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Chapter 13 Personality Disorders. Ch 13. Personality Disorders. Personality Disorders refer to long-standing, pervasive and inflexible patterns of behavior Depart from cultural expectations Impair social and occupational functioning Cause emotional distress

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Chapter 13

Personality Disorders

Ch 13

personality disorders
Personality Disorders
  • Personality Disorders refer to long-standing, pervasive and inflexible patterns of behavior
    • Depart from cultural expectations
    • Impair social and occupational functioning
    • Cause emotional distress
  • Personality disorders are coded on Axis II of the DSM
    • Personality disorders can be a co-morbid condition for an Axis I disorder

Ch 13.1

personality disorders facts and statistics
Personality Disorders: Facts and Statistics
  • Prevalence of Personality Disorders
    • About 0.5% to 2.5% of the general population
    • Rates are higher in inpatient and outpatient settings
  • Origins and Course of Personality Disorders
    • Thought to begin in childhood
    • Tend to run a chronic course if untreated
  • Co-Morbidity Rates are High
  • Gender Distribution and Gender Bias in Diagnosis
    • Gender bias exists in the diagnosis of personality disorders
    • Such bias may be a result of criterion or assessment gender bias
personality disorder clusters
Personality Disorder Clusters
  • Personality disorders fall into three general clusters:
    • Persons in cluster A seem odd or eccentric
      • Paranoid, schizoid, schizotypal
    • Persons in cluster B seem dramatic, emotional or erratic
      • Antisocial, borderline, histrionic, narcissistic
    • Persons in cluster C appear as anxious or fearful
      • Avoidant, dependent, obsessive-compulsive

Ch 13.2

odd eccentric cluster
Odd/Eccentric Cluster
  • Paranoid personality disorder (PD) involves suspicion of others, hostility, jealousy
    • No hallucinations and no full-blown delusions are present in paranoid PD
  • Paranoid PD occurs more frequently in men than in women
  • Lifetime prevalence is about 2 percent (D&N, 9th edition, p. 412)

Ch 13.3

odd eccentric cluster6
Odd/Eccentric Cluster
  • Schizoid personality disorder (PD) involves
    • Reduced social relations and few friends
    • Reduced sexual desire and few pleasurable activities
    • Indifference to praise or criticism
    • Lonely life style
  • Prevalence of schizoid PD is less than 2 percent and occurs more commonly in men than women

Ch 13.4

odd eccentric cluster7
Odd/Eccentric Cluster
  • Schizotypal personality disorder (PD) involves
    • An attenuated form of schizophrenia
      • Odd beliefs and magical thinking
      • Recurrent illusions (things not present)
      • Ideas of reference (hidden meaning)
      • Behavior and appearance is eccentric
  • Prevalence of schizotypal PD is less than 1 percent.

Ch 13.5

etiology of the odd eccentric cluster
Etiology of the Odd/Eccentric Cluster
  • These disorders are linked to schizophrenia and may represent a less severe form of the disorder
    • Schizophrenia has clear genetic determinants
    • Family studies reveal that relatives of schizophrenic patients are at increased risk for developing schizotypal PD as well as paranoid PD
      • No clear pattern for schizoid PD
  • Additional similarities for Schizotypal PD
    • Have cognitive and neuropsychological problems similar to those found in individuals with schizophrenia.
    • Have enlarged ventricles and less temporal lobe gray matter.

Ch 13.6

dramatic erratic cluster
Dramatic/Erratic Cluster
  • Borderline personality disorder (PD) involves
    • Impulsivity (gambling, spending, sexual sprees)
    • Instability in relationships, mood and self-image
    • Borderline PD persons are argumentative and difficult to live with
  • Prevalence of Borderline PD is about 1 percent and occurs more commonly in women than men
  • Linehan’s diathesis-stress theory
    • Difficulty controlling emotions (biological diathesis)
    • Raised in “invalidating” family environment

Ch 13.7

figure 13 1 linehan s diathesis stress theory etiology of borderline personality disorder
Figure 13.1 Linehan’s Diathesis-Stress theory: Etiology of borderline personality disorder
  • Emotional dysregulation in child (diathesis) and a failure to
  • validate the child’s feelings by the parents (stress) leads to a
  • vicious cycle.
    • The emotional dysregulation may be inadvertently
    • reinforced by parents if it becomes one of the only times the
    • child receives parental attention.

The Cluster B

Personality Disorders

  • Borderline Personality Disorder
  • Unstable Relationships
    • Avoid Abandonment
  • Poor Self-Image
    • Mood Swings, Feel Empty
  • Impulsivity
    • Substance Abuse, Sex, Suicidality

The Cluster B

Personality Disorders

  • Borderline Personality Disorder
  • Causes
    • Runs in Families
    • Connection With Mood Disorders
    • Contribution of Early Abuse

The Cluster B

Personality Disorders

  • Borderline Personality Disorder
  • Treatment
    • Few Controlled Studies
    • Dialectical Behavior Therapy (DBT)
    • Medications
    • Antidepressants , Mood Stabilizers, Antipsychotics
dramatic erratic cluster14
Dramatic/Erratic Cluster
  • Histrionic personality disorder (PD) involves
    • People who are overly dramatic and attention seeking
    • People who exhibit emotional displays but are emotionally shallow
    • People who are self-centered and overly concerned about physical attractiveness
  • Prevalence of histrionic PD is about 2 percent and occurs slightly more commonly in women than men

