Chapter 12 Personality Disorders

1. Chapter 12 Personality Disorders Amber Gilewski Tompkins Cortland Community College

2. Personality Disorders: Overview • The Nature of Personality Disorders • Enduring and relatively stable predispositions • Inflexible and maladaptive, causing distress and/or impairment • Coded on Axis II of the DSM-IV-TR • May not perceive the need for change • Dimensions of personality or categories?

3. Personality Disorders: Clusters • Cluster A – Odd or eccentric (Paranoid, Schizoid, Schizotypal) • Cluster B – Dramatic, emotional, erratic (Antisocial, Borderline, Histrionic, Narcissistic) • Cluster C – Fearful or anxious (Avoidant, Dependent, Obsessive-Compulsive)

4. Personality Disorders: Statistics & Development • Prevalence of Personality Disorders • Affects about 0.5% to 2.5% of the general population • Rates are higher in inpatient and outpatient settings (10-20% - inpatient settings; 2-10% -outpatient settings) • Origins and Course of Personality Disorders • Thought to begin in childhood • Tend to run a chronic course • Comorbidity rates are high

5. Personality Disorders: Diagnoses & Gender Differences • Gender bias exists in the diagnosis • Criterion and/or assessment gender bias • Borderline, histrionic, dependent personality disorders more often diagnosed in females • Antisocial personality disorder more often diagnosed in males

6. Paranoid Personality Disorder • Pervasive and unjustified mistrust and suspicion • Causes • Biological and psychological contributions are unclear • Early learning that people and the world is a dangerous place • Treatment Options • Few seek professional help on their own • Treatment focuses on development of trust • Cognitive therapy to counter negativistic thinking • Lack of good outcome studies

7. Schizoid Personality Disorder • Pervasive pattern of detachment from social relationships • Very limited range of emotions in interpersonal situations • Causes • Etiology is unclear • Preference for social isolation resembles autism • Treatment Options • Few seek professional help on their own • Focus on the value of interpersonal relationships • Building empathy and social skills • Lack of good outcome studies

8. Schizotypal Personality Disorder • Behavior and dress is odd and unusual • Socially isolated and highly suspicious • Magical thinking, ideas of reference, and illusions • Many meet criteria for major depression • Causes • A phenotype of a schizophrenia genotype? • More generalized brain deficits • Treatment Options • Main focus is on developing social skills • Medical treatment is similar to that used for schizophrenia • Treatment prognosis is generally poor

9. Antisocial Personality Disorder: Characteristics • Failure to comply with social norms • Violation of the rights of others • Irresponsible, impulsive, and deceitful • Lack a conscience, empathy, and remorse • Higher prevalence in men • Poor prognosis http://en.wikipedia.org/wiki/Image:Ted_Bundy_3.jpg#file

10. Antisocial Personality Disorder: Psychopathy & ASPD • Psychopathy (Cleckley): 16 major characteristics: superficial charm, good intelligence, no delusions or irrational thinking, absence of nervousness, unreliability, insincere, lack of remorse/shame, etc. • DSM criteria focuses on observable behaviors • Cleckley/Hare criteria focuses on underlying personality traits • Some psychopaths are not criminals nor are all criminals, psychopaths • Dyssocial psychopathy: culturally deviant

11. Antisocial Personality Disorder: Causes • Families with inconsistent parental discipline and support • Families often have histories of criminal and violent behavior • Gene-environment interaction • Underarousal Hypothesis: low levels of cortical arousal • Fearlessness Hypothesis: higher threshold for fear

12. Antisocial Personality Disorder: Treatment • Few seek treatment on their own • Antisocial behavior is predictive of poor prognosis • Emphasis is placed on prevention and rehabilitation • Often incarceration is the only viable alternative

13. Borderline Personality Disorder: Characteristics • Unstable moods and relationships • Impulsivity, fear of abandonment, very poor self-image • Self-mutilation and suicidal gestures • Very common in psychiatric settings • Comorbidity rates are high

14. Borderline Personality Disorder • Causes • Runs in families • Early trauma and abuse seem to play some etiologic role • Treatment Options • Few good outcome studies • Antidepressant medications provide some short-term relief • Dialectical behavior therapy (DBT) is most promising treatment

15. Histrionic Personality Disorder • Overly dramatic, sensational, and sexually provocative; often impulsive, need to be center of attention • Thinking and emotions are perceived as shallow • Common diagnosis in females • Causes • Largely unknown: Variant of ASPD? • Treatment Options • Focus on attention seeking and long-term negative consequences • Targets may also include problematic interpersonal behaviors • Little evidence that treatment is effective

16. Narcissistic Personality Disorder • Exaggerated and unreasonable sense of self-importance; preoccupied w/receiving attention • Lack sensitivity and compassion for other people • Highly sensitive to criticism, envious, and arrogant • Causes • Failure to learn empathy as a child • Sociological view – Product of the “me” generation • Treatment Options • Focus on grandiosity, lack of empathy, unrealistic thinking • May also address co-occurring depression • Little evidence that treatment is effective

17. Avoidant Personality Disorder • Extreme sensitivity to the opinions of others • Highly avoidant of most interpersonal relationships • Are interpersonally anxious and fearful of rejection • Causes • Numerous factors have been proposed • Difficult temperament and early rejection • Treatment Options • Treatment is similar to that used for social phobia • Treatment targets include social skills and anxiety

18. Dependent Personality Disorder • Reliance on others to make major and minor life decisions; clingy & submissive in relationships • Unreasonable fear of abandonment • Causes • Still largely unclear • Linked to early disruptions in learning independence • Treatment Options • Research on treatment efficacy is lacking • Therapy typically progresses gradually • Treatment targets include skills that foster independence

19. Obsessive-Compulsive Personality Disorder • Excessive and rigid fixation on doing things the right way • Highly perfectionistic, orderly, and emotionally shallow • Obsessions and compulsions are rare • Causes • Are largely unknown • Treatment Options • Data supporting treatment are limited • Addresses fears related to the need for orderliness, rumination, procrastination, and feelings of inadequacy