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Personality Disorders. Personality Traits. characteristic ways of thinking, feeling, and behaving that are stable across time and across situations considered to be a disorder when traits are inflexible and maladaptive cause significant functional impairment and/or distress. The Question.

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personality traits
Personality Traits
  • characteristic ways of thinking, feeling, and behaving that are stable across time and across situations
  • considered to be a disorder when
    • traits are inflexible and maladaptive
    • cause significant functional impairment and/or distress
the question
The Question
  • Are people with personality disorders qualitatively different from people without?

OR

  • Are personality disorders simply extreme versions of otherwise normal personality variations?
the answer
The Answer
  • Personality disorders are probably best thought of as extremes on one or more personality dimensions
dsm iv tr
DSM-IV-TR
  • Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision
  • lists diagnostic criteria for each mental disorder
prevalence
Prevalence
  • 0.5 - 2.5% of the general population
  • 2 - 10% of outpatients
  • 10 - 30% of inpatients
course
Course
  • thought to originate in childhood and continue into adulthood
  • believed to be relatively stable, difficult to treat
comorbidity
Comorbidity
  • considerable overlap among categories
  • about 50% of people diagnosed with one personality disorder also meet criteria for another
  • questions
    • do people really tend to have more than one personality disorder?
    • do rates of comorbidity indicate problems with reliability and validity of diagnostic categories?
lack of research
Lack of Research
  • for many personality disorders, there is relatively little empirical research on the causes and treatments
three clusters
Three Clusters
  • odd/eccentric
  • dramatic/erratic
  • anxious/fearful
cluster a odd or eccentric
Cluster A: Odd or Eccentric
  • paranoid
  • schizoid
  • schizotypal
paranoid personality disorder
Paranoid Personality Disorder
  • pervasive pattern of distrust and suspiciousness of others such that their motives are interpreted as malevolent
dsm iv tr at least 4 sx
DSM-IV-TR: at least 4 sx
  • suspects others are exploiting, harming, or deceiving him
  • preoccupied with doubts about loyalty/trustworthiness of friends, associates
  • reluctant to confide in others (fears info will be used against him)
dsm iv tr continued
DSM-IV-TR (continued)
  • reads hidden threatening meanings into benign events
  • bears grudges, is unforgiving
  • perceives attacks on character or reputation and is quick to counterattack
  • suspicious of fidelity of sexual partner
causes
Causes
  • Biological
    • slightly more common among relatives of people with schizophrenia
  • Psychological
    • theory: certain basic mistaken assumptions about others
    • “people are malevolent and deceptive” and “they’ll attack you if they get the chance”
    • result of upbringing? taught by parents?
treatment
Treatment
  • unlikely to seek professional help; difficulty trusting therapist
  • difficulty that brings them in is a crisis
  • cognitive therapy
    • changing person’s mistaken beliefs about others
  • no confirmed demonstrations that any form of tx works
schizoid personality disorder
Schizoid Personality Disorder
  • pervasive pattern of detachment from social relationships and restricted range of expression of emotion in interpersonal settings
dsm iv tr at least 4 sx18
DSM-IV-TR: at least 4 sx
  • neither desires nor enjoys close relationships
  • chooses solitary activities
  • little, if any, interest in sexual experiences with another person
  • lacks close friends
  • appears indifferent to praise/criticism
  • shows emotional coldness, detachment
  • takes pleasure in few, if any, activities
causes and treatment
Causes and Treatment
  • causes
    • no research
    • preference for social isolation resembles aspects of autism
  • treatment
    • don’t usually seek tx (only in response to crisis)
    • point out value of social relationships
    • learn empathy
    • social skills training
    • many therapists believe therapy doesn’t help this group
schizotypal personality disorder
Schizotypal Personality Disorder
  • pervasive pattern of social and interpersonal deficits marked by acute discomfort with, and reduced capacity for, close relationships and cognitive or perceptual distortions and eccentricities of behavior
dsm iv tr at least 5 sx
DSM-IV-TR: at least 5 sx
  • ideas of reference
  • odd beliefs or magical thinking
  • unusual perceptual experiences
  • odd thinking and speech
  • suspiciousness/paranoia
dsm iv tr continued22
DSM-IV-TR (continued)
  • inappropriate or constricted affect
  • behavior or appearance that is odd, eccentric, or peculiar
  • lack of close friends
  • excessive social anxiety: associated with paranoid fears
causes and treatment23
Causes and Treatment
  • Biological
    • more common among relatives of people with schizophrenia
  • Treatment
    • research is limited
    • tx for comorbid depression
    • psychological: social skills to help reduce isolation or help person adjust to solitary lifestyle
    • medical: Haldol. Results in improvement in some sx, but many stop taking due to side effects
cluster b dramatic or erratic
Cluster B: Dramatic or Erratic
  • antisocial
  • borderline
  • histrionic
  • narcissistic
antisocial personality disorder
Antisocial Personality Disorder
  • pervasive pattern of disregard for and violation of the rights of others since age 15
dsm iv tr26
DSM-IV-TR
  • at least 3 sx
    • failure to conform to social norms with respect to lawful behavior (repeated arrests)
