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Personality Disorders

Personality Disorders. Chapter 10. Introduction. A person’s characteristic traits, coping styles, and ways of interacting with the environment emerge during childhood and become solid during adolescence and early adulthood.

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Personality Disorders

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  1. Personality Disorders Chapter 10

  2. Introduction A person’s characteristic traits, coping styles, and ways of interacting with the environment emerge during childhood and become solid during adolescence and early adulthood. These patterns constitute a person’s personality – the set of unique traits and behaviors that characterize an individual. Most psychologists agree that there are 5 personality traits: neuroticism, extraversion/introversion, openness to experience, agreeableness/antagonism, and conscientiousness.

  3. Clinical Features of Personality Disorders Our adult personalities tend to be attuned to the demands of society. Some people display obvious symptoms (certain traits) that are so inflexible and maladaptive that they are unable to perform at least some of the varied roles expected of them by their society. This means that they have a personality disorder. Personality disorders used to be called, “character disorders”. The most pervasive characteristics found in persons with personality disorders include: chronic interpersonal difficulties and problems with one’s identity or sense of self.

  4. Clinical Features of Personality Disorder In order to be diagnosed with a personality disorder, the behavior of the individual must be pervasive and inflexible as well as stable and of long duration. It must also cause either clinically significant distress or impairment in functioning and be manifested in at least two of the following areas: cognition, affectivity, interpersonal functioning, or impulse control. These individuals tend to cause as much difficulty in other’s lives as they do their own. Other people tend to find their behaviors confusing, exasperating, unpredictable, and unacceptable.

  5. Clinical Features of a Personality Disorder Individuals with personality disorders tend not to learn from their mistakes and tend to make the same mistakes over and over again. As an example, a dependent person may cause the end of relationships due to incessant demands to never be left alone at home. These disorders tend to not come from stress. They come from the gradual development of inflexible and distorted personality and behavioral patterns that result in maladaptive ways of perceiving, thinking about, and relating to the world. These can stem from majorly stressful events in childhood.

  6. Clinical Features of a Personality Disorder Friends and family may describe these people as: troublesome, eccentric, or hard to get to know. They tend to have trouble developing close relationships or getting along with others. The DSM-IV-TR used to categorize personality disorders into 3 categories: 1) Paranoid, schizoid, and schizotypal personality disorders – people are odd or eccentric, with behaviors ranging from distrust and suspiciousness to social detachment. 2) Histrionic, narcissistic, antisocial, and borderline personality disorders – share a tendency to be dramatic, emotional, and erratic. 3) Avoidant, dependent, and obsessive compulsive disorder – show anxiety and fear. These categories will probably not exist in the DSM-5, but many psychologists still categorize them this way.

  7. Clinical Features of a Personality Disorder More misdiagnoses occur than correct diagnoses with personality disorders. This is so because there are no sharp definitions provided concerning personality disorders. Most psychologists and psychiatrists arrive at a diagnosis for personality disorders by self-reports and interviews. There tends to be a comorbidity that follows individuals identified with personality disorders. There is more evidence showing that personality disorders come from heritability.

  8. Cluster A Personality Disorders Cluster A personality disorders display unusual behavior such as distrust, suspiciousness, and social detachment and come across as odd or eccentric. Individuals with paranoid personality disorder – have a pervasive suspiciousness and distrust of others, leading to numerous interpersonal difficulties. They tend to see themselves as blameless even pointing to the evil motives of others. These people tend to be “on guard” expecting trickery and looking for clues to validate their expectations while disregarding all evidence to the contrary.

  9. Cluster A Personality Disorders These individuals doubt the loyalty of friends and are reluctant to confide in others. They tend to bare grudges, refuse to forgive insults and slights, and are quick to react with anger and sometimes violent behavior. These people tend not to be psychotic. Most of the time they are in reality. They may experience psychotic symptoms during periods of stress.

  10. Schizoid Personality Disorder These individuals are usually unable to form social relationships and usually lack much interest in doing so. They do not have good friends, but may have a close relative. These people tend to have problems expressing their feelings and are often cold and distant. They often lack social skills and can be classified as loners, with solitary interests and occupations. These individuals do not tend to marry as they do not take interest in sexual activity or in other activities. They tend not to be emotionally reactive. They rarely experience positive or negative emotions. They tend to show an apathetic mood.

  11. Schizotypal Personality Disorder These individuals are excessively introverted and have pervasive social and interpersonal deficits. They tend to have cognitive and perceptual distortions, as well as oddities and eccentricities in their communication and behavior. Highly personalized and superstitious thinking is characteristic of people with schizotypal personality disorder. These individuals believe that they have magical powers and may engage in magical rituals. Oddities in thinking, speech, and other behaviors are the most stable characteristics of schizotypal personality disorder.

