Transcript Personality Disorders

Personality
Disorders
Personality Disorders (Axis II):
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Are long-standing, pervasive, & inflexible patterns
of behavior.
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Usually impair social & occupational functioning.
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Are often comorbid with Axis I disorders.
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Make treating an Axis I disorder more difficult.
Personality disorder clusters in the DSM-IV
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Cluster A (paranoid, schizoid, &
schizotypal): odd/eccentric
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Cluster B (antisocial, borderline, histrionic,
& narcissistic): dramatic/erratic
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Cluster C (avoidant, dependent, &
obsessive-compulsive): anxious/fearful
I. Odd/Eccentric Cluster:
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1. Paranoid Personality Disorder: PPD
Suspiciousness of others is hallmark of personality.
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--secretiveness; hostility & anger
--assume others are out to harm them
--reluctant to confide in others;
--blame others when they are at fault
--jealous & accusatory
-read hidden messages in others actions
Prevalence (1%): occurs mostly in men
How does PPD differ from paranoid
schizophrenia?
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Hallucinations & other symptoms
(negative) aren’t present in PPD.
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Impairment in functioning is less than in
schizophrenia.
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**Also differs from delusional disorder
because delusions are not full-blown.
2. Schizoid personality disorder
People with this:
 appear dull, bland, aloof
 -don’t show warmth for or interest in others
 -report little enjoyment in life
 -are indifferent to praise, criticism;
 -show flat affect; are loners
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Prevalence (less than 1%); occurs more in men
3. Schizotypal personality disorder:
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Have interpersonal problems of people with schizoid
PD & excessive social anxiety that does not diminish.
These people:
 -are superstitious (magical thinking)
 -think they’re clairvoyant & telepathic
 -behavior & dress oddly
 -may show paranoid ideation
 -may show flat affect
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Is like a mild version of schizophrenia; prevalence3%; mostly in males
Etiology of Odd/Eccentric cluster
May be genetically linked.
Relatives of schizophrenics & patients with major
depression are at increased risk for schizotypal
personality disorder.
Family studies of PPD find higher rates of disorder in
relatives of schizophrenics.
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No clear pattern has emerged for schizoid personality
disorder. Is higher among relatives with schizotypal
personality disorder.
II. Dramatic/erratic cluster:
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1. Borderline personality disorder (BPD):
 Core features are impulsivity & instability in
relationships, mood, & self-image.
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-attitudes, thoughts, & emotions are erratic
-emotions shift abruptly from idealization to
contemptuous anger (angel to devil)
-argumentative, irritable, sarcastic, defensive
-indulge in self destructive behaviors (drugs, sex)
-lack of coherent sense of self
-self mutilation (cutting with razor/knife)
-suicide attempts
-intense fear of abandonment
Borderline PD: Facts
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Prevalence is 1 to 2 %; more common in women than
in men.
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Treatment prognosis is very poor; extremely difficult
to treat.
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In a 7 year follow-up study, 50% of patients still had
disorder.
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Comorbidity with Axis I mood disorder, substance
abuse, PTSD, and eating disorders
Kellerman’s account:
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“The borderline patient is a therapist’s nightmare...because
borderlines never really get better. The best you can do is help them
coast, without getting sucked into their pathology...They’re chronically
depressed, the determinedly addictive, the compulsively divorced,
living from one emotional disaster to the next. Bed hoppers, stomach
pumpers, freeway jumpers, and sad-eyed bench-sitters with arms
stitched up like footballs and psychic wounds that can never be
sutured. Their egos are as fragile as spun sugar, their psyches
irretrievably fragmented, like a jigsaw puzzle with crucial pieces
missing. They play roles with alacrity, excel at being anyone but
themselves, crave intimacy but repel it when they find it. Some of
them gravitate toward stage or screen; others do their acting in more
subtle ways.
Borderlines go from therapist to therapist, hoping to find a magic
bullet for the crushing feelings of emptiness. They turn to chemical
bullets, gobble tranquilizers and antidepressants, alcohol and cocaine.
Embrace gurus and heaven-hucksters, any charismatic creep promising
a quick fix for the pain. And they end up taking temporary vacations
in psychiatric wards and prison cells, emerge looking good, raising
everyone’s hopes. Until the next letdown, real or imagined, the next
excursion into self-damage. What they don’t do is change.”
