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TitleTHE CONCEPTUALIZATION OF PERSONALITY DISORDERS
LanguageEnglish
File Size1.2 MB
Total Pages104
Document Text Contents
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lifestyle of the 1980s, where family men had affairs and wives resentfully stood by them.

This movie was also of great interest to the mental health profession, as Alex was

discussed as the prototypical case of borderline personality disorder. Glenn Close, who

played Alex in the movie, even visited with psychiatrists to gain a better understanding of

borderline personality disorder in order that she may realistically portray Alex’s

character. However, the mental health profession was displeased with the released ending

of the movie, as the final scenes did not correspond with the nature and behaviors of a

borderline personality. In order to satisfy and entertain audiences, Fatal Attraction was

released with an overdramatic, Hollywood thriller conclusion of Alex attacking Dan’s

family with a knife. After a lengthy fight scene between Alex and Dan, Alex was

ultimately shot to death by Dan’s wife. The original ending involved Alex taking her own

life and framing Dan for her death. This less gory and suspenseful conclusion

disappointed audiences but was a more realistic portrayal of a borderline personality

character.

Fatal Attraction was one of the top grossing films in 1987. It was assumed most

of the participants would be able to correctly identify Alex. However, just over 47%

provided a correct response in identifying Alex. Such a low correct response rate may be

attributed to the fact that the case vignette concluded with the original movie ending,

rather than the horror-like movie conclusion. However, the percentage of correct

responses was comparable to Aileen (49%), who was portrayed in a more recent, but less

popular movie than Fatal Attraction.

Given the popularity of this movie and the continued reference of her character as

a classic borderline personality disorder, presumably the participants of this study would

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exhibit high levels of agreement when using the DSM to describe Alex’s case history.

Across all the case vignettes, more agreement occurred with Alex when determining a

DSM personality disorder diagnosis. Clearly, the psychologists saw Alex as fitting into

the category of borderline personality disorder. Interestingly, even such a “clear-cut”

example of borderline personality disorder does not excuse it from one of the inherent

problems of the DSM personality disorders, which is the overlap of diagnostic criteria.

The participants also placed Alex in six other personality disorder categories, thus

suggesting that she may meet criteria for well over half of the personality disorders. This

problem of comorbidity was seen for all the case vignettes, as the minimum number of

personality diagnoses given was five. Comorbidity has been a well documented concern

of the DSM personality disorders, including those cases considered to be prototypic

(Blashfield, McElroy, Pfohl, & Blum, 1994).

As mentioned before, participants had a difficult time agreeing on assigning GAF

scores to Alex. Standard deviations ranged from about 15 to 20 across the three forms of

GAF scores (the correct GAF score, lowest possible GAF scores, and highest possible

GAF score), suggesting that Alex’s level of functioning potentially could extend across

multiple 10-point increment GAF levels. Again, it is difficult to assign a single GAF

score to describe behavior that ranges from professional success to suicidal stalking.

As opposed to the GAF, participants were able to use the FFM to adequately

represent specific features of Alex’s pathological presentation, such as high levels of

angry hostility, impulsivity, and excitement-seeking behaviors. Once these facets were

well represented, participants then had the opportunity to portray more adaptive features

of Alex, such as relatively normal levels of competency and achievement striving

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Table 9

Ranking of variability values for each case vignette across the classification systems


Rank DSM FFM GAF Total

1 Alex Macon Madeline Madeline

2 Madeline Madeline Earnst Alex

3 Ted Alex Macon

4 Aileen Earnst Aileen
Earnst and

Macon

5 Earnst Ted Marianne Aileen

6 Macon Aileen Meursault Ted

7 Charles Alex Marianne

8 Marianne
Meursault and

Marianne Charles Charles

9 Meursault Charles Ted Meursault
Note. A ranking of 1 represents best agreement (low variability value). A ranking of 9

represents worst agreement (high variability value).

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Table 10

Frequency (and percentage) of descriptors across all case vignettes for each classification system

9
6




Alabama
Sample


(n = 71)

Idaho/Connecticut Sample


(n = 44)

Combined
Sample


(n = 115)




First Word-List Memory Cues Second Word-List Total




DSM 691 (45.73%)


480 (49.43%) 160 (44.08%) 289 (50.70%) 929 (48.79%)


1620 (47.44%)

FFM 781 (51.69%)


528 (54.38%) 104 (28.65%) 273 (47.89%) 905 (47.53%)


1686 (49.37%)

GAF 114 (7.54%)


76 (7.83%) 36 (9.92%) 41 (7.19%) 153 (8.04%)


267 (7.82%)

Total 1511


971 363 570 1904


3415

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