Psychopathology: Schizophrenia and Personality Disorders

8/12/2019 Psychopathology: Schizophrenia and Personality Disorders

http://slidepdf.com/reader/full/psychopathology-schizophrenia-and-personality-disorders 1/31

Schizophrenia

Facts

If you can’t understand the difference between what is real and what

is unreal, you have a psychosis.

One of the most common psychotic disorders is schizophrenia.

Most people with schizophrenia develop it in their late teenage or

early adult years.

Schizophrenia is chronic (lasts for a long period of time).

Within the United States, 1 to 2 percent of the population will

develop schizophrenia at some time in their lives.

Symptoms

There are three categories of symptoms: positive symptoms, negative symptoms, and cognitive deficits.

A. Positive SymptomsThe positive symptoms of schizophrenia include:

1. Delusions

2. Hallucinations

3. Disorganized thought and speech

4. Disorganized or catatonic behavior

1) Delusions



Delusions are ideas or beliefs that are very unlikely or almost

impossible (like flying to moon, every weekend).

People with delusion think about them most of the time (they are

preoccupied with their delusions). People with delusions don’t accept logical arguments and facts that

are against their delusions. They are blind to any fact that is contrary

to their delusions.

Common Types of Delusions

Persecutory delusions: People with persecutory delusions think that

someone ( e.g. from CIA, FBI, ..) is watching or spying on them all the

time. Most of the time, they think someone is going to hurt them (like

their friends, teachers, or others).

Delusions of reference: People with these delusions think that

random events have some meaning and happen because of them. For

example they may think BBC News reporter is specifically talking about

them.

Grandiose delusions: People with these delusions think they are very

important and have some special powers and talents. Someone with

these delusions may think he is the most intelligent person in the

world or have powers to change the universe.

Delusions of thought insertion: People with these delusions think that

someone or something is controlling their thoughts or putting

thoughts in their heads. For example, they may think their body is

possessed by devil or some ghosts.

Odd or impossible beliefs that are part of a culture’s shared belief

system cannot be considered delusions.

2) Hallucinations



Hallucinations are strange and unreal perceptual (visual or auditory)

experiences, like hearing voices or seeing things that don’t exist. The most

common type of hallucinations are auditory (the person hears some voices

talking to him or telling him what to do. Sometimes they may hear two or

more voices talking to each other). Some research findings show that during

auditory hallucinations, Broca’s area of the brain (that is responsible for

speech) is active, suggesting that the person’s brain is talking to itself.

3) Disorganized Thought and Speech

People with disorganized thought and speech can’t follow a topic like a

normal person. They suddenly shift between different unrelated topicswhen they are talking and their speech does not follow a logical structure.

This is called loosening of associations. Sometimes the speech is

disorganized and the content is so unrelated that it is named, word salad.

The person may answer a question like “where are you right now?” with “I

feel the earth is going to explode”.

4) Disorganized or Catatonic Behavior

People with disorganized or catatonic behaviors, may suddenly get agitated

aggressive, or energetic with no clear reason. They may suddenly shout or

start running or jumping. Catatonic behaviors include unresponsiveness to

the environment (e.g. no movements and no speech), unpredicted and

sudden agitation (suddenly shouting and jumping up), repetitive movements

or speech, or holding odd and bizarre postures (catalepsy).

B. Negative SymptomsThe negative symptoms of schizophrenia involve deficits in certain

domains. Three types of negative symptoms are:

1. Affective flattening



2. Alogia

3. Avolition

1) Affective Flattening

Affective flattening or blunted affect is when the person experiences little

or no emotions (however sometimes the person may experience the

emotions but is unable to express them). These people show no facial

expressions in response to emotions. Sometimes they can’t show or express

the correct emotions in response to the environment. For example a man

whose house is burning in fire, may seem so calm or may even smile gently.

2) Alogia

Alogia, is when the person doesn’t talk or talks in a very short and

telegraphic way. In most cases this shows a lack of motivation for talking

which heavily reduces the person’s verbal communications.

3) Avolition

Avolition is when the person can’t continue his daily tasks. Following goals

and finishing tasks become significantly hard for the person (the person

can’t persist in daily responsibilities and activities). Avolition is caused by the

lack of motivation in tasks and goals.

