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Personality Disorders

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Personality Disorders Personality Traits characteristic ways of thinking, feeling, and behaving that are stable across time and across situations considered to be a ... – PowerPoint PPT presentation

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Title: Personality Disorders


1
Personality Disorders
2
Personality Traits
  • characteristic ways of thinking, feeling, and
    behaving that are stable across time and across
    situations
  • considered to be a disorder when
  • traits are inflexible and maladaptive
  • cause significant functional impairment and/or
    distress

3
The Question
  • Are people with personality disorders
    qualitatively different from people without?
  • OR
  • Are personality disorders simply extreme versions
    of otherwise normal personality variations?

4
The Answer
  • Personality disorders are probably best thought
    of as extremes on one or more personality
    dimensions

5
DSM-IV-TR
  • Diagnostic and Statistical Manual of Mental
    Disorders, Fourth Edition, Text Revision
  • lists diagnostic criteria for each mental disorder

6
Prevalence
  • 0.5 - 2.5 of the general population
  • 2 - 10 of outpatients
  • 10 - 30 of inpatients

7
Course
  • thought to originate in childhood and continue
    into adulthood
  • believed to be relatively stable, difficult to
    treat

8
Comorbidity
  • considerable overlap among categories
  • about 50 of people diagnosed with one
    personality disorder also meet criteria for
    another
  • questions
  • do people really tend to have more than one
    personality disorder?
  • do rates of comorbidity indicate problems with
    reliability and validity of diagnostic categories?

9
Lack of Research
  • for many personality disorders, there is
    relatively little empirical research on the
    causes and treatments

10
Three Clusters
  • odd/eccentric
  • dramatic/erratic
  • anxious/fearful

11
Cluster A Odd or Eccentric
  • paranoid
  • schizoid
  • schizotypal

12
Paranoid Personality Disorder
  • pervasive pattern of distrust and suspiciousness
    of others such that their motives are interpreted
    as malevolent

13
DSM-IV-TR at least 4 sx
  • suspects others are exploiting, harming, or
    deceiving him
  • preoccupied with doubts about loyalty/trustworthin
    ess of friends, associates
  • reluctant to confide in others (fears info will
    be used against him)

14
DSM-IV-TR (continued)
  • reads hidden threatening meanings into benign
    events
  • bears grudges, is unforgiving
  • perceives attacks on character or reputation and
    is quick to counterattack
  • suspicious of fidelity of sexual partner

15
Causes
  • Biological
  • slightly more common among relatives of people
    with schizophrenia
  • Psychological
  • theory certain basic mistaken assumptions about
    others
  • people are malevolent and deceptive and
    theyll attack you if they get the chance
  • result of upbringing? taught by parents?

16
Treatment
  • unlikely to seek professional help difficulty
    trusting therapist
  • difficulty that brings them in is a crisis
  • cognitive therapy
  • changing persons mistaken beliefs about others
  • no confirmed demonstrations that any form of tx
    works

17
Schizoid Personality Disorder
  • pervasive pattern of detachment from social
    relationships and restricted range of expression
    of emotion in interpersonal settings

18
DSM-IV-TR at least 4 sx
  • neither desires nor enjoys close relationships
  • chooses solitary activities
  • little, if any, interest in sexual experiences
    with another person
  • lacks close friends
  • appears indifferent to praise/criticism
  • shows emotional coldness, detachment
  • takes pleasure in few, if any, activities

19
Causes and Treatment
  • causes
  • no research
  • preference for social isolation resembles aspects
    of autism
  • treatment
  • dont usually seek tx (only in response to
    crisis)
  • point out value of social relationships
  • learn empathy
  • social skills training
  • many therapists believe therapy doesnt help this
    group

20
Schizotypal Personality Disorder
  • pervasive pattern of social and interpersonal
    deficits marked by acute discomfort with, and
    reduced capacity for, close relationships and
    cognitive or perceptual distortions and
    eccentricities of behavior

21
DSM-IV-TR at least 5 sx
  • ideas of reference
  • odd beliefs or magical thinking
  • unusual perceptual experiences
  • odd thinking and speech
  • suspiciousness/paranoia

22
DSM-IV-TR (continued)
  • inappropriate or constricted affect
  • behavior or appearance that is odd, eccentric, or
    peculiar
  • lack of close friends
  • excessive social anxiety associated with
    paranoid fears

23
Causes and Treatment
  • Biological
  • more common among relatives of people with
    schizophrenia
  • Treatment
  • research is limited
  • tx for comorbid depression
  • psychological social skills to help reduce
    isolation or help person adjust to solitary
    lifestyle
  • medical Haldol. Results in improvement in some
    sx, but many stop taking due to side effects

24
Cluster B Dramatic or Erratic
  • antisocial
  • borderline
  • histrionic
  • narcissistic

25
Antisocial Personality Disorder
  • pervasive pattern of disregard for and violation
    of the rights of others since age 15

