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Personality Disorders Chapter 8

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Title: Personality Disorders Chapter 8


1
Personality Disorders Chapter 8
2
The Personality Disorders
  • Personality Disorder Characterized by inflexible
    and maladaptive personality traits that cause
    significant functional impairment or subjective
    distress for the individual.
  • Gender differences and gender bias in diagnosis.
  • Diagnosis based on a number of traits that have
    characterized long-term functioning.
  • Signs become evident during adolescence.
  • Cultural and ethnic differences

3
The Personality Disorders
  • Diagnosed on Axis II of DSM-IV-TR
  • Tend to develop early and remain stable.
  • Little or no anxiety or depression
  • Behaviors not due to stress, trauma or defense
    mechanisms.
  • Prognosis worse when combined with an Axis I
    diagnosis.
  • Behaviors are learned
  • Behaviors are inappropriate, distract others, can
    be offensive.
  • Behaviors cause problems in social contexts.
  • Disrupt personal relationships.
  • Create long-standing problems dealing with
    others.
  • Always seem to encounter the same problems.
  • Tend to see problems as being outside themselves.

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5
The Personality Disorders Etiology and Treatment
  • Five-factor Model (FFM) of Personality
  • Neuroticism (emotional adjustment and stability)
  • Extraversion
  • Openness to experience
  • Agreeableness
  • Conscientiousness
  • Heredity and twin studies Interaction between
    genetics and environment.

6
The Personality Disorders Etiology and
Treatment Five Factor Model of Personality
  • A trait is a temporally stable, cross-situational
    individual difference. Currently the most popular
    approach among psychologists for studying
    personality traits is the five-factor model or
    Big Five dimensions of personality. The five
    factors were derived from factor analyses of a
    large number of self- and peer reports on
    personality-relevant adjectives and questionnaire
    items. The following are some of the important
    characteristics of the five factors. First, the
    factors are dimensions, not types, so people vary
    continuously on them, with most people falling in
    between the extremes. Second, the factors are
    stable over a 45-year period beginning in young
    adulthood. Third, the factors and their specific
    facets are heritable (i.e., genetic), at least in
    part. Fourth, the factors probably had adaptive
    value in a prehistoric environment. Fifth, the
    factors are considered universal, having been
    recovered in languages as diverse as German and
    Chinese. Sixth, knowing one's placement on the
    factors is useful for insight and improvement
    through therapy.

7
The Personality Disorders Etiology and Treatment
  • Treatment Attempts to build resilience in
    clients
  • Many people with the disorders do not seek
    treatment.
  • Many people with the disorders function in
    society.
  • Motivation to change is often weak.
  • Different responses to therapy, depending on the
    disorder.

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10
Disorders Characterized By Odd or Eccentric
Behaviors Paranoid Personality Disorder
  • Paranoid Personality Disorder Unwarranted
    suspiciousness, hypersensitivity, and reluctance
    to confide in others.
  • May demonstrate restricted affect.
  • Excessive trust in own knowledge and abilities.
  • Quick to challenge the loyalties of others.
  • Unfounded beliefs are resistant to change
  • Prevalence 0.5-2.5 somewhat higher in males

11
Disorders Characterized By Odd or Eccentric
Behaviors Paranoid Personality Disorder
  • Etiology Engagement of the defense mechanism of
    projection, denying own unacceptable impulses and
    attributing them to others.
  • Evaluation must consider cultural factors.
  • Treatment Usually psychodynamic, but difficult
    to treat.
  • Due to suspiciousness, often dont engage in
    therapy.

12
Disorders Characterized By Odd or Eccentric
Behaviors Schizoid Personality Disorder
  • Schizoid Personality Disorder Social isolation,
    emotional coldness, and indifference to others.
  • Prefer to be alone, reclusive and withdrawn.
  • Do not make good dating or marital partners.
  • Relationships are superficial.
  • Prevalence Uncommon, slightly more males than
    females.
  • Unclear relationship with schizophrenia.

13
Disorders Characterized By Odd or Eccentric
Behaviors Schizoid Personality Disorder
  • Etiology Associated with a cold, unempathetic,
    and emotionally impoverished childhood.
  • Treatment People with disorder tend to seek help
    only when a crisis evolves and therapy aimed at
    crisis resolution.