  12. Causal Factors Concerning Schizotypal Personality Disorder There has been a significant amount of research on schizotypal personality disorder. There is generally a 2% prevalence within the general population. These individuals tend to show mild impairments in cognitive functioning, including deficits in their ability to sustain attention, and deficits in working memory, and both of which are common in schizophrenia. These individuals show language abnormalities in their auditory processing.

  13. Cluster B Personality Disorders Histrionic Personality Disorder – tend to have excessive attention-seeking behavior and emotionality are the key characteristics. These individuals tend to feel unappreciated if they are not the center of attention; their lively, dramatic, and excessively extraverted styles often ensure that they can charm others into attending to them. In craving stimulation and attention, their appearance and behavior are often quite theatrical and emotional as well as sexually provocative and seductive. Their speech is often vague and impressionistic, and they are usually considered self-centered, vain, and excessively concerned about the approval of others, who see them as overly reactive, shallow, and insincere.

  14. Cluster B Personality Disorder Narcissistic Personality Disorder – shows an exaggerated sense of self-importance, a preoccupation with being admired, and a lack of empathy for the feelings of others. There is grandiose and vulnerable narcissism. The grandiose narcissism have traits related to grandiosity, aggression, and dominance. These individuals tend to overestimate their abilities and accomplishments while underestimating the abilities and accomplishments of others.

  15. Cluster B Personality Disorders Persons with narcissistic personality disorder tend to have a sense of entitlement that astonishes others. They believe they can only be understood by high-status people or that they should only associate with certain individuals. They tend not to forgive others for perceived slights and they easily take offense. These individuals also tend to have fragile and unstable self-esteems. They may avoid interpersonal relationships due to fear of rejection or criticism.

  16. Cluster B Personality Disorders For the grandiose narcissist, the family and friends may be more concerned about the behavior of the person than the person themselves. Some individuals may fluctuate between grandiosity and vulnerability. These individuals have an extremely difficult time understanding other’s perspectives. If they do not receive the validation or assistance they desire, they are inclined to be hypercritical and retaliatory. This tends to be seen in more men than more women.

  17. Cluster B Personality Disorders Antisocial Personality Disorder – continually violate and show disregard for the rights of others through deceitful, aggressive, or antisocial behavior, typically without remorse or loyalty to anyone. They tend to be impulsive, irritable, and aggressive and to show a pattern of generally irresponsible behavior. This pattern must have occurred since the age of 15 and before 15 years old, the person must have had symptoms of conduct disorder. This disorder has been researched substantially.

  18. Borderline Personality Disorder People with BPD tend to show a pattern of behavior characterized by impulsivity and instability in interpersonal relationships, self-image, and moods. BPD has a long and rather confusing history. The current diagnosis is no longer related to schizophrenia. The central characteristic of BPD is affective instability, which has emotional responses to environmental triggers. This is also characterized by drastic and rapid changes from one emotion to another.

  19. Borderline Personality Disorder These individuals do not tend to have stable self-images. Their relationships tend to be stormy, involve disillusionment, disappointment, and anger. Their fears of abandonment are huge. There is also intense and often uncontrollable rage. There is an impulsivity characterized by rapid responding to environmental triggers without thinking (or caring) about long-term consequences. These often lead to self-destructive behaviors such as gambling sprees or reckless driving. They tend to partake in lots of suicide attempts. They are also at-risk for self-mutilation.

  20. Borderline Personality Disorders About 75% with BPD have cognitive symptoms that include: being out of contact with reality and can experience hallucinations, paranoid ideas, or severe dissociative symptoms. 1-2% of the population may qualify for the diagnosis of BPD, but they represent about 10% of patient in outpatient and 20% of patients in inpatient clinical settings. Genetic factors tend to play a role with BPD. The 5-HTT gene could be responsible for BPD.

  21. Cluster C Personality Disorders These individuals often show anxiety and fearfulness, characteristics that we have not seen in the other two clusters. Avoidance Personality Disorder – show extreme social inhibition and introversion, leading to lifelong patterns of limited social relationships and reluctance to enter into social interactions. They do not seek out other people, yet they desire to seek out other people. They do desire affection and are often lonely and bored. These individuals do not seem to enjoy their aloneness; their inability to relate comfortably to other people causes acute anxiety which is often accompanied by depression.

  22. Cluster C Personality Disorders The key difference between the loner with schizoid personality disorder and the loner who is avoidant is that the one with avoidant is shy, insecure, and hypersensitive to criticism. The avoidant also desires interpersonal contact, but avoids it for fear of rejection. There is a modest genetic influence.

