CLUSTER B

PERSONALITY DISORDERS

Presented By: Priya Singh

Chair Person:Dr. L.N. Suman

PSYCHOSOCIAL THEORIES FOR CLUSTER B PERSONALITY

DISORDERS

PSYCHODYNAMIC PERSPECTIVE

• Theory of Personality Organization - Otto Kernberg (1975, 1984, 1996)

• Proposed a continuum of pathology, from chronically psychotic levels of functioning, through borderline functioning through neurotic to normal functioning

• Borderline functioning- entails severe personality disorders including– Maladaptive modes of regulating emotions including reality

distorting defenses such as denial and projection (primitive defenses)

– Difficulty in forming mature, multifaceted representations of themselves and significant others (identity diffusion)

• Previous studies have demonstrated that insecure attachment patterns and a trait disposition toward negative affect and impulsivity are both associated with borderline personality disorder (BPD) features. According to attachment theory, insecure attachment patterns impart greater risk for the maladaptive personality traits underlying BPD. Hence, insecure attachment might be indirectly related to BPD through its association with these traits.

• A study by Lori N. Scott, Kenneth N. Levy, and Aaron L. Pincus, favoured a model in which the relationship between adult attachment anxiety and BPD features is fully mediated by trait negative affect and impulsivity.

• results extend upon the research reported by King-Casas et al. (2008) by showing that the failure of BPDs to restore ruptured cooperation can most likely be explained by a particularly detrimental combination of personality traits. The joint presence of high N and low A, a combination typical to BPD patients, predicted failure to rebuild ruptured cooperation in exactly the same way as did the BPD diagnosis in the study by King- Casas et al. (2008). Furthermore, as other Cluster B disorders, such as Narcissistic PD or Antisocial PD, may to some, albeit lesser extent also be characterized by high N and low A (Saulsman & Page, 2004), a similar failure to repair cooperation could be predicted to occur in these groups. Although our results suggest that at least this particular behavioral consequence of BPD can be predicted in terms of the personality dimensions identified by the five-factor model, the necessity to consider combinations of the five dimensions to appreciate the consequences of BPD highlights one of the advantages of the categorical approach: The category label is a much more economic means of description than the delineation of interactions between dimensions.

Narcissistic Personality Disorder(NPD) • According to Freud (1914), parental over evaluation, erratic,

unreliable caretaking in early life disrupts the development of object love in the child, due to fixation in narcissistic phase of development, they are unable to form lasting relationships

• In Kernberg’s view, individuals with NPD need to construct a grossly inflated view of themselves to maintain self-esteem, and may appear grandiose, sensitive to the slightest attacks on their self-esteem (and hence vulnerable to rage or depression), or both.

• Not only are the conscious self-representations of narcissistic patients inflated, but so, too, are the representations that constitute their ideal self.

• Actual and ideal self representations stand in dynamic relation to one another. Thus, one reason narcissistic patients must maintain an idealized view of self is that they have a correspondingly grandiose view of who they should be, divergence from which leads to tremendous feelings of shame, failure, and humiliation.

• According to Kohut, results from faulty self development. The “self” in its particular Kohutian meaning refers to the nucleus of a person’s central ambitions and ideals, and the talents and skills used to actualize them (Kohut 1971; Kohut 1977; Wolf 1988).

• It develops through two pathways (in Kohut’s language, “poles”), which provide the basis for self esteem.

• The first is what he calls the grandiose self—an idealized representation of self that emerges in children through empathic mirroring by their parents (“mommy, watch!”) and provides the nucleus for later ambitions and strivings.

• The second he calls the idealized parent imago—an idealized representation of the parents, which provides the foundation for ideals and standards for the self.

• Parental mirroring allows the child to see his reflection in the eyes of a loving and admiring parent; idealizing a parent or parents allows the child to identify with and become like them.

• In the absence of adequate experiences with parents who can mirror the child or serve as appropriate targets of her idealization (for example, when the parents are self-involved or abusive), the child’s self structure cannot develop, preventing the achievement of cohesion, vigour, and normal self-esteem (which Kohut describes as “healthy narcissism”).

• As a result, the child develops a disorder of the self, of which pathological narcissism is a prototypic example.

• Millon (1981) proposes a social learning theory of narcissism. This view sees narcissism developing not as a response to parental devaluation but rather as a consequence of parental overvaluation. The child is treated as a special person, provided much attention, and led to believe he or she is lovable and perfect. According to Millon (1981), such unrealistic overvaluation will lead to self-illusions that .cannot be sustained in the outer world.

