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Chapter 12 Personality Disorders. Amber Gilewski Tompkins Cortland Community College. Personality Disorders: Overview. The Nature of Personality Disorders Enduring and relatively stable predispositions

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chapter 12 personality disorders

Chapter 12 Personality Disorders

Amber Gilewski

Tompkins Cortland Community College

personality disorders overview
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?
personality disorders clusters
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)

personality disorders statistics development
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
personality disorders diagnoses gender differences
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
paranoid personality disorder
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
schizoid personality disorder
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
schizotypal personality disorder
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
antisocial personality disorder characteristics
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

antisocial personality disorder psychopathy aspd
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
antisocial personality disorder causes
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
antisocial personality disorder treatment
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
borderline personality disorder characteristics
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
borderline personality disorder
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
histrionic personality disorder
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
narcissistic personality disorder
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
avoidant personality disorder
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
dependent personality disorder
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
obsessive compulsive personality disorder
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