Ch 13.8

dramatic erratic cluster15
Dramatic/Erratic Cluster
  • Narcissistic personality disorder (PD) involves
    • A grandiose view of the person’s own importance
    • A strong sense of entitlement
    • A lack of empathy for others
  • Prevalence of narcissistic PD is less than 1 percent and this disorder co-occurs with borderline PD

Ch 13.9

dramatic erratic cluster16
Dramatic/Erratic Cluster
  • Antisocial personality disorder (PD) involves
    • The presence of conduct disorder before the age of fifteen
      • Conduct disorder includes truancy, lying, theft, arson, running away from home and destruction of property
    • The continuation of these behaviors into adulthood
  • Prevalence of antisocial PD is about 3% of men and 1 % of women

Ch 13.10

etiology of antisocial pd
Etiology of Antisocial PD
  • Family issues may play a role in the development of antisocial PD
    • Lack of affection
    • Severe parental rejection
    • Inconsistent (or no) discipline
  • Twin studies show a greater concordance for antisocial PD in MZ twins relative to DZ twins
  • Adoption studies (e.g., Cadoret et al., 1995)
    • Adverse adoptive environment may be the stressor triggering the ASPD biological diathesis
  • Psychopaths
    • Have reduced gray matter in frontal lobes
    • Perform more poorly on tests of frontal lobe functioning
    • These findings are supportive of a key role for impulsivity in psychopathy

Ch 13.11

cluster b antisocial personality disorder
Cluster B: Antisocial Personality Disorder

Figure 12.2 Barlow/Durand, 3rd. Edition

Overlap and lack of overlap among antisocial personality disorder, psychopathy, and criminality

cluster b antisocial personality disorder cont
Cluster B: Antisocial Personality Disorder (cont.)

Figure 12.3 Barlow/Durand, 3rd. Edition

Lifetime course of criminal behavior in psychopaths and non-psychopaths


Figure 13.2 Skin-conductance responses of psychopathic and non-psychopathic men. Psychopathic men's response to distress stimuli is evidence of a lack of empathy

Fig 13.2


The Cluster B

Personality Disorders

  • Antisocial Personality Disorder
  • Neurobiological Influences
    • Underarousal Hypothesis
    • Low Corical Arousal or “Tuning it Out”?
    • Fearlessness Hypothesis
    • Fail to Show Normal Fear
    • Fail to Avoid Punishment

The Cluster B

Personality Disorders

  • Antisocial Personality Disorder
  • Treatment
    • Many Do Not Seek Treatment
    • Poor Prognosis
    • Focus on Prevention
anxious fearful cluster
Anxious/Fearful Cluster
  • Avoidant personality disorder (PD) involves
    • People who are fearful in social situations
    • People who are keenly sensitive to criticism, rejection or disapproval
    • People whose lives and job are restricted by their fear of negative interactions
  • Prevalence of Avoidant PD is about 5 percent and this disorder is co-morbid with dependent PD and borderline PD

Ch 13.12


The Cluster C

Personality Disorders

  • Avoidant Personality Disorder
  • Treatment
    • Several Well Controlled Studies
    • Target Anxiety and Social Skills
    • Treatment Similar to Social Phobia
      • Systematic Desensitization
      • Behavioral Rehearsal
anxious fearful cluster25
Anxious/Fearful Cluster
  • Dependent personality disorder (PD) involves
    • A lack of self confidence
    • A lack of a sense of autonomy
    • A view that others are powerful while they are weak
  • Prevalence of Dependent PD is about 1.5 percent and occurs slightly more commonly in women than men
    • May be related to insecure “anxious” attachment

Ch 13.13

anxious fearful cluster26
Anxious/Fearful Cluster
  • Obsessive-Compulsive personality disorder (PD) involves a person who
    • Is a perfectionist, but who does not complete projects
    • Is a ‘control freak” who must have their own way
  • Prevalence of Obsessive-Compulsive PD is about 1 percent and this disorder is co-morbid with avoidant PD

Ch 13.14


The Nature of

Personality Disorders

  • Dimensional vs. Categorical
    • Problem of Degree?
    • Problem of Kind?
  • DSM-IV
    • Categorical View
    • Axis II
    • Ten Types
dimensional approach to personality disorders
Dimensional Approach to Personality Disorders
  • Five-Factor Model (McRae & Costa, 1990)
    • Neuroticism / emotional stability
    • Extroversion/introversion
    • Openness to experience
    • Agreeableness/antagonism
    • Conscientiousness
  • Relationship of PDs to FFM (Widiger & Costa, 1994)
  • Advantages of dimensional model
    • Handles the comorbidity problem
    • Makes a link between normal and abnormal personality
    • Supported by behavior-genetic and statistical techniques
therapies for personality disorders
Therapies for Personality Disorders
  • Therapists treating PD patients are concerned about co-morbid Axis I disorders
  • Therapy modalities include:
    • Antianxiety or antidepressant drugs
    • Psychodynamic therapy aims to change the person’s understanding of the childhood problems that underlie the PD
    • Behavioral and cognitive therapy focuses on specific symptoms and issues (e.g. social skills)
  • Overall therapeutic goal: change the “disorder’ into a “style”, except for ASPD (D&N, p.431)
    • Recent meta-analysis (Salekin, 2002) shows promising results with CBT for younger psychopaths.

Ch 13.15