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Personality Disorders. Abnormal Psychology. Personality Disorders are:. more subtle and less incapacitating than many Axis I disorders rigid, inflexible, maladaptive patterns of relating to oneself and one’s environment most often untreated egosyntonic (as opposed to egodystonic)

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personality disorders

Personality Disorders

Abnormal Psychology

personality disorders are
Personality Disorders are:
  • more subtle and less incapacitating than many Axis I disorders
  • rigid, inflexible, maladaptive patterns of relating to oneself and one’s environment
  • most often untreated
  • egosyntonic (as opposed to egodystonic)
  • best viewed on a continuum (dimensional)
are pds really important problems
Are PDs really important problems?
  • disrupt interpersonal relationships
  • make therapy very difficult when they occur together with Axis I disorders
  • may represent predispositions toward, or early manifestations of, other Axis I disorders
problems regarding pds
Problems regarding PDs
  • diagnostic reliability is quite low
  • tremendous overlap among categories
  • questions remain about temporal stability
  • not clear that they are “culturally universal”
  • little evidence to show that they can be treated successfully
pds are difficult to treat because
PDs are difficult to treat because
  • person does not recognize that he or she has a problem
  • interpersonal difficulties interfere with the therapeutic relationship
  • very little research evidence on treatment efficacy because the PDs overlap so extensively with Axis I disorders
general criteria for pds dsm iv
General Criteria for PDs (DSM-IV)
  • an enduring pattern of inner experience and behavior that deviates markedly from the expectations of the individual’s culture
  • manifested in two or more of the following areas:
  • 1. cognition
  • 2. affectivity
  • 3. interpersonal functioning
  • 4. impulse control
general criteria for pds continued
General Criteria for PDs (continued)
  • enduring pattern is inflexible and pervasive across a range of situations
  • enduring pattern leads to clinically significant distress or impairment
  • pattern is stable and of long duration (onset traced at least to adolescence)
  • pattern is not better explained by another type of mental disorder
pd clusters in dsm iv
PD Clusters in DSM-IV
  • Cluster A: odd, eccentric, socially isolated
  • Cluster B: flamboyant, overly emotional
  • Cluster C: anxious or avoidant
pds listed in cluster a dsm iv
PDs listed in Cluster A (DSM-IV)
  • PARANOID: distrust and suspicion of others
  • SCHIZOID: detachment from social relationships; little expression of emotion
  • SCHIZOTYPAL: discomfort with close relationships; cognitive and perceptual distortions; eccentricities of behavior
pds listed in cluster b dsm iv
PDs listed in Cluster B (DSM-IV)
  • ANTISOCIAL: disregard for and frequent violation of the rights of others
  • BORDERLINE: instability of interpersonal relationships, self-image, emotions, and control over impulses
pds listed in cluster b dsm iv11
PDs listed in Cluster B (DSM-IV)
  • HISTRIONIC: excessive emotionality and attention-seeking
  • NARCISSISTIC: grandiosity, need for admiration, lack of empathy
pds listed in cluster c dsm iv
PDs listed in Cluster C (DSM-IV)
  • AVOIDANT: social inhibition, feelings of inadequacy, hypersensitivity to negative evaluation
  • DEPENDENT: excessive need to be taken care of; submissing, clinging behavior
  • OBSESSIVE-COMPULSIVE: preoccupation with orderliness and perfectionism
problems with categorical approach
Problems with Categorical Approach
  • tremendous overlap among categories
  • problems of setting thresholds
  • need for 10 diagnoses on Axis II creates unnecessary complexity (making decisions on 8 or 9 criteria for each category)
  • it might be simpler and more accurate descriptively to use a few dimensions
personality dimensions the big five
Personality Dimensions: The Big Five
  • neuroticism
  • extraversion
  • openness
  • agreeableness
  • conscientiousness
personality dimensions the big five16
Personality Dimensions: The Big Five
  • neuroticism (expression of negative emotions)
  • extraversion (interest in interacting with other people; positive emotions)
  • openness (willingness to consider and explore unfamiliar ideas, feelings, and activities
personality dimensions the big five17
Personality Dimensions: The Big Five
  • agreeableness (willingness to cooperate and empathize with others)
  • conscientiousness (persistence in pursuit of goals; organization; dependability)
paranoid pd viewed in terms of dimensions
Paranoid PD viewed in terms of dimensions
  • extraversion: low
  • openness: low
  • agreeableness: low
histrionic pd viewed in terms of dimensions
Histrionic PD viewed in terms of dimensions
  • neuroticism: high
  • extraversion: high
  • agreeableness: low
  • conscientiousness: low
o c pd viewed in terms of dimensions
O-C PD viewed in terms of dimensions
  • neuroticism: high
  • extraversion: low
  • openness: low
  • conscientiousness: high
dsm criteria for schizotypal pd
DSM Criteria for Schizotypal PD
  • a pervasive pattern of social / interpersonal deficits marked by acute discomfort with, and reduced capacity for, close relationships
  • cognitive or perceptual distortions and eccentricities of behavior
  • plus five (or more) of the following:
criteria for schizotypal pd 5 or more
Criteria for Schizotypal PD (5 or more)
  • ideas of reference
