive-aggressive | ||
Aggressive subtype | |||||
Explosive | |||||
Asthenic | |||||
Avoidant | Avoidant | Avoidant | Avoidant | ||
Narcissistic | Narcissistic | Narcissistic | Narcissistic** | ||
Sociopathic personality | |||||
Disturbance: | |||||
Antisocial reaction | Antisocial | Antisocial | Antisocial | Antisocial | Antisocial-psychopathic |
Dyssocial reaction | |||||
Sexual deviation | |||||
Addiction | |||||
Appendix: | Appendix: | Appendix: | |||
Self-defeating | Negativistic | Dependent | |||
Sadistic | Depressive | Histrionic | |||
Paranoid | |||||
Schizoid | |||||
Negativistic | |||||
Depressive |
* – Not actually to be classified as a personality disorder; classified instead as a form of schizophrenia-spectrum disorder.
** – Originally proposed for deletion; status remains unclear for DSM-5.
Millon's description[edit]
Psychologist Theodore Millon, who has written numerous popular works on personality, proposed the following description of personality disorders:
Millon's brief description of personality disorders[22] | |
Type of personality disorder | Description |
Paranoid | Guarded, defensive, distrustful and suspiciousness. Hypervigilant to the motives of others to undermine or do harm. Always seeking confirmatory evidence of hidden schemes. Feels righteous, but persecuted. |
Schizoid | Apathetic, indifferent, remote, solitary, distant, humorless. Neither desires nor needs human attachments. Withdrawal from relationships and prefer to be alone. Little interest in others, often seen as a loner. Minimal awareness of feelings of self or others. Few drives or ambitions, if any. |
Schizotypal | Eccentric, self-estranged, bizarre, absent. Exhibits peculiar mannerisms and behaviors. Thinks can read thoughts of others. Preoccupied with odd daydreams and beliefs. Blurs line between reality and fantasy. Magical thinking and strange beliefs. |
Antisocial | Impulsive, irresponsible, deviant, unruly. Acts without due consideration. Meets social obligations only when self-serving. Disrespects societal customs, rules, and standards. Sees self as free and independent. |
Borderline | Unpredictable, manipulative, unstable. Frantically fears abandonment and isolation. Experiences rapidly fluctuating moods. Shifts rapidly between loving and hating. Sees self and others alternatively as all-good and all-bad. Unstable and frequently changing moods. |
Histrionic | Dramatic, seductive, shallow, stimulus-seeking, vain. Overreacts to minor events. Exhibitionistic as a means of securing attention and favors. Sees self as attractive and charming. Constant seeking for others' attention. |
Narcissistic | Egotistical, arrogant, grandiose, insouciant. Preoccupied with fantasies of success, beauty, or achievement. Sees self as admirable and superior, and therefore entitled to special treatment. |
Avoidant | Hesitant, self-conscious, embarrassed, anxious. Tense in social situations due to fear of rejection. Plagued by constant performance anxiety. Sees self as inept, inferior, or unappealing. Feels alone and empty. |
Dependent | Helpless, incompetent, submissive, immature. Withdraws from adult responsibilities. Sees self as weak or fragile. Seeks constant reassurance from stronger figures. |
Obsessive–compulsive | Restrained, conscientious, respectful, rigid. Maintains a rule-bound lifestyle. Adheres closely to social conventions. Sees the world in terms of regulations and hierarchies. Sees self as devoted, reliable, efficient, and productive. |
Depressive | Somber, discouraged, pessimistic, brooding, fatalistic. Presents self as vulnerable and abandoned. Feels valueless, guilty, and impotent. Judges self as worthy only of criticism and contempt. |
Passive–aggressive (Negativistic) | Resentful, contrary, skeptical, discontented. Resists fulfilling others' expectations. Deliberately inefficient. Vents anger indirectly by undermining others' goals. Alternately moody and irritable, then sullen and withdrawn. |
Sadistic | Explosively hostile, abrasive, cruel, dogmatic. Liable to sudden outbursts of rage. Feels selfsatisfied through dominating, intimidating and humiliating others. Is opinionated and close-minded. |
Self-defeating (Masochistic) | Deferential, pleasure-phobic, servile, blameful, self-effacing. Encourages others to take advantage. Deliberately defeats own achievements. Seeks condemning or mistreatful partners. |
Additional classification factors[edit]
Except for classifying by category and cluster, it is possible to classify personality disorders using such additional factors as severity, impact on social functioning, and attribution.[23]
This involves both the notion of personality difficulty as a measure of subthreshold scores for personality disorder using standard interviews and the evidence that those with the most severe personality disorders demonstrate a "ripple effect" of personality disturbance across the whole range of mental disorders. In addition to subthreshold (personality difficulty) and single cluster (simple personality disorder), this also derives complex or diffuse personality disorder (two or more clusters of personality disorder present) and can also derive severe personality disorder for those of greatest risk.
Dimensional System of Classifying Personality Disorders[24] | |||
Level of Severity | Description | Definition by Categorical System | |
0 | No Personality Disorder | Does not meet actual or subthreshold criteria for any personality disorder | |
1 | Personality Difficulty | Meets sub-threshold criteria for one or several personality disorders | |
2 | Simple Personality Disorder | Meets actual criteria for one or more personality disorders within the same cluster | |
3 | Complex (Diffuse) Personality Disorder | Meets actual criteria for one or more personality disorders within more than one cluster | |
4 | Severe Personality Disorder | Meets criteria for creation of severe disruption to both individual and to many in society |
There are several advantages to classifying personality disorder by severity:[23]
- It not only allows for but also takes advantage of the tendency for personality disorders to be comorbid with each other.
- It represents the influence of personality disorder on clinical outcome more satisfactorily than the simple dichotomous system of no personality versus personality disorder.
- This system accommodates the new diagnosis of severe personality disorder, particularly "dangerous and severe personality disorder" (DSPD). Politicians and the public both want to know who comprise the most dangerous group.
Effect on social functioning[edit]
Social function is affected by many other aspects of mental functioning apart from that of personality. However, whenever there is persistently impaired social functioning in conditions in which it would normally not be expected, the evidence suggests that this is more likely to be created by personality abnormality than by other clinical variables.[25] The Personality Assessment Schedule[26] gives social function priority in creating a hierarchy in which the personality disorder creating the greater social dysfunction is given primacy over others in a subsequent description of personality disorder.
Many who have a personality disorder do not recognize any abnormality and defend valiantly their continued occupancy of their personality role. This group have been termed the Type R, or treatment-resisting personality disorders, as opposed to the Type S or treatment-seeking ones, who are keen on altering their personality disorders and sometimes clamor for treatment.[23] The classification of 68 personality disordered patients on the caseload of an assertive community team using a simple scale showed a 3 to 1 ratio between Type R and Type S personality disorders with Cluster C personality disorders being significantly more likely to be Type S, and paranoid and schizoid (Cluster A) personality disorders significantly more likely to be Type R than others.[27]
Signs and symptoms[edit]
In the workplace[edit]
Depending on the diagnosis, severity and individual, and the job itself, personality disorders can be associated with difficulty coping with work or the workplace - potentially leading to problems with others by interfering with interpersonal relationships. Indirect effects also play a role; for example, impaired educational progress or complications outside of work, such as substance abuse and co-morbid mental diseases, can plague sufferers. However, personality disorders can also bring about above-average work abilities by increasing competitive drive or causing the sufferer to exploit his or her co-workers.[28][29]
In 2005, psychologists Belinda Board and Katarina Fritzon at the University of Surrey, UK, interviewed and gave personality tests to high-level British executives and compared their profiles with those of criminal psychiatric patients at Broadmoor Hospital in the UK. They found that three out of eleven personality disorders were actually more common in executives than in the disturbed criminals:
- Histrionic personality disorder: including superficial charm, insincerity, egocentricity and manipulation
- Narcissistic personality disorder: including grandiosity, self-focused lack of empathy for others, exploitativeness and independence.
- Obsessive-compulsive personality disorder: including perfectionism, excessive devotion to work, rigidity, stubbornness and dictatorial tendencies.[30]
According to leading leadership academic Manfred F.R. Kets de Vries, it seems almost inevitable these days that there will be some personality disorders in a senior management team.[31]
Relationship with other mental disorders[edit]
The disorders in each of the three clusters may share some underlying common vulnerability factors involving cognition, affect and impulse control, and behavioral maintenance or inhibition, respectively, and may have a spectrum relationship to certain syndromal mental disorders:[32]
- Paranoid or schizotypal personality disorders may be observed to be premorbid antecedents of delusional disorders or schizophrenia.
- Borderline personality disorder is seen in association with mood and anxiety disorders and with impulse control disorders, eating disorders, ADHD, or a substance use disorder.
- Avoidant personality disorder is seen with social anxiety disorder.
The DSM-IV lists General diagnostic criteria for a personality disorder, which must be met in addition to the specific criteria for a particular named personality disorder. This requires that there be (to paraphrase):[33]
- An enduring pattern of psychological experience and behavior that differs prominently from cultural expectations, as shown in two or more of: cognition (i.e. perceiving and interpreting the self, other people or events); affect (i.e. the range, intensity, lability, and appropriateness of emotional response); interpersonal functioning; or impulse control.
- The pattern must appear inflexible and pervasive across a wide range of situations, and lead to clinically significant distress or impairment in important areas of functioning.
- The pattern must be stable and long-lasting, have started as early as at least adolescence or early adulthood.
- The pattern must not be better accounted for as a manifestation of another mental disorder, or to the direct physiological effects of a substance (e.g. drug or medication) or a general medical condition (e.g. head trauma).