ATTACHMENT THEORIES

Histrionic Personality Disorder (HPD)

HPD is characterized by Preoccupied Attachment Style i.e., positive mental model of others but negative model of self (Hart et al, 2001). Also have strong relational needs & are hyper vigilant.

Premature perception of relationships as intimate (Westen,2008), difficulty in achieving emotional intimacy in romantic or sexual relationships, these difficulties speculated to originate from problematic relationships with parental figures (Benjamin, 1996)

Narcissistic Personality Disorder (NPD)

Narcissism is the result of an insecure attachment style between child & caretaker Bowlby(1973, 79)

Parental devaluation hypothesis- cold & rejecting parents lead to withdrawal in child, child

forms pathological grandiose self- representation (aspects of real child, fantasized self, ideal parent). However rejects negative self- representation, hence split- off leads to emptiness, hunger for admiration.

Antisocial Personality Disorder

According to a study of ‘juvenile thieves’, separation of a young child from its mother could lead to antisocial behavior & failure to form close relationships (Bowlby 1944,1946). Marital disharmony partly accounts for the association between separation & antisocial disorder in sons (Rutter; 1972).

Chodorow (1978, 1989) and Baker-Miller, Jordan, Kaplan, Stiver, and Surrey (1991) consider the fact that the primary attachment person in children’s lives is usually a woman—their mother—as an important factor for sex differences in autonomy development.

• Because daughters are of the same sex, mothers would unconsciously experience a daughter as very similar to them, and a son (i.e., a child of the opposite sex) as different. These differences in the way the mother experiences children of the two sexes would strongly affect the relationships of girls and boys with her.

• The early, preoedipal “symbiosis” between mother and daughter, a phase in which children do not experience clear boundaries between themselves and their mothers, would be more intense and longer lasting than the mother-son symbiosis.

• Girls’ early relational experiences would contribute to their greater potential for, and need for, functioning in intimate relationships in adulthood their later “ego-boundaries” (sense of personal, psychological division from the rest of the world) would be vague, or, in positive terms (Chodorow, 1989), more flexible.

• When the primary caregiver of boys is a woman, they might on the contrary likely turn away from the mother earlier and identify with the father, who is usually less available.

• As a result, boys define their masculine identity as the absence of femininity, a relative denial of attachment, and “separation.”

• Chodorow’s descriptions refer to “normal” feminine and masculine personality development, sex-bound psychopathologies from her perspective are extreme forms of these “normal” pictures.

• Mental disorders, those with a higher prevalence in men, for example, antisocial behaviour, might be affected by extreme tendencies toward more masculine attachment styles, such as detachment and separation.

• According to Benjamin (1993) developmental histories of harsh, neglectful parenting leads to an adult who is neglectful & insensitive to the needs of others & exploits others.

Social Learning in childhood leads to ASPD by following four ways(Scott, 1960):

1. Antisocial family2. Lack of rules3. Overcoming another problem4. Poor ability to sustain attention, inherently deficient in

acquiring learned responses

Cognitive-Behavioral Perspective

• Early life experiences, including family routines and relationships, traumatic events, formation of assumptions about the world and in inter-personal relationships automatic thoughts emotional reactions and behavioral reactions

• Such rigid cognitive schemata develop over time, each of which governs behavior and reduces adaptability and responsiveness to the environment

Histrionic Personality DisorderDysfunctional Schemas-strong dependency & rejection sensitivity tendencies as a childCore belief “I am basically unattractive”Reinforcement history “I need others to admire me in order to be happy”Individual compensates “I am lovable, entertaining” “I am entitled to admiration”Thus, deserve unfaltering attention & view others positively as long as they provide it, conceals underlying anxiety & rejection sensitivity

Narcissistic Personality Disorder

Cognitive-behavioral theorists propose that narcissistic personality disorder may develop when people are treated too positively rather than too negatively in early life

Those with the disorder have been taught to “overvalue their self-worth”

Antisocial Personality Disorder

Following are the dysfunctional cognitions in an antisocial personality disorder:Self- loners, autonomous & strongLife- cruel & harshOthers- exploitative & manipulative or as weak & vulnerable

TRAIT THEORY• Gordon Allport (1937)• Traits are emotional, cognitive, and behavioral tendencies on which

the individual varies

• Most common approach is Five Factor Model of Personality (FFM) Costa and McCrae (1992)

• FFM consists of five broad dimensions of personality, namely Openness to experience, Conscientiousness, Extraversion, Agreeableness and Neuroticism

• Personality profile is represented by a culmination of each of these 5 factors and a number of lower order sub factors.