  23. Cluster C Personality DisordersDependent Personality Disorder These individuals show an extreme need to be taken care of, which leads to clinging and submissive behavior. They also show acute fear at the possibility of separation or sometimes of simply having to be alone. These individuals build their lives around other people and subordinate their own needs and views to keep people involved with them. These people often fail to get angry with others because of a failure of losing their support. These people will remain in psychologically or physically abusive relationships. They have difficulties with everyday simple decisions and they have a lack of self-confidence. They can function as well as they are not required to be on their own.

  24. Dependent Personality Disorder It is very common for those with dependent personality disorders to have anxiety and depression. These individuals tend to have a need for assurance. It is difficult for individuals with this disorder to get out of relationships because they do not want to be on their own. They have a need to be taken care of. These individuals fear criticism and rejection.

  25. Obsessive-Compulsive Personality Disorder Perfectionism and an excessive concern with maintaining order are the characteristics of those with OCPD. There is careful attention paid to rules, order, and schedules. They are preoccupied with the details of events and things. This perfection is often quite dysfunctional in that it can mean never finishing projects. They tend to be obsessed with work and don’t care about putting off leisure activities. They have trouble relaxing and having fun. They have difficulty giving tasks to others and are rigid, color, and stubborn. Others tend to view them this way, too. These individuals do not have extreme anxiety or obsessive or compulsive rituals.

  26. Obsessive-Compulsive Personality Disorder The three main characteristics are: perfectionism, preoccupation with details, and hoarding. These individuals have high levels of conscientiousness, which leads to an extreme devotion to work, perfectionism, and excessive controlling behavior. They like to comply and be assertive.

  27. Treatments and Outcomes for Personality Disorders Personality disorders are very difficult to treat because they are enduring, pervasive, and inflexible patterns of behavior and inner experience. Many different goals of treatment can be formulated, and some are more difficult to achieve than others. Goals might include reducing subjective distress, changing specific dysfunctional behaviors, and changing patterns of behavior or the entire structure of the personality.

  28. Treatments and Outcomes for Personality Disorders People with personality disorders enter treatment only at someone else’s insistence and often do not believe that they need to change. These individuals often have trouble trusting therapists and maintaining good relationships. They may disrupt their sessions may being loud and main refuse to complete treatment. 37% of individuals will drop out of therapy, prematurely. Sometimes, individuals will need to be hospitalized. They may live in rehabilitation centers during the weekdays. In-patient treatment seems to be more effective than out-patient treatment.

  29. Treating Borderline Personality Disorder With BPD, there generally needs to be psychotherapy as well as medication. The medication sometimes creates more suicidal behavior. Antidepressants are considered most safe and useful for treating rapid mood shifts, anger, and anxiety. These individuals tend to have a high incidence of self-mutilation. Patients show some improvement in depression, anxiety, suicide, impulsive aggression, rejection sensitivity, and especially transient psychotic symptoms.

  30. Treating Borderline Personality Disorder Mood-stabalizing medications such as carbazemine may be useful in reducing irritability, suicidal behaviors, and impulsive aggression. Overall, drugs tend to be mildly beneficial for BPD. Psychotherapy may be very effective for this disorder. Dialectical behavior therapy – is a unique kind of cognitive and behavioral therapy specifically adapted for this disorder. One of the goals of this therapy is to help individuals realize they have negative afffect and not to engage in self-harming behavior. There is an increase in teaching coping skills. There are individual, group, and phone components to this therapy. They are encouraged not to put everyone under the label of “good” or “bad”. This treatment is expensive and time-consuming.

  31. Antisocial Personality Disorder and Psychopathy People with antisocial personality disorder (ASPD) tend to disregard and violate the rights of others. They do this through deceitful, aggressive, and antisocial behaviors. They tend to have unsocialized and irresponsible behavior with little regard for safety. Only those that are above 18 years of age can be diagnosed with this disorder. Much of the population with this disorder are in prison. Other symptoms include: repeatedly performing acts that are grounds for arrest, showing repeated deceitfulness, impulsivity, irritability, and aggressiveness, shows disregard for safety, shows consistent irresponsibility in work or financial matters. The person may have had conduct disorder before the age of 15 years old.

  32. Psychopathy and Antisocial Personality Disorder The earliest description of psychopathy was made by Cleckley in 1941. Psychopathy includes the symptoms of Antisocial Personality Disorder, but also has a lack of empathy, inflated and arrogant self-appraisal, and glib and superficial charm. 1% of females are ASPD. 3% of males fit the criteria of ASPD. This may be as low as 1%, though.