The ICD-10 'clinical descriptions and diagnostic guidelines' introduces its specific personality disorder diagnoses with some general guideline criteria that are similar. To quote:[34]
- Markedly disharmonious attitudes and behavior, generally involving several areas of functioning; e.g. affectivity, arousal, impulse control, ways of perceiving and thinking, and style of relating to others;
- The abnormal behavior pattern is enduring, of long standing, and not limited to episodes of mental illness;
- The abnormal behavior pattern is pervasive and clearly maladaptive to a broad range of personal and social situations;
- The above manifestations always appear during childhood or adolescence and continue into adulthood;
- The disorder leads to considerable personal distress but this may only become apparent late in its course;
- The disorder is usually, but not invariably, associated with significant problems in occupational and social performance.
The ICD adds: "For different cultures it may be necessary to develop specific sets of criteria with regard to social norms, rules and obligations."
In clinical practice, individuals are generally diagnosed by an interview with a psychiatrist based on a mental status examination, which may take into account observations by relatives and others. One tool of diagnosing personality disorders is a process involving interviews with scoring systems. The patient is asked to answer questions, and depending on their answers, the trained interviewer tries to code what their responses were. This process is fairly time consuming.
Normal personality[edit]
The issue of the relationship between normal personality and personality disorders is one of the important issues in personality and clinical psychology. The personality disorders classification (DSM IV TR and ICD-10) follows a categorical approach that views personality disorders as discrete entities that are distinct from each other and from normal personality. In contrast, the dimensional approach is an alternative approach that personality disorders represent maladaptive extensions of the same traits that describe normal personality. Thomas Widiger[35] and his collaborators have contributed to this debate significantly. He discussed the constraints of the categorical approach and argued for the dimensional approach to the personality disorders. Specifically, he proposed that Five Factor Model of personality is alternative to the classification of personality disorders. For example, this view specifies that Borderline Personality Disorder can be understood as a combination of emotional lability (i.e., high neuroticism), impulsivity (i.e., low conscientiousness), and hostility (i.e., low agreeableness). Many studies across cultures have explored the relationship between personality disorders and the Five Factor Model.[36] This research has demonstrated that personality disorders largely correlate in expected ways with measures of the Five Factor Model[37] and has set the stage for including the Five Factor Model within the upcoming DSM-5.[38]
DSM-IV-TR Personality Disorders from the Perspective of the Five-Factor Model of General Personality Functioning[32] | ||||||||||||
Factors | PPD | SzPD | StPD | ASPD | BPD | HPD | NPD | AvPD | DPD | OCPD | PAPD | DpPD |
Neuroticism (vs. emotional stability) | ||||||||||||
Anxiousness (vs. unconcerned) | n/a | n/a | High | Low | High | n/a | n/a | High | High | High | n/a | n/a |
Angry hostility (vs. dispassionate) | High | n/a | n/a | High | High | n/a | High | n/a | n/a | n/a | High | n/a |
Depressiveness (vs. optimistic) | n/a | n/a | n/a | n/a | High | n/a | n/a | n/a | n/a | n/a | n/a | High |
Self-consciousness (vs. shameless) | n/a | n/a | High | Low | n/a | Low | Low | High | High | n/a | n/a | High |
Impulsivity (vs. restrained) | n/a | n/a | n/a | High | High | High | n/a | Low | n/a | Low | n/a | n/a |
Vulnerability (vs. fearless) | n/a | n/a | n/a | Low | High | n/a | n/a | High | High | n/a | n/a | n/a |
Extraversion (vs. introversion) | ||||||||||||
Warmth (vs. coldness) | Low | Low | Low | n/a | n/a | n/a | Low | n/a | High | n/a | Low | Low |
Gregariousness (vs. withdrawal) | Low | Low | Low | n/a | n/a | High | n/a | Low | n/a | n/a | n/a | Low |
Assertiveness (vs. submissiveness) | n/a | n/a | n/a | High | n/a | n/a | High | Low | Low | n/a | Low | n/a |
Activity (vs. passivity) | n/a | Low | n/a | High | n/a | High | n/a | n/a | n/a | n/a | Low | n/a |
Excitement seeking (vs. lifeless) | n/a | Low | n/a | High | n/a | High | High | Low | n/a | Low | n/a | Low |
Positive emotionality (vs. anhedonia) | n/a | Low | Low | n/a | n/a | High | n/a | Low | n/a | n/a | n/a | n/a |
Openness (vs. closedness) | ||||||||||||
Fantasy (vs. concrete) | n/a | n/a | High | n/a | n/a | High | n/a | n/a | n/a | n/a | n/a | n/a |
Aesthetics (vs. disinterest) | n/a | n/a | n/a | n/a | n/a | n/a | n/a | n/a | n/a | n/a | n/a | n/a |
Feelings (vs. alexithymia) | n/a | Low | n/a | n/a | High | High | Low | n/a | n/a | Low | n/a | n/a |
Actions (vs. predictable) | Low | Low | n/a | High | High | High | High | Low | n/a | Low | Low | n/a |
Ideas (vs. closed-minded) | Low | n/a | High | n/a | n/a | n/a | n/a | n/a | n/a | Low | Low | Low |
Values (vs. dogmatic) | Low | n/a | n/a | n/a | n/a | n/a | n/a | n/a | n/a | Low | n/a | n/a |
Agreeableness (vs. antagonism) | ||||||||||||
Trust (vs. mistrust) | Low | n/a | n/a | Low | n/a | High | Low | n/a | High | n/a | n/a | Low |
Straightforwardness (vs. deception) | Low | n/a | n/a | Low | n/a | n/a | Low | n/a | n/a | n/a | Low | n/a |
Altruism (vs. exploitative) | Low | n/a | n/a | Low | n/a | n/a | Low | n/a | High | n/a | n/a | n/a |
Compliance (vs. aggression) | Low | n/a | n/a | Low | n/a | n/a | Low | n/a | High | n/a | Low | n/a |
Modesty (vs. arrogance) | n/a | n/a | n/a | Low | n/a | n/a | Low | High | High | n/a | n/a | High |
Tender-mindedness (vs. tough-minded) | Low | n/a | n/a | Low | n/a | n/a | Low | n/a | High | n/a | n/a | n/a |
Conscientiousness (vs. disinhibition) | ||||||||||||
Competence (vs. laxness) | n/a | n/a | n/a | n/a | n/a | n/a | n/a | n/a | n/a | High | Low | n/a |
Order (vs. disorderly) | n/a | n/a | Low | n/a | n/a | n/a | n/a | n/a | n/a | n/a | High | Low |
Dutifulness (vs. irresponsibility) | n/a | n/a | n/a | Low | n/a | n/a | n/a | n/a | n/a | High | Low | High |
Achievement striving (vs. lackadaisical) | n/a | n/a | n/a | n/a | n/a | n/a | n/a | n/a | n/a | High | n/a | n/a |
Self-discipline (vs. negligence) | n/a | n/a | n/a | Low | n/a | Low | n/a | n/a | n/a | High | Low | n/a |
Deliberation (vs. rashness) | n/a | n/a | n/a | Low | Low | Low | n/a | n/a | n/a | High | n/a | High |
Abbreviations used: PPD – Paranoid Personality Disorder, SzPD – Schizoid Personality Disorder, StPD – Schizotypal Personality Disorder, ASPD – Antisocial Personality Disorder, BPD – Borderline Personality Disorder, HPD – Histrionic Personality Disorder, NPD – Narcissistic Personality Disorder, AvPD – Avoidant Personality Disorder, DPD – Dependent Personality Disorder, OCPD – Obsessive-Compulsive Personality Disorder, PAPD – Passive-Aggressive Personality Disorder, DpPD – Depressive Personality Disorder, n/a – not available.
There are numerous possible causes of mental disorders, and they may vary depending on the disorder, the individual, and the circumstances. There may be genetic dispositions as well as particular life experiences, which may or may not include particular incidents of trauma or abuse.
A study of almost 600 male college students, averaging almost 30 years of age and who were not drawn from a clinical sample, examined the relationship between childhood experiences of sexual and physical abuse and currently reported personality disorder symptoms. Childhood abuse histories were found to be definitively associated with greater levels of symptomatology. Severity of abuse was found to be statistically significant, but clinically negligible, in symptomatology variance spread over Cluster A, B and C scales.[39]
Child abuse and neglect consistently evidence themselves as antecedent risks to the development of personality disorders in adulthood.[40] In the following study, efforts were taken to match retrospective reports of abuse with a clinical population that had demonstrated psychopathology from childhood to adulthood who were later found to have experienced abuse and neglect. In a study of 793 mothers and children, researchers asked mothers if they had screamed at their children, and told them that they did not love them or threatened to send them away. Children who had experienced such verbal abuse were three times as likely as other children (who did not experience such verbal abuse) to have borderline, narcissistic, obsessive-compulsive or paranoid personality disorders in adulthood.[41] The sexually abused group demonstrated the most consistently elevated patterns of psychopathology. Officially verified physical abuse showed an extremely strong correlation with the development of antisocial and impulsive behavior. On the other hand, cases of abuse of the neglectful type that created childhood pathology were found to be subject to partial remission in adulthood.[40]
The prevalence of personality disorder in the general community was largely unknown until surveys starting from the 1990s. In 2008 the median rate of diagnosable PD was estimated at 10.6%, based on six major studies across three nations. This rate of around one in ten, especially as associated with high use of services, is described as a major public health concern requiring attention by researchers and clinicians.[42]
The prevalence of individual personality disorders ranges from about 2% to 3% for the more common varieties, such as schizotypal, antisocial, borderline, and histrionic, to 0.5–1% for the least common, such as narcissistic and avoidant.[32]
A screening survey across 13 countries by the World Health Organization using DSM-IV criteria, reported in 2009 a prevalence estimate of around 6% for personality disorders. The rate sometimes varied with demographic and socioeconomic factors, and functional impairment was partly explained by co-occurring mental disorders.[43] In the US, screening data from the National Comorbidity Survey Replication between 2001 and 2003, combined with interviews of a subset of respondents, indicated a population prevalence of around 9% for personality disorders in total. Functional disability associated with the diagnoses appeared to be largely due to co-occurring mental disorders (Axis I in the DSM).[44]
A UK national epidemiological study (based on DSM-IV screening criteria), reclassified into levels of severity rather than just diagnosis, reported in 2010 that the majority of people show some personality difficulties in one way or another (short of threshold for diagnosis), while the prevalence of the most complex and severe cases (including meeting criteria for multiple diagnoses in different clusters) was estimated at 1.3%. Even low levels of personality symptoms were associated with functional problems, but the most severely in need of services was a much smaller group.[45]
There are also some sex differences in the frequency of personality disorders. They are shown in the table below.
