Personality Disorders

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Personality Disorders

• Thomas G. Bowers Ph.D.
• Penn State Harrisburg

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General Characteristics

• Long-standing maladaptive patterns of behavior
• Generally recognizable by adolescence
• Tend to be inflexible persistent and resistant
  to change
• Must also be associated with significant life
  problems

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Three Ws Wild Weird and Withdrawn

• Easier to remember than Clusters A B C
• Wild
• 1. Borderline Personality Disorder
• 2. Histrionic Personality Disorder
• 3. Narcissistic Personality Disorder
• 4. Antisocial Personality Disorder

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Three Ws Wild Weird and Withdrawn

• Weird
• 1. Paranoid Personality Disorder
• 2. Schizoid Personality Disorder
• 3. Schizotypal Personality Disorder

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Three Ws Wild Weird and Withdrawn

• Withdrawn
• Avoidant Personality Disorder
• Dependent Personality Disorder
• Obsessive-Compulsive Personality Disorder

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Borderline Personality Disorder

• Intense unstable relationships
• Instability in mood self-image
• Who am I
• Unpredictable and impulsive behavior
• Often self damaging as gambling sexual
  behavior spending sprees

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Borderline Personality Disorder

• Intense fear of aloneness
• Extreme fears of abandonment
• Demand attention
• Alternate between idealization and devaluation
• Chronic feelings of emptiness and boredom
• Often suicidal feelings and gestures

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Borderline Personality Disorder

• Long interest from psychoanalytic field (as
  Kernberg)
• Thought to be borderline between psychosis and
  neurosis
• Tend to decompensate into psychotic state under
  stress

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Borderline Personality Disorder

• Object relations theory
• Introjection of important values and images of
  other important people (as parents) may be faulty
• Frequently see issues as a weak ineffectual
  father (often totally absent or even abandoning
  family)
• Domineering mother

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Borderline Personality Disorder

• Inconsistent provision of warmth and affection
• Frequently reported childhood physical and sexual
  abuse
• Some biological relationships
• Respond positively to SSRI
• Familial thought to be be genetic links
• Related to bipolar affective disorder

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Borderline Personality Disorder

• Video assignment Fatal Attractions note Glen
  Close in her role

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Histrionic Personality Disorder

• Overly dramatic attention-seeking
• Display excessive emotion but in fact are
  emotionally shallow
• Self-centered
• Inappropriately sexually provocative and
  seductive
• Pseudohypersexuality

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Narcissistic Personality Disorder

• Grandiose and exaggerated sense of self
• Literary in love with themselves
• Require constant attention and admiration
• Lack of empathy strong feelings of arrogance
  entitlement
• Take advantage of others

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Antisocial Personality Disorder

• Psychopathy (or sociopathy)
• Cleckly - The Mask of Sanity
• Emotional aloofness and detachment
• Hare - contemporary researcher
• Psychopathy appears to be distinct from ASPD

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Antisocial Personality Disorder

• Little ability to profit from experience
• In particular ASPD individuals do not seem to
  learn well to aversive stimulus conditions
• Genetic factors appear to play a role as do
  environmental factors
• Lack of affection severe rejection inconsistent
  discipline fathers often are antisocial

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Antisocial Personality Disorder

• Chronic cortical under arousal
• Impulsivity difficulties in goal directed
  behavior
• Noted increased slow wave activity temporal
  region spikes on EEG

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Weird Cluster

• Paranoid Personality
• Highly suspicious of people tends to mistrust
  others expects to be mistreated
• Extremely jealous
• Schzoid Personality
• Does not desire or enjoy social relationships
• Bland aloof loners

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Weird Cluster

• Schizotypal Personality
• Attenuated form of schizophrenia
• Interpersonally similar to schizoid with
  eccentric nature
• Odd beliefs magical thinking
• Illusions

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Weird Cluster

• Etiology
• May be a variant of schizophrenic range disorders
• Family patterns noted

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Withdrawn Cluster

• Dependent Personality
• Lacks self-confidence independence
  self-reliance
• Passive and dependent stance
• Intense need to be taken care of unable to make
  demands on others
• Tends to sacrifice needs of self for others
• Fairly common

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Withdrawn Cluster

• Avoidant Personality
• Keenly sensitive to rejection disapproval
• Extremely restrained easily embarrassed
• Exaggerate risks dangers

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Withdrawn Cluster

• Obsessive Compulsive Personality
• Perfectionistic preoccupied with rules details
• Work excessively
• Stubborn rigid demanding
• Tend to be rigid and inflexible moralistic

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Diagnostic Issues

• Reliability problems been noted
• Structured interviews are now helpful
• Considerable comorbidity

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Interrater and Test-retest Reliability
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Treatment of Personality Disorders

• Psychodynamic therapy
• Object relations therapy (Kernberg)
• Focus on ego development
• Interpretative
• Reality testing
• Dialectical behavior therapy
• Linehan - Empirically tested
• Client centered and cognitive methods

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Treatment of Personality Disorders

• Dynamic-Cognitive Therapy
• Turner
• Cognitive Therapy
• Beck
• Negative schemata of world thought to operate

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Treatment of Personality Disorders

• Psychopathy is very difficult to treat
  effectively
• May be unsuitable for psychotherapy (or any type
  of personal relationship)