Transcript Personality Disorder

Mental Illness
1
Defining Psychological Disorders
When behavior is:
Deviant (atypical)
Distressful
Dysfunctional
(and dangerous)
…it is labeled as a disorder
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Some early treatments of people with
psych disorders
trephination, exorcism, being caged, being
beaten, burned, castrated, mutilated, abandoned
in the wild, or imprisoned
Trephination (boring holes in the skull to remove evil forces)
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Philippe Pinel & the Medical
Model
• Pinel introduced “talk therapy”
• Medical Model of Mental Illness
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Diagnosed
Symptoms
Cured
Therapy (talk or pharmaceuticals)
• Brain structure/biochemistry  mental
illness
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Biopsychosocial Approach
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Culture-bound Syndromes
• Share same underlying cause, yet the
manifestation is different
– Anxiety (anorexia vs. susto)
– Stress/guilt (koro vs. nervios)
– Anger (Hwa-byung vs. borderline)
• OR diagnoses vary based on gender
– ADHD versus depression
http://rjg42.tripod.com/culturebound_syndromes.htm
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Diagnostic & Statistical Manual of
Mental Disorders
Axis I
Axis II
Is a Clinical Syndrome (cognitive, anxiety,
mood disorders [16 syndromes]) present?
Is a Personality Disorder or Mental Retardation
present?
Is a General Medical Condition (diabetes,
Axis III
hypertension or arthritis etc) also present?
Are Psychosocial or Environmental Problems
Axis IV
(school or housing issues) also present?
What is the Global Assessment of the person’s
Axis V functioning?
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Multiaxial Classification
Note 16 syndromes in Axis I
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Multiaxial Classification
Note Global Assessment for Axis V
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Labeling Psychological Disorders
• Labels may stigmatize individuals
– Discrimination
• Labels bias perceptions
– Job interview study
• People who are told a person has a mental illness are more
likely to interpret their behaviors through that lens
– David Rosenhan study (1973)
• Rosenhan et al pretended to have mental illness
• Biased perceptions change others’ behaviors
– “self-fulfilling prophecy”
• People treat individuals with mental illnesses differently,
resulting in different interactions AND responses, compared to
someone who is “normal”
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Psychological Disorders in the U.S.
Approximately 25% of American
adults suffer from a mental illness
in a given year…
Theodore Kaczynski
(Unabomber)
Jared Loughner
(Arizona Shooter)
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Anxiety Disorders
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Generalized Anxiety Disorder
Panic Disorder
Phobias
Obsessive-Compulsive Disorder
Post-Traumatic Stress Disorder
Understanding Anxiety Disorders
Anxiety Disorders
Feelings of excessive apprehension and anxiety.
1.
2.
3.
4.
5.
Generalized anxiety disorder
Panic disorder
Phobias
Obsessive-compulsive disorder
Post-traumatic stress disorder
Generalized Anxiety Disorder
1. Persistent and uncontrollable tenseness and
apprehension.
2. Autonomic arousal—sympathetic division
3. Inability to identify or avoid the cause of
certain feelings.
Panic Disorder
Minutes-long episodes of intense dread which may
include feelings of terror, chest pains, choking, or
other frightening sensations.
Anxiety is a component of both disorders. It
occurs more in the panic disorder, making
people avoid situations that cause it.
Panic Disorder-Sleep Paralysis
• Related to paralysis that occurs as a natural part of REM
sleep
– Occurs when the brain awakes from a REM state, but the body
paralysis persists
– Leaves the person fully conscious, but unable to move
– May be unable to move/speak for a few seconds up to a few
minutes
– Some may feel chest pressure or a sense of choking/inability to
breathe
• Symptoms may also include sensations of noises, smells,
levitation, paralysis, terror, and images of frightening
intruders, as a result of dream state overlaying on real
physical world
– Understandably results in panic in the sufferer!!
Phobias
Marked by a persistent and irrational fear of an
object or situation that disrupts behavior.
Kinds of Phobias
Agoraphobia
Acrophobia
Claustrophobia
Hemophobia
Phobia of open places.
Phobia of heights.
Phobia of closed spaces.
Phobia of blood.
Obsessive-Compulsive Disorder
Persistence of unwanted thoughts (obsessions)
and urges to engage in senseless rituals
(compulsions) that cause distress.