C. Cognitive DeficitsPeople with schizophrenia show problems in attention and memory.

Compared to people without schizophrenia, they have greater difficulty

focusing and keeping their attention, for example, in tracking a moving

object with their eyes. In addition, people with schizophrenia show

problems in working memory, the ability to keep information in memory

and manipulate it. These problems in attention and working memory make



it difficult for people with schizophrenia to pay attention to relevant

information and to ignore unwanted or irrelevant information. This makes it

difficult for them to distinguish real from unreal.

Diagnosis

In order to be diagnosed with schizophrenia, an individual must show some

symptoms of the disorder for at least 6 months. During this 6-month period,

there must be at least 1 month of acute symptoms during which two or

more of the broad groups of symptoms (e.g., delusions, hallucinations,

disorganized speech, disorganized or catatonic behavior, negative

symptoms) are present and severe enough to impair the individual’s social

or occupational functioning.

Prodromal symptoms are symptoms that are present before people

go into the acute phase of schizophrenia.

Residual symptoms are symptoms that are present after the acute

phase.

During the prodromal and residual phases, people with schizophrenia mayexpress beliefs that are unusual but not delusional. They may have strange

perceptual experiences, such as sensing another person in the room,

without reporting full hallucinations. They may speak in a somewhat

disorganized and strange way but remain logical. Their behavior may be odd

but not very disorganized. The negative symptoms are especially present in

the prodromal and residual phases of the disorder. The person may be

withdrawn and uninterested in social relations or in work or school.

Gender and Age Factors

Women with schizophrenia tend to have better histories than men.

They are more likely to have graduated from high school or college, to



have married and had children, and to have developed good social

skills.

In both men and women with schizophrenia, functioning seems to

improve with age. The aging of the brain might somehow reduce thelikelihood of new episodes of schizophrenia.

Schizoaffective Disorder

Schizoaffective disorder is a mix of schizophrenia and a mood disorder.

People with schizoaffective disorder simultaneously experience

schizophrenic symptoms (delusions, hallucinations, disorganized speech and

behavior, and/or negative symptoms) and mood symptoms meeting the

criteria for a major depressive episode, a manic episode, or an episode of

mixed mania/depression. Mood symptoms must be present for much of the

period of schizophrenic symptoms.

Schizophreniform Disorder

The diagnosis of schizophreniform disorder requires that individuals meetCriteria for schizophrenia but show symptoms that last only 1 to 6 months.

This is a relatively rare disorder, with only approximately 0.2 percent of the

population meeting the diagnosis.

Brief Psychotic Disorder

Individuals with brief psychotic disorder show a sudden start of delusions,

hallucinations, disorganized speech, and/or disorganized behavior. However,

the episode lasts only between 1 day and 1 month, after which the

symptoms disappeared completely. Symptoms sometimes start after a

major stressor, such as being in an accident.



Delusional Disorder

Individuals with delusional disorder have delusions lasting at least 1

month. Delusions are about situations that occur in real life, such as beingfollowed, being poisoned, being cheated by a spouse, or having a disease.

They do not show any other symptoms. Other than the behaviors that may

follow from their delusions, they do not act strangely or have difficulty

functioning. It appears to affect females more than males.

Biological Theories

There are several biological theories of schizophrenia.

1) Genetic factors play role in schizophrenia.

2) Some people with schizophrenia show structural and functional

abnormalities in specific areas of the brain.

3) Many people with schizophrenia have a history of birth

complications or prenatal exposure to viruses, which may affect

brain development.4) Neurotransmitter theories state that high levels of dopamine

contribute to schizophrenia; new research also is focusing on the

neurotransmitters serotonin, GABA, and glutamate.

A. Genetic factors in SchizophreniaFamily, twin, and adoption studies all show a genetic component of

schizophrenia. Many scientists believe that different genes are responsiblefor different symptoms of the disorder; for example, one set of genes may

cause the positive symptoms, and a different set of genes may cause the

negative symptoms.



B. Structural and Functional Brain Abnormalities1) Enlarged Ventricles: The most consistent structural brain abnormality

found in schizophrenia is enlarged ventricles. The ventricles are fluid-filled

spaces in the brain. Enlarged ventricles suggest atrophy, or deterioration, inother brain tissue. People with schizophrenia with enlarged ventricles also

show reductions in the prefrontal areas of the brain and an abnormal

connection between the prefrontal cortex and the amygdala and

hippocampus.

