PowerPoint Lecture Notes Presentation Chapter 12 Personality Disorders Abnormal Psychology,...

PowerPoint Lecture Notes Presentation Chapter 12

Personality Disorders

Abnormal Psychology, Eleventh Editionby

Ann M. Kring, Gerald C. Davison, John M. Neale, & Sheri L. Johnson

Copyright 2009 John Wiley & Sons, NY 2

Personality Disorders (PD) Longstanding, pervasive, inflexible patterns of behavior

and inner experience Patterns present in at least 2 areas:

» Cognition» Emotions» Relationships» Impulse control

Coded on Axis II Often comorbid with Axis I disorders

» More severe symptoms and poorer outcome when comorbid– 50+% of people diagnosed with a personality disorder meet

criteria for another personality disorder– More than two-thirds meet lifetime criteria for an Axis I disorder

(Lenzenwenger et al., 2007)


Table 12.1 Key Features of the DSM-IV-TR Personality Disorders

Table 12.2 Rates of DSM-IV Personality Disorders in the

Community and in Treatment Settings



Table 12.3 Interrater Reliability for the Personality Disorders


Classifying Personality Disorders DSM-IV-TR categorical approach Classifies in 3 clusters:

» Cluster A Odd/Eccentric» Cluster B Dramatic/Erratic» Cluster C Anxious/Fearful

Diagnostic reliability» Initially poor; improved since DSM-III

Test-retest reliability (diagnostic stability)» ½ of those initially diagnosed with PD did not receive same

diagnosis 1 year later (Shea et al., 2002) Gender bias

» Certain diagnoses applied more often to men, others to women


Figure 12.1 Test–retest stability for personality disorders and major

depressive disorder across 6-, 12-, and 24-month follow-up interviews


Dimensional Approach: Five-Factor Model

Five-factor model (McCrae & Costa, 1990)» Neuroticism, extraversion/introversion, openness

to experience, agreeableness/antagonism, and conscientiousness

» Five factors are heritable Personality traits form a continuum

» Individuals with PDs endorse the extremes Dimensional approach involves rating each

individual on the five factors» Avoids applying a categorical label which may not

completely fit


Dimensional Approach: Five-Factor Model

Most personality disorders are characterized by high neuroticism and antagonism.

High extraversion tied to histrionic and narcissistic disorders (involve dramatic behavior)

Low extraversion linked to disorders that involve social isolation, such as schizoid, schizotypal, and avoidant personality disorders


Table 12.4 Sample Items from the Revised NEO Personality Inventory assessing Five-

Factor Model


Odd/Eccentric Cluster: Paranoid Personality Disorder

Suspicious» Secretive; reluctant to

confide in others Expects to be

mistreated/exploited» Vigilant for hints of abuse

Blames others when things go wrong

Questions loyalty No hallucinations or full

blown delusions

More common in men than women

Cormorbidity high for» Schizotypal» Borderline » Avoidant


Odd/Eccentric Cluster: Schizoid Personality Disorder

Avoids close interpersonal relationships» Few close friends» Aloof & distant

Loner» Likes solitary activities

Rarely report strong emotions

Little interest in sex Experiences anhedonia

Comorbidity high for» Schizotypal» Avoidant » Paranoid


Odd/Eccentric Cluster: Schizotypal Personality Disorder

Interpersonal difficulties similar to schizoid Odd beliefs or magical thinking

» Superstitious» Telepathic

Illusions» Feels the presence of a force or person not actually present.