14
Disorders Characterized By Odd or Eccentric
Behaviors Schizotypal Personality Disorder
  • Schizotypal Personality Disorder Peculiar
    thoughts and behaviors and poor interpersonal
    relationships.
  • Many believe disorder represents mild
    schizophrenia.
  • The disorder is characterized by odd forms of
    thinking and perceiving, and individuals with
    this disorder often seek isolation from others.
  • They sometimes believe to have extra sensory
    ability or that unrelated events relate to them
    in some important way.
  • They generally engage in eccentric behavior and
    have difficulty concentrating for long periods of
    time.
  • Prevalence 3 more males than females

15
Disorders Characterized By Odd or Eccentric
Behaviors Schizotypal Personality Disorder
  • Etiology Possibly genetic, higher risk of
    schizotypal personality disorder among relatives
    of people with schizophrenia.
  • Despite genetic influence, early environmental
    enrichment reduces frequency of disorder.
  • Treatment dynamic, supportive,
    cognitive-behavioral, and group therapy small
    doses of anxiolytics for anxiety.

16
Disorders Characterized By Dramatic, Emotional,
or Erratic Behaviors Histrionic Personality
Disorder
  • Histrionic Personality Disorder
    Self-dramatization, exaggerated expression of
    emotions, and attention-seeking behaviors.
  • Constant attention seekers
  • Use grandiose language to describe everyday
    events and seek constant praise.
  • May dress provocatively or exaggerate illnesses
    in order to gain attention.
  • Tend to exaggerate friendships and relationships,
    believing that everyone loves them.
  • Prevalence 1-3 no gender differences

17
Disorders Characterized By Dramatic, Emotional,
or Erratic Behaviors Histrionic Personality
Disorder
  • Etiology Parental reinforcement of childs
    attention-seeking behaviors. Parental models.
  • Treatment No consensus for best
  • Psychodynamic Establish therapeutic alliance and
    provide insight
  • Cognitive behavioral Focus on changing
    irrational thinking

18
Disorders Characterized By Dramatic, Emotional,
or Erratic Behaviors Narcissistic Personality
Disorder
  • Narcissistic Personality Disorder Exaggerated
    sense of self-importance, exploitative attitudes,
    and lack of empathy.
  • Characterized by self-centeredness.
  • Seek attention and praise expecting others to
    recognize them as being superior.
  • Tend to be choosy about picking friends, believe
    that not just anyone is worthy of being their
    friend.
  • Tend to make good first impressions, yet have
  • difficulty maintaining long-lasting
    relationships.
  • Generally uninterested in the feelings of others
  • and may take advantage of them.
  • Prevalence 1 more males than females

19
Disorders Characterized By Dramatic, Emotional,
or Erratic Behaviors Narcissistic Personality
Disorder
  • Etiology Use of dissociation and denial as
    defense mechanisms.
  • Teenagers are narcissistic, but usually not
    clinically so.
  • Treatment Individual psychotherapy and group
    therapy

20
Disorders Characterized By Dramatic, Emotional,
or Erratic Behaviors Antisocial Personality
Disorder
  • Antisocial Personality Disorder Failure to
    conform to social and legal codes, lack of
    anxiety and guilt, and irresponsible behaviors.
  • Much more frequently diagnosed in males than in
    females.
  • Historic terms Moral insanity, moral imbecility,
    moral defect, and psychopathic inferiority
  • Currently also called sociopathic and
    psychopathic personality

21
Disorders Characterized By Dramatic, Emotional,
or Erratic Behaviors Antisocial Personality
Disorder
  • Characterized by lying, manipulativeness, and a
    selfish disregard for the rights of others some
    may act impulsively.
  • Frequently chemically dependent and sexually
    promiscuous.
  • A common misconception is that antisocial
    personality disorder refers to people who have
    poor social skills. The opposite is often the
    case.
  • Characterized by a lack of conscience. People
    with this disorder are prone to criminal
    behavior, believing that their victims are weak
    and deserving of being taken advantage of. They
    tend to lie and steal. Often, they are careless
    with money and take action without thinking about
    consequences. They are often aggressive and are
    much more concerned with their own needs than the
    needs of others.

22
Disorders Characterized By Dramatic, Emotional,
or Erratic Behaviors Antisocial Personality
Disorder Diagnosis
  • Cleckleys description (based on clinical
    observations)
  • Superficial charm/good intelligence
  • Shallow emotions and lack of empathy, guilt or
    remorse.
  • Behaviors indicate little life plan or order
  • Failure to learn from experiences and absence of
    anxiety.
  • Unreliability, insincerity, and untruthfulness

23
Disorders Characterized By Dramatic, Emotional,
or Erratic Behaviors Antisocial Personality
Disorder Diagnosis
  • DSM-IV-TR
  • At least 18 years old and history prior to age 15
    of failure to conform to norms of lawful
    behavior.
  • Irritability, aggressiveness, impulsivity, lack
    of remorse, and deceitfulness.
  • Appropriateness of DSMs emphasis on criminality
    is being questioned.
  • Misses the conceptual sense of the disorder.