    • deceitfulness (repeated lying, use of aliases, conning)
    • impulsivity, failure to plan ahead
    • irritability and aggressiveness (repeated fights)
    • reckless disregard for safety of others
    • consistent irresponsibility (no steady employment, doesn’t honor financial obligations)
    • lack of remorse (indifferent to or rationalizes having hurt, mistreated, or stolen from others)
dsm iv tr continued27
DSM-IV-TR (continued)
  • must be at least 18
  • evidence of conduct disorder prior to age 15
    • violation of basic rights of others and major social rules
    • aggression toward people and/or animals
    • destruction of property
    • deceitfulness or theft
    • serious violation of rules (stays out all night, truant)
psychopathy
Psychopathy
  • antisocial personality disorder overlaps with personality trait called “psychopathy”
    • glib or superficial charm
    • grandiose sense of self-worth
    • proneness to boredom/need for stimulation
    • pathological lying
    • conning/manipulative
    • lack of remorse
  • not all psychopaths display aggressiveness that is a DSM-IV-TR criterion for antisocial personality
causes biological
Causes: Biological
  • genetics
    • family, adoption, and twin studies show evidence of a genetic link
    • examples:
      • offspring of felons raised by adoptive families show higher rates of arrests and antisocial personality disorder than controls
      • concordance rates for criminality are 55% for MZ twins and 13% for DZ twins
but what do they inherit
But what do they inherit?
  • underarousal hypothesis
    • psychopaths have abnormally low levels of cortical arousal
    • engage in antisocial and risk-taking behaviors to increase level of arousal
    • evidence
      • longitudinal study found that future criminals had lower skin conductance activity, lower heart rate, and more slow-frequency brain wave activity
slide31
fearlessness hypothesis
    • psychopaths have a higher threshold for experiencing fear than most people
    • evidence
      • psychopaths are less likely to develop a classically conditioned fear response
psychological and social influences
Psychological and Social Influences
  • oversensitivity to reward
    • will persist in efforts to achieve goal, even when goal is no longer attainable
  • inconsistent parental discipline
    • giving in to problem behavior and poor monitoring
  • other environmental influences
    • low SES, stress, and degree of mutual trust and solidarity in neighborhood linked to antisocial behaviors
treatment33
Treatment
  • prognosis for adults is poor
  • best strategy is to intervene with “high risk” children
    • teach parents to use behavioral management principles to reduce problem behavior and increase prosocial behavior
    • research suggests such programs reduce antisocial behavior
borderline personality disorder
Borderline Personality Disorder
  • pervasive pattern of instability of interpersonal relationships, self-image, and affects marked by impulsivity
dsm iv tr at least 5 sx35
DSM-IV-TR: at least 5 sx
  • frantic efforts to avoid real or imagined abandonment
  • intense and unstable interpersonal relationships
    • alternate between extremes of idealization and devaluation
  • unstable self-image or sense of self
  • impulsivity in at least 2 areas that are potentially self-damaging (sex, money)
dsm iv tr continued36
DSM-IV-TR (continued)
  • recurrent suicidal behavior or self-mutilation
  • emotional instability due to marked reactivity of mood
  • chronic feelings of emptiness
  • inappropriate, intense anger
  • transient, stress-related paranoid thoughts or dissociative sx
causes37
Causes
  • family studies
    • suggest genetic link
    • suggest that BPD is linked to mood disorders
  • early trauma
    • 91% report h/o childhood sexual or physical abuse
  • one theory
    • child who has biological vulnerability to emotional dysregulation and is raised by invalidating family
treatment38
Treatment
  • few controlled studies
  • medical
    • many respond positively to antidepressants and lithium
treatment continued
Treatment (continued)
  • psychological
    • dialectical behavior therapy
      • help people cope with stressors that trigger suicidal behaviors
      • teach patients how to identify and regulate their emotions
      • teach problem solving
      • re-exposure to prior traumatic events to extinguish fear
      • trust own responses, rather than depend on others for validation
    • reduces suicide attempts, dropouts from treatment, and hospitalizations
histrionic personality disorder
Histrionic Personality Disorder
  • pervasive pattern of excessive emotionality and attention seeking
dsm iv tr at least 5 sx41
DSM-IV-TR: at least 5 sx
  • uncomfortable when not the center of attention
  • inappropriate sexually seductive or provocative behavior
  • rapidly shifting and shallow expression of emotions
  • consistently uses physical appearance to draw attention to self
dsm iv tr continued42
DSM-IV-TR (continued)
  • speech is excessively impressionistic and lacking in detail
  • shows self-dramatization, theatricality, and exaggerated expression of emotion
  • highly suggestible
  • considers relationships to be more intimate than they actually are
causes and treatment43
Causes and Treatment
  • very little research
  • try to teach more appropriate ways of expressing their needs and getting their needs met
    • point out costs associated with manipulative style
narcissistic personality disorder
Narcissistic Personality Disorder
  • pervasive pattern of grandiosity, need for admiration, and lack of empathy
dsm iv tr at least 5 sx45
DSM-IV-TR: at least 5 sx
  • grandiose sense of self-importance
    • example: exaggerates achievements and talents
  • preoccupied with fantasies of unlimited success, power, beauty, etc.