Brain Imaging & OCD
Hyper-activity in the
frontal lobe areas
(anterior cingulate
cortex)
--monitors actions
--checks for errors
--ordering
--hoarding
Brain image of an OCD
Hoarding & OCD
• Acquisition and failure to
discard, a large number of
possessions that appear to
be of useless or of limited
value
• Living spaces so cluttered
they preclude activities for
which those spaces were
designed
Post-Traumatic Stress Disorder
4+ weeks of the following symptoms:
1. Haunting memories
2. Nightmares
3. Social withdrawal
4. Jumpy anxiety
5. Sleep problems
Resilience to PTSD
Only about 10% of women and 20% of men
react to traumatic situations and develop PTSD.
Holocaust survivors show remarkable resilience
against traumatic situations.
All major religions of the world suggest that
surviving a trauma leads to the growth of an
individual.
Explaining Anxiety Disorders
• Learning Perspective
• Biological Perspective
Learning Perspective
• Fear conditioning
– anxiety becomes associated
with other
objects/events/people (stimulus
generalization)
– Reinforced
• Example: You’re bitten by a
dog as a child and you come to
fear ALL dogs as result
– May also selectively remember
interacting with only “mean
dogs” and forget about the nice
ones. Thus your [faulty]
memory serves to reinforce
your fears
The Learning Perspective
• Investigators believe
that fear responses are
inculcated through
observational learning.
– Young monkeys develop
fear when they watch
other monkeys who are
afraid of various stimuli
– We may learn phobias
from our parents…like a
fear of drowning 
Biological/Evolutionary Perspective
• Twin studies suggest that
our genes may be partly
responsible for
developing fears and
anxiety. Twins are more
likely to share phobias.
Somatoform & DID
• Somatoform Disorders
– Conversion disorder (Freudian based)
• More extreme version of psychosomatic disorders
– Anxiety is converted into a physical symptom
– Makes NO sense physiologically, BUT has real physical
symptoms (i.e. they are NOT faking)
– E.g. person may report losing feeling in a limb, which makes no
neurological sense BUT, if stuck with pins in that limb, would
show no response
– Other examples: unexplained paralysis, blindness, inability to
speak, non-epileptic seizes, etc.
More Somatoform
• Somatoform Disorders
– Hypochondriasis (aka hypochondriac)
• Person regularly interprets normal symptoms as indicative of
terrible disease(s)
– Continuously seeking medical care for their imagined
“illness(es)”
– Sympathy or temporary relief from daily demands reinforces this
behavior
– “Psychosomatic”
• Physical disorder (with physical symptoms) caused/markedly
influenced by mental or emotional factors
– E.g. feeling sick in a class you hate and then feeling better the
minute you leave the classroom
Dissociative Disorders
• Amnesia: Conscious awareness
separated/dissociated from previous memories,
thoughts, & feelings
– Your running narrative of self “shuts off.” Akin to
blacking out, but you’re awake. No memory of self.
• Depersonalization: Also may have memory of
self BUT
– Have a sense of being unreal
– Feel separated from the body
– Watching yourself as if in a movie
Multiple Personality Disorder
(MPD)
A type of dissociative
identity disorder where a
person exhibits two or
more distinct and
alternating personalities
Some supporters believe
that it is a learned
response to trauma that
reinforces reductions in
anxiety
DID Critics
• Critics argue that the
diagnosis of DID
increased in the late
20th century.
• Other critics note that
DID has not been
found in other
countries.
• Some critics believe it
is role-playing by
people open to a
therapist’s suggestion
– i.e., the therapist is
leading them to believe
they have the disorder
Rates of Psychological Disorders
Mood Disorders
Mood Disorders
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Major Depressive Disorders
Dysthymia
Bipolar Disorder
Mania/Manic
Mood Disorders
Emotional extremes of mood disorders come in
two principal forms.
1. Major depressive disorder
2. Bipolar disorder
Major Depressive Disorder
Major depressive disorder occurs when signs of
depression last two weeks or more and are not
caused by drugs or medical conditions.
Signs include:
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Lethargy and tiredness
Feelings of worthlessness
Loss of interest in family & friends
Loss of interest in activities
Reduced cognitive functioning
Dysthymic Disorder
Lies between blue mood and major depressive disorder.