2) Prefrontal Cortex: The prefrontal cortex of the brain consistently is

smaller and shows less activity in people with schizophrenia than in other

people. The prefrontal cortex connects to all other cortical regions, as well

as to the limbic system, which is involved in emotion and cognition, and the

basal ganglia, which is involved in motor movement. The prefrontal cortex is

important in language, emotional expression, planning, and carrying out

plans. Thus, it seems logical that a person with an unusually small or inactive

prefrontal cortex would show the deficits in cognition, emotion, and social

interactions seen with schizophrenia, such as difficulty holding

conversations, appropriately responding to social situations, and carryingout tasks.

C. Damage to the Developing Brain1) Birth Complications: Serious prenatal and birth difficulties are more

frequent in the histories of people with schizophrenia than in those of

people without schizophrenia and may play a role in the development of

neurological difficulties. One type of birth complication that may beespecially important in neurological development is perinatal

hypoxia(oxygen deprivation at birth or in the few weeks before or after

birth)



2) Prenatal Viral Exposure: Prenatal Viral Exposure Epidemiological studies

have shown high rates of schizophrenia among persons whose mothers

were exposed to viral infections while pregnant. Interestingly, people with

schizophrenia are somewhat more likely to be born in the spring months

than at other times of the year. Pregnant women may be more likely to

contract influenza and other viruses at critical phases of fetal development if

they are pregnant during the fall and winter.

D. NeurotransmittersThe neurotransmitter dopamine has long been thought to play a role in

schizophrenia. The original dopamine theory was that the symptoms ofschizophrenia are caused by high levels of dopamine in the brain,

particularly in the prefrontal cortex and limbic system.

This theory was supported by several lines of evidence.

A group of drugs that tend to reduce the symptoms of schizophrenia,

the phenothiazines or neuroleptics, reduces the functional level of

dopamine in the brain.

Drugs that increase the functional level of dopamine in the brain, such

as amphetamines, tend to increase the positive symptoms of

schizophrenia.

More recent research, however, suggests that the original dopamine theory

of schizophrenia was too simple. A more complex version of the dopamine

theory can explain both the positive symptoms and the negative symptoms.

There may be high dopamine activity in the mesolimbic pathway.

There may be unusually low dopamine activity in the prefrontal area

of the brain, which is involved in attention, motivation, and the

organization of behavior. Low dopamine activity here may lead to the



negative symptoms of schizophrenia: lack of motivation, inability to

care for oneself in daily activities, and the blunting of affect.

Psychosocial Perspectives

A. Stress and RelapseStressful circumstances may not cause someone to develop schizophrenia,

but they may trigger new episodes in people with the disorder.

B. Schizophrenia and the Family1) Double binds: Parents (particularly mothers) of children who develop

schizophrenia put their children in double binds by constantly

communicating conflicting messages to their children. Such a mother might

physically comfort her child when he falls down and is hurt but, at the same

time, be verbally hostile to and critical of the child. Children chronically

exposed to such mixed messages supposedly cannot trust their feelings or

their perceptions of the world and thus develop distorted views of

themselves, of others, and of their environment that contribute to

schizophrenia.

2) Expressed emotion: One family interaction factor that research shows is

associated with schizophrenia is expressed emotion. Families high in

expressed emotion are overinvolved with one another, are overprotective of

the ill family member, and voice self sacrificing attitudes toward the familymember while at the same time being critical, hostile, and resentful toward

him or her. Although high-expressed-emotion family members do not doubt

their loved one’s illness, they talk as if the ill family member can control his

or her symptoms. People with schizophrenia whose families are high in



expressed emotion are more likely to suffer relapses of psychosis than those

whose families are low in expressed emotion. Being in a high-expressed-

emotion family may create stresses for persons with schizophrenia that

overwhelm their ability to cope and thus trigger new episodes of psychosis.

Perhaps the best evidence that family expressed emotion does in fact

influence relapse in schizophrenic patients is that interventions to reduce

family expressed emotion tend to reduce the relapse rate in family members

with schizophrenia.

