CHAPTER NINE Personality Disorders. What are Personality Disorders?What are Personality Disorders?...

CHAPTER NINECHAPTER NINE

Personality Disorders

Personality Disorders

• What are Personality Disorders?What are Personality Disorders?

• Classification of Personality DisordersClassification of Personality DisordersCategorical vs. Dimensional modelsCategorical vs. Dimensional models

• Features of Axis IIFeatures of Axis IIImplications for AssessmentImplications for Assessment

• Specific Disorders:Specific Disorders:Cluster ACluster ACluster B Cluster B Cluster CCluster C

Personality

• Most mental disorders are Most mental disorders are defined in terms of states: defined in terms of states: episodes of symptomsepisodes of symptoms

• Personality refers to Personality refers to enduring enduring traitstraits that are that are fairlyfairly stable over stable over time or make a person who time or make a person who s/he iss/he is

What are Personality Disorders?

• Enduring patterns of Enduring patterns of perceivingperceiving,, relating torelating to & & thinking aboutthinking about the the environment and oneself environment and oneself

– that are that are inflexibleinflexible and and pervasivepervasive

– and cause either and cause either significantsignificant functional impairmentfunctional impairment oror subjective distresssubjective distress

• AdvantagesAdvantages

Familiar & Familiar & convenientconvenient

Ease in Ease in communicationcommunication

Consistent with Consistent with clinical diagnosesclinical diagnoses

Categorical Classification of PDs (DSM)

Categorical Classification of PDs (DSM)

• DisadvantagesDisadvantages

low inter-rater reliabilitylow inter-rater reliability

very high comorbidityvery high comorbidity

high overlap among symptom criteriahigh overlap among symptom criteria

not based on a theoretical model not based on a theoretical model

ambiguity occurs regarding the ambiguity occurs regarding the presence vs. absence of a PDpresence vs. absence of a PD

most commonly diagnosed PD is PD-most commonly diagnosed PD is PD-NOSNOS

Dimensional Model of Personality

• Looks at a Looks at a continuumcontinuum of normal to of normal to abnormal personality abnormal personality – all individuals have some degree of all individuals have some degree of

these traits, but those with PDs have these traits, but those with PDs have maladaptive levelsmaladaptive levels

• Various dimensional models existVarious dimensional models exist– Five Factor Dimensional ModelFive Factor Dimensional Model

Normal Traits

Personality Disorder

trait

Five-Factor Model

• NeuroticismNeuroticism: expression of negative : expression of negative emotionsemotions

• ExtraversionExtraversion: : interest in interacting with interest in interacting with other people; positive emotionsother people; positive emotions

• OpennessOpenness: : willingness to consider and willingness to consider and explore unfamiliar ideas, feelings, and explore unfamiliar ideas, feelings, and activitiesactivities

• AgreeablenessAgreeableness: willingness to : willingness to cooperate and empathize with otherscooperate and empathize with others

• ConscientiousnessConscientiousness: persistence in : persistence in pursuit of goals; organization; pursuit of goals; organization; dependabilitydependability

Dimensional Model

• AdvantagesAdvantages Theoretical basisTheoretical basis Retention of information Retention of information

• Leads to less stereotypingLeads to less stereotyping• Adaptive traits are also highlightedAdaptive traits are also highlighted

Flexible Flexible Resolution of a variety of Resolution of a variety of classification dilemmas classification dilemmas • Avoids arbitrary assignment decisionsAvoids arbitrary assignment decisions• Addresses problems with comorbidity in Addresses problems with comorbidity in

the Categorical Modelthe Categorical Model• Higher inter-rater reliabilityHigher inter-rater reliability

Dimensional Model

DisadvantagesDisadvantages

Less familiar Less familiar

Lacks clinical applicationLacks clinical application

May be too complex May be too complex

Disagreement exists about Disagreement exists about preference of which dimensional preference of which dimensional model to usemodel to use

Features of Axis II

• Different etiology than Axis IDifferent etiology than Axis I– not always truenot always true