Sex differences in the frequency of personality disorders[32] | |
Type of personality disorder | Sex |
Paranoid personality disorder | Male |
Schizoid personality disorder | Male |
Schizotypal personality disorder | Male |
Antisocial personality disorder | Male |
Borderline personality disorder | Female |
Histrionic personality disorder | Female |
Narcissistic personality disorder | Male |
Avoidant personality disorder | Equal |
Dependent personality disorder | Female |
Obsessive–compulsive personality disorder | Male |
There is a considerable personality disorder diagnostic co-occurrence. Patients who meet the DSM-IV-TR diagnostic criteria for one personality disorder are likely to meet the diagnostic criteria for another.[32] Diagnostic categories provide clear, vivid descriptions of discrete personality types but the personality structure of actual patients might be more accurately described by a constellation of maladaptive personality traits.
DSM-III-R personality disorder diagnostic co-occurrence aggregated across six research sites[32] | |||||||||||
Type of Personality Disorder | PPD | SzPD | StPD | ASPD | BPD | HPD | NPD | AvPD | DPD | OCPD | PAPD |
Paranoid (PPD) | 8 | 19 | 15 | 41 | 28 | 26 | 44 | 23 | 21 | 30 | |
Schizoid (SzPD) | 38 | 39 | 8 | 22 | 8 | 22 | 55 | 11 | 20 | 9 | |
Schizotypal (StPD) | 43 | 32 | 19 | 4 | 17 | 26 | 68 | 34 | 19 | 18 | |
Antisocial (ASPD) | 30 | 8 | 15 | 59 | 39 | 40 | 25 | 19 | 9 | 29 | |
Borderline (BPD) | 31 | 6 | 16 | 23 | 30 | 19 | 39 | 36 | 12 | 21 | |
Histrionic (HPD) | 29 | 2 | 7 | 17 | 41 | 40 | 21 | 28 | 13 | 25 | |
Narcissistic (NPD) | 41 | 12 | 18 | 25 | 38 | 60 | 32 | 24 | 21 | 38 | |
Avoidant (AvPD) | 33 | 15 | 22 | 11 | 39 | 16 | 15 | 43 | 16 | 19 | |
Dependent (DPD) | 26 | 3 | 16 | 16 | 48 | 24 | 14 | 57 | 15 | 22 | |
Obsessive-Compulsive (OCPD) | 31 | 10 | 11 | 4 | 25 | 21 | 19 | 37 | 27 | 23 | |
Passive-Aggressive (PAPD) | 39 | 6 | 12 | 25 | 44 | 36 | 39 | 41 | 34 | 23 |
Sites used DSM-III-R criterion sets. Data obtained for purposes of informing the development of the DSM-IV-TR personality disorder diagnostic criteria.
Abbreviations used: PPD – Paranoid Personality Disorder, SzPD – Schizoid Personality Disorder, StPD – Schizotypal Personality Disorder, ASPD – Antisocial Personality Disorder, BPD – Borderline Personality Disorder, HPD – Histrionic Personality Disorder, NPD – Narcissistic Personality Disorder, AvPD – Avoidant Personality Disorder, DPD – Dependent Personality Disorder, OCPD – Obsessive-Compulsive Personality Disorder, PAPD – Passive-Aggressive Personality Disorder.
Specific approaches[edit]
There are many different forms (modalities) of treatment used for personality disorders:[46]
- Individual psychotherapy has been a mainstay of treatment. There are long-term and short-term (brief) forms.
- Family therapy, including couples therapy.
- Group therapy for personality dysfunction is probably the second most used.
- Psychological-education may be used as an addition.
- Self-help groups may provide resources for personality disorders.
- Psychiatric medications for treating symptoms of personality dysfunction or co-occurring conditions.
- Milieu therapy, a kind of group-based residential approach, has a history of use in treating personality disorders, including therapeutic communities.
There are different specific theories or schools of therapy within many of these modalities. They may, for example, emphasize psychodynamic techniques, or cognitive or behavioral techniques. In clinical practice, many therapists use an 'eclectic' approach, taking elements of different schools as and when they seem to fit to an individual client. There is also often a focus on common themes that seem to be beneficial regardless of techniques, including attributes of the therapist (e.g. trustworthiness, competence, caring), processes afforded to the client (e.g. ability to express and confide difficulties and emotions), and the match between the two (e.g. aiming for mutual respect, trust and boundaries).
Response of Patients with Personality Disorders to Biological and Psychosocial Treatments[32] | |||
Cluster | Evidence for Brain Dysfunction | Response to Biological Treatments | Response to Psychosocial Treatments |
A | Evidence for relationship of schizotypal personality to schizophrenia; otherwise none known | Schizotypal patients may improve on antipsychotic medication; otherwise not indicated | Poor. Supportive psychotherapy may help |
B | Evidence suggestive for antisocial and borderline personalities; otherwise none known | Antidepressants, antipsychotics, or mood stabilizers may help for borderline personality; otherwise not indicated | Poor in antisocial personality. Variable in borderline, narcissistic, and histrionic personalities |
C | None known | No direct response. Medications may help with comorbid anxiety and depression | Most common treatment for these disorders. Response variable |
The management and treatment of personality disorders can be a challenging and controversial area, for by definition the difficulties have been enduring and affect multiple areas of functioning. This often involves interpersonal issues, and there can be difficulties in seeking and obtaining help from organizations in the first place, as well as with establishing and maintaining a specific therapeutic relationship. On the one hand, an individual may not consider themselves to have a mental health problem, while on the other, community mental health services may view individuals with personality disorders as too complex or difficult, and may directly or indirectly exclude individuals with such diagnoses or associated behaviors.[47] The disruptiveness people with personality disorders can create in an organisation makes these, arguably, the most challenging conditions to manage.
Apart from all these issues, an individual may not consider their personality to be disordered or the cause of problems. This perspective may be caused by the patient's ignorance or lack of insight into their own condition, an ego-syntonic perception of the problems with their personality that prevents them from experiencing it as being in conflict with their goals and self-image, or by the simple fact that there is no distinct or objective boundary between 'normal' and 'abnormal' personalities. Unfortunately, there is substantial social stigma and discrimination related to the diagnosis.
The term 'personality disorder' encompasses a wide range of issues, each with different a level of severity or disability; thus, personality disorders can require fundamentally different approaches and understandings. To illustrate the scope of the matter, consider that while some disorders or individuals are characterized by continual social withdrawal and the shunning of relationships, others may cause fluctuations in forwardness. The extremes are worse still: at one extreme lie self-harm and self-neglect, while at another extreme some individuals may commit violence and crime. There can be other factors such as problematic substance use or dependency or behavioral addictions. A person may meet criteria for multiple personality disorder diagnoses and/or other mental disorders, either at particular times or continually, thus making coordinated input from multiple services a potential requirement.
Therapists in this area can become disheartened by lack of initial progress, or by apparent progress that then leads to setbacks. Clients may be experienced as negative, rejecting, demanding, aggressive or manipulative. This has been looked at in terms of both therapist and client; in terms of social skills, coping efforts, defence mechanisms, or deliberate strategies; and in terms of moral judgements or the need to consider underlying motivations for specific behaviors or conflicts. The vulnerabilities of a client, and indeed therapist, may become lost behind actual or apparent strength and resilience. It is commonly stated that there is always a need to maintain appropriate professional personal boundaries, while allowing for emotional expression and therapeutic relationships. However, there can be difficulty acknowledging the different worlds and understandings that client and therapist may live with. A therapist may assume that the kinds of relationships and ways of interacting that make them feel safe and comfortable, have the same effect on clients. As an example at one extreme, people who may in their lives have been used to hostility, deceptiveness, rejection, aggression or abuse, may in some cases be made confused, intimidated or suspicious by presentations of warmth, intimacy or positivity. On the other hand, reassurance, openness and clear communication are usually helpful and needed. It can take several months of sessions, and perhaps several stops and starts, to begin to develop a trusting relationship that can meaningfully address issues.[48]
Personality disorder is a term with a distinctly modern meaning, owing in part to its clinical usage and the institutional character of modern psychiatry. The currently accepted meaning must be understood in the context of historical changing classification systems such as DSM-IV and its predecessors. Although highly anachronistic, and ignoring radical differences in the character of subjectivity and social relations, some have suggested similarities to other concepts going back to at least the ancient Greeks.[3] For example, the Greek philosopher Theophrastus described 29 'character' types that he saw as deviations from the norm, and similar views have been found in Asian, Arabic and Celtic cultures. A long-standing influence in the Western world was Galen's concept of personality types which he linked to the four humours proposed by Hippocrates.