24
Disorders Characterized By Dramatic, Emotional,
or Erratic Behaviors Antisocial Personality
Disorder Diagnosis
  • Psychopathy Checklist-Revised (PCL-R) suggests
    three factors Arrogant and deceitful
    interpersonal style, deficient affective
    experience, and impulsive/irresponsible
    behavioral style.
  • Prevalence 2 3 times as many males as females

25
Disorders Characterized By Dramatic, Emotional,
or Erratic Behaviors Antisocial Personality
Disorder Etiology
  • Psychodynamic Faulty superego development allows
    free expression of id impulses.
  • Family and Socialization
  • Poor parental supervision and involvement
  • Parental rejection/deprivation
  • Dysfunctional family structure
  • Parental separation or absence
  • Do not learn to pay attention to social stimuli
  • Antisocial father

26
Disorders Characterized By Dramatic, Emotional,
or Erratic Behaviors Antisocial Personality
Disorder Etiology
  • Genetic influences
  • Findings from twin studies and adoption studies
    suggest some genetic basis, particularly when
    biological father is antisocial.
  • Could Lombroso have been correct? Is there such a
    thing as a born criminal?
  • Central nervous system abnormality
  • Violent, antisocial people have less gray matter
    in their frontal lobes.
  • Autonomic nervous system abnormalities
  • Fearlessness or lack of anxiety

27
Disorders Characterized By Dramatic, Emotional,
or Erratic Behaviors Antisocial Personality
Disorder Etiology
  • Arousal, sensation-seeking, and behavioral
  • Underarousal Low levels of ANS reactivity
  • Impulsive, unsocialized sensation-seeking and
    varying levels of thrill-seeking (Big T)
    behaviors that can lead to constructive or
    destructive behaviors in mental or physical
    domains.
  • Differential responses to punishment
  • Monetary loss is effective, but not physical or
    social punishment.

28
Disorders Characterized By Dramatic, Emotional,
or Erratic Behaviors Antisocial Personality
Disorder Etiology
  • PET scans illustrate reduced activation in a
    murderers frontal cortex which normally helps to
    reduce impulsive behavior.

29
Disorders Characterized By Dramatic, Emotional,
or Erratic Behaviors Antisocial Personality
Disorder Etiology
  • When expecting to be electrically shocked, people
    with an antisocial disorder, as compared to
    normal people, show less fear and less autonomic
    arousal.

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31
Multipath Analysis Antisocial Personality
Disorder
  • Biological
  • Central nervous system abnormality
  • Autonomic nervous system abnormalities
  • Genetic predisposition to fearlessness or lack of
    anxiety
  • Arousal, sensation-seeking, and behavioral
    perspectives

32
Multipath Analysis Antisocial Personality
Disorder
  • Psychological
  • Psychodynamic
  • Faulty superego development
  • Cognitive
  • Stress core beliefs that influence behavior
  • Learning
  • Neurobiological traits that delay/impede learning
  • Lack of positive role models
  • Presence of poor models

33
Multipath Analysis Antisocial Personality
Disorder
  • Social
  • Family and Socialization
  • Poor parental supervision and involvement
  • Parental rejection/deprivation
  • Dysfunctional family structure
  • Parental separation or absence
  • Do not learn to pay attention to social stimuli
  • Antisocial parent, especially father

34
Disorders Characterized By Dramatic, Emotional,
or Erratic Behaviors Antisocial Personality
Disorder
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Disorders Characterized By Dramatic, Emotional,
or Erratic Behaviors Antisocial Personality
Disorder Treatment
  • Little anxiety results in lack of motivation to
    change.
  • Tranquilizing drugs have reduced antisocial
    behavior.
  • May need enough control to force them to confront
    their relationships and the effect their
    behavior has on others.
  • Most useful Skill-based and behavioral treatment
    using material rewards, but not long-lasting.

37
Disorders Characterized By Dramatic, Emotional,
or Erratic Behaviors Antisocial Personality
Disorder Treatment
  • Cognitive Therapist must build rapport and guide
    APD toward higher levels of thinking regarding
    self and others.
  • Current treatments are not effective Need to
    involve families and peers.
  • Good news The disorder diminishes with age.

38
Disorders Characterized by Dramatic, Emotional,
or Erratic Behaviors Borderline Personality
Disorder
  • Borderline Personality Disorder Intense
    fluctuations in mood, self-image, and
    interpersonal relationships.
  • Prevalence 2 3 times as many females as males
    are diagnosed
  • Transient, ego-dystonic psychotic symptoms
  • Usually drop out of therapy before it can be
    effective
  • Many of these patients have histories of severe
    childhood abuse or neglect.