• More stable than Axis I disorders More stable than Axis I disorders or more resistant to treatmentor more resistant to treatment– however, some Axis I disorders are however, some Axis I disorders are

very stablevery stable– some PDs are treatablesome PDs are treatable

Features of Axis II

• Other disorders: Other disorders: ego-dystonicego-dystonic– personal distress, discomfort with personal distress, discomfort with

one’s symptomsone’s symptoms

• Personality disorders: Personality disorders: ego-syntonicego-syntonic – ideas and impulses do ideas and impulses do notnot bother the bother the

personperson

Assessment of PDs

• The ego-syntonic nature of The ego-syntonic nature of personality disorders can personality disorders can make them difficult to assess make them difficult to assess using traditional measuresusing traditional measures

• Others who have regular Others who have regular contact with an individual contact with an individual might be better judges of might be better judges of how that person’s behavior how that person’s behavior affects those around him/heraffects those around him/her

Culture and Personality

• Culture plays a large role in Culture plays a large role in determining what is determining what is appropriateappropriate or or acceptableacceptable at a given time and place at a given time and place

• Cultures may differ in:Cultures may differ in:

Degree of emotional Degree of emotional

expressionexpression

Individualism vs.Individualism vs.

collectivismcollectivism

Clusters of Personality Disorders

• Cluster ACluster A Paranoid PDParanoid PD

Schizoid PDSchizoid PD

Schizotypal PDSchizotypal PD

• Cluster BCluster B Narcissistic PD Narcissistic PD

Antisocial PDAntisocial PD

Histrionic PDHistrionic PD

Borderline PDBorderline PD

• Cluster CCluster C Avoidant PDAvoidant PD

Dependent PDDependent PD

Obsessive-Compulsive PDObsessive-Compulsive PD

Cluster A Personality Disorders

Characterized by odd, Characterized by odd, eccentric, and/or socially eccentric, and/or socially isolated behaviorisolated behavior Paranoid PDParanoid PD

Schizoid PDSchizoid PD Schizotypal PDSchizotypal PD

Paranoid Personality Disorder

• A pervasive distrust and suspiciousness of others such that their motives are interpreted as malevolent.

– Reluctant to confide in others

– Hold grudges– Finds threatening hidden meaning in benign comments– Doubt the loyalty and trustworthiness of others

• Requires 4 of the 7 possible criteria.

• Prevalence rates: 0.5 to 2.5 %Prevalence rates: 0.5 to 2.5 %

• More common in menMore common in men

• Unlikely to seek treatmentUnlikely to seek treatment

• Treatment –Treatment –

• Trusting atmosphereTrusting atmosphere• Cognitive therapy to correct Cognitive therapy to correct

cognitive errorscognitive errors

• Most therapists pessimisticMost therapists pessimistic

Paranoid Personality Disorder

Schizoid Personality Disorder

• A pervasive pattern of detachment from social relationships and a restricted range of expression of emotions in interpersonal settings

- Doesn’t desire or enjoy close relationships- Prefers solitary activities and takes pleasure in few things- Is indifferent to praise and

criticism

• Requires 4 of the 7 possible criteria

• Prevalence: < 1% Prevalence: < 1%

• More common in malesMore common in males

• Unlikely to seek Unlikely to seek treatmenttreatment

• Many therapists think Many therapists think schizoid untreatableschizoid untreatable

Schizoid Personality Disorder

Schizotypal Personality Disorder

• A pervasive pattern of interpersonal and social deficits marked by acute discomfort with, and reduced capacity for, close relationships as well as by cognitive or perceptual distortions and eccentricities of behavior

– Ideas of reference, magical thinking, and bodily illusions

– Suspiciousness/paranoid thinking– Inappropriate affect– Lack of close friends/confidants– Social anxiety

• Requires 5 of the 9 possible criteria

Prevalence: 3-5% Prevalence: 3-5%

More common in malesMore common in males

Schizotypal Personality Disorder

Schizotypal PD and Schizophrenia

• Individuals with schizotypal PD:Individuals with schizotypal PD:– Sometimes have a history of psychological trauma, Sometimes have a history of psychological trauma,

especially childhood maltreatmentespecially childhood maltreatment

– Are at an increased risk of developing schizophreniaAre at an increased risk of developing schizophrenia