Treatment

A. Biological Treatments

1) ECT

Electroconvulsive therapy ,or ECT, was also used to treat schizophrenia until

it became clear that it had little effect.

2) Antipsychotic Drugs (neuroleptics)

One of a class of drugs called the phenothiazines, calms agitation and

reduces hallucinations and delusions in patients with schizophrenia.

Phenothiazines that became widely used include chlorpromazine

(Thorazine ), trifluoperazine (Stelazine), thioridazine (Mellaril), and

fluphenazine (Prolixin).

Collectively, these drugs are known as the neuroleptics. Neuroleptics

are more effective in treating the positive symptoms of schizophrenia

than in treating the negative symptoms.

A common side effect is akinesia, which includes slowed motor

activity, monotonous speech, and an expressionless face. Patients

taking these drugs often show symptoms similar to those seen in



Parkinson’s disease, including muscle stiffness, freezing of the facial

muscles, tremors and spasms.

One serious side effect is tardive dyskinesia, a neurological disorder

that involves involuntary movements of the tongue, face, mouth, or jaw. People with this disorder may involuntarily smack their lips, make

sucking sounds, stick out their tongue, puff their cheeks, or make

other bizarre movements over and over again.

3) Atypical Antipsychotics

Fortunately, newer drugs (atypical antipsychotics) seem to be more

effective in treating schizophrenia than the neuroleptics, without theneurological side effects of the latter. One of the most common of these

drugs, clozapine. Clozapine appears to reduce the negative as well as the

positive symptoms in many patients. Other atypical antipsychotic drugs

stabilize dopamine levels across the brain, increasing the level of dopamine

where it is deficient and decreasing it where it is in excess. Some of these

drugs, including Olanzapine (Zyprexa), decrease symptoms of schizophrenia

while inducing significantly fewer neurological side effects than either the

typical antipsychotics or clozapine.

B. Cognitive, Behavioral and Social Interventions1) Cognitive interventions: Include helping people with schizophrenia

recognize and change demoralizing attitudes they may have toward their

illness so that they will seek help when needed and participate in society to

the extent that they can.

2) Behavioral interventions: Based on social learning theory include the use

of operant conditioning and modeling to teach persons with schizophrenia

skills such as initiating and maintaining conversations with others, asking for

help or information from physicians, and persisting in an activity, such as



cooking or cleaning. In psychiatric hospitals and residential treatment

centers, token economies sometimes are established, based on the

principles of operant conditioning. Patients earn tokens that they can

exchange for privileges (such as time watching television) by completing

assigned duties (such as making their bed) or even by simply engaging in

appropriate conversations with others.

3)Social interventions: Include increasing contact between people with

schizophrenia and supportive others, often through self-help support

groups.

C. Family TherapyRecall that high levels of expressed emotion within the family of a person

with schizophrenia can substantially increase the risk for and frequency of

relapse. Many researchers have examined the effectiveness of family-

oriented therapies for people with schizophrenia. Successful therapies

combine basic education on schizophrenia with training of family members

in coping with their loved one’s inappropriate behaviors and the disorder’s

impact on their lives. In the educational portion of these therapies, familiesare taught about the disorder’s biological causes, its symptoms, and the

medications and their side effects. The hope is that this information will

reduce self-blame in family members, increase their tolerance for the

uncontrollable symptoms of the disorder, and allow them to monitor their

family member’s use of medication and possible side effects.



Personality Disorders

Personality is all the ways we have of acting, thinking, believing, and feeling

that make each of us unique. A personality trait is a complex pattern of

behavior, thought, and feeling that is stable across time and across many

situations.

DSM-IV groups personality disorders into three clusters:

Cluster A: Includes three disorders characterized by odd or eccentric

behaviors and thinking:

Paranoid personality disorder

Schizoid personality disorder

Schizotypal personality disorder

Each of these has some of the features of schizophrenia, but people

diagnosed with these personality disorders are not out of touch with reality.

Cluster B: Includes four disorders characterized by dramatic, erratic, and

emotional behavior and interpersonal relationships:

Antisocial personality disorder

Histrionic personality disorder

Borderline personality disorder

Narcissistic personality disorder.

