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Chapter 11 Personality Disorders

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Chapter 11 Personality Disorders Amber Gilewski Tompkins Cortland Community College * * * * * * * Personality Disorders: Overview The Nature of Personality Disorders ... – PowerPoint PPT presentation

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Title: Chapter 11 Personality Disorders


1
Chapter 11 Personality Disorders
  • Amber Gilewski
  • Tompkins Cortland Community College

2
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?

3
Personality Disorders Clusters
  • Cluster A Odd or eccentric
  • (Paranoid, Schizoid, Schizotypal)
  • Cluster C Fearful or anxious
  • (Avoidant, Dependent, Obsessive-Compulsive)
  • Cluster B Dramatic, emotional, erratic
  • (Antisocial, Borderline, Histrionic,
    Narcissistic)

4
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

5
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

6
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

7
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

8
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

9
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

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10
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

11
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

12
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

13
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

14
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

15
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

16
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

17
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

18
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

19
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
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