26
DSM-IV-TR
  • at least 3 sx
  • failure to conform to social norms with respect
    to lawful behavior (repeated arrests)
  • deceitfulness (repeated lying, use of aliases,
    conning)
  • impulsivity, failure to plan ahead
  • irritability and aggressiveness (repeated fights)
  • reckless disregard for safety of others
  • consistent irresponsibility (no steady
    employment, doesnt honor financial obligations)
  • lack of remorse (indifferent to or rationalizes
    having hurt, mistreated, or stolen from others)

27
DSM-IV-TR (continued)
  • must be at least 18
  • evidence of conduct disorder prior to age 15
  • violation of basic rights of others and major
    social rules
  • aggression toward people and/or animals
  • destruction of property
  • deceitfulness or theft
  • serious violation of rules (stays out all night,
    truant)

28
Psychopathy
  • antisocial personality disorder overlaps with
    personality trait called psychopathy
  • glib or superficial charm
  • grandiose sense of self-worth
  • proneness to boredom/need for stimulation
  • pathological lying
  • conning/manipulative
  • lack of remorse
  • not all psychopaths display aggressiveness that
    is a DSM-IV-TR criterion for antisocial
    personality

29
Causes Biological
  • genetics
  • family, adoption, and twin studies show evidence
    of a genetic link
  • examples
  • offspring of felons raised by adoptive families
    show higher rates of arrests and antisocial
    personality disorder than controls
  • concordance rates for criminality are 55 for MZ
    twins and 13 for DZ twins

30
But what do they inherit?
  • underarousal hypothesis
  • psychopaths have abnormally low levels of
    cortical arousal
  • engage in antisocial and risk-taking behaviors to
    increase level of arousal
  • evidence
  • longitudinal study found that future criminals
    had lower skin conductance activity, lower heart
    rate, and more slow-frequency brain wave activity

31
  • fearlessness hypothesis
  • psychopaths have a higher threshold for
    experiencing fear than most people
  • evidence
  • psychopaths are less likely to develop a
    classically conditioned fear response

32
Psychological and Social Influences
  • oversensitivity to reward
  • will persist in efforts to achieve goal, even
    when goal is no longer attainable
  • inconsistent parental discipline
  • giving in to problem behavior and poor monitoring
  • other environmental influences
  • low SES, stress, and degree of mutual trust and
    solidarity in neighborhood linked to antisocial
    behaviors

33
Treatment
  • prognosis for adults is poor
  • best strategy is to intervene with high risk
    children
  • teach parents to use behavioral management
    principles to reduce problem behavior and
    increase prosocial behavior
  • research suggests such programs reduce antisocial
    behavior

34
Borderline Personality Disorder
  • pervasive pattern of instability of interpersonal
    relationships, self-image, and affects marked by
    impulsivity

35
DSM-IV-TR at least 5 sx
  • frantic efforts to avoid real or imagined
    abandonment
  • intense and unstable interpersonal relationships
  • alternate between extremes of idealization and
    devaluation
  • unstable self-image or sense of self
  • impulsivity in at least 2 areas that are
    potentially self-damaging (sex, money)

36
DSM-IV-TR (continued)
  • recurrent suicidal behavior or self-mutilation
  • emotional instability due to marked reactivity of
    mood
  • chronic feelings of emptiness
  • inappropriate, intense anger
  • transient, stress-related paranoid thoughts or
    dissociative sx

37
Causes
  • family studies
  • suggest genetic link
  • suggest that BPD is linked to mood disorders
  • early trauma
  • 91 report h/o childhood sexual or physical abuse
  • one theory
  • child who has biological vulnerability to
    emotional dysregulation and is raised by
    invalidating family

38
Treatment
  • few controlled studies
  • medical
  • many respond positively to antidepressants and
    lithium

39
Treatment (continued)
  • psychological
  • dialectical behavior therapy
  • help people cope with stressors that trigger
    suicidal behaviors
  • teach patients how to identify and regulate their
    emotions
  • teach problem solving
  • re-exposure to prior traumatic events to
    extinguish fear
  • trust own responses, rather than depend on others
    for validation
  • reduces suicide attempts, dropouts from
    treatment, and hospitalizations

40
Histrionic Personality Disorder
  • pervasive pattern of excessive emotionality and
    attention seeking

41
DSM-IV-TR at least 5 sx
  • uncomfortable when not the center of attention
  • inappropriate sexually seductive or provocative
    behavior
  • rapidly shifting and shallow expression of
    emotions
  • consistently uses physical appearance to draw
    attention to self

42
DSM-IV-TR (continued)
  • speech is excessively impressionistic and lacking
    in detail
  • shows self-dramatization, theatricality, and
    exaggerated expression of emotion
  • highly suggestible
  • considers relationships to be more intimate than
    they actually are