Such views lasted into the 18th century, when experiments began to question the supposed biologically based humours and 'temperaments'. Psychological concepts of character and 'self' became widespread. In the 19th century, 'personality' referred to a person's conscious awareness of their behavior, a disorder of which could be linked to altered states such as dissociation. This sense of the term has been compared to the use of the term 'multiple personality disorder' in the first versions of the DSM.[49]
Physicians in the early 19th century started to diagnose forms of insanity that involved disturbed emotions and behaviors but seemingly without significant intellectual impairment or delusions or hallucinations. Philippe Pinel referred to this as 'manie sans délire' – insanity without delusion – and described a number of cases mainly involving excessive or inexplicable anger or rage. James Cowles Prichard advanced a similar concept he called moral insanity, which would be used to diagnose patients for some decades. 'Moral' in this sense referred to affect (emotion or mood) rather than necessarily ethics, but it was arguably based in part on religious, social and moral beliefs, with a pessimism about medical intervention so that social control should take precedence.[50] These categories were much different and broader than later definitions of personality disorder, while also being developed by some into a more specific meaning of moral degeneracy akin to later ideas about 'psychopaths'. Separately, Richard von Krafft-Ebing popularized the terms sadism and masochism, as well as homosexuality, as psychiatric issues.
The German psychiatrist Koch sought to make the moral insanity concept more scientific, suggesting in 1891 the phrase 'psychopathic inferiority', theorized to be a congenital disorder. This referred to continual and rigid patterns of misconduct or dysfunction in the absence of apparent mental retardation or illness, supposedly without a moral judgement. Described as deeply rooted in his Christian faith, his work has been described as a fundamental text on personality disorders that is still of use today.[51]
20th century[edit]
In the early 20th century, another German psychiatrist, Emil Kraepelin, included a chapter on psychopathic inferiority in his influential work on clinical psychiatry for students and physicians. He suggested six types – excitable, unstable, eccentric, liar, swindler and quarrelsome. The categories were essentially defined by the most disordered criminal offenders observed, distinguished between criminals by impulse, professional criminals, and morbid vagabonds who wandered through life. Kraepelin also described three paranoid (meaning then delusional) disorders, resembling later concepts of schizophrenia, delusional disorder and paranoid personality disorder. A diagnostic term for the latter concept would be included in the DSM from 1952, and from 1980 the DSM would also include schizoid and schizotypal personality disorders; interpretations of earlier (1921) theories of Ernst Kretschmer led to a distinction between these and another type later included in the DSM, avoidant personality disorder.
In 1933 Russian psychiatrist Pyotr Borisovich Gannushkin published his book Manifestations of psychopathies: statics, dynamics, systematic aspects, which was one of the first attempts to develop a detailed typology of psychopathies. Regarding maladaptation, ubiquity, and stability as the three main symptoms of behavioral pathology, he distinguished 9 clusters of psychopaths: cycloids (including constitutionally depressive, constitutionally excitable, cyclothymics, and emotionally labile), asthenics (including psychasthenics), schizoids (including dreamers), paranoiacs (including fanatics), epileptoids, hysterical personalities (including pathological liars), unstable psychopaths, antisocial psychopaths, and constitutionally stupid.[52] Some elements of Gannushkin's typology were later incorporated into the theory developed by a Russian adolescent psychiatrist, Andrey Yevgenyevich Lichko, who was also interested in psychopathies along with their milder forms, the so-called accentuations of character.[53]
Psychiatrist David Henderson published in 1939 a theory of 'psychopathic states' which ended up contributing to the term becoming popularly linked to anti-social behavior. Hervey M. Cleckley's 1941 text, The Mask of Sanity, based on his personal categorization of similarities he noted in some prisoners, marked the start of the modern clinical conception of psychopathy and its popularist usage.[54]
Towards the mid 20th century, psychoanalytic theories were coming to the fore based on work from the turn of the century being popularized by Sigmund Freud and others. This included the concept of 'character disorders', which were seen as enduring problems linked not to specific symptoms but to pervasive internal conflicts or derailments of normal childhood development. These were typically understood as weaknesses of character or willful deviance, and were distinguished from neurosis or psychosis. The term 'borderline' stems from a belief that some individuals were functioning on the edge of those two categories, and a number of the other personality disorder categories were also heavily influenced by this approach, including dependent, obsessive-compulsive and histrionic,[55] the latter starting off as a conversion symptom of hysteria particularly associated with women, then a hysterical personality, then renamed histrionic personality disorder in later versions of the DSM. A passive aggressive style was defined clinically by Colonel William Menninger during World War II in the context of men's reactions to military compliance, which would later be referenced as a personality disorder in the DSM.[56] Otto Kernberg was influential with regard to the concepts of the borderline and narcissistic personalities which were later incorporated as disorders into the DSM in 1980.
Meanwhile, a more general personality psychology had been developing in academia and to some extent clinically. Gordon Allport was publishing theories of personality traits from the 1920s, and Henry Murray advanced a theory called 'personology' which influenced a later key advocate of personality disorders, Theodore Millon. Tests were developing or being applied for personality evaluation, including projective tests such as the Rorshach, as well as questionnaires such as the Minnesota Multiphasic Personality Inventory. Around mid-century, Hans Eysenck was analysing traits and personality types, and psychiatrist Kurt Schneider was popularising a clinical use in place of the previously more usual terms 'character', 'temperament' or 'constitution'.
American psychiatrists officially recognised concepts of enduring personality disturbances in the first Diagnostic and Statistical Manual of Mental Disorders in the 1950s, which relied heavily on psychoanalytic concepts. Somewhat more neutral language was employed in the DSM-II in 1968, though the terms and descriptions had only a slight resemblance to current definitions. The DSM-III published in 1980 made some major changes, notably putting all personality disorders onto a second separate 'axis' along with mental retardation, intended to signify more enduring patterns, distinct from what were considered axis one mental disorders. 'Inadequate' and 'asthenic' personality disorder' categories were deleted, and others were unpacked into more types, or changed from being personality disorders to regular disorders. Sociopathic personality disorder, which had been the term for psychopathy, was renamed Antisocial Personality Disorder. Most categories were given more specific 'operationalized' definitions, with standard criteria that psychiatrists could agree on in order to conduct research and diagnose patients.[57] In the DSM-III revision, self-defeating personality disorder and sadistic personality disorder were included as provisional diagnoses requiring further study. They were dropped in the DSM-IV, though a proposed 'depressive personality disorder' was added; in addition, the official diagnosis of passive-aggressive personality disorder was dropped, tentatively renamed 'negativistic personality disorder.'[58]
International differences have been noted in how attitudes have developed towards the diagnosis of personality disorder. Kurt Schneider had argued that they were simply 'abnormal varieties of psychic life' and therefore not necessarily the domain of psychiatry, a view said to still have influence in Germany today. British psychiatrists have also been reluctant to address such disorders or consider them on a par with other mental disorders, which has been attributed partly to resource pressures within the National Health Service, as well as to negative medical attitudes towards behaviors associated with personality disorders. In the US, the prevailing healthcare system and psychanalytic tradition has been said to provide a rationale for private therapists to diagnose some personality disorders more broadly and provide ongoing treatment for them.[59]
Early stages and preliminary forms of personality disorders need a multi-dimensional and early treatment approach. Personality development disorder is considered to be a childhood risk factor or early stage of a later personality disorder in adulthood.[60] In addition, in Robert F. Krueger's review of their research indicates that some children and adolescents do suffer from clinically significant syndromes that resemble adult personal disorders, and that these syndromes have meaningful correlates and are consequential. Much of this research has been framed by the adult personality disorder constructs from Axis II of the Diagnostic and Statistical Manual. Hence, they are less likely to encounter the first risk they described at the outset of their review: clinicians and researchers are not simply avoiding use of the PD construct in youth. However, they may encounter the second risk they described: under-appreciation of the developmental context in which these syndromes occur. That is, although PD constructs show continuity over time, they are probabilistic predictors; not all youths who exhibit PD symptomatology become adult PD cases.[60]
Five Factor Model[edit]
As of 2002, there were over fifty published studies relating the Five Factor Model (FFM) to personality disorders.[61] Since that time, quite a number of additional studies have expanded on this research base and provided further empirical support for understanding the DSM personality disorders in terms of the FFM domains.[62]
In her seminal review of the personality disorder literature published in 2007, Dr. Lee Anna Clark asserted that "the five-factor model of personality is widely accepted as representing the higher-order structure of both normal and abnormal personality traits".[63]
The Five Factor Model has been shown to significantly predict all ten personality disorder symptoms and outperform the Minnesota Multiphasic Personality Inventory (MMPI) in the prediction of borderline, avoidant, and dependent personality disorder symptoms.[64]
Research results examining the relationships between the FFM and each of the ten DSM personality disorder diagnostic categories are widely available. For example, in a study published in 2003 titled "The five-factor model and personality disorder empirical literature: A meta-analytic review",[65] the authors analyzed data from 15 other studies to determine how personality disorders are different and similar, respectively, with regard to underlying personality traits. In terms of how personality disorders differ, the results showed that each disorder displays a FFM profile that is meaningful and predictable given its unique diagnostic criteria. With regard to their similarities, the findings revealed that the most prominent and consistent personality dimensions underlying a large number of the personality disorders are positive associations with neuroticism and negative associations with agreeableness.