Odd/eccentric behavior or appearance» Wears strange clothes» Talks to self

Ideas of reference


Etiology of the PDS in Odd/Eccentric Cluster

Highly heritable Links to schizophrenia

» Relatives of individuals with schizophrenia at greater risk for schizotypal

» Individuals with schizotypal PD show problems similar to those found in schizophrenia

– Cognitive and neuropsychological deficits

– Enlarged ventricles

– Less temporal gray matter


Dramatic/Erratic Cluster: Borderline Personality Disorder (BPD)

Impulsive, self-damaging behaviors Unstable, stormy, intense relationships Emotional reactivity Frantic efforts to avoid abandonment Unstable sense of self Anger control problems Chronic feelings of emptiness Recurrent suicidal gestures Transient psychotic or dissociative symptoms


Dramatic/Erratic Cluster: Borderline Personality Disorder (BPD)

Onset during adolescence or early adulthood Prognosis poor within 10 years of diagnosis

» Later in life, most no longer meet diagnostic criteria (Paris, 2002)

Cormorbidity high with PTSD, MDD, substance-related, and eating disorders» Comorbidity predicts symptoms 6 years later

Suicide rates high» Self-mutilation also a problem


Etiology of Borderline Personality Disorder (BPD): Neurobiological factors

Genetic component» Highly heritable» May play a role in impulsivity and emotional

dysregulation Decreased functioning of serotonin

system Frontal lobe dysfunction Increased activation of amygdala


Etiology of Borderline Personality Disorder (BPD): Social Environmental Factors

Parental separation Verbal and emotional abuse during childhood Object-Relations Theory (Kernberg, 1985)

» Introjection » Object-representation

– BPD involves disturbed object representations, possibly due to inconsistent parenting

» Conflict between introjected values and current needs– Splitting


Etiology of Borderline Personality Disorder (BPD): Social Environmental Factors

Linehan’s Diathesis-Stress Theory» Individuals with BPD have difficulty controlling

their emotions– Possible biological diathesis

» Family invalidates or discounts emotional experiences and expression

» Interaction between extreme emotional reactivity and invalidating family → BPD


Figure 12.2 Linehan’s Diathesis-Stress Theory of BPD


Dramatic/Erratic Cluster: Histrionic Personality Disorder

Formerly known as hysterical personality Overly dramatic and attention seeking behavior Craves attention

» Loves to be in the spotlight Emotionally shallow despite strong displays of

emotion Easily influenced by others Overly concerned with physical attractiveness May be sexually provocative and seductive


Etiology of Histrionic Personality Disorder

Psychoanalytic theory» Emotional displays and seductiveness

result from parental seductiveness– Father’s sexual attention towards daughter

» Conflicting family attitudes towards sexuality

– Negative attitudes towards sex while simultaneously acknowledging titillation

Theory untested


Dramatic/Erratic Cluster: Narcissistic Personality Disorder

Grandiose view of self» Preoccupied with fantasies of success

Self-centered» Demands constant attention and adulation

Feelings of entitlement and arrogance Envious of others Little concern for needs and well being of others

» Lacks empathy Sensitive to criticism Seeks out high-status partners


Etiology of Narcissistic Personality Disorder

Kohut’s Self-Psychology Model» Characteristics mask low self-esteem» In childhood, narcissist valued as a means to increase

parent’s own self-esteem– Not valued for his or her own competency and self worth

» People with high levels of narcissism report cold parents who overemphasized child’s achievement

Social cognitive model» Narcissist has low self esteem» Sense of self depends on “winning”» Interpersonal relationships are a way to bolster sagging self

esteem rather than increase closeness to others» Lab studies reveal cognitive biases that maintain narcissism


Dramatic/Erratic Cluster: Antisocial Personality Disorder

Pervasive disregard for the rights of others since age 15» Lies» Aggression » Impulsiveness» Violates the law» Irresponsible » Lacks remorse

Conduct disorder before age 15» Truancy, running away, lying, theft, arson, destruction of

property Substance abuse most common comorbid

disorder Culture plays a role

» More common in US than Scotland More common among lower SES groups


Dramatic/Erratic Cluster: Antisocial Personality Disorder

Psychopathy (sociopathy) (Cleckley, 1941)

Predates DSM-IV-TR category

Focuses on internal thoughts and feelings» Poverty of emotion

– Negative emotions Lacks shame and anxiety

– Positive emotions Used to manipulate

others

» Impulsivity– Behave irresponsibly for

thrills

Psychopathy Checklist – revised (Hare, 2008)» Interpersonal

symptoms– Pathological lying,

manipulativeness, and charm

» Affective symptoms– Lack of remorse and

empathy, shallow affect Onset before age 15

not required.


