W. W. Norton & Company | The Personality Puzzle, 4th ed.

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Chapter 18: Disorders of Personality

When learning about personality disorders many of the symptoms seem quite common; you can see them in yourself and in others. In fact, you may look at a personality disorder and see enough of the symptoms in yourself or someone else to wonder, "Do I have it?" "Does he or she have it?" If you are a college student who was able to accumulate enough academic success to gain admissions into a college, then finish some college classes it is still possible that you could have a personality disorder . . . however, data from Dr. Eaton's lab (and others) indicates that it is statistically unlikely.

Remember that to receive a diagnosis not only does one need to have a certain number of symptoms (e.g., 5 of 9 symptoms), but the way that the symptom manifests itself in behavior must be extreme and unusual. Many of you reading this activity will have never met someone with behaviors this extreme or unusual. For you it will be hard to imagine what that looks like. This activity is intended to give you a sense of how extreme or dysfunctional a behavior should appear before it meets a diagnostic criterion for a personality disorder.

There is a written example; it illustrates one symptom for obsessive-compulsive personality disorder.

More vivid examples can be found in extraordinarily good cinematic portrayals of personality disorders. Go buy some popcorn, rent a movie, and gain a better idea of extreme and unusual behaviors that are indicative of personality disorders. A list of recommended movies and resource guides appear of this activity.

DSM-IV-TR Personality Disorders Portrayed in the Popular Cinema
Personality Disorder		Movie	Character to Watch
Cluster A:
	Paranoid	The Caine Mutiny (1954)	Humphrey Bogart’s portrayal of Captain Queeg
	Schizoid	The Accidental Tourist (1988)	William Hurt’s portrayal of Macon Leary
	Schizotypal	Taxi Driver (1976)	Robert De Niro’s portrayal of Travis Bickle
Cluster B:
	Antisocial	Fight Club (1999)	Brad Pitt’s portrayal of Tyler Durden**
	Borderline	Girl, Interrupted (1999)	Winona Ryder’s portrayal of Susanna Kaysen (true story)
	Histrionic	Gone with the Wind (1939)	Vivien Leigh’s portrayal of Scarlett O’Hara
	Narcissistic	To Die For (1995)	Nicole Kidman’s portrayal of Suzanne Stone Maretto
Cluster C:
	Avoidant	Zelig (1983)	Woody Allen’s portrayal of Leonard Zelig
	Dependent	What About Bob? (1991)	Bill Murray’s portrayal of Bob “Bobby” Wiley*
	Obsessive-Compulsive	As Good as It Gets (1997)	Jack Nicholson’s portrayal of Melvin Udall

Note: Some of these films are my personal favorites, and some I viewed because they were recommended by Hyler (1988)—they are all very good films.

* Just like the difficulties in real-life diagnosis there are many DSM symptoms that overlap in movie characters as well—in What About Bob? Bill Murray supposedly plays a character with obsessive-compulsive personality disorder; however, the entire comedic script for this movie is written in the light of dependent personality disorder; Bob's major problems, during the movie, appear to be much more related to dependent personality disorder than his character's diagnosis of obsessive-compulsive personality disorder—watch the movie and see if you agree with me.

** I'm afraid all films that portray a realistic view of antisocial personality disorder will likely be very violent; Fight Club is no exception. Another highly recommended film involving antisocial personality disorder is A Clockwork Orange (1971). Watch Malcolm McDowell's portrayal of Alex de Large.

If you would prefer something more funny than violent, watch Robert De Niro's portrayal of Paul Vitti, who is an antisocial character, in Analyze This (1999). If you have not yet seen this movie, it's a must-see for sure because the comedic script often highlights the strange work-life of a psychotherapist.

For more movie ideas, see:

Hyler, S. E. (1988). DSM-III at the cinema: Madness in the movies. Comprehensive Psychiatry, 29, 195–206.