Openness to experience[edit]
At least three aspects of openness to experience are relevant to understanding personality disorders: cognitive distortions, lack of insight and impulsivity. Problems related to high openness that can cause problems with social or professional functioning are excessive fantasising, peculiar thinking, diffuse identity, unstable goals and nonconformity with the demands of the society.[66]
High openness is characteristic to schizotypal personality disorder (odd and fragmented thinking), narcissistic personality disorder (excessive self-valuation) and paranoid personality disorder (sensitivity to external hostility). Lack of insight (shows low openness) is characteristic to all personality disorders and could explain the persistence of maladaptive behavioral patterns.[67]
The problems associated with low openness are difficulties adapting to change, low tolerance for different worldview or lifestyles, emotional flattening, alexithymia and a narrow range of interests.[66] Rigidity is the most obvious aspect of (low) openness among personality disorders and that shows lack of knowledge of one's emotional experiences. It is most characteristic of obsessive-compulsive personality disorder, the opposite of it known as impulsivity (here: an aspect of openness that shows a tendency to behave unusually or autistically) is characteristic of schizotypal and borderline personality disorders.[67]
- ^ a b American Psychiatric Association (2013). Diagnostic and Statistical Manual of Mental Disorders (Fifth ed.). Arlington, VA: American Psychiatric Publishing. pp. 646–649. ISBN 978-0-89042-555-8.
- ^ Berrios, G E (1993). "European views on personality disorders: a conceptual history". Comprehensive Psychiatry 34 (1): 14–30. doi:10.1016/0010-440X(93)90031-X. PMID 8425387.
- ^ a b Millon, Theodore; Roger D. Davis (1996). Disorders of Personality: DSM-IV and Beyond. New York: John Wiley & Sons, Inc. p. 226. ISBN 0-471-01186-X.
- ^ A Guide to DSM-5: Personality Disorders Medscape Psychiatry, Bret S. Stetka, MD, Christoph U. Correll, May 21, 2013
- ^ Saß, H. (2001). "Personality Disorders," pp. 11301-11308 in Smelser, N. J. & Baltes, P. B. (eds.) International encyclopedia of the social & behavioral sciences, Amsterdam: Elsevier doi:10.1016/B0-08-043076-7/03763-3 ISBN 978-0-08-043076-8
- ^ Kernberg, O. (1984). Severe Personality Disorders. New Haven, CT: Yale University Press, ISBN 0300053495.
- ^ a b Schacter, D. L.; Gilbert, D. T. and Wegner, D. M. (2011) Psychology, 2nd Edition. p. 330, ISBN 1429237198.
- ^ McWilliams, Nancy (29 July 2011). Psychoanalytic Diagnosis, Second Edition: Understanding Personality Structure in the Clinical Process. Guilford Press. pp. 196–. ISBN 978-1-60918-494-0. Retrieved 2 December 2011.
- ^ Hickey, Philip. (2010-05-05) Personality Disorders Are Not Illnesses. Behaviorismandmentalhealth.com. Retrieved on 2013-04-16.
- ^ Ancowitz, Nancy. (2010-08-06) A Giant Step Backward for Introverts (Nancy Ancowitz). Psychologytoday.com. Retrieved on 2013-04-16.
- ^ Bradshaw, James. (2006-11-01) Glasser headlines psychotherapy conference. The National Psychologist. Retrieved on 2013-04-16.
- ^ Widiger TA (October 2003). "Personality disorder diagnosis". World Psychiatry 2 (3): 131–5. PMC 1525106. PMID 16946918.
- ^ WHO (2010) ICD-10: Disorders of adult personality and behaviour
- ^ American Psychiatric Association (2013). Diagnostic and Statistical Manual of Mental Disorders (Fifth ed.). Arlington, VA: American Psychiatric Publishing. pp. 451–459. ISBN 978-0-89042-555-8.
- ^ WHO (2010) ICD-10: Specific Personality Disorders
- ^ "International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10) Version for 2010 (Online Version)". Apps.who.int. Retrieved on 2013-04-16.
- ^ Langmaack, C. (2000). "'Haltlose' type personality disorder (ICD-10 F60.8)". The Psychiatrist 24 (6): 235–236. doi:10.1192/pb.24.6.235-b.
- ^ American Psychiatric Association (2013). Diagnostic and Statistical Manual of Mental Disorders (Fifth ed.). Arlington, VA: American Psychiatric Publishing. pp. 645–684, 761–781. ISBN 978-0-89042-555-8.
- ^ Fuller, AK, Blashfield, RK, Miller, M, Hester, T (1992). "Sadistic and self-defeating personality disorder criteria in a rural clinic sample". Journal of Clinical Psychology 48 (6): 827–31. doi:10.1002/1097-4679(199211)48:6<827::AID-JCLP2270480618>3.0.CO;2-1. PMID 1452772.
- ^ Millon, Theodore (2004) Personality Disorders in Modern Life, John Wiley & Sons, ISBN 0471668508.
- ^ Widiger, Thomas (2012). The Oxford Handbook of Personality Disorders. Oxford University Press. ISBN 978-0199735013.
- ^ Millon, Theodore (2004). Personality Disorders in Modern Life, p. 4. John Wiley & Sons, Inc., Hoboken, New Jersey. ISBN 0-471-23734-5.
- ^ a b c Murray, Robin M. et al (2008). Psychiatry. Fourth Edition. Cambridge University Press. ISBN 978-0-521-60408-6.
- ^ Tyrer, P. (2000) Personality Disorders: Diagnosis, Management and Course. Second Edition. London: Arnold Publishers Ltd., pp. 126–32. ISBN 9780723607366.
- ^ Nur, U., Tyrer, P., Merson, S., & Johnson, T. (2004). "Relationship between clinical symptoms, personality disturbance, and social function: a statistical enquiry". Irish Journal of Psychological Medicine 21: 19–22.
- ^ Tyrer, P., & Alexander, J. (1979). "Classification of Personality Disorder". British Journal of Psychiatry 135 (2): 238–242. doi:10.1192/bjp.135.2.163. PMID 486849.
- ^ Tyrer, P., Mitchard, S., Methuen, C., & Ranger, M. (2003). "Treatment-rejecting and treatment-seeking personality disorders: Type R and Type S". Journal of Personality Disorders 17 (3): 263–268. doi:10.1521/pedi.17.3.263.22152. PMID 12839104.
- ^ Ettner, Susan L. 2011. "Personality Disorders and Work." In Work Accommodation and Retention in Mental Health, Chapter 9
- ^ Ettner, Susan L.; Maclean, Johanna Catherine, French, Michael T. (1 January 2011). "Does Having a Dysfunctional Personality Hurt Your Career? Axis II Personality Disorders and Labor Market Outcomes". Industrial Relations: A Journal of Economy and Society 50 (1): 149–173. doi:10.1111/j.1468-232X.2010.00629.x.
- ^ Board, Belinda Jane; Fritzon, Katarina (2005). "Disordered personalities at work". Psychology Crime and Law 11: 17. doi:10.1080/10683160310001634304.
- ^ de Vries, Manfred F. R. Kets (2003). "The Dark Side of Leadership". Business Strategy Review 14 (3): 26.
- ^ a b c d e f g Tasman, Allan et al (2008). Psychiatry. Third Edition. John Wiley & Sons, Ltd. ISBN 978-0470-06571-6.
- ^ Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), 4th edition, Text Revision. Washington, DC: American Psychiatric Association; 2000.
- ^ WHO (2010) ICD-10: Clinical descriptions and diagnostic guidelines: Disorders of adult personality and behavior
- ^ Widiger, T. A.; Shedler, J (1993). "The DSM-III-R categorical personality disorder diagnoses: A critique and an alternative". Psychological Inquiry 4 (2): 75–90. doi:10.1207/s15327965pli0402_1. PMID 9989563.
- ^ Costa, P.T., & Widiger, T.A. (2001). Personality disorders and the five-factor model of personality (2nd ed.). Washington, DC: American Psychological Association.
- ^ Samuel, D.B. & Widiger, T.A. (2008). "A meta-analytic review of the relationships between the five-factor model and DSM personality disorders: A facet level analysis". Clinical Psychology Review 28 (8): 1326–1342. doi:10.1016/j.cpr.2008.07.002. PMC 2614445. PMID 18708274.
- ^ Widiger, Thomas A., Costa, Paul T. (2012). Personality Disorders and the Five-Factor Model of Personality, Third Edition. ISBN 978-1-4338-1166-1.
- ^ Miller, P. M. & Lisak, D. (1999). "Associations Between Childhood Abuse and Personality Disorder Symptoms in College Males". Journal of Interpersonal Violence 14 (6): 642. doi:10.1177/088626099014006005. Retrieved May 25, 2010.
- ^ a b Cohen, Patricia; Brown, Jocelyn and Smailes, Elizabeth (2001). "Child Abuse and Neglect and the Development of Mental Disorders in the General Population". Development and Psychopathology 13 (4): 981–999. PMID 11771917.
- ^ "What Causes Psychological Disorders?". American Psychological Association. 2010. Archived from the original on 2010-11-20.
- ^ Lenzenweger, Mark F. (2008). "Epidemiology of Personality Disorders". Psychiatric Clinics of North America 31 (3): 395–403. doi:10.1016/j.psc.2008.03.003. PMID 18638642.
- ^ Huang, Y.; Kotov, R., de Girolamo, G., Preti, A., Angermeyer, M., Benjet, C., Demyttenaere, K., de Graaf, R., Gureje, O., Karam, A. N., Lee, S., Lepine, J. P., Matschinger, H., Posada-Villa, J., Suliman, S., Vilagut, G., Kessler, R. C. (30 June 2009). "DSM-IV personality disorders in the WHO World Mental Health Surveys". The British Journal of Psychiatry 195 (1): 46–53. doi:10.1192/bjp.bp.108.058552. PMC 2705873. PMID 19567896.
- ^ Lenzenweger, Mark F.; Lane, Michael C., Loranger, Armand W., Kessler, Ronald C. (2006). "DSM-IV Personality Disorders in the National Comorbidity Survey Replication". Biological Psychiatry 62 (6): 553–564. doi:10.1016/j.biopsych.2006.09.019. PMC 2044500. PMID 17217923.
