Personality Disorders

Personality Disorders

Bo r d e r l i n e Neurotic Beh • Anxiety-based • No distortions in reality • Recognizes problem • No great personality disorganization Psychotic • Gross distortions in reality (e.g., perception) • Some personality disorganization • Does not recognize problem

Neurotic Behaviour • “Doing the same thing over and over expecting a different outcome” • “You yourself produce the thing you fear the most” • Deals with anxiety-based disorders including: • Generalized Anxiety • Panic • Obsessive Complusive • Phobias • Others that have anxiety as a basis

Neurotic Behaviour • Maladaptive behaviour pattern that does not involve gross distortions in reality or marked personality disorganization • Person recognizes that behaviour is unacceptable or irrational (ego dystonic  apart from the ego)

Central component of anxiety disorders and anxiety-based disorders No obvious danger or threat Event or stimulus is, objectively, minor or insignificant (e.g., mouse, thunder, shopping mall, etc.) Neurotic Anxiety

Neurotic Paradox I • Neurotic evaluates innocuous events as anxiety provoking  inordinate anxiety response • Deals with anxiety in defensive fashion, usually avoidance  reduces anxiety in short term

Neurotic Paradox II • This defensive behaviour results in self-defeating behaviour: • Does exactly opposite of what is healthy or adaptive

Neurotic Paradox Outcomes • Blocks personal growth • Relationship problems (especially intimacy) • Anxiety focus of life • Lack of energy and enthusiasm • Egocentric concerns

Neurotic Paradox Process • Maximize pleasure • Minimize pain • Immediate Effect: Reduce Anxiety • Long Term: Don’t resolve the actual problem • E.G. Doug, the Graduate Student

Neurotic Styles: Characteristics • Deficit in behavioural repertoire (Inhibition) • Behaves in an inflexible and exaggerated manner opposite to the deficient behaviour • Behaviour does not fully contain the anxiety

Neurotic Styles • Aggression/Assertion Inhibition • Responsibility/Independence Inhibition • Compliance/Submission Inhibition • Intimacy/Trust Inhibition

Aggression/Assertion Inhibition • Person uncomfortable with aggression and/or assertion and avoids situations where need to engage in this behaviour • Irrationally clings to cooperative stance • Thought to result in problems such as hypertension,ulcers, migraines, other stress-related disorders • Potential sudden aggressive outbursts

Responsibility/Independence Inhibition • Person has aversion to autonomy • Avoids situations where they are in charge or in control other others or themselves • Appear incompetent in simple tasks to “pull” direction by others • Poor relationships, helplessness, depression

Compliance/Submission Inhibition • Neurotic is often the “rebel” and avoids submission to authority • Need to be non-compliant (i.e., self-reliant, independent, free-thinking, to a fault)

Intimacy/Trust Inhibition • Retreats from closeness and withdraws from people who want deeper relationships • All relationships short-term to avoid intimacy • End relationships at crucial points in the establishment of intimacy (not just romantic relationships, friendships too)

Interpersonal Consequences • Some will result in depending too much on others that results in others feeling “used and manipulated” • Unpredictable demands on others that results in others feeling angry, frustrated, guilty, etc.

Interpersonal Aspects of Neurotic Styles I • Extremely sensitive to acts, opinions, feelings of others • Lack of spontaneity (stilted, controlled, mechanical) • Superficial relationships if any • Relationships often stormy • Private life is one of turmoil and inner torment

Interpersonal Aspects of Neurotic Styles II • Don’t have large networks of enduring relationships • Speculation that some complementary “hooking up” is match made in hell • Two people with aggression/assertion inhibition • One with responsibility/independence style and one with compliance/submsission style

Personality Disorders • When behaviour patterns become inflexible and maladaptive to the point of causing distress or social/occupation impairment can say have Personality Disorder

Personality Disorders • Don’t stem from reactions to stress but from gradual development of inflexible and distorted personality • Maladaptive ways of perceiving, thinking, relating to world

Personality Disorders • Excessively rigid patterns of behaviour or ways to relating to others that prevents people from adjusting to external demands and, thus, become self-defeating. • Have always been there for an individual

Personality Disorders • Mild: Function reasonably well, viewed as troublesome, eccentric, etc. • Severe: Extreme or unethical behaviour, may be incarcerated.

