Chapter 12Chapter 12 Personality Disorders Personality Disorders

Amber GilewskiAmber Gilewski

Tompkins Cortland Community CollegeTompkins Cortland Community College

Personality Disorders: OverviewPersonality Disorders: Overview

The Nature of Personality DisordersThe 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?

Personality Disorders: ClustersPersonality Disorders: Clusters

Cluster ACluster A – Odd or eccentric

(Paranoid, Schizoid, Schizotypal)

Cluster BCluster B – Dramatic, emotional, erratic

(Antisocial, Borderline, Histrionic, Narcissistic)

Cluster CCluster C – Fearful or anxious

(Avoidant, Dependent, Obsessive-Compulsive)

Personality Disorders: Personality Disorders: Statistics & DevelopmentStatistics & Development

Prevalence of Personality DisordersPrevalence 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 DisordersOrigins and Course of Personality Disorders

Thought to begin in childhood

Tend to run a chronic course

Comorbidity rates are high

Personality Disorders: Diagnoses & Personality Disorders: Diagnoses & Gender DifferencesGender 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

Paranoid Personality DisorderParanoid 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

Schizoid Personality DisorderSchizoid 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

Schizotypal Personality DisorderSchizotypal 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

Antisocial Personality Disorder: Antisocial Personality Disorder: CharacteristicsCharacteristics

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 prognosishttp://en.wikipedia.org/wiki/Image:Ted_Bundy_3.jpg#file

Antisocial Personality Disorder: Antisocial Personality Disorder: Psychopathy & ASPDPsychopathy & 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

Antisocial Personality Disorder: Antisocial Personality Disorder: CausesCauses

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

Antisocial Personality Disorder: Antisocial Personality Disorder: TreatmentTreatment

Few seek treatment on their ownFew seek treatment on their own

Antisocial behavior is predictive of poor Antisocial behavior is predictive of poor prognosisprognosis

Emphasis is placed on prevention and Emphasis is placed on prevention and rehabilitationrehabilitation

Often incarceration is the only Often incarceration is the only viable alternativeviable alternative

Borderline Personality Disorder: Borderline Personality Disorder: CharacteristicsCharacteristics

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

Borderline Personality DisorderBorderline 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

Histrionic Personality DisorderHistrionic 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

Narcissistic Personality DisorderNarcissistic 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

Avoidant Personality DisorderAvoidant 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

Dependent Personality DisorderDependent 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

Obsessive-Compulsive Obsessive-Compulsive Personality DisorderPersonality 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