– Are commonly relatives of Are commonly relatives of individuals with schizophreniaindividuals with schizophrenia• BUT…the vast majority of BUT…the vast majority of

individuals with Schizotypal PD individuals with Schizotypal PD still do NOT have relatives withstill do NOT have relatives with

schizophreniaschizophrenia

Individuals with

Schizotypal PDPeople with Schizophreni

a

Cluster B Personality Disorders

Characterized by overly dramatic, Characterized by overly dramatic, flamboyant, emotional, and/or flamboyant, emotional, and/or erratic behaviorerratic behavior Narcissistic PD Narcissistic PD

Antisocial PDAntisocial PD

Histrionic PDHistrionic PD

Borderline PDBorderline PD

Narcissistic Personality Disorder• A pervasive pattern of

grandiosity, need for admiration, and lack of empathy

– Preoccupied with fantasies– Associates only with high-

status others– Has a strong sense of

entitlement– Is interpersonally exploitative– Is envious and thinks others

are envious of him/her

• Requires 5 of the 9 possible criteria

Narcissistic Personality Disorder

• Prevalence: 1%Prevalence: 1%

• Link with poor parentingLink with poor parenting

• TreatmentTreatment• Little researchLittle research

• Cognitive therapy to Cognitive therapy to improve empathy & improve empathy & coping with criticismcoping with criticism

• Vulnerable to depressive Vulnerable to depressive episodes, may need episodes, may need treatment for depressiontreatment for depression

Histrionic Personality Disorder

• A pervasive pattern of excessive emotionality and attention seeking

– Inappropriately seductive/provocative– Impressionistic style of speech– Suggestible, easily influenced by others and

circumstances– Considers relationships more intimate than they really are

• Requires 5 of the 8 possible criteria

Histrionic Personality Disorder

• Prevalence: 2-3%Prevalence: 2-3%

• More common in femalesMore common in females

• Link with Antisocial PD?Link with Antisocial PD?

• TreatmentTreatment

• Behavior therapy and focus on Behavior therapy and focus on interpersonal relationsinterpersonal relations

• Generally poor prognosisGenerally poor prognosis

Borderline Personality Disorder

• A pervasive pattern of instability ofinterpersonal relationships, self-image, and affects, and marked impulsivity

– Fears of abandonment– Suicidal gestures or self-mutilation– Chronic feelings of emptiness– Stress-related paranoid ideation or severe

dissociative symptoms

• Requires 5 of the 9 possible criteria

Borderline Personality Disorder

• Prevalence: 2%Prevalence: 2%

• More common in femalesMore common in females

• Link to ASPDLink to ASPD

• Familial association w/ Familial association w/ BPD & mood disordersBPD & mood disorders

• Poor/abusive parentingPoor/abusive parenting

• Early traumaEarly trauma

• Challenges in treatmentChallenges in treatment

Antisocial Personality Disorder

• A pervasive pattern of disregard for and violation of the rights of others

– Performing acts that are ground for arrest– Deceitfulness– Impulsivity– Consistent irresponsibility– Lack of remorse

• Requires:– Age 18 or older– Evidence of Conduct Disorder by age 15

Antisocial Personality Disorder

• Conduct Disorder Conduct Disorder Antisocial Antisocial Prison Prison

• Often comorbid with substance abuseOften comorbid with substance abuse

• Poor prognosisPoor prognosis

• Prevalence: 3% in males, 1% in femalesPrevalence: 3% in males, 1% in females

• May “burn out” after age 40May “burn out” after age 40

Psychopathy

• Deceptiveness or duplicityDeceptiveness or duplicity

• Absence of empathy, Absence of empathy, compassion or remorse toward compassion or remorse toward the victims of the psychopath's the victims of the psychopath's exploitative self-interest.exploitative self-interest.

• Can often be charming and Can often be charming and appear socially well-adjusted. appear socially well-adjusted.

• May or may not engage in May or may not engage in criminal behavior.criminal behavior.