Quote From Lorna Benjamin (1996) “A great way to come down with a case of “medical student disease (syndrome)” is to read a survey of personality disorders”

Some Trait Pattern Example • Suspiciousness • Self-regard • Fear of Rejection • Come to dominate reactions to new situations • Repetitive maladaptive behaviour

Difference between DSM’s Clinical Syndromes & PD • Clinical Syndrome specific symptom clusters, time limited, ego-distonic (viewed as separate from self, unacceptable, objectionable and alien) • E.g., depression, anxiety disorders, psychotic disorders

Continued Personality Disorder Individual with PD are perceived as ego-syntonic (e.g., personality issues are acceptable, unobjectionable and part of the self). Tend to blame others for problems in their lives.

Difficulties with Diagnosis of Personality Disorder • Need to infer traits to make diagnosis, do not have specific behaviours clinician can judge • Disorders and criteria are relatively new, therefore not as much research has been done on them • Great deal of overlap among the disorders • Hard to draw a line between disorder and normal behaviour

Personality Disorder Clusters • Cluster One: Odd-Eccentric: • Behaviours similar to schizophrenia, suspiousness, withdrawal, peculiar thinking

The Odd Eccentric PD Group 1. Paranoid Personality Disorder 2. Schizoid Personality Disorder 3. Schizotypal Personality Disorder

Paranoid Personality Disorder Reverend Jim Jones People’s Temple

Paranoid Personality Disorder • suspicious of other’s motives • interprets actions of others as deliberately demeaning/threatening • expectation of being exploited • see hidden messages in benign comments • easily insulted/ bears grudges • appear cold and serious

Paranoid Personality Disorder Example • Undergraduate student/patient who followed

Schizoid Personality Disorder Theodore Kaczynski: Unabomber

Schizoid • indifferent to relationships • limited social range (some are hermits) • aloof, detached, called loners • no apparent need of friends, sex • solitary activities • seem to be missing the “human part”

Schizotypal • peculiar patterns of thinking and behaviour • perceptual and cognitive disturbances • magical thinking • not psychotic • perhaps a distant “cousin” of schizophrenia

Personality Disorder Clusters • Cluster Two: Dramatic-Emotional: • Behaviours are so dramatic, emotional, or erratic that it is almost impossible to have truly giving and satisfying relationships • More commonly diagnosed than other PD’s

The Dramatic-Emotional PD Group 1. Antisocial Personality Disorder (Dissocial) 2. Borderline Personality Disorder 3. Histrionic Personality Disorder 4. Narcissistic Personality Disorder

Antisocial Personality Disorder • pattern of irresponsibility, recklessness, impulsivity beginning in childhood or adolescence (e.g., lying, truancy) • adulthood: • criminal behaviour • little adherence to societal norms, • little anxiety • conflicts with others • callous/exploitive

Difficulties in establishing secure identity • Distrust • Impulsive and self-destructive behavior • Difficulty in controlling anger and other emotions

Borderline Personality Disorder • marked instability of mood, relationships, self-image • intense, unstable relationships • uncertainty about sexuality • everything is “good” or “bad” • chronic feeling of “emptiness • recurrent threats of self-harm/ “slashers”

Single White Female (Jennifer Jason Leigh) or Fatal Attraction (Glen Close).

Narcissistic Personality Disorder • grandiose, sense of self-importance • lack of empathy • hyper-sensitive to criticism • exaggerate accomplishments/ abilities • special and unique • entitlement • below surface is fragile self-esteem

Armand Hammer • “There has never been anyone like me, and my likes will never be seen again.”

Armand Hammer - Again “The brilliance of my mind can only be described as dazzling. Even I am impressed by it.”

Focus on Borderline PD

Borderline Personality Disorder • Therapist “killers” (not really killers) • Very difficult to treat • Tend to be avoided by many clinicians • Takes lots of training and experience to treat effectively • Lots of turmoil in treatment

Borderline Personality Disorder: Four Core Elements • Difficulties in establishing secure self- identity • Distrust & Splitting • Impulsive and Self Destructive Behaviour • Difficulty in controlling anger and other emotions

Borderline Examples: From Therapist • First experience with BPD under my supervision

Identity Disturbance • In terms of identity disturbance, she relied heavily on a sort of reflected identity from others and saw herself as she believed others saw her. • With respect to her poor ego boundaries and the melding of her identity with my own, one particularly surprising thing she said to me was that she had googled my name on the internet and found out that I had won a presitious academic award. She said she felt really sad because she did not have an award herself.

Distrust and Splitting • She vascillated quite wildly between idealizing me (including telling me that she loved me and at times wanted us to sit together on the couch so I could hold her) and devaluing me (lots of anger in session, and a fairly caustic email that said "Ain't it so nice and easy. Tell you what M***, go out and get ourself abused, loose that charming smile of yours and come back and tell me who's mentally ill", which was followed shortly after by an apologetic one.)

Personality Disorders