Causes of BPD
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1. Object-Relations Theory
 Adverse childhood experiences (receiving praise, but
not warmth) cause children to develop insecure egos.
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Patients engage in splitting– where they lump objects
into all good or all bad categories (black-n-white
thinking).
Evidence:
 *BPD patients report low level of maternal care
 *families are emotionally unexpressive, high in conflict.
 *childhood sexual & physical abuse common
Linehan’s Diathesis-Stress theory
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BPD occurs when people with a biological
diathesis (possibly genetic) of emotion
dysregulation are raised in a family environment
that is invalidating.
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An invalidating environment-the persons wants
and feelings are discounted and disrespected.
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dysregulation & invalidation interact in a dynamic
system.
2. Histrionic personality disorder
(HPD)
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Applies to people who are overly dramatic &
attention seeking.
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Symptoms:
-attention to physical appearance
-may act inappropriately sexual
-needs to be center of attention
-displays of emotion are extravagant & shallow
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Prevalence (2-3 %), occurs more in women than
men.
3. Narcissistic personality disorder (NPD)
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Core feature: they are the “center of the universe”
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-grandiose view of one’s own importance
-great fantasies of success
-extremely self-centered
-require constant attention & admiration
-lack empathy for others; expect special
considerations
-malignant arrogance
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Prevalence (less than 1%)
Causes of NPD:
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Parents did not provide unconditional love &
empathy they needed.
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Rather, parents placed their own needs above
the needs of the child.
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People with NPD spend lives trying to bolster
low sense of self, through endless quests for
love & attention.
4. Antisocial Personality Disorder (APD):
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DSM diagnosis:
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1. The presence of a conduct disorder before
the age of 15
 Truancy; running away from home
 Theft; compulsive lying
 Arson; vandalism
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2. The continuation of this pattern of
behavior into adulthood.
APD features:
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Irresponsible & antisocial behavior
Criminality (breaking laws)**core feature
Irritability
Physically aggressive
Default on debts
Impulsivity
Pathological lying
Lack of remorse ***Not necessary for diagnosis***
Prevalence: 3% of males; 1% of females
Psychopaths
Core features
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Psychopaths lack remorse
Poverty of emotions (positive & negative)
Psychopaths are:
Superficially charming
Pathological liars & cheaters
Impulsive; sensations seekers
Manipulative, will change story to fit facts
Less responsive to fear/anxiety
Immoral
Prevalence greater among men
Psychopaths identified by Hare checklist
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Two clusters:
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1. Emotional detachment cluster (a selfish
remorseless individual with inflated selfesteem who exploits others.)
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2. Antisocial lifestyle cluster- marked by
impulsivity & irresponsibility.
Problems with diagnosis of APD:
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1. You can’t trust reports made by antisocial
personalities (they are chronic liars).
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2. Many researchers believe psychopathology
should not be synonymous with criminality.
3. “Lack of remorse,” a core symptom of
psychopathy is not required for diagnosis of
APD.
Causes of APD & Psychopathy
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Family
 Lack of affection & severe parental rejection
may cause psychopathic behavior (McCord &
McCord, 1964)
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Fathers of psychopaths likely to be antisocial
themselves.
Genetic factors: APD
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1. Higher concordance rate for MZ twins than
for DZ twins.
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2. Higher rate of antisocial behavior in adopted
children of biological parents with APD.
Emotions & Psychopathy
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Psychopaths feel emotions less intensely than
normal individuals.
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Psychopaths not under-aroused compared to
normal Ss, but are better at tuning out unpleasant
stimuli.
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They lack empathy
III. Anxious/Fearful Cluster:
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1. Dependent Personality Disorder:
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Core feature: lack of self-confidence &
autonomy
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--need to be taken care of
 --uncomfortable with self
 --intense fear of abandonment
 --need to be in relationships
2. Obsessive-compulsive Personality
disorder:
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Core feature—perfectionist person preoccupied
with details, schedules, & rules.
--work oriented
 --difficulty making decisions
 --poor interpersonal relationships
 --stubborness; need to control events
 --rigid thinking—overly moralistic
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Does not include obsessions & compulsions