Antisocial PD and Psychopathy

• Earlier conceptualizations of ASPD Earlier conceptualizations of ASPD had a greater overlap with had a greater overlap with psychopathypsychopathy

• However, due to DSM-IV’s focus However, due to DSM-IV’s focus on observable behaviors, ASPD is on observable behaviors, ASPD is a distinct concept from a distinct concept from psychopathy (there is still some psychopathy (there is still some overlap)overlap)

• Psychopathy is a better predictor Psychopathy is a better predictor of recidivism than ASPDof recidivism than ASPD

Overlap between ASPD, Psychopathy, & Criminality

ASPD

Criminals

Psychopaths

15-25% of criminals are Psychopaths

75-85% of criminals have ASPD

20% of people with ASPD are Psychopaths

Overlap between ASPD, Psychopathy, & Criminality

ASPD

Criminals

Psychopaths

Criminal Behavior among Male Adoptees

0

10

20

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40

50

In adoptive family with noASPD

In adoptive family withASPD

Had biologicalparentswithout ASPD

Had biologicalparents withASPD

Social Factors & the Etiology of ASPD

• Inconsistent discipline (or complete Inconsistent discipline (or complete lack of discipline) often seen in the lack of discipline) often seen in the prior family history of ASPD men prior family history of ASPD men

• Kids with a “difficult temperament” are Kids with a “difficult temperament” are especially irritating to parentsespecially irritating to parents

• Parents respond inappropriately by Parents respond inappropriately by giving up or becoming severe in giving up or becoming severe in punishmentpunishment

• Person selects friends who share Person selects friends who share antisocial interests and problems antisocial interests and problems (‘skinheads’, gangs)(‘skinheads’, gangs)

Continuity in Life-Course-Persistent ASPD

• Person’s options become narrowed; Person’s options become narrowed; locked into further antisocial behaviorlocked into further antisocial behavior

• Limited range of behavioral skills (can’t Limited range of behavioral skills (can’t pursue more appropriate responses)pursue more appropriate responses)

• Ensnared by consequences of earlier Ensnared by consequences of earlier behaviors behaviors • drug addiction drug addiction • parenthood parenthood • school dropout school dropout • criminal recordcriminal record

Psychological Factors: the Etiology of ASPD

• Avoidance learning in the labAvoidance learning in the lab

• Psychopaths unaffected by Psychopaths unaffected by anticipation of punishmentanticipation of punishment

• Hypothesis 1: they can ignore Hypothesis 1: they can ignore the effects of punishment the effects of punishment ((emotional poverty)emotional poverty)

• Hypothesis 2: they have trouble Hypothesis 2: they have trouble shifting their attention shifting their attention ((impulsivity)impulsivity)

Cluster C Personality Disorders

Characterized by anxious Characterized by anxious or avoidant behaviorsor avoidant behaviors Avoidant PDAvoidant PD

Dependent PDDependent PD

Obsessive-Compulsive PDObsessive-Compulsive PD

Avoidant Personality Disorder• A pervasive pattern of social inhibition, feelings

of inadequacy, and hypersensitivity to negative evaluation

- Avoids interpersonal job activities

- Won’t get involved with others - Is preoccupied with criticism and rejection

- Views self as socially inept, personally unappealing, or

inferior to others- Won’t try new things in case

they are embarrassing

• Requires 4 of the 7 possible criteria

Avoidant Personality Disorder

• Prevalence: < 1%Prevalence: < 1%

• May have biological May have biological predisposition combined predisposition combined with poor learning history with poor learning history of early relationshipsof early relationships

• Can be considered a Can be considered a severe version of social severe version of social phobia, general typephobia, general type

Dependent Personality Disorder

• A pervasive and excessive need to be taken care of that leads to submissive and clinging behavior and fears of separation

– Has difficulty making everyday andmajor decisions

– Won’t express disagreement– Fails to initiate projects on own– Feels uncomfortable or helpless

when alone– Urgently seeks another relationship

when one ends

• Requires 5 of the 8 possible criteria

• Prevalence: 2% (no gender Prevalence: 2% (no gender difference)difference)

• May be linked to early neglect & May be linked to early neglect & disruptions in attachment patternsdisruptions in attachment patterns

• Treatment -- little research, must Treatment -- little research, must make sure client does not make sure client does not become dependent on therapist!become dependent on therapist!

