Personality Disorders

SymptomsDiagnosisFrequency

Personality: enduring patterns of thinking and behavior that define the person and distinguish him or her from other people.

Personality disorder - emphasizes the duration of the pattern and the social impairment associated with the traits in question.

Disorders characterized by extreme and rigid personality traits that cause impairment

Axis II disorders Ego syntonic

The concept of social dysfunction plays an important role.

If the personality characteristics typically interfere with the person’s ability to get along with other people and perform social roles, they become more than just a collection of eccentric traits or peculiar habits.

Social MotivationMotives describe the way that the person would like things to be, and they help to explain why people behave in a particular fashion.

Two of the most important motives in understanding human personality areaffiliation—the desire for close relationships with other people.

power—the desire for impact, prestige, or dominance.

Social MotivationMany of the symptoms of personality disorders can be described in terms of maladaptive variations with regard to needs for affiliation and power.

Cognitive Perspectives Regarding Self and OthersOne central issue involves our image of ourselves.Is the self-image stable?Is self-esteem maintained by external validation?

Prevalence in Community and Clinical SamplesThe overall lifetime prevalence for

having at least one personality disorder varies between 10% and 14%.

Highest prevalence rates for OCPD, ASPD, and APD.

75% of patients with Axis II disorder also have Axis I disorder.

Low rates for NPD may not recognize the nature of their own problems.

Gender DifferencesThe overall prevalence of

personality disorders is approximately equal in men and women.

Antisocial personality disorder: 5% reported for men and 1% for women

Gender Bias and DiagnosisCritics contend that the definitions

of some categories are based on sex role stereotypes and therefore are inherently sexist.

Stability of Personality Disorders over TimeTemporal stability is one of the most

important assumptions about personality disorders.

The long-term prognosis is less optimistic for schizotypal and schizoid personality disorders. People with these diagnoses are likely to remain socially isolated and occupationally impaired.

Cluster A are people who are perceived as odd or eccentric

Includes paranoid, schizoid, and schizotypal personality disorders

Cluster B are people whose behavior is overly dramatic, emotional, or erratic

Includes antisocial, borderline, histrionic and narcissistic personality disorders

Cluster C are people who often appear anxious or fearful

Includes avoidant, dependent, and obsessive-compulsive personality disorders

Paranoid Personality Disorder

Personality traits involving extreme distrust and suspiciousness.

Paranoid Personality Disorder Includes four or more of the following:

Suspiciousness of others Unjustified doubts about disloyalty Reluctance to confide in others Reading threatening meanings into benign events Persistent tendency to bear grudges Tendency to feel attacked and counterattack Unjustified suspiciousness about infidelity of partner

Schizoid Personality DisorderPersonality traits involving detachment from social relationships and a restricted range of emotional expression

Schizoid Personality Disorder Include four or more of the following:

Neither desires nor enjoys close relationshipsAlmost always chooses solitudeLittle if any interest in sexual relationshipsTakes pleasure in few activitiesLacks close friendsIndifferent to praise or criticismEmotional coldness, detachment or flatness

Schizotypal Personality Disorder

Personality traits involving eccentricities of behavior, cognitive or perceptual distortions, and acute discomfort in close relationships

Schizotypal Personality DisorderFive or more of the following:

Ideas of referenceOdd beliefs or magical thinkingUnusual perceptual experiencesOdd thinking and speechSuspiciousness or paranoid ideasInappropriate or constricted affectOdd, eccentric or peculiar behavior or appearanceLack of close friendsExcessive social anxiety

Antisocial Personality DisorderPersonality traits

involving profound disregard for, and violation of, the rights of others

Antisocial Personality DisorderIncludes three or more of the following:Failure to conform to lawful behaviorDeceitfulnessImpulsivityIrritability or aggressivenessReckless disregard for safety of self and

othersConsistent irresponsibilityLack of remorse

Borderline Personality Disorder

Personality traits involving instability in interpersonal relationships, self-image, and emotions, impulsivity, and self-destructive behavior

Borderline Personality Disorder

Five or more of the following:

Frantic efforts to avoid abandonmentUnstable and intense relationshipsUnstable self imageImpulsivity (self destructive)Suicidal behaviorAffective instabilityChronic feelings of emptinessInappropriate, intense anger

One of the most perplexing, most disabling, and most frequently treated forms of PD.