- ^ Yang, M.; Coid, J., Tyrer, P. (31 August 2010). "Personality pathology recorded by severity: national survey". The British Journal of Psychiatry 197 (3): 193–199. doi:10.1192/bjp.bp.110.078956. PMID 20807963.
- ^ Magnavita, Jeffrey J. (2004) Handbook of personality disorders: theory and practice, John Wiley and Sons, ISBN 978-0-471-48234-5.
- ^ Davison, S. E. (2002). "Principles of managing patients with personality disorder". Advances in Psychiatric Treatment 8 (1): 1–9. doi:10.1192/apt.8.1.1.
- ^ McVey, D. & Murphy, N. (eds.) (2010) Treating Personality Disorder: Creating Robust Services for People with Complex Mental Health Needs, ISBN 0-203-84115-8
- ^ Suryanarayan, Geetha (2002) The History of the Concept of Personality Disorder and its Classification, The Medicine Publishing Company Ltd.
- ^ Augstein, HF (1996). "J C Prichard's concept of moral insanity—a medical theory of the corruption of human nature". Medical history 40 (3): 311–43. doi:10.1017/S0025727300061329. PMC 1037128. PMID 8757717.
- ^ Gutmann, P (2008). "Julius Ludwig August Koch (1841–1908): Christian, philosopher and psychiatrist". History of Psychiatry 19 (74 Pt 2): 202–14. doi:10.1177/0957154X07080661. PMID 19127839.
- ^ Ганнушкин П. Б. (2000). Клиника психопатий, их статика, динамика, систематика. Издательство Нижегородской государственной медицинской академии. ISBN 5-86093-015-1.
- ^ Личко А. Е. (2010) Психопатии и акцентуации характера у подростков. Речь, ISBN 978-5-9268-0828-6.
- ^ Arrigo, B. A. (1 June 2001). "The Confusion Over Psychopathy (I): Historical Considerations". International Journal of Offender Therapy and Comparative Criminology 45 (3): 325–344. doi:10.1177/0306624X01453005.
- ^ Amy Heim & Drew Westen (2004) Theories of personality and personality disorders
- ^ Lane, C. (1 February 2009). "The Surprising History of Passive-Aggressive Personality Disorder". Theory & Psychology 19 (1): 55–70. doi:10.1177/0959354308101419.
- ^ Hoermann, Simone; Zupanick, Corinne E. and Dombeck, Mark (January 2011) The History of the Psychiatric Diagnostic System Continued. mentalhelp.net.
- ^ Oldham, John M. (2005). "Personality Disorders". FOCUS 3: 372–382.
- ^ Kendell, RE (2002). "The distinction between personality disorder and mental illness". The British Journal of Psychiatry 180 (2): 110. doi:10.1192/bjp.180.2.110.
- ^ a b Krueger, R.; Carlson, Scott R. (2001). "Personality disorders in children and adolescents". Current Psychiatry Reports 3 (1): 46–51. doi:10.1007/s11920-001-0072-4. PMID 11177759.
- ^ Widiger TA, Costa PT., Jr. Five-Factor model personality disorder research. In: Costa Paul T, Jr, Widiger Thomas A., editors. Personality disorders and the five-factor model of personality. 2nd. Washington, DC, US: American Psychological Association; 2002. pp. 59–87. 2002.
- ^ Mullins-Sweatt SN, Widiger TA. The five-factor model of personality disorder: A translation across science and practice. In: Krueger R, Tackett J, editors. Personality and psychopathology: Building bridges. New York: Guilford; 2006. pp. 39–70.
- ^ Clark LA. Assessment and diagnosis of personality disorder: Perennial issues and an emerging reconceptualization" Annual Review of Psychology 2007; 58:227–257, 246.
- ^ The paper, authored by R. Michael Bagby, Martin Sellbom, Paul T. Costa Jr., and Thomas A. Widiger was published in Personality and Mental Health, Volume 2, Issue 2, pages 55–69, April 2008
- ^ The five-factor model and personality disorder empirical literature: A meta-analytic review. LM Saulsman, AC Page - Clinical Psychology Review, 2004 - Elsevier Science
- ^ a b Piedmont, R. L., Sherman, M. F., Sherman, N. C. (2012). "Maladaptively High and Low Openness: The Case for Experiential Permeability.". Journal of Personality.
- ^ a b Piedmont, R. L., Sherman, M. F., Sherman, N. C., Dy-Liacco, G. S., Williams, J. E. G. (2009). "Using the Five-Factor Model to Identify a New Personality Disorder Domain: The Case for Experiential Permeability.". Journal of Personality and Social Psychology 96: 1245–1258.
Further reading[edit]
- Marshall, W. & Serin, R. (1997) Personality Disorders. In Sm.M. Turner & R. Hersen (Eds.) Adult Psychopathology and Diagnosis. New York: Wiley. 508–541
- Murphy, N. & McVey, D. (2010) Treating Severe Personality Disorder: Creating Robust Services for Clients with Complex Mental Health Needs. London: Routledge
- Millon, Theodore (and Roger D. Davis, contributor) – Disorders of Personality: DSM IV and Beyond – 2nd ed. – New York, John Wiley and Sons, 1995 ISBN 0-471-01186-X
- Yudofsky, Stuart C. (2005). Fatal Flaws: Navigating Destructive Relationships With People With Disorders of Personality and Character (1st ed. ed.). Washington: D.C. ISBN 1-58562-214-1.
External links[edit]
Library resources about Personality disorders |
- The Institute for Advanced Studies in Personology and Psychopathology the official website for Theodore Millon, Ph.D., D.Sc.
- Personality Disorders Foundation
- National Personality Disorder website for England
- Dangerous severe personality disorder
- National Mental Health Association Personality Disorder Fact Sheet
- Personality Disorders information leaflet from The Royal College of Psychiatrists


text:
Most of my codes where found Here!
I do:
✿ Check out your blog
I don't:
Follow back
✿ I'll be more than happy to help you with html, theme customization, banner/icon making and all for the low price of FREE! :)
Any other questions? Ask below!
✿ Promo for promo IF you have 4k +
✿ Vote for you (send me the link trough FAN MAIL)
✿ Click on your ads IF you give me a good reason to do so..you can always try CashCrate You can EASILY gain $100 + with them, no scam :)
Promote you on request
Reblog/like your picture UNLESS it fits my blog.
Hey there! :)
I'm Paulina and I love playing piano, drinking tea and reading and I don't know what to tell you about myself... I'm kind of good with html,so I can help you...just ask :)

subset: commoncrawl


text:
Current Exhibits
Permanent Exhibits
Online Exhibits
Civil Rights Summit - April 8-10
The Moyers' Journey From Addiction To Recovery
Lyndon Johnson's Legacy
After visiting this library (do not miss it) I became more aware of the trials of the Johnson presidency: sworn into office after JFK was killed, struggled with the Viet Nam War, Civil Rights, and a time when the USA was in upheaval. I was not a fan, but I became one. -Patricia M., Swanpoint MD
This exhibit introduces visitors to the Civil Rights legislation passed by LBJ during his administration and includes an interactive feature about "The Journey of a Bill."


text:
XING Events GmbH
Sandstraße 33
80335 Munich
Commercial Register Hamburg
Norbert Stockmann, Ingo Chu, Gerhard Mohr
Norbert Stockmann
XING Events GmbH
Sandstr. 33
80335 Munich
Phone: +49 89 552 73 58-0
Fax: +49 89 552 73 58-10
Email: email@example.com
Contents of the websites xing-events.com and amiando.com are – if not marked otherwise – subject to copyright protection and neither the whole nor parts may be spread, copied, or changed without prior written permission from XING Events. Pictures included in this website may not be used without prior written permission from XING Events. Pictures that are included in this website are partly subject to copyright of third-parties.
Despite careful control of contents we are not liable for contents of external links. Responsibility for the page contents of linked sites lies solely on their administrators. All within the internet offer specified and if applicable by third-parties protected marks and registered trade marks are subject to the regulations of the valid characteristic and possession rights of the respective registered owners. However, due to the bare denomination, the conclusion is not to be drawn that brand names are not protected by rights of third parties!
0800 612 15 22
From outside the UK:
+49 89 552 73 58 13


text:
90 The New York Times | Stephen Holden Time slows to a near-standstill as the film peers into humanity's troubled soul, glimpsed through the individual faces, which sometimes appear to be studying us as intently as we are studying them. Read full review
80 The Dissolve | Noel Murray The film is a poetic and lulling mediation on humanity as some kind of ancient alien race, which Reggio means to isolate and examine, as though he's never encountered them before. Read full review
78 Austin Chronicle | Marc Savlov What Reggio's ultimate point or conclusion might be is, as ever, left up to the viewer for interpretation. And while this is patently not a film that big-box cineplexers are going to rush to in droves, Visitors remains a wondrous work of artistic achievement. Read full review
75 RogerEbert.com | Steven Boone It's Glass who gives Visitors something like a structure, alternating between long, contemplative stretches and moments of ecstatic grandeur, like the crowd of sports fans who erupt in (extreme slow-motion) joy at some victory. Read full review


text:
The Jefferson Center of Ashland, Oregon, is sponsoring a trip for me there in early May (2012). I'll be in the area for over a week. The main event is my lecture on "How the First Christians Claimed to Know What They Know (and Why That Matters Now)," which will touch on both philosophy (epistemology) and ancient history. That is scheduled for Thursday May 10 from 7 to 9pm, which includes Q&A and selling and signing my books (including my new book Proving History), in the Meese Room (3rd floor) of Hannon Library at Southern Oregon University (campus address: 1250 Siskiyou Boulevard, in Ashland, Oregon 97520). I believe it will be free to all. I will also be interviewed on an affiliated public radio show (The Jefferson Exchange on JPR) on Wednesday, May 9 (2012), from 9 to 10am, followed by a fundraiser luncheon (which I believe is already booked, but if you want in and you are keen on supporting the JeffC with a generous donation, it couldn't hurt to contact them and at least ask about it). I might also be giving a special lecture for the philosophy department at OSU, but that hasn't been confirmed, and won't be open to the public. If you have any kind of godless meetup group in the area, feel free to contact me about the possibility of stopping by that week (if I can fit it into my schedule).