People diagnosed with these disorders tend to be manipulative and uncaring

in social relationships and prone to impulsive behaviors.



Cluster C: Includes three disorders characterized by anxious and fearful

emotions and chronic self-doubt:

Dependent personality disorder

Avoidant personality disorder

Obsessive- compulsive personality disorder

People diagnosed with these dis orders have little self-confidence and

difficulty in relationships.

Odd-Eccentric Personality Disorders

A. Paranoid Personality DisorderAn important feature of paranoid personality disorder is a pervasive and

illogical mistrust of others. People diagnosed with this disorder believe that

other people are always trying to hurt, deceive or exploit them, and they are

preoccupied with concerns about the trustworthiness of others. They are all

the time looking for evidence to confirm their suspicions. Often they are

observing situations, noting details most other people miss. Moreover, theyconsider these events to be highly meaningful and spend a great deal of

time trying to find and interpret such clues (that other people are deceiving

them or abusing them). They are also sensitive to criticism. People with

paranoid personality disorder misinterpret situations according to their

suspicions. For example, a husband might interpret his wife’s cheerfulness

one evening as evidence that she is cheating him with someone at work.

These people are resistant to logical arguments against their suspicions and

may consider the fact that another person is arguing with them as evidence

that the person is against them. Some withdraw from other people in an

attempt to protect themselves, but others become aggressive and arrogant,

sure that their way of looking at the world is right and superior. Not



surprisingly, their interpersonal relationships, including intimate

relationships, tend to be unstable.

Main features

Cognitive therapy for people diagnosed with this disorder focuses on

increasing their sense of self-efficacy in dealing with difficult situations, thus

decreasing their fear and hostility toward others and develops their trust.

B. Schizoid Personality DisorderPeople diagnosed with schizoid personality disorder lack the desire to form

interpersonal relationships and are emotionally cold in their interactions

with others. Other people describe them as aloof, distant, and detached or

as boring, uninteresting, and soulless. People diagnosed with this disorder

show little emotion in interpersonal interactions. They view relationships

They can't trust other people

They view everybody in a very negative way

They think everybody is trying to hurt or abuse them

They don't accept facts and evidences that are against theirsuspicions



with others as unrewarding, messy, and useless. People with schizoid

personality disorder can function in society, particularly in occupations that

do not require interpersonal interactions.

Main features

for

Treatment

Therapies for Schizoid personality disorder focus on increasing the person’s

awareness of his or her own feelings, as well as increasing his or her social

skills and social contacts. The therapist may model the expression of feelings

for the client and help the client identify and express his or her own feelings.

Social skills training, done through role-playing with the therapist and

homework assignments in which the client tries out new social skills with

other people, is an important component of cognitive therapies.

They are not interested in people and social relations

Their lack of social relations is not due to anxiety or low self-esteem, but it is due to lack of motivation and interest inrelations

Most people see them as distant and cold



C. Schizotypal Personality DisorderLike people diagnosed with schizoid personality disorder, people diagnosed

with schizotypal personality disorder tend to be socially isolated, to have a

restricted range of emotions, and to be uncomfortable in interpersonalinteractions. As children, people who develop schizotypal personality

disorder are passive, socially unengaged, and hypersensitive to criticism. The

distinguishing characteristics of schizotypal personality disorder are the

strange cognitions, which generally fall into four categories:

1) Paranoia or suspiciousness: As in paranoid personality disorder, people

diagnosed with schizotypal personality disorder perceive other people as

deceitful and hostile, and much of their social anxiety emerges from this

paranoia.

2) Ideas of reference: People diagnosed with schizotypal personality

disorder tend to believe that random events or circumstances are related to

them. For example, they may think it highly significant that a fire occurred in

a store in which they had shopped only yesterday.

3) Odd beliefs and magical thinking: For example, they may believe thatothers know what they are thinking.

4) Illusions: These illusions are like mild versions of hallucinations. For

example, they may think they see people in the patterns of wallpaper.

In addition to possessing these oddities of thought, people diagnosed with

schizotypal personality disorder have speech that is unclear, disorganized, or

overelaborate. In interactions with others, they may have inappropriate

emotional responses or no emotional response to what other people say or

do. Their behaviors also are odd, sometimes reflecting their odd thoughts.