Dependent Personality Disorder

Obsessive-Compulsive PD

• A pervasive pattern of preoccupation with orderliness, perfectionism, and mental and interpersonal control, at the expense of flexibility, openness, and efficiency

– Preoccupied with rules, lists, details– Neglects family/friends because of

devotion to work– Is overconscientious about rules,

ethics, values– Cannot discard worthless objects– Hoards money in case of disaster– Refuses to delegate tasks to others

• Requires 4 of the 8 possible criteria

Obsessive-Compulsive PD

• Prevalence: 1% Prevalence: 1%

• More common in malesMore common in males

• Don’t confuse with OCDDon’t confuse with OCD• Some behaviors look similar Some behaviors look similar

but OCD is ego-dystonic, but OCD is ego-dystonic,

OCPD is ego-syntonicOCPD is ego-syntonic

• Treatment addressesTreatment addresses• Fears underlying need for order & controlFears underlying need for order & control• Distraction & relaxation techniquesDistraction & relaxation techniques

Prevalence & Course: PD Summary

• PDs often originate in childhood & PDs often originate in childhood & become ingrained by adulthoodbecome ingrained by adulthood

• Overall prevalence rate of 10-14%Overall prevalence rate of 10-14%

• Course & prognosis depend on Course & prognosis depend on disorder, but prognosis is disorder, but prognosis is generally poorgenerally poor

Optional Slides

Five-Factor Model

• NeuroticismNeuroticism: expression of negative : expression of negative emotionsemotions

• ExtraversionExtraversion: : interest in interacting with interest in interacting with other people; positive emotionsother people; positive emotions

• OpennessOpenness: : willingness to consider and willingness to consider and explore unfamiliar ideas, feelings, and explore unfamiliar ideas, feelings, and activitiesactivities

• AgreeablenessAgreeableness: willingness to : willingness to cooperate and empathize with otherscooperate and empathize with others

• ConscientiousnessConscientiousness: persistence in : persistence in pursuit of goals; organization; pursuit of goals; organization; dependabilitydependability

Practice Example (kinda)

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Paranoid PD: Five Factor Profile

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Schizoid PD: Five Factor Profile

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Schizotypal PD: Five Factor Profile

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Narcissistic PD: Five Factor Profile

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Histrionic PD: Five Factor Profile

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Histrionic PD: Five Factor Profile

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Borderline PD: Five Factor Profile

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Borderline PD: Five Factor Profile

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Antisocial PD: Five Factor Profile

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Avoidant PD: Five Factor Profile

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Dependent PD: Five Factor Profile

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Dependent PD: Five Factor Profile

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OCPD: Five Factor Profile

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Why care about PDs?

• PDs are associated with significant PDs are associated with significant impairment (e.g., social impairment)impairment (e.g., social impairment)

• Presence of pathological personality Presence of pathological personality traits as an adolescent is associated traits as an adolescent is associated with increased risk for the later with increased risk for the later development of other mental disordersdevelopment of other mental disorders

• Sometimes, PDs represent the Sometimes, PDs represent the beginning stages of the onset of a beginning stages of the onset of a more serious disordermore serious disorder

How do we describe PDs?

• Axis II — chronic and long termAxis II — chronic and long term

• Tend to irritate people around Tend to irritate people around themthem

• Difficult to maintain personal Difficult to maintain personal relationshipsrelationships

Peer Nomination

• Done with groups of individualsDone with groups of individuals

• Members of a group are asked to Members of a group are asked to name individuals in the group who name individuals in the group who have high levels of a particular traithave high levels of a particular trait

• Studies have found that Studies have found that informantsinformants are more willing to identify the are more willing to identify the negative aspects of personality than negative aspects of personality than individuals are to self-report themindividuals are to self-report them

• SS stubborn, sarcastic, hostilestubborn, sarcastic, hostile

• UU unforgiving - bears grudges unforgiving - bears grudges

• SS suspicious (of others) suspicious (of others)

• PP perceives attacks (reacts quickly) perceives attacks (reacts quickly)

• EE enemy in everyone (suspects all) enemy in everyone (suspects all)