Apr 02 2012
Appearing in Oregon
28 comments
Just be caught up on your vaccines and be careful–Ashland is a notorious hotbed of anti-vaccinationism.
You should come closer to Portland!
Richard Carrier
I'd love to come to Portland. Convince a group out there to fly me out, and I'm there. Or convince several groups to chip in together. I'm not too expensive.
Emma Zunz
Hi Richard
when will we see your review of Ehrman?
Mike Gantt
Richard, you said:
"If you have any kind of godless meetup group in the area, feel free to contact me about the possibility of stopping by that week (if I can fit it into my schedule)."
That's speaks volumes about your agenda as a "historian."
Mike Gantt
A historian sets out to learn what happened and then make it known. Your goal, by contrast, is to encourage the faithless and discourage the faithful. It's not a historian's agenda.
Richard Carrier
My goal as a historian is to learn what happened and then make it known. If it somehow "encourages the faithless and discourages the faithful" that's not my problem. Nor my aim.
Mike Gantt
I watched your debate with Mike Licona. He laid out a historical case. By contrast, you laid out no alternative case. Rather, time after time you countered with doubt about his case. You could have challenged his case with an alternative case or you could have challenged his case merely by sowing doubt about it. A historian would have chosen the former, you chose the latter. Repeatedly and consistently.
You are making a name for yourself being defined by who you don't believe existed and what you don't believe happened. A historian makes a name for himself by who he does chronicle and what he does believe happened.
Richard Carrier
Which debate are you talking about? And why is this relevant to this topic thread?
(And I certainly did lay out an alternative case, in both debates; indeed, he and I spent considerable time debating my alternative case. I must assume then you didn't actually watch either debate. Or perhaps you are confusing "I present several alternatives that are more probable than his" with "I present no alternatives to his," which would suggest you are logic challenged and must have scored low on the English comprehension portion of the SAT.)
Mike Gantt
You forgot to throw in that my mother wears army boots…but I get your drift nonetheless.
I watched the debate on YouTube a month or so ago. I didn't keep notes so I don't know the date. Nor did I know that this one one of two debates that you had. I think the two of spoke from the podium initially but then spent most of the discussion sitting in armchairs across from each other in dialogue.
You do offer alternatives to specific points, but only to undermine the point. What I don't see you offer, and haven't found on your web site, is a complete alternative case. And by "complete," I don't mean long. It should only take a paragraph. I simply mean a coherent and succinct statement of what happened such that a third of the world proclaims allegiance to someone who never existed.
That is, if you believe Jesus is a myth, who are the perpetrators of that myth and who are the victims? What was the motive, means, and opportunity of those who foisted myth as history? When and why did they do it such that for centuries supporters and detractors alike have believed that Jesus really existed and now you and others have uncovered the truth?
Richard Carrier
That would be our second debate. Our first was on my specific theory of the origins of Christianity; Licona wanted the second debate to be more general and conversational, getting at our exact differences. But even there I listed several alternative theories that are the most commonly proposed by mainstream scholars or that I have particular evidence for.
You do not seem to understand how a debate works: the person speaking first affirms a proposition, and it is the responsibility of the opponent to rebut. This creates the structure you are referring to, but that is created by the debate format. The structure is not the same thing as the content. If you are asking what my positive beliefs are (my actual conclusions as a historian), you have to look at the content, not the structure. If you only look at the structure, then you are being misled by the format. The content consists of the facts I educated the audience on, which rebut the assertions of Licona, but nevertheless consist of positive statements about history and historical method.
As to the answers to your specific questions, read Not the Impossible Faith and chapter 2 of The End of Christianity, which were designed for that purpose.
This may reflect another failure to understand how a debate works: it is physically impossible to outline what one fully believes happened (and why you believe that) in a debate, because you are set against a clock. You have only very limited time. This forces you to only make absolutely essential points. Accordingly, it is not possible to learn what I teach about the origins of Christianity from a debate, since that requires a great deal more time than is available in a debate. That is precisely what my publications are for.
Mike Gantt
Richard, you said:
"Our first [debate] was on my specific theory of the origins of Christianity…"
I listened to your opening statement in this video and you did not present the mythicist position at all. Rather you argued the theory that the apostles, disillusioned by Jesus' crucifixion, searched the Scriptures and had "prophetic dreams and visions" which they then began to promulgate. Thus your singular theme seems to be against Christ, whether it be a historical one or a mythical one.
"…I listed several alternative theories that are the most commonly proposed by mainstream scholars…"
If you mean mainstream scholars arguing against the resurrection, perhaps. But as Ehrman is making clear, there are no mainstream scholars against the historicity of Jesus.
"Accordingly, it is not possible to learn what I teach about the origins of Christianity from a debate, since that requires a great deal more time than is available in a debate."
If you can't outline your theory of Christian origins as a myth in a 20-minute, or even 10-minute, opening debate session, then there's something wrong with your logic. Sure, your argument in a nutshell would not contain all the nuance and substance, but if the core can't be pulled out maybe there's no core there.
"That is precisely what my publications are for."
I hope you will recognize how self-serving this sounds. "I can't explain it to you so you'll have to buy my books." I am willing to give serious thought to your theory, but if you aren't willing to put that theory, at least in outline form, on your blog, don't expect me to buy your books. I don't have enough money or time to buy books in order to find out what someone is saying. I buy books when I know what someone is saying and want to know more.
Richard, I don't know how smart you are, but I know you are a lot smarter than I am. If you want me to give serious consideration to your claim of being a historian who wants to get history right you've got to do a better job of telling your story and not spend so much effort on trying to discredit someone else's.
Richard Carrier
I was not defending the mythicist position in that debate. I have never debated mythicism. I may do so later this year or next, but always I have maintained that it is a speculative hypothesis, and in debates on other subjects I maintain the common view that Jesus existed, and only that he was not actually resurrected from the dead etc. So you clearly are very confused.
And it's certainly not true that "if you can't outline your theory of Christian origins as a myth in a 20-minute, or even 10-minute, opening debate session, then there's something wrong with your logic," not only because a debate does not consist only of an opening statement but a series of rebuttals and replies (and it is there that countless complexities arise too numerous to cover in so short a period), but also because to understand why a particular theory is credible, you need to be educated on all the relevant background evidence (e.g. the nature of savior religions before the first century, the history and science of schizotypal cults, the relevant theological background from pre-Christian Jewish literature, the political and literary context, e.g. the fact that ancient biographies were often fictional creations turning things said by the person into imagined stories about them; and so on and so forth). It is impossible to do that in 20 minutes.
For example, my book Not the Impossible Faith (which doesn't even argue for mythicism–I have yet to publish anything defending that thesis) would take 17 hours to read, and yet contains most of the background information you need to understand why an argument for mythicism has merit (for example, if I just said there were dying and rising gods predating Christianity, you or someone would doubt that, so I'd have to prove it; that alone would take at least 5-10 minutes at a podium; I devote a chapter to it in NIF; and that's just one of a hundred premises you have to be persuaded of).
Now, if your response is "I'm too lazy and disinterested to find out if you are correct" then why are you even bothering to communicate with me? If you don't give a shit, go away. If you do give a shit, meet your epistemic obligation and read what I've written specifically to educate people. But don't claim I'm not educating people on historical facts because you won't read the books I write to educate them on historical facts. That would be a really stupid thing to say, don't you agree?
Mike Gantt
I'll tell you what, Richard: You read my book and I'll read yours. How about that?
My book is "The Biblical Case for Everyone Going to Heaven." It's available online and you don't have to buy it or sign up for anything. Just as the title suggests, it describes how the Bible teaches that through Jesus Christ everyone is going to heaven when they die. In other words, evangelical Christianity has gotten it only half right. They're right that Jesus dying on the cross for our sins and rising from the dead is a whopping big deal, but they're wrong when they think that only they are going to heaven. Moreover, rank in heaven won't have anything to do with whether one is a Christian or not. Rather, it will have to do with how morally we lived given the knowledge of God that we had.
It's about 55,000 words, which I'm guessing is shorter than yours.
So, it seems like a good deal for you: you get to read the shorter book and you won't even have to pay for it. What do you say?
Richard Carrier
I don't see how that book has anything whatever to do with what we were discussing.
It makes no sense to say "You don't do history, because I refuse to read any book where you do history, until you read my book that doesn't."
Mike Gantt
That you are willing to concede the historical Jesus in order to argue against his resurrection and also willing to argue against the historical Jesus is demonstration enough that your main concern is not history.
Richard Carrier
You obviously don't know much about historical scholarship. Historians concede different possibilities and argue from them all the time. Particularly when we are dealing with untested hypotheses (as I believe the non-existence of Jesus is, since it has never yet been properly argued and debated). All responsible historians acknowledge and argue from any near-universal consensus view until they can prove that view incorrect. And that is precisely how I have behaved. Which actually demonstrates my main concern is history.
Richard Carrier
No it's not. If you are really interested in the state of historical evidence for the resurrection see chapter 11 of The Christian Delusion.
Please keep your remarks from now on relevant to the topic of the blog. And respond to things I've actually said. Unsourced and unargued assertions that ignore everything I've already said on the subject are in violation of my comments policy.