Etiology of Antisocial Personality Disorder

Genetics» Antisocial behavior heritable

– Estimates as high as .96

» Genetic risk for APD, psychopathy, conduct disorder, and substance abuse related.

Family environment» Lack of warmth, negativity, and parental

inconsistency predict APD» Poverty, exposure to violence» Family environment interacts with genetics


Etiology of Antisocial Personality Disorder

Emotion and psychopathy» Lack of fear or anxiety» Low baseline levels of skin

conductance» Skin conductance

reactivity at age 3 predicted APD at age 28 (Glenn et al., 2007)

Makes it difficult for them to avoid behavior that leads to punishment

Also show less SCR to other’s distress» Lack empathy

Figure 12.3


Anxious/Fearful Cluster: Avoidant Personality Disorder

Avoids interpersonal situations» Fears criticism or rejection

Hesitant about involvement with others» Wants to be certain of acceptance

Restrained and inhibited in interpersonal situations » Fears ridicule» Feelings of inadequacy

Avoids taking risks or trying new activities » Doesn’t want to risk embarrassment

High comorbidity with major depression and generalized social phobia» Related toJapanese syndrome called taijin kyofusho (taijin

means “interpersonal” and kyofusho means “fear”).


Anxious/Fearful Cluster: Dependent Personality Disorder

Lack of self confidence Excessive reliance on others Intense need to be cared for Uncomfortable when alone Feels helpless to care for self Behavior focused on maintaining relationships Quickly initiates new relationship if current one

fails Prevalence higher in India and Japan than US


Anxious/Fearful Cluster: Obsessive-Compulsive Personality Disorder

A perfectionist Preoccupied with rules, details, & organization Rigid and inflexible Overly focused on work

» Little time for leisure, family, & friends Tendency to hoard

» Difficulty discarding worthless items Reluctant to delegate Moral inflexibility Does not have the obsessions/compulsions of OCD Most frequently comorbid with Avoidant PD


Etiology of Personality Disorders in the Anxious/Fearful Cluster

Not much available research Avoidant PD

» Overly protective and authoritarian parents Obsessive-Compulsive PD

» Fixation at anal stage of development (Freud)» More recent theorists

– Cope with fears of losing control by overcompensation Dependent PD

» Disruption of early childhood attachment by death, neglect, rejection, or overprotectiveness


Treatment of Personality Disorders

Axis I disorder usually drives individual to treatment» Presence of PD, reduces success of treatment for Axis I

Medications» Avoidant PD

– Antianxiety medication or antidepressants» Schizotypal PD

– Antipsychotic medications Psychotherapy

» Psychodynamic– Seek awareness of early childhood problem

» Cognitive behavioral– Break personality disorder down into discrete problems

Treat sensitivity to criticism with social skills training


Table 12.5 Maladaptive Cognitions Associated with Personality Disorders


Treatment of Borderline PD

Difficult to treat » Interpersonal problems play out in therapy» Attempts to manipulate therapist

Object Relations Therapy (Kernberg et al., 1985) Dialectical Behavioral Therapy (Linehan, 1987)

» Acceptance and empathy plus CBT, emotion regulation, and social skills

Schema-Focused Cognitive Therapy for BPD» Identify maladaptive assumptions that underlie cognitions

Medications» Antidepressants» Antipsychotics

– Olanzapine


Treatment of Psychopathy

Intensive psychoanalytic therapy Cognitive behavioral therapy Issue remains

» Are therapy successes ‘faking good’ or genuinely improved?


COPYRIGHT

Copyright 2009 by John Wiley & Sons, New York, NY. All rights reserved. No part of the material protected by this copyright may be reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording or by any information storage and retrieval system, without written permission of the copyright owner.

PowerPoint Lecture Notes Presentation Chapter 12 Personality Disorders Abnormal Psychology,...

Documents

Transcript of PowerPoint Lecture Notes Presentation Chapter 12 Personality Disorders Abnormal Psychology,...