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(flaunting her nudity) are not uncommon party behaviors for her, and on at least one occasion she reportedly bit the buttons off the shirt of a man she had just met To some, these antics are amusing; to others, they are highly offensive (Trobst & Wiggins, 2003, p 313) Finally, low A is associated with paranoid thinking and cynicism, exploitative and manipulative behaviors, and rude and inconsiderate actions that alienate others Her peers agree that she is boastful and self-promoting and a master of manipulation (Trobst & Wiggins, 2003, p 314) whose interpersonal shrewdness is a considerable asset to her as a trial lawyer But her self-centeredness was apparently at the root of her failed relationship: Her husband left her a few months after her initial assessment, complaining that she never had time or concern for him.

Caregiver depression after bereavement: Chronic stress isn t over when it s over Psychology and Aging, 9(3), 372 380 Bolger, N (1990) Coping as a personality process: A prospective study Journal of Personality and Social Psychology, 59(3), 525 537 Boscarino, J A, & Chang, J (1999) Higher abnormal leukocyte and lymphocyte counts 20 years after exposure to severe stress: Research and clinical implications Psychosomatic Medicine, 61(3), 378 386 Bovbjerg, D H, Redd, W H, Maier, L A, Holland, J C, Lesko, L M, Niedzwiecki, D, et al (1990) Anticipatory immune suppression and nausea in women receiving cyclic chemotherapy for ovarian cancer Journal of Consulting and Clinical Psychology, 58, 153 157 Bower, J E, Kemeny, M E, Taylor, S E, & Fahey, J L (1998) Cognitive processing, discovery of meaning, CD4 decline, and AIDS-related mortality among bereaved HIV-seropositive men.

This was a devastating event for Madeline, who went into a yearlong depression and was still unattached three years later These examples make it clear that the problems listed by Widiger et al are clinical hypotheses that must be individually evaluated We cannot simply attribute a set of problems to a patient because the patient has the relevant personality characteristics Some of the problems listed apply to Madeline, but others do not, and as with her interpersonal cunning in the courtroom some may not be problems at all or may be advantageous in some circumstances In addition to assessing the presence of the problems, the clinician needs to determine if they should be addressed in therapy Outrageous behavior is apparently egosyntonic for Madeline and does not seem to have significantly affected her social adaptation.

She might, however, be persuaded to deal with her egocentrism and inconsiderateness to others, especially those close to her, because these behaviors endanger her relationships Step 3 requires a judgment about the severity of the problems and whether they constitute a diagnosable personality disorder Occupationally, Madeline is quite successful; she does not have problems with substance abuse; and she is a valuable member of her community, proudly upholding the rights of Native Americans Her marriage, however, ended in failure and has not been replaced With neither spouse nor children, one might argue that her low A has led to significant impairment in personal relationships The optional Step 4 consists of identifying applicable PD patterns Costa and Piedmont (2003) used the rpa algorithm applied to the mean personality profile and suggested that, if she were a treatment-seeking patient, Madeline might have antisocial, histrionic, or narcissistic PDs.

Journal of Consulting and Clinical Psychology, 66, 979 986..

Applying the cutoffs for NEO-PI-R PD scales given in Table 142 to mean raw facet scores, Madeline could be characterized by paranoid, antisocial, histrionic, or narcissistic PD patterns Her own self-reports would add obsessive-compulsive, and her husband s ratings suggest borderline PD pattern The histrionic and narcissistic elements of her character are clear, but whether these designations add to the understanding of Madeline s personality is for each clinician to decide Perhaps it would be better to use Millon s (1981) terminology and say that Madeline exhibits gregarious and egotistic patterns..

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