• PD reflects extreme versions of normal personality and so a same system can be used to diagnose normal and pathological personality

HISTRIONIC PERSONALITY DISORDER(HPD)•19 experts on HPD rated prototypical person with HPD on a scale of 1 to 5( Lynam & Widiger ;2001) •Ratings for 5 broad domains: OCEAN•On average, clinicians rated HPD as low on self- consciousness & high on impulsiveness (N domain)•High on gregariousness, activity, excitement seeking & positive emotions (E domain)• High on fantasy, feelings & actions (O)•Low on self- discipline & deliberation (C)

NARCISSISTIC PERSONALITY DISORDER(NPD)• Practising clinicians rated a prototypic case of NPD on the Five Factor Model (Samuel & Widiger; 2004)• High scores on Extraversion (e.g., assertiveness, excitement seeking)• Very low scores on Agreeableness (e.g., straightforwardness, compliance, modesty)• High levels of externally- directed negative affect (angry hostility)• low levels of internally- directed negative affect (self consciousness)

ANTISOCIAL PERSONALITY DISORDER(ASPD)• A Five-Factor-based re-interpretation of the Psychopathy Checklist-Revised factor structure shows that:• The “Aggressive Narcissism” factor taps into facets of low agreeableness (with some contribution of facets of neuroticism and extraversion), • And the “Socially deviant lifestyle” factor represents facets of low conscientiousness and low agreeableness.

INTEGRATIVE THOERIES

Millon’s Evolutionary Social Learning Model

• Based on social learning concepts• Describes personality in 4 polarities

Pleasure- pain: nature of reinforcement that controls one’s behavior

Self- other: sources that provide reinforcement Passive- active: behavior & coping strategies Thinking- feeling- extent of abstract thinking or intuition

Identified 14 personality prototypes based on these polarities

• 4 evolutionary principles (based on 4 polarities)- Aims of existence- life enhancement or preservation

(pleasure/pain) Modes of adaptation- accommodation or modification of

environment (passive/active) Strategies of replication/reproduction- extent to which

focus on individuation/nurturance of others (self/others) Process of abstraction- ability for symbolic thought

(thinking/feeling)

• Patients with histrionic personality disorder are pleasure seeking, interpersonally focused(although in a self-centered way), highly active, and short on abstract thinking.

Cloninger’s Temperament and Character Model (1993)

Neurobiological ModelProvided with 7 factor model of personality divided in 2 domains

• 4 Temperamental dimensions (automatic associative responses to basic emotional stimuli)

• 3 Character dimensions (self-aware concepts that influence voluntary intensions and attitudes

• Each domain is defined by a mode of learning and underlying neural systems that are involved in that learning

Temperament Determinants1. Novelty Seeking: Excited and exhilarated responses to novel

stimuli. Low novelty-seeking implies preference for routine, order, details and social stability. Associated with Dopamine NS

2. Persistence (Happiness Seeking): Determination and tenacity to achieve a goal, industrious, stable and resolute in the face of frustration or fatigue. Associated with Serotonin and Glutamate NS

3. Harm Avoidance: Intense response (fear, timidity, pessimism) to aversive stimuli, avoiding behaviors that may expose them to punishment or loss. Associated with Serotonin and GABA NS

4. Reward Dependence (Security-Seeking, Social attachment, openness): Responds to rewards of social approval or sympathy. Low reward dependence implies introversion, self-reliance and self-directedness. Associated with Serotonin and nor-epinephrine NS

High novelty seeking is in the cluster B (Preiss & Klose 2001)

Character determinants

1. Self directedness- responsibility, purposefulness, self acceptance. It is considered the major determinant for the presence/absence of PD

2. Cooperativeness- empathy, compassion, helpfulness

3. Self transcendence- spirituality, idealism, enlightenment

All PDs are found to be low on self directedness and cooperativeness (Cloninger,1998)

Stress Diathesis Model (Monroe & Simons,1991)

• Non-reductionist and interactional theory• Genes shape individual variability in temperament and traits

(diathesis)• Traits become maladaptive only under certain environmental

conditions (stress)• Interaction between the two is bidirectional

Sociobiological Model

• Psychopaths have a genotype that results in an “inborn temperament or personality, coupled with a particular pattern of autonomic hyper arousal that, together, design the child to be selectively unresponsive to the cues necessary for normal socialization and moral development” ( Mealey;1995).

Fearlessness Model

• Lykken (1957) has argued that psychopaths are relatively fearless, a condition that makes it difficult for them to “learn to avoid antisocial behaviors and to inhibit forbidden impulses, through punishment and the conditioned fear it leaves behind”.