  • odd beliefs or magical thinking
  • unusual perceptual experiences
  • odd thinking and speech
  • suspiciousness or paranoid ideation
  • inappropriate or constricted affect
  • behavior or appearance that is odd or peculiar
  • lack of close friends or confidants
  • excessive social anxiety
schizotypal personality disorder
Schizotypal Personality Disorder
  • closely tied to the concept of schizophrenia
  • odd or peculiar behaviors frequently seen among the first-degree relatives of schizophrenic patients
  • overlaps primarily with paranoid, schizoid, and avoidant PDs
etiology and treatment of schizotypal pd
Etiology and Treatment of Schizotypal PD
  • mostly focused on genetic factors
  • treatment usually focused on low doses of antipsychotic medication
borderline personality disorder bpd
Borderline Personality Disorder (BPD)
  • GUNDERSON: identified descriptive features of BPD for DSM-III definition
  • focused on intense, unstable interpersonal relationships
  • unstable emotional reactions, including intense anger
dsm criteria for borderline pd 5 or more
DSM Criteria for Borderline PD (5 or more)
  • frantic efforts to avoid abandonment
  • unstable and intense interpersonal relationships
  • identity disturbance
  • impulsivity in areas that are self-damaging
  • recurrent suicidal behavior or gestures
  • affective instability / marked reactivity of mood
  • chronic feelings of emptiness
  • inappropriate, intense anger
  • transient, stress-related paranoid ideation
borderline personality disorder
Borderline Personality Disorder
  • AKISKAL: says BPD is a mix of different things, including mild forms of brain dysfunction, conditions that resemble schizophrenia, and sub-clinical mood disorders
  • when all of that is removed, a “residual” group remains that is difficult to distinguish from many other PDs
etiology of borderline pd
Etiology of Borderline PD
  • Akiskal on etiology of his “residual” group
  • they suffer from the negative consequences of parental loss during childhood
  • infant monkeys separated from their mothers experience persistent attachment problems and high negative affect
  • relationships with peers are disrupted
etiology of borderline pd30
Etiology of Borderline PD
  • research studies frequently point to abuse by parents (borderline adolescents)
  • but what is the direction of effect ?
  • note people with other types of mental disorders also report childhood abuse and neglect (e.g., Brown’s work on anxiety disorders)
psychopathy and antisocial pd
Psychopathy and Antisocial PD
  • two different traditions for this disorder
  • both attempting to define same concept
  • Hervey Cleckley (1941) The Mask of Sanity
  • described “the psychopath” as being intelligent and superficially charming
  • but also deceitful, unreliable, and incapable of learning from experience
  • disregard for the truth; lack of remorse
psychopathy and antisocial personality
Psychopathy and Antisocial Personality
  • Lee Robins (1966) Deviant Children Grown Up
  • described (as adults) people who had been treated many years earlier at a child guidance clinic
  • conduct disorder among boys predicted antisocial behavior in adults
  • formed basis for ASP in DSM-III
dsm criteria for antisocial pd
DSM Criteria for Antisocial PD
  • a pervasive pattern of disregard for and violation of the rights of others occurring since age 15 years, as indicated by 3 (or more) of the following:
dsm criteria for antisocial pd 3 or more
DSM Criteria for Antisocial PD (3 or more)
  • failure to conform to social norms (re laws)
  • deceitfulness
  • impulsiveness
  • irritability and aggressiveness (e.g., fights)
  • reckless disregard for safety of self or others
  • consistent irresponsibility (e.g., failure to work)
  • lack of remorse
  • plus evidence of conduct disorder before age 15
shift to dsm iii definition of asp
Shift to DSM-III definition of ASP
  • improved reliability
  • questionable validity
  • more criminals defined as meeting criteria for ASP (50% meet DSM-III, but only 35% meet Cleckley’s definition of psychopathy)
etiology of asp psychopathy
Etiology of ASP / Psychopathy
  • adoption studies point to influence of genetic factors
  • Cadoret et al. (1995) found an interaction between genetic factors and rearing environment
  • adverse adoptive home environment increases risk of conduct disorder in offspring of antisocial parents
social factors and the etiology of asp
Social Factors and the Etiology of ASP
  • inconsistent discipline (or complete lack of discipline) often seen in the prior family history of ASP men (Robins, 1966)
  • kids with a “difficult temperament” are especially irritating to parents
  • parents respond inappropriately (giving up, or becoming severe in punishment)
  • person selects friends who share antisocial interests and problems
continuity in life course persistent asp
Continuity in Life-Course-Persistent ASP
  • person’s options become narrowed; locked into further antisocial behavior
  • limited range of behavioral skills (can’t pursue more appropriate responses)
  • ensnared by consequences of earlier behaviors (drug addiction, parenthood, school dropout, criminal record)
psychological factors the etiology of asp
Psychological Factors: the Etiology of ASP
  • avoidance learning in the lab (sequences)
  • psychopaths unaffected by anticipation of punishment
  • Hypothesis 1: they can ignore the effects of punishment; they are emotionally impoverished
  • Hypothesis 2: they have trouble shifting their attention; they are impulsive