39
Disorders Characterized by Dramatic, Emotional,
or Erratic Behaviors Borderline Personality
Disorder
  • Patients with borderline personality disorder
    (BPD) are highly unstable, with wide mood swings,
    a history of intense but stormy relationships,
    impulsive behavior, and confusion about career
    goals, personal values, or sexual orientation.
  • These often highly conflictual ideas may
    correspond to an even deeper confusion about
    their sense of self (identity).
  • People with BPD frequently cut or burn
    themselves, or threaten or attempt suicide.

40
Disorders Characterized by Dramatic, Emotional,
or Erratic Behaviors Borderline Personality
Disorder Etiology
  • Psychodynamic Others seen as all good or all bad
    (object splitting), resulting in emotional
    fluctuations toward others.
  • Social Learning
  • Faulty self-identity, difficulty coping
  • Want proximity and attachment but dread and avoid
    engagement.
  • Dysfunction in emotions is core of the disorder.

41
Disorders Characterized by Dramatic, Emotional,
or Erratic Behaviors Borderline Personality
Disorder Etiology
  • Cognitive
  • Difficulty regulating emotions
  • Unstable, intense interpersonal relationships
  • Distorted or inaccurate attributions
  • Beck Thoughts influence perceptions,
    interpretations, and behavioral/emotional
    responses.

42
Disorders Characterized by Dramatic, Emotional,
or Erratic Behaviors Borderline Personality
Disorder Treatment
  • Dialectical Behavior Therapy (DBT) Teaches
    skills such as emotional regulation, distress
    tolerance, and interpersonal effectiveness.
  • Generally effective therapy that has resulted in
    a decrease in dropping out and suicidal
    behaviors.
  • Goals of therapy include changing suicidal
    behaviors, behaviors that interfere with therapy,
    behaviors that interfere with the quality of
    life, behavioral skills acquisition,
    posttraumatic stress behavior, and self-respect
    behaviors.

43
Disorders Characterized By Anxious or Fearful
Behavior Avoidant Personality Disorder
  • Avoidant Personality Disorder Fear of rejection
    and humiliation and a reluctance to enter into
    social relationships.
  • Genuinely want social relationships, unlike
    schizoid personality disorder
  • Possibly related to (an extension of?) social
    phobia
  • People with this disorder often feel inadequate,
    avoid social situations, and seek out jobs with
    little contact with others. They are fearful of
    being rejected and worry about embarrassing
    themselves in front of others.
  • Prevalence Less than 1 no gender differences

44
Disorders Characterized By Anxious or Fearful
Behavior Avoidant Personality Disorder
  • Etiology Parental rejection and censure,
    reinforced by rejecting peers?
  • Treatment Cognitive-behavioral, psychodynamic,
    interpersonal, psychopharmacological

45
Disorders Characterized By Anxious or Fearful
Behavior Dependent Personality Disorder
  • Dependent Personality Disorder Reliance on
    others and unwillingness to assume
    responsibility.
  • Characterized by a need to be taken care of.
  • Tend to cling to people and fear losing them.
  • May become suicidal when a break-up is imminent.
  • Tend to let others make important decisions for
    them.
  • Often jump from relationship to relationship.
  • Often remain in abusive relationships.
  • Overly sensitive to disapproval.
  • Often feel helpless and depressed.
  • Prevalence 2.5 unclear about gender differences

46
Disorders Characterized By Anxious or Fearful
Behavior Dependent Personality Disorder
  • Etiology
  • Maternal deprivation which causes fixation at the
    oral stage of development?
  • Social environment that rewards dependent
    behaviors?
  • Distorted beliefs about inadequacy?
  • Overprotective, authoritarian parenting?
  • Consider cultural or situational causes.
  • Treatment Various forms used more successful
    than with other personality disorders

47
Disorders Characterized By Anxious or Fearful
Behavior Obsessive-Compulsive Personality Disorder
  • Obsessive-Compulsive Personality Disorder
    Perfectionism, tendency to be interpersonally
    controlling, devotion to details, and rigidity
  • Differs from OCD Involves personality traits
    (e.g., perfectionism, inflexibility) rather than
    recurrent thoughts and repetitive behaviors.
  • Focused on orderliness and perfection.
  • Need to do everything "right" often interferes
    with their productivity.
  • Tend to get caught up in the details and miss the
    bigger picture.
  • Prevalence 1 twice as many males as females