Characterized by depressive symptoms for most of the
day, more days than not, for at least 2 years.
Symptom-free interval cannot last longer than 2 months
Blue
Mood
Dysthymic
Disorder
Major Depressive
Disorder
Bipolar Disorder
Formerly called manic-depressive disorder,
alteration between depression and mania
signals bipolar disorder.
Depressive Symptoms
Manic Symptoms
Gloomy
Elation
Withdrawn
Euphoria
Inability to make decisions
Tired
Slowness of thought
Desire for action
Hyperactive
Multiple ideas
Bipolar Disorder
Many great writers, poets, composers suffered
from bipolar disorder. During their manic
phases, their creativity surged and dropped off
during their depressive phases.
Earl Theissen/ Hulton Getty Pictures Library
The Granger Collection
Wolfe
George C. Beresford/ Hulton Getty Pictures Library
Bettmann/ Corbis
Whitman
Clemens
Hemingway
Explaining Mood Disorders
Lewinsohn et al., (1985, 1995) note that a theory
of depression should explain:
1. Behavioral and cognitive changes
2. Common causes of depression
Theory of Depression
3. Gender differences
Theory of Depression
4. Depressive episodes self-terminate.
5. Stressful events often precede depression.
6. Depression is increasing, especially in the
teens.
Desiree Navarro/ Getty Images
Post-partum depression
Suicide
The most severe form of behavioral response to
depression is suicide. Each year some 1 million
people commit suicide worldwide.
Women are more likely to attempt suicide, however,
men are 2-4 times more likely to succeed because
Biological Perspective
Genetic Influences: Mood disorders run in
families. Rates of depression is higher in
identical (50%) than fraternal twins (20%).
Neurotransmitters & Depression
Reduction of
serotonin has been
implicated in
depression.
Drugs that alleviate
mania reduce
norepinephrine.
Pre-synaptic
Neuron
Serotonin
Post-synaptic
Neuron
The Depressed Brain
PET scans show that brain energy consumption
rises and falls with manic and depressive
episodes.
Courtesy of Lewis Baxter an Michael E.
Phelps, UCLA School of Medicine
Social-Cognitive Perspective
The social-cognitive perspective suggests that
depression arises partly from self-defeating
beliefs and negative explanatory styles.
Depression Cycle
1. The negative stressful
events.
2. Pessimistic explanatory
style.
3. Hopeless depressed state.
4. Hampers the way the
individual thinks and acts,
and thus fuels personal
rejection.
Symptoms of Schizophrenia
Literal translation “split mind”. A group of
severe disorders characterized by:
1. Disorganized and delusional
thinking.
2. Disturbed perceptions.
3. Inappropriate emotions and
actions.
Symptoms of Schizophrenia
Positive symptoms: the presence of inappropriate
behaviors (hallucinations, disorganized or
delusional talking)
Negative symptoms: the absence of appropriate
behaviors (expressionless faces, rigid bodies)
Disorganized & Delusional Thinking
This morning when I was at Hillside [Hospital], I was
making a movie. I was surrounded by movie stars …
I’m Marry Poppins. Is this room painted blue to get me
upset? My grandmother died four weeks after my
eighteenth birthday.”
This monologue illustrates fragmented, bizarre
thinking with distorted beliefs, called delusions
(“I’m Mary Poppins”).
Other forms of delusions include, delusions of
persecution (“someone is following me”) or
grandeur (“I am a king”).
Disorganized & Delusional Thinking
Many psychologists believe disorganized
thoughts occur because of selective attention
failure (fragmented and bizarre thoughts).
In other words, they have difficulty ignoring
irrelevant stimuli (e.g. the hum of machinery,
the texture of the wall, etc.)
Disturbed Perceptions
A schizophrenic person may perceive things
that are not there (hallucinations). Frequently
such hallucinations are auditory and lesser
visual, somatosensory, olfactory, or gustatory.
L. Berthold, Untitled. The Prinzhorn Collection, University of Heidelberg
August Natter, Witches Head. The Prinzhorn Collection, University of Heidelberg
Photos of paintings by Krannert Museum, University of Illinois at Urbana-Champaign
Inappropriate Emotions & Actions
A schizophrenic person may laugh at the news
of someone dying or show no emotion at all
(flat affect or apathy).