  • believes he/she is special and unique
    • can only be understood by or associate with other special high status people
  • requests excessive admiration
  • sense of entitlement
    • unreasonable expectations for favorable treatment
dsm iv tr continued46
DSM-IV-TR (continued)
  • interpersonally exploitative
  • lacks empathy
  • often envious of others, or believes others are envious of him/her
  • arrogant, haughty behaviors or attitudes
causes47
Causes
  • little research
  • one theory:
    • grandiosity is a defense against very fragile self-esteem
    • develops because parents do not respond with approval to child’s displays of competency
treatment48
Treatment
  • little research
  • therapy focuses on grandiosity, sensitivity to evaluation, and lack of empathy
cluster c anxious or fearful
Cluster C: Anxious or Fearful
  • avoidant
  • dependent
  • obsessive-compulsive
avoidant personality disorder
Avoidant Personality Disorder
  • pervasive pattern of social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation
dsm iv tr at least 4 sx51
DSM-IV-TR: at least 4 sx
  • avoids occupational activities that involve significant interpersonal contact, because of fears of criticism, disapproval, or rejection
  • unwilling to get involved with people unless certain of being liked
  • shows restraint in interpersonal relationships because of fears of being shamed or ridiculed
dsm iv tr continued52
DSM-IV-TR (continued)
  • preoccupied with being criticized or rejected in social situations
  • inhibited in new interpersonal situations
  • views self as socially inept, unappealing, or inferior
  • reluctant to take risks or engage in new activities (due to fears of embarrassment)
causes53
Causes
  • one theory
    • person born with difficult temperament or personality characteristics
    • parents reject them or don’t provide enough early, uncritical love
    • rejection results in low self-esteem and social alienation
treatment54
Treatment
  • controlled studies show evidence for effectiveness of behavioral intervention techniques for anxiety and social skills
    • systematic desensitization
    • behavioral rehearsal
dependent personality disorder
Dependent Personality Disorder
  • pervasive and excessive need to be taken care of that leads to submissive, clinging behavior and fears of separation
dsm iv tr at least 5 sx56
DSM-IV-TR: at least 5 sx
  • difficulty making everyday decisions
  • needs others to assume responsibility
  • difficulty expressing disagreement
    • due to fears of loss or support or approval
  • difficulty initiating projects or doing things on his/her own
    • due to lack of self-confidence in own judgment or abilities
dsm iv tr continued57
DSM-IV-TR (continued)
  • goes to excessive lengths to obtain nurturance and support
    • volunteers to do unpleasant things
  • feels uncomfortable or helpless when alone
    • because of fears of being unable to take care of self
  • urgently seeks another relationship as a source of care/support when one ends
  • preoccupied with fears of being left to take care of him/herself
causes and treatment58
Causes and Treatment
  • causes
    • one theory is that early death of parent or neglect/rejection by caregiver cause person to grow up fearing abandonment
  • treatment
    • little research
obsessive compulsive personality disorder
Obsessive-Compulsive Personality Disorder
  • pervasive pattern of preoccupation with orderliness, perfectionism, and mental and interpersonal control, at the expense of flexibility, openness, and efficiency
dsm iv tr at least 4 sx60
DSM-IV-TR: at least 4 sx
  • preoccupied with details, rules, lists, order, organization, or schedules to the extent that the major point of the activity is lost
  • perfectionism that interferes with task completion
  • excessively devoted to work and productivity to the exclusion of leisure activities and friendships
  • overconscientious and inflexible about morality, ethics, or values
slide61
unable to discard worn-out or worthless objects
    • even when they have no sentimental value
  • reluctant to delegate tasks
    • unless others submit to person’s exact way of doing things
  • has miserly spending attitude
    • money to be hoarded for future catastrophes
  • rigidity and stubbornness
causes and treatment62
Causes and Treatment
  • causes
    • weak genetic contribution
    • possible parental reinforcement of conformity and neatness
  • treatment
    • little research
    • therapy addresses fears that underlie need for orderliness
    • relaxation techniques
relationship of personality disorders to the big five
Relationship of Personality Disorders to the Big Five
  • Avoidant
    • low on extraversion
    • high on neuroticism
  • Schizoid
    • low on extraversion
    • high on neuroticism (not at high as avoidant)
slide64
Borderline
    • high on neuroticism
    • low on agreeableness
  • Paranoid
    • low on agreeableness
  • Antisocial
    • low on agreeableness
slide65
Histrionic
    • high on extraversion
    • high on neuroticism
  • Dependent
    • high on agreeableness
    • high on neuroticism
ad