Personality Disorders

Personality • The five basic personality traits

that characterize individuals are:– Neuroticism – Extraversion/ Intraversion– Openness to experience– Agreeableness/antagonism– Conscientiousness

• Personality is attuned to the demands of societal expectations; we readily comply.

Clinical Features of Personality Disorders

• Some although not displaying symptoms of an Axis I disorder, are so inflexible and maladaptive in perceiving, thinking about and relating to the world, that they have a personality disorder that they are unable to perform adequately in roles expected by society:– Chronic interpersonal difficulties– Problems with ones identity or sense of self

• According to the DSM-IV, the pattern of behavior must be:– Stable – Long duration– Clinically significant distress or impairment in

functioning– Be manifested in:

• Cognition • Affectivity • Interpersonal functioning • Impulse control

• Cluster A, Cluster B, and Cluster C

– Cluster A: includes the personality disorders that seem odd or eccentric e.g. distrust & suspiciousness to social detachment

– Cluster B: tends to be more dramatic, emotional, and erratic.

– Cluster C: is people with these disorders who show anxiety and fearfulness.

Difficulties Doing Research on Personality Disorders

• Diagnostic criteria & Clinical judgment of traits and patterns of behavior is not sharply defined:– Lack of reliable measurement tools

• More misdiagnoses & unreliability can occur than with any other disorder

• No one theoretical view on dimensional classification – Little known about the causal factors– High level of comorbidity – Not many epidemiological studies

Cluster A Personality Disorders

Paranoid, Schizoid & Schizotypal

Paranoid Personality Disorder

• Pervasive distrust or suspiciousness of others in at least 4:– Blameless, therefore blame others for their

own mistake and failures

– Suspiciousness of being deceived, harmed• Unjustified doubts of loyalty• Reluctance to confide in others

– Hidden demeaning or threatening meanings in benign marks• Bear grudges• Refuse to forgive • Quick to react, violent behavior

– High levels of antagonism and neuroticism• Chronically ‘tense’ or ‘on guard’

Causes – A gene for Schizophrenia

– Heritability of high levels of antagonism (low agreeableness)

– Neuroticism (angry-hostility)

– Parental neglect/abuse

– Exposure to violent adults

Case Study Paranoid Construction Worker

• 40 year old construction worker• Changed jobs several times • Never gets along with bosses • Fears coworkers hate him and will let

scaffold loose whereby he will be injured • Started after disagreement over lunch• Noticed new enemy laughing with other

men• Sits tense• Observes everything • Reads between the lines • Feels criticized• Imagines interviewer is siding with

coworker

• Loner as a boy • Felt other children would

form teams and be mean to him

• Preferred girls or sissies• School drop out • Feels discriminated against

due to being catholic• Father is referred to as ‘sir’

Schizoid Personality Disorder

• Pervasive detachment from social relationships shown in at least 4:

– Neither desires nor enjoys close relationships

– Almost always chooses solitary activities; Loners

– Has little if any interest in sexual experiences

– Takes pleasure in few if any activities

– Lacks close friends

– Appears indifferent to the praise of others

– Shows emotional coldness, detachment, and flat affect

Schizotypal Personality Disorder

• Two types:

– Biological association with schizophrenia:• Deficit in tracking a

moving object • Inability to sustain

attention • Deficits in working

memory

– Linked to history of childhood abuse and elderly trauma

– Unusual perceptual experiences

– Odd thinking and speech

– Suspiciousness or paranoid ideation

– Inappropriate or constricted affect

– Excessive social anxiety that does not diminish with familiarity

– Odd beliefs or magical thinking

Case StudySpacey Lady

• 32 years old • Un married • Unemployed • On welfare • Feels like she is watching

herself moving through life • Feels strange when looking

in mirror• Feels she has a special

mission in life but is unaware of it

• Feels people are paying special attention to her and would move away to avoid her

• Most of her day she watches series and is lost in her fantasies

Cluster B Personality Disorders

Histrionic, Narcissistic, Antisocial & Borderline

Histrionic Personality Disorder“Unless I captivate people, I am nothing’

‘I cant entertain people they will abandon me’

• Pervasive pattern of excessive emotionality in at least 5 of the following:– Discomfort when not the center of

attention; self-centered insincere– Inappropriate sexually seductive

behavior to control partners– Shallow expression of emotions – Considers relationships to be more

intimate – Uses physical appearance to draw

attention, theatrical– Excessively impressionistic style of

speech; vague – Exaggerated expression of emotions,

and overly suggestible

Prevalence higherIn women:

• Overdramatization • Vanity • Seductiveness • Overconcern with

physical appearance• The histrionic housewife

Individuals with Histrionic Personality Disorder use their

appearance and sexual seduction to get their way.

True or false?

True. Individuals with this disorder are uncomfortable if they are not the center of attention and we utilize their appearance

and seductive behavior to draw attention to themselves.

True or False? You decide…

Narcissistic Personality Disorder‘Promiscuous Exploitative vs. Promiscuous Overtly Needy ’

Pervasive pattern of grandiosity as indicated by at least 5:

• Grandiose sense of self importance; belief that he/she is special

• Preoccupation with success/ being admired

• Tendency to be interpersonally exploitative

• Lacks empathy for others• Often arrogant ; bragging • Sense of entitlement ; due to

unwillingeness to forgive others• Envious of others • Hypercritical – only see things through

their eyes.

• Causes- (child phase of parents mirroring grandiosity)

– School 1: Narcissistic personality disorder is thought to stem from either parental neglect and devaluing.