They may be easily distracted or fixate on an object for long periods of time,

lost in thought or fantasy. Although the quality of these oddities of thought,

speech, and behavior is similar to that in schizophrenia, their severity is not



as great as in schizophrenia, and people diagnosed with schizotypal

personality disorder retain basic contact with reality.

For a person to be given a diagnosis of schizotypal personality

disorder, his or her odd or eccentric thoughts cannot be part of

cultural beliefs, such as a cultural belief in magic or specific

superstitions.

Main features

Treatment

Schizotypal personality disorder is most often treated with the same drugs

used to treat schizophrenia, including traditional neuroleptics such as

appear to relieve psychotic-like symptoms, which include ideas of reference,

magical thinking, and illusions. Therapy is used to help clients increase social

contacts and learn socially appropriate behaviors through social skills

They have a strange and delusional way of thinking.

They lack social relations not because they are not interested inpeople, but because they feel they are different from other people.

They feel other people don't like them, that is why they withdraw fromsociety

They think other people may try to hurt them or make fun of them(paranoia)



training. Group therapy may be especially helpful in increasing clients’ social

skills. The crucial component of cognitive therapy with clients diagnosed with

schizotypal personality disorder is teaching them to look for objective

evidence for their thoughts in the environment and to disregard bizarre

thoughts.

Dramatic-Emotional Personality

Disorders

A. Antisocial Personality Disorder

People with severe antisocial tendencies were labeled psychopaths in the

late nineteenth and early twentieth centuries. The key features of antisocial

personality disorder, as defined by the DSM-IV-TR, are an impairment in the

ability to form positive relationships with others and a tendency to engage

in behaviors that violate basic social norms and values. People with this

disorder are deceitful, repeatedly lying or conning others for personal profit

or pleasure. They commit violent criminal offenses against others—including

assault, murder, and rape—much more frequently than do people withoutthe disorder. When caught, they tend to have little remorse and seem

indifferent to the pain and suffering they have caused others. An important

characteristic of antisocial personality disorder is poor control of impulses.

People with this disorder have a low tolerance for frustration and often act

impulsively, with no concern for the consequences of their behavior.

The difference between successful psychopaths and those who end up in

prison is that the successful ones are better able to maintain an outward

appearance of normality. They may be able to do this because they have

superior intelligence and can put on a “mask ” and social charm in order to

achieve their goals.



Men are substantially more likely than women to be diagnosed with

this disorder.

Almost 80% of people with antisocial personality disorder abuse

substances such as alcohol and illicit drugs. Adults with antisocial personality most would have been diagnosed

with conduct disorder as children.

Theories of Antisocial Personality Disorder

A. Genetics: There is substantial evidence of a genetic influence on

antisocial behaviors, particularly criminal behaviors.

B. Low serotonin level: Some researchers argue that poor impulse control is

at the heart of antisocial personality disorder. Many studies have shown

that impulsive and aggressive behaviors are linked to low levels of the

neurotransmitter serotonin, leading to the suggestion that people with

antisocial personality disorder also may have low levels of serotonin.

C. Low verbal intelligence and deficits in executive functions: People with

antisocial personalities also show deficits in verbal skills and in the executivefunctions of the brain: the ability to sustain concentration, abstract

reasoning, concept and goal formation, the ability to anticipate and plan,

self-monitoring and self-awareness, and the ability to shift control and plan

behaviors.

D. Low arousal level (fearlessness): People with antisocial personality

disorder show low levels of arousability. One interpretation of these data is

that low levels of arousal indicate low levels of fear in response tothreatening situations. fearlessness also may predispose some people to

antisocial and violent behaviors that require fearlessness to execute, such as

fighting and robbery. In addition, low-arousal children may not fear



punishment and may not be deterred from antisocial behavior by the threat

of punishment.

E. Cortical immaturity: some, but not all, studies have found differences

between antisocial adults (usually prison inmates) and the generalpopulation in the structure or functioning of the temporal and frontal lobes

of the brain (specifically prefrontal cortex)

Main features

Lithium and the atypical antipsychotics have been used successfully to

control impulsive and aggressive behaviors in people with antisocial

personality disorder. When clinicians attempt psychotherapy, they focus on

helping the person with antisocial personality disorder gain control over his

or her anger and impulsive behaviors by recognizing triggers and developing

alternative coping strategies.