48
Disorders Characterized By Anxious or Fearful
Behavior Obsessive-Compulsive Personality Disorder
  • Etiology Tension between the assertion of ones
    own autonomy and the development of self control
    (problems with toilet training)?
  • Treatment Cognitive-behavioral and supportive
    forms of psychotherapy no medications are known
    to be helpful

49
Disorders of Impulse Control
  • Impulse Control Disorders Repeated expression of
    impulsive acts that lead to physical or financial
    damage to the individual or another person.
  • Characteristics
  • Failure to resist an impulse or temptation to
    perform an act known to be considered wrong by
    society or known to be harmful.
  • Tension or arousal before the act
  • Sense of excitement, gratification, or release
    after the act is committed (guilt or regret may
    or may not follow).
  • Excludes Behaviors related to sexual conduct or
    compulsive ingestion of drugs or alcohol.

50
Disorders of Impulse Control
51
Disorders of Impulse Control
52
Disorders of Impulse Control Intermittent
Explosive Disorder
  • Intermittent Explosive Disorder Loss of control
    over aggressive impulses, resulting in serious
    assaults on others or destruction of property.
  • No aggressiveness between episodes.
  • Prevalence Rare more common in males than
    females
  • Often co-occurs with other disorders (e.g., mood,
    anxiety, substance use)

53
Disorders of Impulse Control Kleptomania
  • Kleptomania Recurrent failure to resist impulses
    to steal objects (even though the objects arent
    needed for personal use or monetary value).
  • Prevalence Rare more in females than males
  • May be associated with depression

54
Disorders of Impulse Control Pathological Gambling
  • Pathological Gambling Chronic, progressive
    failure to resist impulses to gamble despite
    detrimental consequences.
  • Prevalence 1-3 of adults
  • Higher rates for adolescents and college students
    than in general population, but the problem is
    episodic, not chronic.
  • Cognitive-behavioral therapies erroneous beliefs
    about ability to influence outcomes.
  • Brief therapy (motivational messages) also
    helpful.

55
Disorders of Impulse Control Pyromania
  • Pyromania Characterized by deliberate and
    purposeful fire setting on more than one
    occasion.
  • Begins in childhood and associated with
  • Being a young male, overwhelming anger, having
    conduct/personality disorder.
  • Poor family environment and interpersonal
    maladjustment.
  • Stressful life events
  • Prevalence among adults is unknown but believed
    rare more males than females.

56
Disorders of Impulse Control Trichotillomania
  • Trichotillomania Inability to resist impulses to
    pull out ones own hair (primarily from the
    scalp, but also any other parts of the body).
  • Follows the tension and release pattern.
  • Hair may be chewed or swallowed.
  • Prevalence Unknown, but probably more common
    than currently believed more females than males
    (1 of college students have past or current
    history of the disorder).
  • Hair pulling associated with pleasure

57
Disorders of Impulse Control Etiology
  • Little is known about specific causes
  • Similarities with traits of other disorders
  • Obsessive-compulsive quality, although the
    repetitive behaviors are not purposeful and do
    not serve to prevent/produce future event.
  • Compulsive feature found in substance
    abusers/addicts, but no physiological
    involvement.
  • Some resemble sexual disorders Tension,
    fascination, and release precede or follow the
    acts.

58
Disorders of Impulse Control Etiology
  • Psychodynamic
  • Pathological gambling likened to masturbation, or
    unconscious need to lose because of underlying
    guilt.
  • Kleptomania Attempt to gain esteem, nourishment,
    sexual gratification.
  • Pyromania Sexual gratification, feelings of
    impotence and inferiority, unconscious anger.
  • Trichotillomania Unhealthy parent-child
    relationships.

59
Disorders of Impulse Control Etiology
  • Behavioral Learning principles such as operant
    conditioning, classical conditioning, and
    modeling.
  • Pathological gambling could be because of way
    gambling is viewed (a string a losses which
    inevitably is concluded by a win).
  • Physiological Compulsive gambling related to
  • Abnormalities in noradrenergic systems,
    indicating greater sensation-seeking.
  • Neurotransmitter serotonin

60
Disorders of Impulse Control Treatment
  • No established psychological or medical treatment
  • Behavioral and cognitive-behavioral are
    moderately successfully
  • Recognize tension states
  • Rehearse alternative responses
  • Aversive conditioning
  • Change cognitive styles

61
Disorders of Impulse Control Treatment
  • Insight-oriented approaches helpful with
    kleptomania.
  • Anger management and awareness techniques for
    intermittent explosive disorder.
  • Multimodal approaches involving family, friends,
    organizations may be helpful.
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