– School 2:Unrealistic parental overvaluation which can lead to searching for affirmation of an idealized and grandiose sense of self.

– More in men than women

Case Study

• 21 years old• Very smart • Tall & Stylish• Manner is distant but

charming• Superiority • Resentful to other

brothers births • Cold/ insensitive

• Parents take him for therapy

• Starts by saying he has no problems

• He failed his tests and so spread rumors that teachers were homosexual

• Showed no remorse

Antisocial Personality Disorder

• Pervasive pattern of disregard for and violation of the rights of others by at least 3:

– Failure to conform to social norms– Deceitfulness– Impulsivity– Irritability– Reckless disregard for safety– Irresponsible– The individual is at least 18 years of age

• People with Antisocial personality disorder tend to be diagnosed or show signs of Conduct Disorder before the age of 15.

– A high proportion become incarcerated.

Borderline Personality Disorder

It is commonly reported in cases of childhood abuse and trauma.

Pervasive pattern of instability in interpersonal relationships shown in at least 5:

-Frantic efforts to avoid abandonment-A pattern of unstable interpersonalrelationships-Identity disturbance-Impulsivity in at least two potentially selfdamaging areas; spending, sex, substance abuse, reckless driving -Recurrent suicidal behaviors-Affective instability-Chronic feelings of emptiness-Intense anger-Paranoid ideation Multidimensional Diathesis-Stress

Theory of Borderline Personality Disorder

Treatment For Borderline Personality Disorder

• Medication

– SSRIs for treating rapid shifts in mood, anger, and anxiety

– Antipsychotics assist with depression, suicidality, impulsive aggression

– Mood stabilizers such as carbazemine reduce irritability and suicidality

• Dialectical Behavior Therapy (i.e., DBT)

• Psychodynamic therapy

True or False? You decide…

In Borderline Personality Disorder self injury is a way to communicate distress.

Fact or fiction?

Fact. This is another common feature of BPD and is associated with relief from stress, anxiety, dysphoria, and also serves as a cry for help.

Cluster C Personality Disorders

Avoidant, Dependant & Obsessive-Compulsive

Avoidant Personality Disorder• A pervasive pattern of social inhibition

indicated by at least 4:

– Avoids occupations with interpersonal contact

– Unwilling to get involved with people unless certain of being liked

– Restraint within intimate relationships– Preoccupation with being criticized– Feelings of inadequacy– Views self as socially inept– Usually have an extreme reluctance to

take personal risks!– Inhibited temperament and elevated

levels of introversion and neuroticism.

Case Study The Avoidant Librarian

• 35 year old• No close friends • Father was a drunk • Could not explain to friends

his awkward behavior • Therefore avoided having

friends • Went out on a date, refused

to stay because she felt she was dressed bad and never saw person again

Dependent Personality Disorder“The Dependent Wife’

• Result of authoritarian and overprotective parenting.

• Pervasive and excessive need to be taken care of as indicated by at least 5:

– Difficulties making everyday decisions– Need others to take responsibility in life– Difficulty expressing disagreement– Difficulty doing things on own– Goes to great lengths to obtain nurturance from

others– Feels uncomfortable when alone– Seeks another close relationship when one ends– Unrealistic fears of being left to take care of him or

herself.

Obsessive-Compulsive Personality Disorder

• Pervasive pattern of preoccupation with orderliness indicated by at least 4:

– Preoccupied with rules, details, and order– High levels of conscientiousness which

can lead to extreme devotion and Perfectionism

– Excessive devotion to work– High on assertiveness and low on

compliance– Overly inflexible– Inability to discard worn-out objects– Reluctance to delegate tasks– Miserly toward self and others

Treatments for Clusters A, B & C

• Use of antipsychotics and antidepressants for schizotypal personality disorder

• Short-term psychotherapy that is active and confrontational for Cluster C

• Cognitive-Behavioral Therapy for avoidant personality disorder, as well as use of MAO inhibitors and SSRIs

Psychopathy• These individuals are often irresponsible and

need constant stimulation.

• Affective and interpersonal core of the disorder– Lack of remorse/guilt– Callousness/lack of empathy– Glibness/superficial charm– Grandiose sense of self-worth– Pathological lying

• Behavior– Antisocial– Impulsive– Socially deviant lifestyle

Survival Curve of Months Free Before Reoffense

Clinical Picture of Psycopathy• These individuals are thrill seekers

whom often break law and have high rates of substance abuse/dependence.

– Often charming and likable first encounter

– Use others to achieve their own ends

– Inadequate conscience development

– Irresponsible and impulsive behavior

– Ability to both impress and exploit others

Causal Factors in Psychopathy and Antisocial Personality Disorder

• Moderate heritability• Exposure to adverse environments (e.g.,

marital conflict, divorce, legal problems, and parental psychopathology)

• MAO-A gene• Parental loss/rejection• Low trait anxiety and show poor

conditioning of fear• Deficient behavioral inhibition system• Less significant physiological reactivity to

distress

A Model for the Association of Family Context and Antisocial Behavior

Question 1

1. _____ is when an individual displays suspiciousness and mistrust of others and may suspect infidelity in a sexual partner. (a) Antisocial Personality Disorder(b) Borderline Personality Disorder(c) Schizoid Personality Disorder(d) Paranoid Personality Disorder

Question 2

2. _____ is when an individual displays ideas of reference, odd beliefs, and unusual perceptual experiences. (a) Schizotypal Personality Disorder(b) Obsessive-Compulsive Personality Disorder(c) Schizoid Personality Disorder(d) Paranoid Personality Disorder