• CC confiding in others is feared confiding in others is feared

• TT threats seen in benign eventsthreats seen in benign events

Paranoid Personality Disorder

• SS shows emotional coldness shows emotional coldness • OO omits close relationships omits close relationships • LL lacks close friends or confidants lacks close friends or confidants • II involved in solitary activities involved in solitary activities • TT takes pleasure in few activities takes pleasure in few activities • AA appears indifferent to praise or appears indifferent to praise or

criticism criticism • RR restricted interest in sexual restricted interest in sexual

experiences experiences • YY yanks himself or herself from yanks himself or herself from

social relationships social relationships

Schizoid Personality Disorder

• MM magical thinking, superstitious, paranormalmagical thinking, superstitious, paranormal • EE eccentric behavior or appearanceeccentric behavior or appearance

• PP paranoid ideation (suspicious)paranoid ideation (suspicious)• EE experiences unusual perceptions experiences unusual perceptions • CC constricted affect constricted affect • UU unusual thinking & speech unusual thinking & speech • LL lacks friends lacks friends • II ideas of reference ideas of reference • AA anxiety (socially) anxiety (socially) • RR rule out psychotic disorders & PDDrule out psychotic disorders & PDD

Schizotypal Personality Disorder

• WW wants special treatment from others wants special treatment from others

• OO overestimates abilities, boastful overestimates abilities, boastful

• RR requires excessive admirationrequires excessive admiration

• SS strong sense of entitlementstrong sense of entitlement

• HH has grandiose sense of self-importancehas grandiose sense of self-importance

• II insists on only being affiliated with insists on only being affiliated with important people and institutionsimportant people and institutions

• PP preoccupied with fantasies of preoccupied with fantasies of brilliance, beauty or ideal lovebrilliance, beauty or ideal love

• MM Machiavellian attitudeMachiavellian attitude

• EE envious of othersenvious of others

Narcissistic Personality Disorder

Histrionic Personality Disorder

• PP provocative or seductive behavior provocative or seductive behavior • RR relationships, considered more relationships, considered more

intimate than they are intimate than they are • AA attention (must be the center of)attention (must be the center of)• II influenced easilyinfluenced easily• SS speech style – impressionisticspeech style – impressionistic• EE emotional lability, shallownessemotional lability, shallowness

• MM make-up, draws attention to selfmake-up, draws attention to self• EE exaggerated emotions, theatricalexaggerated emotions, theatrical

• PP paranoid ideasparanoid ideas

• RR relationship instability relationship instability

• AA angry outbursts, abandonment angry outbursts, abandonment fears, affective instabilityfears, affective instability

• II impulsive behavior, identity impulsive behavior, identity disturbance disturbance

• SS suicidal behavior suicidal behavior

• EE emptinessemptiness

Borderline Personality Disorder

• CC cannot follow lawcannot follow law

• OO obligations ignored obligations ignored

• RR remorselessness remorselessness

• RR recklessness recklessness

• UU underhandedness (deceitful) underhandedness (deceitful)

• PP planning deficit planning deficit

• TT tempertemper

Antisocial Personality Disorder

• AA avoids occupational activities avoids occupational activities • VV views self as socially inept views self as socially inept • OO occupied with being criticized or occupied with being criticized or

rejected (insecure)rejected (insecure)• II inhibited in new interpersonal inhibited in new interpersonal

situations (afraid around others)situations (afraid around others)• DD denies involvement with people denies involvement with people • EE embarrassed by engaging in new embarrassed by engaging in new

activities activities • RR reluctant to get involved in reluctant to get involved in

intimate intimate relationshipsrelationships

Avoidant Personality Disorder

• DD difficulty making everyday decisions difficulty making everyday decisions • EE excessive lengths to obtain nurturanceexcessive lengths to obtain nurturance• PP preoccupied with fears of being left to preoccupied with fears of being left to

take care take care • EE exaggerated fears of being unable to exaggerated fears of being unable to

care for himself or herself care for himself or herself • NN needs others to assume responsibility needs others to assume responsibility • DD difficulty expressing disagreement difficulty expressing disagreement • EE end of one relationship is the end of one relationship is the

beginning of another relationship beginning of another relationship • NN noticeable difficulties in initiating noticeable difficulties in initiating

projects (low self-confidence)projects (low self-confidence)• TT “take care of me” is his or her motto “take care of me” is his or her motto

Dependent Personality Disorder

• PP preoccupation with details, rules, preoccupation with details, rules, order, organization or schedulesorder, organization or schedules

• EE excessive devotion to work and excessive devotion to work and productivityproductivity