They have a low level of empathy

They can't control their impulses. They act based on what theirfeel at the moment, not based on the consequences of thebehavior

They have no respect and concern about the rights and well-beingof other people



B. Borderline Personality Disorder

This personality disorder may be described with out-of-control emotions,

hypersensitivity to abandonment, tendency to depend on other people, and

a history of hurting oneself. Instability, impulsivity and self-hurt are keyfeatures of borderline personality disorder.

1) Mood Instability: The mood of people with borderline personality

disorder is unstable, with phases of severe depression, anxiety, or anger

seeming to arise frequently, often without good reason (shifting between

depression, anger and mania).

2) Self Concept Instability: Their self-concept is unstable, with periods of

extreme self-doubt alternating with periods of grandiose self-importance

(shifting between good and bad feelings about themselves).

3) Interpersonal relationships Instability: Their interpersonal relationships

are extremely unstable—they can switch from idealizing others to

devaluation of them without provocation (for them a friend can be an angel

now, and a devil two days later).

4) Worry of abandonment: People with borderline personality disorder

often describe an emptiness, which makes them to attach and cling to other

people (depend on them). They worry about abandonment and

misinterpret other people’s actions as rejection. For example, if a therapist

has to cancel an appointment because she is ill, a client with borderline

personality disorder might interpret this as a rejection by the therapist and

become extremely depressed or angry.

5) Self-hurt and suicide: With the instability of mood, self-concept, and

interpersonal relationships comes a tendency toward impulsive, self-

damaging behaviors, including self-hurt and suicidal behavior (cutting or

burning one’s body or attempting suicide).



Theories of Borderline Personality Disorder

Borderline personality disorder is much more often diagnosed in

women than in men. People with borderline personality disorder tend to see themselves

and other people as either all good or all bad and to shift between

these two views, a process known as splitting. The instability in

emotions and interpersonal relationships is due to such splitting: Their

emotions and their perspectives on their interpersonal relationships

reflect their shifts between the all-good and the all-bad self and the

all-good and the all-bad other.

Studies have found decreased metabolism in the prefrontal cortex of

patients with borderline personality disorder, as is also found in

patients with mood disorders.

Other studies suggest impulsive behaviors in people with borderline

personality disorder are correlated with low levels of serotonin.

Treatment of Borderline Personality Disorder

1) Dialectical behavior therapy: One of the first psychotherapies shown to

have positive effects in patients with borderline personality disorder was

dialectical behavior therapy. This therapy focuses on helping clients with

borderline personality disorder gain a more realistic and positive sense of

self, learn adaptive skills for solving problems and regulating emotions, and

correct thinking.

2) Antianxiety and antidepressant drugs: These drugs are used to treat

anxiety and depressive symptoms in people with borderline personality

disorder. Serotonin reuptake inhibitors (SRI) can reduce aggressiveness and

impulsivity.



C. Histrionic Personality Disorder

Histrionic personality disorder shares features with borderline personality

disorder, including rapidly shifting emotions and intense, unstable

relationships. The difference is that people with Histrionic personality

disorder like to be the center of attention. The person with borderline

personality disorder may attach or cling to others as an expression of self-

doubt and need, but the person with histrionic personality disorder simply

wants the attention of others. Individuals with histrionic personality

disorder try to get others’ attention by being highly dramatic (showing too

much emotions) and seductive (trying to get attentions by being over-sexy)

and by emphasizing the positive qualities of their physical appearance

(oversensitive on how they look). They are impulsive and have difficulties in

They are instable and impuslive in their relations

They see everything (themselves and otherpeople) in black and white (all-good or all-bad)

Their ideas about themselves and otherpeople change easily and fast

They depend on other people and are afraid ofbeing left alone

They tend to hurt themselves or commite suicide



delaying. Most people diagnosed with this disorder are women. In order to

attract attentions, they tend to exaggerate their medical problems and has

an increased rate of suicidal behavior and threats.

D. Narcissistic Personality Disorder

The characteristics of narcissistic personality disorder are similar to those of

histrionic personality disorder. In both disorders, individuals act in adramatic and grandiose manner, seek admiration from others, and are

shallow in their emotional expressions and relationships with others.