You might not want to waste much time responding to Mike Gantt. The guy seems to be another hack. He wrote a hack piece on Thom Stark's book *The Human Faces of God* and he seems to like an evil guy like James Holding. I personally do not wish to have anything to do with Mr. Gantt or anyone like him. He's another excellent reason why I could never want to be a Christian; even if there was an eternity in heaven (with Christ) and he was going there, I can't imagine spending it with the likes of creepy hacks like him.
Kristen McBride
I believe that photo is from Oregon State University, not Southern Oregon University, my alma mater, as it turns out.
Richard Carrier
Well, all I can say is that it's supposed to be Hannon Library, which SOU's own website claims exists there.
Huh. You're right…..looks A LOT nicer than when I was searching for secluded corners….but that's another story.
Richard Carrier
Well, it's obviously a well-prepared night shot, which always looks more amazing than seeing things by the light of day.
How about an appearance in Eugene, OR that week? I think I could come up with a sponsor for a discussion if you are interested…
Geoff Barrett
Richard Carrier
That's three hours away (so would entail six hours in a car). Unfortunately I can't swing that. But if any group there wants to fly me out some day in future, I'd certainly love to speak there.


text:
An American historical drama about a group of settlers known as Rogers' Rangers--led by Major Rogers (Spencer Tracy)--and the hardships of survival ... Show synopsis
Find your copy
Buy it from | $0.99 |
Buy new from | $37.46 |
Collectible from | $2.99 |
You're signed up (and we ♥ you). Watch for our Welcome e-mail and your first coupon. Thanks!


text:
Wednesday, March 12, 2014
Follow us:
Mohawk Valley
Time Warner Cable video customers:Sign in with your TWC ID to access our video clips.
Sign in
Syracuse University is well on its way to a strong connection with downtown through a series of bus routes, walking paths and bike lanes. That's thanks to the project called the Connective Corridor. Phase one is already complete. Our Katie Gibas met with project developers to give us a look at phase two.
SYRACUSE, N.Y. -- For those who travel East Genesee Street regularly, the nightmare of construction this past summer is hard to forget. But fast forward a few months and the new streetscape is all people can talk about.
"Little by little, each improvement they make is just going to enhance that area and the pedestrian traffic," said Tony Ortega, the president of the Armory Square Association.
Now that construction is moving down the street as phase two of the Connective Corridor project is already underway. The project picks up at Forman Park on East Genesee Street and will continue to State Street. Right now, crews are removing trees to prepare the way for summer construction. The second phase will add more walkable and bikable infrastructure, enhanced lighting and public art.
"It's important on a variety of different levels. Obviously connecting to growing parts of our community downtown and University Hill to very important economic engines of our community. Enhancing that connection, bringing people back and forth, making it safe, encouraging people to use it," said Owen Kerney, the Deputy Director of the Syracuse Bureau of Planning and Sustainability. One of the biggest and most complicated parts of phase two is here at the end of Forman Park where East Genesee Street goes under 81.
"Through that intersection, a relatively complicated and busy and dark intersection. That's the connection. That's the crux, that connection between University Hill and Downtown," said Kerney.
Project leaders are still working out that issue out as they complete the designs for Phase two.
The final design for phase two will be completed in May. Bids for the project will go out in June. While some work is already being done, the streetscape construction won't begin until mid summer.
If you'd like to check out more of the project or designs, visit the links below:
Weather alert » More alerts
From the Weather On The Ones Forecast Center, The National Weather Service Has Issued A BLIZZARD WARNING for the following counties: Cayuga (North), Wayne -- expires Thursday at 5:00AM. WINTER STORM WARNING for the following counties: Cayuga (South), Madison, Oneida (North), Oneida (South), Onondaga, Oswego, Seneca, Oswego, Chenango, Cortland, Otsego, Tompkins -- expires Thursday at 8:00AM. WINTER STORM WARNING for the following counties: Herkimer (North), Herkimer(South) -- expires Thursday at 11:00AM.


text:
Morning Drive starts your day with the absolute best music on the radio and combines it with news from NPR, local updates, features, traffic and weather, and more!
Sending a Valentine's Day card is one of the most traditional ways to say "I Love You".
In 1862, during the Civil War, Cincinnati and Northern Kentucky faced the likelihood of an invasion by Confederate troops. But the area was able to avoid a military confrontation, thanks to volunteers who came forward to defend the city and to help bolster its fortifications. Among those volunteers was a group of local African-Americans that came to be known as The Black Brigade. As part of the commemoration of Black History Month, WNKU's Steve Hirschberg talked about this historical episode with Richard Cooper, Interpretive Services Manager at Cincinnati's National Underground Railroad
The popular social networking site, Facebook is getting ready for another big change and maybe it's already happened for you. Facebook's Timeline will be mandatory for users.
A new study compiled for the National Park Service shows Mammoth Cave National Park generates $62 million a year for the South-Central Kentucky area. The park is located about halfway between Louisville and Nashville, near I-65. Vickie Carson is the park's Public Information Officer. In this Postcard story, WNKU's Steve Hirschberg asked Carson about the findings of the economic impact study.
This Saturday, the first in a series of three free arts sampler days takes place around the Cincinnati area. Rebecca Bromels is Director of Communications for Artswave. Bromels tells WNKU's Steve Hirschberg that all three sampler days take place on Saturdays.
dunnhumbyUSA is working on a formal agreement with the city of Cincinnati, the state of Ohio and 3CDC to keep its headquarters downtown but in a new location. WNKU's Steve Hirschberg talked with Stuart Aitken, the company's CEO.
U.S. Secretary of Agriculture Tom Vilsack says his department is doing everything it can to help grow Ohio's economy and to help improve the state's rural areas. Vilsack talked with WNKU's Steve Hirschberg in the wake of President Obama's recent State of the Union Address.
Sunday night's Super Bowl, just like every Super Bowl before it, will be played with a football made in the small town of Ada in Northwest Ohio. That's where the Wilson company has been making all of the NFL's official footballs since 1955. WNKU's Steve Hirschberg talked with company spokeswoman Molly Wallace.
Local songwriter and musician Josh Eagle of "Josh Eagle and the Harvest City" was in the WNKU studios last Friday to perform live. Afterwards WNKU's Steve Hirschberg sat down with him for an interview. Eagle was asked when he first realized he that wanted to make music his career.
When you think of adult beverages made or mixed in Kentucky, you naturally think of Bourbon and, perhaps, Mint Juleps. But now The Bluegrass State is starting to produce its own locally-crafted beers. In fact, there is even a new website for beer-loving tourists. It's called The Brewgrass Trail. In this Postcard story, WNKU's Steve Hirschberg talked about the burgeoning breweries with Adam Johnson. He is Executive Director of the Danville/Boyle County Convention and Visitors Bureau.


text:
Help Center answers
What credit or debit cards can I use with PayPal?
You can use Visa, MasterCard, and American Express cards to make PayPal payments.
Here's how to add a credit or debit card:- Log in to your PayPal account.
- Click Profile near the top of the page.
- Click My money.
- Click Add my card next to Credit and debit cards.
- Click Add a Card.


text:
You are currently viewing the beta version of the new AMM site. Click here to return to the current site.
Jun 07, 2013 | 12:54 PM | Corinna Petry
Tags Mississippi River, flooding, navigation, locks, dams, U.S. Army Corps of Engineers, U.S. Coast Guard, Corinna Petry
CHICAGO The U.S. Coast Guard and the U.S. Army Corps of Engineers have begun taking steps to get Mississippi River traffic moving again as floodwaters began to recede. The Coast Guards Upper Mississippi River sector, after consulting with vessel operators and shippers, reopened a five-mile stretch of the river to southbound commercial traffic between mile markers 179 and 184. That lane was closed June 3 after a "drift" of trees made navigation dangerous to vessel operations (amm.com, June 5). Northbound....
CHICAGO The U.S. Coast Guard and the U.S. Army Corps of Engineers have begun taking steps to get Mississippi River traffic moving again as floodwaters began to recede.
To access AMM's full content, please log in below. If you do not have an AMM account, we invite you to take a free trial or subscribe below.
Access to amm.com editorial content is granted only to paid subscribers and trialists. If you do not have an active account in your own name, please either subscribe or take a trial and you will have instant access to amm.com content. Sharing your login credentials with individuals who are not subscribers represents a violation of AMM copyright.
Every morning, every minute no matter how often you follow the markets, there's an AMM subscription to fit your needs.
Not sure if you are ready to invest in a subscription right now? Take a free, no-obligation trial. Start your free trial today.
Will more metals companies discontinue health care coverage for their employees in light of the Affordable Care Act?
June 20-21, 2013 New York
I don't think physical users of metal are driving this drop. It's more coming from the investment side.
--Mark Weintraub, Premier Metal Services


text:
Espresso Machines - Semi-Automatic
Make that perfect cup of coffee like you get in most professional cafes with a Semi-Automatic espresso machine. These machines either have a professional heavy duty grade portafilter or a pressurized portafilter handle. Semi-Automatics give you the best control over your espresso extraction and most accept either ground coffee or coffee pods.
Rating: Read Reviews
For a serious espresso machine that won't take up too much counter space, look no further than the Pasquini Livietta T2. The Livietta is one of the most compact semi-automatic machines available, but it still features the commercial quality that you would expect from Pasquini. Housed in stainless steel, the Livietta stands just over 12" tall and 8" wide. Inside the Livietta are a powerful 15 bar pump and 2 thermoblocks that can brew and steam simultaneously. The...
Mon - Thurs: 9am - 8pm
Friday: 9am - 6pm
Saturday: 10am - 3pm
Sunday: 12pm - 5pm