• RR reluctance to work with others reluctance to work with others unless they give up complete controlunless they give up complete control

• FF frugal (miserly spending style frugal (miserly spending style toward toward both self and others)both self and others)

• EE excessive rigidity and excessive rigidity and stubbornness stubbornness

• CC concentrate on details; completion concentrate on details; completion of of tasks is problematictasks is problematic

• TT time is poorly allocatedtime is poorly allocated

Obsessive-Compulsive PD

• The vast majority of individuals with The vast majority of individuals with schizotypal PD do schizotypal PD do notnot have relatives have relatives with schizophreniawith schizophrenia

• Schizotypal PD associated with Schizotypal PD associated with history of psychological trauma, history of psychological trauma, especially childhood maltreatment especially childhood maltreatment (this is (this is notnot true for schizophrenia) true for schizophrenia)

• There may be two distinct pathways There may be two distinct pathways to schizotypal PDto schizotypal PD– genes associated with schizophreniagenes associated with schizophrenia– psychological traumapsychological trauma

Schizotypal PD and Schizophrenia

Individuals with

Schizotypal PD

People with Schizophrenia

Continuity: Life-Course-Persistent

ADOLESCENCEADOLESCENCE

AGEAGE

PRESCHOOPRESCHOOLL

Diffi

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(Loeber, (Loeber, 1990)1990)

Developmental Stacking

BRAIN BRAIN DAMAGEDAMAGE

HYPERACTIVIHYPERACTIVITYTY

OPPOSITIONAL OPPOSITIONAL PROBLEMSPROBLEMS

AGGRESSIVE AGGRESSIVE BEHAVIORSBEHAVIORS

MOTHERMOTHER’S ’S

DRUG DRUG USEUSE

POOR SOCIAL POOR SOCIAL SKILLSSKILLS

PEER PEER PROBLEMPROBLEM

DELINQUENDELINQUENCYCY

TIMETIME

Loeber, 1990Loeber, 1990

According to your book, the enduring deviant patterns of experience and behavior that mark PDs must be present in how many domains?

• A. 1• B. 2• C. 3• D. 4• E. 5

Correct Answer = B

What are some of these domains?

In what area of functioning to do we often see thegreatest impairment in PDs? What about PDs makesthis impairment so important to consider?

What is another name sometimes given to Cluster A PDs?

• A. Dramatic, Emotionally Unstable Disorders

• B. Anxious, Avoidant Disorders• C. Bizarre, Mistrusting Disorders• D. Schizophrenia Spectrum Disorders• E. Bizarre Spectrum Disorders

Correct Answer = D

Why is this alternative name reasonable for Cluster A PDs?

In what ways are each of the Cluster A PDs similar to Schizophrenia? In what ways are they distinct from each other?

One of these things is not like the others…

Which of the following would not be seen in Paranoid PD?

• A. pervasive mistrust of others• B. strong desire for autonomy• C. finding pleasure in few activities• D. an inability to forgive others• E. hostility

Correct Answer = C

Which Cluster A PD is characterized by finding little pleasure in activities?

One of these things is not like the others…

Which of the following would not be seen in Narcissistic PD?

• A. dramatic attention-seeking behaviors

• B. presenting a grandiose self-concept

• C. lack of empathy• D. upward comparisons to famous

people• E. disappointment in response to a

lack of praise

Correct Answer = A

In which Cluster B PD do we usually see dramatic attention-seeking behaviors?

Why is it important that, in option B, I wrote “presenting a grandiose self-concept?

One of these things is not like the others…

Which of the following would not be found in Borderline PD?

• A. identity disturbance/unstable self-concept

• B. fears of abandonment• C. lack of remorse• D. parasuicidal behaviors• E. short-lived dissociative symptoms

Correct Answer = C

What are parasuicidal behaviors? How are these behaviors hypothesized to be connected to dissociative symptoms in BPD?

Which of the following is not a benefit of the dimensional approach to classifying PDs?

• A. it enables us to be more strengths-focused in our treatment

• B. it makes it easier to discuss personality issues with clients

• C. it has a better theoretical and empirical basis than the current categories

• D. it has higher inter-rater reliability• E. it is very familiar to most practicing

cliniciansCorrect Answer = E

What are some of the other disadvantages of the dimensional approach?