  33. Two Dimensions of Psychopathy Robert Hare and his coworkers developed a 20-item Psychopathy Checklist Revised (PCL-R). This was a way that clinicians and researchers could diagnose psychopathy on the basis of the Cleckley criteria. This can be done through an extensive interview and careful checking of school records, police records, and prison records. There are two aspects of psychopathy: 1) This involves a lack of remorse or guilt, callousness/lack of empathy, glibness/superficial charm, grandiose sense of self-worth, and pathological lying. 2) This also involves: impulsive and socially deviant lifestyles with a need for stimulation, poor behavior controls, irresponsbility, and a parasitic lifestyle.

  34. Two Dimensions of Psychopathy In the prison population, 70-80% of inmates fall into the category of ASPD. 25-30% fall into psychopathy. This checklist appears to be the best indicator of future violence and recidivism. Those individuals with psychopathy are three times more likely to reoffend and four times more likely to reoffend violently following prison terms. Individuals that are not in jail, but still might show signs of psychopathy include: predatory business professionals, manipulative lawyers, high-pressure evangelists, and crooked politicians. Not much research exists on psychopaths that have stayed out of the prison system.

  35. The Clinical Picture in Psychopathy and Antisocial Personality Disorder Even though psychopathy might be charming, spontaneous, and likable when you meet them; they are deceitful and manipulative and use others to meet their own ends. Psychopaths tend to live in the moment and not in the past or future. They may also be hostile and act out in remorseful and senselessly violent ways. Psychopaths appear unable to understand and accept ethical values except on a verbal level. Their conscience development is severely retarded or nonexistent. They generally act as though laws do not apply to them. Their intellectual development is typically normal.

  36. Irresponsible and Impulsive Behavior - Psychopaths Psychopaths tend to take what they want and not earn it. They are prone to thrill seeking and deviant and unconventional behavior. They often break the law impulsively with no regard of the consequences. Some of these individuals have high rates of alcohol abuse and dependent and other substance-abuse/dependent disorders. Antisocial personalities tend to have elevated rates of suicide attempts and completed suicides

  37. Ability to Impress and Exploit Others Psychopaths seem to have good insights into people’s needs and weaknesses and are adept at exploiting them. These individuals are not sorry if they are caught in a lie. Psychopaths are seldom able to keep good friends. Psychopaths tend to not understand love in others or give it in return. Manipulative, exploitative, and sometimes coercive in sexual relationships, they tend to be unfaithful mates. Those with psychopathy tend to show very little emotion or reaction to pictures of mutilated or assaulted people. These individuals tend to show less activity in the amygdala.

  38. Conduct Disorder These children take part in: theft, running away from home, and associating with criminal deviants. Those individuals with poor parental supervision, harsh or erratic parenting styles, physical abuse or neglect, disrupted family lifestyle, and a convicted mother increase the chances of conduct disorder given children. The first disorder that tends to come before conduct disorder is ODD (oppositional defiant disorder) and ADHD (attention deficit hyperactivity disorder).

  39. Conduct Disorder Whether or not a child develops conduct disorder depends upon their parent’s antisocial behaviors, divorce, poverty, a crowded-inner-city neighborhood, and parental stress. All of these characteristics contribute to poor and ineffective parenting skills – especially in ineffective disciplining, monitoring, and supervising, which is highly predictive of antisocial behavior.

  40. Sociocultural Causal Factors and Psychopathy There are a wide range of cultures that have individuals that fit on the psychopathology scale. The manifestations of the disorders are influenced by cultural factors, an encouragement or discouragement of the factors. One of the ways in which psychopathology is different in different cultures is the amount of aggressiveness and/or violent behavior that the person takes part in. In China, psychopaths are much less likely to engage in violent behavior. Individualism tends to stem psychopaths and their behaviors.

  41. Treatments and Outcomes in Psychopathic and Antisocial Personality Most psychopathic individuals do not suffer from much personal distress and do not believe they need treatment. If psychopaths take part in rehabilitation programs, they are unlikely to be helped by them. Professionals that work with psychopaths often state that it is nearly impossible to treat them. There are certain treatments that will increase the bad behaviors of psychopaths. Biological treatments (medicines) do not seem to help much either.

  42. Cognitive Behavioral Treatments - Psychopaths Punishment by itself is generally ineffective for changing antisocial behavior. Cognitive-behavioral treatments have been most effective given treatment. The goals of this program tend to include: increasing self-control, self-critical thinking, and social perspective taking, 2) increasing victim awareness, 3) teaching anger management, 4) changing antisocial attitudes, and 5) curing drug addiction. These treatments only tend to make small changes, though. These tend to work better with young offenders versus older offenders.

  43. Cognitive-Behavioral Treatments - Psychopaths Many criminal activities of many psychopathic and antisocial personalities seem to decline after the age of 40 even without treatment, maybe because of weaker biological drives, better insight into self-defeating behaviors, and the cumulative effects of social conditions. 50% of psychopaths still tended to be arrested for criminal acts. The social damage that psychopaths do tends to continue after the 40’s.

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