Robinson, David J. (2003). Reel Psychiatry: Movie Portrayals of Psychiatric Conditions. Port Huron, Mich: Rapid Psychler Press. Dr. Robinson is a psychiatrist and a huge movie buff. In this book he presents a list (complete with summaries) of more than 140 films. Along with the summaries, Dr. Robinson provides a movie index that includes the title of the film and the principle diagnosis portrayed in it. Few libraries hold this book—it is worth ordering through interlibrary loan!

One last recommendation from Dr. Eaton: Dr. Funder recommends A Beautiful Mind (2001); specifically Russell Crowe's portrayal of Nobel Prize winning mathematician John Nash (diagnosed with an Axis I disorder—paranoid schizophrenia; not an Axis II personality disorder). John Nash's real-life case was atypical in timing and developmental course. As Dr. Funder alludes, this film does not do a very good job of portraying Nash's life in true factual manner. Rather, filmmaker Ron Howard used facts from Nash's life to give audiences an excellent sense of how the typical course of schizophrenia appears. In psychological terms: Howard superimposed Nash's life events onto a prototype (a typical case) of paranoid schizophrenia. From personal experience with schizophrenia in my family, I can tell you that this film provides a brilliant portrayal of the disorder. For a factual account of Nash's life read Sylvia Nasar's book by the same name (also highly recommended).

Written Example:

The first diagnostic criteria for obsessive-compulsive personality disorder reads: "is preoccupied with details, rules, lists, order, organization, or schedules to the extent that the major point of the activity is lost"

Normal behavior:
There are many executive consultants who provide very expensive professional development seminars on how to get organized, make schedules, prioritize things-to-do lists, set goals and strategies; all advice intended for executives to become more efficient and accomplish goals. Many Fortune 500 CEOs have attended these seminars, or they have practiced these daily organization rituals throughout their careers — and they swear by them because they work! Each morning most Fortune 500 CEO's begin their day by getting organized, checking their schedules, adding to their things-to-do lists and re-prioritizing them, and they evaluate the progress they have made toward reaching short term and/or long term goals. Many of these executives end their day the same way. They don't have time for this, but they make time to do it — they recognize it is that important — they will tell you that they simply could not function nearly as well without their organization rituals.

Behavior that meets this diagnostic criterion:
Here is a true story written by a daughter about her mother; the mother consistently displayed behaviors that would meet the first diagnostic criteria for obsessive-compulsive personality disorder: "When my grandma got sick with cancer my mom spent much of every day at grandma's, who lived a few miles away from our house. My dad worked full-time, I was a commuter college student and worked part-time, and my little sister was in junior high. My mom did not want her family to be inconvenienced by her absence during the week. So, she did the sweetest thing — on the weekends and sometimes late in the evening after she got home from grandmas, she made huge batches of homemade meals. She had probably over 100 microwaveable 3-compartment plates with lids. After cooking she would package up the meals into these microwavable plates, seal the lids, and she would put the dinners in the deep freezer we had in the garage. I'm sure she worked well into the night on the weekends and evenings, every week, for months on end making these meals so we would not have to come home from school or work without 'eating a proper meal.' Opening the freezer was like buying a TV dinner from the freezer compartment at a grocery store. Every one of my mom's homemade TV dinners were labeled, stacked, and organized by the kind of meat (beef, chicken, poultry). After about 2 weeks of her cooking, and us picking and choosing among the meals there were shorter stacks and my mom thought things were getting out of control. So, my mom made a menu that she had taped to the top of the deep freezer that told us which kind of homemade TV dinners were in there (she used the back side to keep an inventory so she would know what kind of meal to cook next — in the middle of the night — after caring for grandma all day). We tried to get her to stop; we could cook ourselves (I had won several blue ribbons at the county fair for my cooking.) But she did not stop. The freezer was always stacked full of homemade TV dinners, perfectly organized, with the menu on the top for inventory control. As the years passed this story became part of our family's legend — as we told it my mom took great pride in her organizational abilities — when this story gets told no one mentions how kindhearted her act of cooking for us really was — her love and kindheartedness got lost in all the organization of the stupid freezer."