43
Causes and Treatment
  • very little research
  • try to teach more appropriate ways of expressing
    their needs and getting their needs met
  • point out costs associated with manipulative
    style

44
Narcissistic Personality Disorder
  • pervasive pattern of grandiosity, need for
    admiration, and lack of empathy

45
DSM-IV-TR at least 5 sx
  • grandiose sense of self-importance
  • example exaggerates achievements and talents
  • preoccupied with fantasies of unlimited success,
    power, beauty, etc.
  • believes he/she is special and unique
  • can only be understood by or associate with other
    special high status people
  • requests excessive admiration
  • sense of entitlement
  • unreasonable expectations for favorable treatment

46
DSM-IV-TR (continued)
  • interpersonally exploitative
  • lacks empathy
  • often envious of others, or believes others are
    envious of him/her
  • arrogant, haughty behaviors or attitudes

47
Causes
  • little research
  • one theory
  • grandiosity is a defense against very fragile
    self-esteem
  • develops because parents do not respond with
    approval to childs displays of competency

48
Treatment
  • little research
  • therapy focuses on grandiosity, sensitivity to
    evaluation, and lack of empathy

49
Cluster C Anxious or Fearful
  • avoidant
  • dependent
  • obsessive-compulsive

50
Avoidant Personality Disorder
  • pervasive pattern of social inhibition, feelings
    of inadequacy, and hypersensitivity to negative
    evaluation

51
DSM-IV-TR at least 4 sx
  • avoids occupational activities that involve
    significant interpersonal contact, because of
    fears of criticism, disapproval, or rejection
  • unwilling to get involved with people unless
    certain of being liked
  • shows restraint in interpersonal relationships
    because of fears of being shamed or ridiculed

52
DSM-IV-TR (continued)
  • preoccupied with being criticized or rejected in
    social situations
  • inhibited in new interpersonal situations
  • views self as socially inept, unappealing, or
    inferior
  • reluctant to take risks or engage in new
    activities (due to fears of embarrassment)

53
Causes
  • one theory
  • person born with difficult temperament or
    personality characteristics
  • parents reject them or dont provide enough
    early, uncritical love
  • rejection results in low self-esteem and social
    alienation

54
Treatment
  • controlled studies show evidence for
    effectiveness of behavioral intervention
    techniques for anxiety and social skills
  • systematic desensitization
  • behavioral rehearsal

55
Dependent Personality Disorder
  • pervasive and excessive need to be taken care of
    that leads to submissive, clinging behavior and
    fears of separation

56
DSM-IV-TR at least 5 sx
  • difficulty making everyday decisions
  • needs others to assume responsibility
  • difficulty expressing disagreement
  • due to fears of loss or support or approval
  • difficulty initiating projects or doing things on
    his/her own
  • due to lack of self-confidence in own judgment or
    abilities

57
DSM-IV-TR (continued)
  • goes to excessive lengths to obtain nurturance
    and support
  • volunteers to do unpleasant things
  • feels uncomfortable or helpless when alone
  • because of fears of being unable to take care of
    self
  • urgently seeks another relationship as a source
    of care/support when one ends
  • preoccupied with fears of being left to take care
    of him/herself

58
Causes and Treatment
  • causes
  • one theory is that early death of parent or
    neglect/rejection by caregiver cause person to
    grow up fearing abandonment
  • treatment
  • little research

59
Obsessive-Compulsive Personality Disorder
  • pervasive pattern of preoccupation with
    orderliness, perfectionism, and mental and
    interpersonal control, at the expense of
    flexibility, openness, and efficiency

60
DSM-IV-TR at least 4 sx
  • preoccupied with details, rules, lists, order,
    organization, or schedules to the extent that the
    major point of the activity is lost
  • perfectionism that interferes with task
    completion
  • excessively devoted to work and productivity to
    the exclusion of leisure activities and
    friendships
  • overconscientious and inflexible about morality,
    ethics, or values

61
  • unable to discard worn-out or worthless objects
  • even when they have no sentimental value
  • reluctant to delegate tasks
  • unless others submit to persons exact way of
    doing things
  • has miserly spending attitude
  • money to be hoarded for future catastrophes
  • rigidity and stubbornness

62
Causes and Treatment
  • causes
  • weak genetic contribution
  • possible parental reinforcement of conformity and
    neatness
  • treatment
  • little research
  • therapy addresses fears that underlie need for
    orderliness
  • relaxation techniques

63
Relationship of Personality Disorders to the Big
Five
  • Avoidant
  • low on extraversion
  • high on neuroticism
  • Schizoid
  • low on extraversion
  • high on neuroticism (not at high as avoidant)

64
  • Borderline
  • high on neuroticism
  • low on agreeableness
  • Paranoid
  • low on agreeableness
  • Antisocial
  • low on agreeableness

65
  • Histrionic
  • high on extraversion
  • high on neuroticism
  • Dependent
  • high on agreeableness
  • high on neuroticism
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