What are the advantages and disadvantages of the categorical approach?

Is APD redundant with Generalized Social Phobia?

• Social Phobia Generalized Social Phobia APD

• Who tends to suggest that APD is unnecessary?• What do they suggest should be done with the APD

category?– Are these fair or reasonable suggestions?

• What is it that most psychologists don’t know?– Why aren’t they aware of this information?

The dimensions of DPD

• Previous research suggests that DPD is actually bidimensional– Dependence/Incompetence– Dysfunctional or Insecure Attachment

• Different relationships to other PDs

• Implications– Necessity of different treatment approaches– More evidence of comorbidity and symptom

overlap problems

Do Cluster C PDs belong together?

• The research and clinical opinions are a bit mixed.– OCPD is sometimes separate– DPD is bidimensional– There is evidence of a common latent trait

• Seems to center around issues with criticism

• Research on how these disorders both do and do not overlap is still sorely needed

Special TopicSpecial Topic

Understanding Psychopathy

Psychopaths vs. Sociopaths

Paranoid Personality Disorder

Pervasive, extreme Pervasive, extreme mistrust mistrust

Often hostile Often hostile

Suspicious and perceive Suspicious and perceive others’ motives as others’ motives as malevolentmalevolent

Familial association with Familial association with Delusional DisorderDelusional Disorder

Schizoid Personality Disorder

Aloof, coldAloof, cold

Detached from social Detached from social relationsrelations

Restricted experience Restricted experience or range of emotionor range of emotion

NotNot distressed by lack distressed by lack of social contactof social contact

Behavioral eccentricitiesBehavioral eccentricities

Cognitive or perceptual Cognitive or perceptual distortionsdistortions Ideas of referenceIdeas of reference Magical thinkingMagical thinking IllusionsIllusions

Discomfort with close Discomfort with close relationshipsrelationships

Schiztypal Personality Disorder

Narcissistic Personality Disorder

GrandioseGrandiose

Self-absorbedSelf-absorbed

Lack empathyLack empathy

Need admirationNeed admiration

Exploit othersExploit others

Envious, arrogantEnvious, arrogant

Sensitive to criticismSensitive to criticism

Histrionic Personality Disorder

• Excessive emotionalityExcessive emotionality

• Need to be center of Need to be center of attentionattention

• ProvocativeProvocative

• DramaticDramatic

Borderline Personality Disorder

• Fear of abandonment Fear of abandonment

• Unstable interpersonal Unstable interpersonal relationsrelations

• Unstable self-image or Unstable self-image or identityidentity

• Chronic feelings of Chronic feelings of emptinessemptiness

• Affective instability or Affective instability or reactivity of moodreactivity of mood

Borderline Personality Disorder

• ImpulsiveImpulsive

• Inappropriate and intense Inappropriate and intense angeranger

• Transient, stress-related Transient, stress-related dissociative symptoms dissociative symptoms

• Self-mutilation and Self-mutilation and suicidal gesturessuicidal gestures

Antisocial Personality Disorder

Persistent violation of Persistent violation of others’ rightsothers’ rights

ImpulsiveImpulsive

DeceitfulDeceitful

Lack of remorseLack of remorse

Difficulty learning lessonsDifficulty learning lessons

Must be 18Must be 18

Avoidant Personality Disorder

Fear of negative Fear of negative evaluationevaluation

Feelings of inadequacyFeelings of inadequacy

Social inhibition and Social inhibition and interpersonal avoidanceinterpersonal avoidance

Want contact with Want contact with others but are afraid of others but are afraid of criticism criticism

Dependent Personality Disorder

Excessive need to be cared Excessive need to be cared forfor

SubmissiveSubmissive

ClingingClinging

Fears of separationFears of separation

Overly eager to pleaseOverly eager to please(responds to criticism by clinging)(responds to criticism by clinging)

Preoccupied with:Preoccupied with:• DetailsDetails• Orderliness Orderliness • PerfectionismPerfectionism• ControlControl

Excessively devoted to workExcessively devoted to workInflexibleInflexible

• Often interferes with task Often interferes with task completioncompletion

Obsessive-Compulsive PD