Otto Kernberg (1967, 1975)BPD refers to a set of personality

features or deficiencies that can be found in individuals with various disorders.

Common features/abnormal behaviors of BPDSplitting- alternately seeing people as

entirely good or entirely bad.Impulse control problemsSee Figure 9-1

TreatmentMost difficult to treat.Between 1/2 to 2/3 of all patients with BPD

discontinue treatment prematurely.Marsha Linehan – Dialectical Behavioral

Therapy (DBT)Emphasis: Learning to be more

comfortable with strong emotions.Emphasis: Therapist’s acceptance of the

patient and their negative behaviors.

Women treated with DBT tend to drop out of treatment at a lower rate; tend to experience more improvement than women in control groups.

Medication is frequently used adjunctively. AntipsychoticsAntidepressantsLithiumAnticonvulsants.

Histrionic Personality Disorder

Personality traits involving excessive, superficial emotionalityand attention seeking

Histrionic Personality Disorder Five or more of the following:Uncomfortable if not the center of attentionInappropriately seductive or provocativeRapidly shifting and shallow emotionsUse of appearance to draw attention Speech is impressionistic and lacking in detailSelf-dramatization, theatricalitySuggestibilityConsiders relationships more intimate than they

are

Narcissistic Personality Disorder

Personality traits involving extreme grandiosity, need for admiration, and lack of empathy

Narcissistic Personality DisorderFive or more of the following:

Grandiose sense of self-importance Preoccupied with fantasies of unlimited success, power,

brilliance, etc. Belief that he or she is “special” Requires excessive admiration Sense of entitlement Interpersonally exploitative Lacks empathy Often envious Arrogant or haughty

Personality traits involving social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation

• Avoidant Personality Disorder

Avoidant Personality Disorder Four or more of the following:

Avoids activities due to fear of criticism, disapproval or rejection

Unwilling to get involved with people unless certain of being liked

Restrained in relationships due to fear of being shamed or ridiculed

Preoccupied with criticism or rejection in social situations

Inhibited in new situations due to feelings of inadequacy

Views self as inept, unappealing, inferior

Reluctant to take personal risks

Dependent Personality Disorder

Personality traits involving submissive and clinging behavior related to an excessive need to be cared for by others

Dependent Personality Disorder Five or more of the following:

Excessive need for advice and reassurance to make decisions Needs others to assume responsibility for most areas of life Difficulty expressing disagreement Difficulty initiating or doing things on own Goes to excessive lengths for nurturance or support Feels helpless when alone, due to exaggerated fears of being unable to care for self

Urgently seeks new relationship if close relationship ends

Preoccupied with fears of being left to care for self

CAUSES TREATMENT

Little research on the etiology of DPD.

Overprotective, authoritarian parents are likely to foster development of dependency.

Insecurely or anxiously attached children are likely to become dependent.

Virtually no literature on the outcome of treatment for DPD.

Enter therapy for other reasons, such as depression, anxiety or substance use disorder.

Cognitive therapy Psychopharmacology

is typically not used.

Obsessive-Compulsive Personality DisorderPersonality traits involving preoccupation with orderliness, perfectionism, and control at the expense of spontaneity, flexibility, and enjoyment

Obsessive-Compulsive Personality DisorderFour or more of the following:

Preoccupation with rules, lists, order, schedules, etc.PerfectionismExcessive devotion to work and productivityOver-conscientious, scrupulous, inflexible about moralityInability to discard worn-out or worthless objectsReluctance to delegate tasks or work with others unless they submit to exactly his or her way of doing thingsMiserly spending styleRigidity and stubbornness