• A consistent finding was that psychopaths showed relatively small increases in palmar skin conductance in anticipation of an unpleasant or painful event, a finding that implies they experienced relatively little anticipatory fear and that helps to explain their difficulty in learning to avoid punishment.

Other studies..• Narcissism is increasingly recognised as a heterogeneous

construct, with two dimensions of narcissistic dysfunction commonly accepted, Grandiose Narcissism and Vulnerable Narcissism.

• Two distinct dimensions of Narcissism are increasingly accepted (Cain, Pincus, & Ansell, 2008; Wink, 1991). Grandiose Narcissism is characterised by overt grandiosity and exhibitionism. Individuals with this grandiose expression of Narcissism openly display a sense of entitlement and are preoccupied with a need for admiring attention from others. Vulnerable Narcissism is a more covert dimension of Narcissism associated with hypersensitivity to criticism and a tendency to withdraw from social interactions.

• Miller et al. (2011) found Grandiose Narcissism related positively to Extraversion and negatively to Neuroticism, while Vulnerable Narcissism related negatively to Extraversion and positively to Neuroticism through factor and correlational analysis using the Pathological Narcissism Inventory (PNI). Also it was found that Grandiose Narcissism was unrelated to psychological distress, whilst Vulnerable Narcissism was positively related to psychological distress.

• A study by Louise Houlcroft , Miles Bore, Don Munro provided empirical support for the two dimensions of Narcissism, a possible third dimension of Narcissism emerged which was markedly aggressive and antisocial. Along with the Pathological Narcissism Inventory (PNI) and the Narcissism subscale of the Narcissism–Aloofness–Confidence–Empathy (NACE), questionnaires assessing personality traits, psychopathologies, and behavioural characteristics were administered to Australian university students. This study highlighted the phenomenological breadth of Narcissism and the need for an improved understanding of Narcissism, particularly given the imminent publication of DSM-5..

• A study by Marrie H. J. Bekker, Nathan Bachrach, and Marcel A. Croon investigated the relationships among attachment styles, autonomy-connectedness (self-awareness, sensitivity to others, and capacity for managing new situations), alexithymia, and antisocial behaviour among 202 college students (67 men and 135 women).

• For men, anxious attachment had a stronger direct and positive effect on antisocial behaviour than for women, and the positive effect of anxious attachment on passive-aggressive behaviour was smaller for women than for men. Interestingly, capacity for managing new situations had a main and mediating effect on antisocial behaviour. Sensitivity to others appeared as a mediator between anxious attachment style and passive-aggressive behaviour. Contrary to expectations, fantasizing (a component of alexithymia) had a strong, negative association with antisocial behaviour.

• Concerning the assumption that antisocial behaviour might be affected by extreme tendencies toward detachment and separation, several sources of support can be mentioned: Allen and colleagues (2002) found that the acquisition of autonomy forms a threat to preoccupied, insecurely attached individuals and causes dysfunctional and angry behaviour.

• Second, various longitudinal studies found that antisocial adolescents show specific affective-interpersonal characteristics, such as superficial charm, emotional insensitivity, callousness, and a lack of feelings of guilt and empathy (Hare, 1993, 1999), in other words, low sensitivity to others.

• Hare also found that antisocial individuals are often found to be grandiose, egocentric, arrogant, and insensitive and to show only superficial emotions. Hare thus states that antisocial individuals fail to experience or appreciate the emotional meaning of situations, in other words, they exhibit low self-awareness (Hare, 1999).

References

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2. Bennett, P. (2006). Abnormal and Clinical Psychology. New York: Open University Press.

3. Carr, A. (2001). Abnormal Psychology. USA: Psychology Press.4. Cloninger, C. Robert - Biosocial Theory of Personality. (2008)

from wikidot.com: http://paei.wikidot.com/cloninger-c-robert-biosocial-theory-of-personality

5. Davila, J., Ramsay, M., Stroud, C. B., & Steinberg, S. J. (n.d.). Attachment as a Vulnerability to the development of Psychopathology.

6. O'Donohue, W., Fowler, K. A., & Lilienfeld, S. O. (2007). Personality Disorders: Towards the DSM 5. California: Sage Publications.

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8. Preiss M., Klose J. (2001) Personality disorders diagnostics through the C.R.Cloninger’s theory. Proceedings 37th IAMPS, Prague, 21-25 May 2001, 175-181

9. World Health Organization. (1992). ICD-10. Switzerland: World Health Organization.

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