Whereas people with histrionic personality disorder look to others for

approval, however, people with narcissistic personality disorder rely on their

self-evaluations and see dependency on others as weak and dangerous.

They like to be the center of attention

What other people think about them is soimportant to them

They try to get attention by showing theirbody and being sexy

They are impulsive and instable in theirlives and relations

Mostly they don't care about other people



They are preoccupied with thoughts of their self-importance and with

fantasies of power and success, and they view themselves as superior to

most other people. In interpersonal relationships, they make unreasonable

demands on others to follow their wishes, ignore the needs and wants of

others, exploit others to gain power, and are arrogant.

it is more frequently diagnosed in men.

Anxious-Fearful Personality Disorders

A. Avoidant Personality Disorder

People with avoidant personality disorder are extremely anxious about

being criticized by others and thus avoid interactions in which there is any

possibility of being criticized. When they must interact with others, people

with avoidant personality disorder are restrained, nervous, and

hypersensitive to signs of being evaluated or criticized. They are

terrified of saying something silly or doing something that will embarrass

themselves. They tend to be depressed and lonely. While they may need

They are arrogant and self-centered

They think they are much better than everybodyelse, and don't care about other people

They think evething and everyone should be as theywish



relationships with others, they feel unworthy of these relationships and

isolate themselves. People with social phobia tend to want to connect with

others, while people with avoidant personality disorder do not. People with

schizoid personality disorder also withdraw from social situations, but unlike

people with avoidant personality disorder, they do not view themselves as

inadequate and incompetent.

Cognitive and behavior therapies have proven helpful for people with

avoidant personality disorder. These therapies have included graduated

exposure to social settings, social skills training, and challenges to negative

automatic thoughts about social situations.

They are so afraid of being judged or criticized

All the time they think, they may look stupid or sillyinfront of others

They lack social relations, not because they don'tlike relations but because they are afarid of them

They feel anxoius and nervous in most social situaitons



B. Dependent Personality Disorder

People with dependent personality disorder are anxious about

interpersonal interactions, but their anxiety stems from a deep need to be

cared for by others, rather than from a concern that they will be criticized.Their desire to be loved and taken care of by others leads persons with

dependent personality disorder to deny any of their own thoughts and

feelings that might displease others, to submit to even the most

unreasonable demands, and to cling frantically to others. People with this

personality disorder cannot make decisions for themselves and do not

initiate new activities except in an effort to please others. In contrast to

people with avoidant personality disorder, who avoid relationships, people

with dependent personality disorder can function only within a relationship.

They deeply fear rejection and abandonment and may allow themselves to

be exploited and abused rather than lose relationships.

More women than men are diagnosed with this disorder.

Cognitive-behavioral therapy for dependent personality disorder includesbehavioral techniques designed to increase assertive behaviors and

decrease anxiety, as well as cognitive techniques designed to challenge

clients’ assumptions about the need to rely on others. Clients might be given

graded exposure to anxiety provoking situations, such as requesting help

from a salesperson. They also may be taught relaxation skills to enable them

to overcome their anxiety enough to engage in homework assignments.



C. Obsessive Compulsive Personality Disorder

People with obsessive-compulsive personality disorder often seem firm

and overly orderly, tensely in control of their emotions, and lacking in

spontaneity (everything in their lives should be planned and specified). They

are workaholics who see little need for leisure activities or friendships (the

only thing that they care about is work and success). Other people

experience them as stubborn, stingy, possessive, and officious. They tend to

relate to others in terms of rank or status and respecting “superiors” but

authoritarian (giving orders and being arrogant) toward “inferiors.”

Although they are extremely concerned with efficiency, their perfectionism

and obsession about following rules often interfere with their completion of

tasks.

They can't live without other people (theyneed others for every little decision making)

They do anything just to please otherpeople and keep them around

They feel week and dependent most of thetime



They are rigid and stubborn

They are inflexbile and don't like change and

For them, work and order is the mostimprotant thing. Friends, family, going outand such acitivties seem waste of time

They can't live without plans

For them, everything should be so prefect. Theycan't accept error and mistakes

Documents

Psychopathology: Schizophrenia and Personality Disorders