Patients with schizophrenia may continually
rub an arm, rock a chair, or remain motionless
for hours (catatonia).
Onset and Development of
Schizophrenia
Nearly 1 in a 100 suffer from schizophrenia, and
throughout the world over 24 million people
suffer from this disease (WHO, 2002).
Schizophrenia strikes young people as they
mature into adults. It affects men and women
equally, but men suffer from it more severely
than women.
Chronic and Acute Schizophrenia
When schizophrenia is slow to develop
(chronic/process) recovery is doubtful. Such
schizophrenics usually displays negative
symptoms.
When schizophrenia rapidly develops
(acute/reactive) recovery is better. Such
schizophrenics usually shows positive
symptoms.
Warning Signs
Early warning signs of schizophrenia include:
1. A mother’s long lasting schizophrenia.
2. Birth complications, oxygen deprivation and
low-birth weight.
3. Short attention span and poor muscle
coordination.
4. Disruptive and withdrawn behavior.
5. Emotional unpredictability.
6. Poor peer relations and solo play.
Subtypes of Schizophrenia
Schizophrenia is a cluster of disorders.
Subtypes share some features but there are
other symptoms that differentiate these
subtypes.
Understanding Schizophrenia
Brain scans show abnormal activity in frontal
cortex, thalamus and amygdala of
schizophrenic patients. Also adolescent
schizophrenic patients show brain lesions.
Paul Thompson and Arthur W. Toga, UCLA Laboratory of Neuro
Imaging and Judith L. Rapport, National Institute of Mental Health
Viral Infection
Schizophrenia has also been observed in
individuals who contracted a viral infection
(flu) during the middle of their fetal
development.
Genetic Factors
The likelihood of individuals suffering from
schizophrenia is 50% if their identical twins
have the disease (Gottesman, 1991).
0 10 20 30 40 50
Identical
Both parents
Fraternal
One parent
Sibling
Nephew or niece
Unrelated
Genetic Factors
Prevalence of schizophrenia in identical twins
as seen in different countries.
Psychological Factors
Psychological and environmental factors can
trigger schizophrenia if the individual was
genetically predisposed (Nicols & Gottesman, 1983).
Genain Sisters
Personality
Disorders
Personality trait
• An enduring pattern of
perceiving, relating to,
and thinking about the
environment and
others.
Personality disorders
• Ingrained patterns of
relating to other
people, situations, and
events with a rigid and
maladaptive pattern of
inner experience and
behavior, dating back
to adolescence or early
adulthood.
The Nature of Personality
Disorders
A longstanding maladaptive pattern of inner
experience and behavior dating back to
adolescence or adulthood that is manifest
in at least two of the following areas:
1. Cognition
2. Affectivity
3. Interpersonal functioning
4. Impulse control
The Nature of Personality
Disorders
At present, each personality disorder is
categorized distinctly in that a person’s
symptoms either fit it or they don’t.
Researchers who argue for a dimensional
approach point out that the most
commonly assigned Axis II diagnosis is
personality disorder not otherwise
specified.
DSM-IV Personality Disorder
Clusters
The DSM-IV includes a set of
separate diagnoses grouped into
three clusters based on shared
characteristics:
• CLUSTER A – The Eccentric Ones
• CLUSTER B – The Dramatic Ones
• CLUSTER C – The Anxious Ones
Because Cluster B disorders have been the most
extensively researched, we’ll start with them.
The Dramatic Ones
Antisocial Personality Disorder
Borderline Personality Disorder
Histrionic Personality Disorder
Narcissistic Personality Disorder
ANTISOCIAL PERSONALITY
DISORDER
A personality disorder characterized by a
lack of regard for society's moral or legal
standards.
ANTISOCIAL
History
– Philippe Pinel (1801)
- Defect of moral character
– Hervey Cleckley (1941)
- Psychopathy
– Robert Hare (1997)
Psychopathy Check List
– DSM
Goes beyond psychopathy traits
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ANTISOCIAL
Associated Behaviors
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Deceitfulness
Impulsivity
Unlawfulness
Recklessness
Aggressiveness
Manipulativeness
Lack of remorse
Important Distinctions
• Adult Antisocial Behavior
Illegal or immoral behavior
such as stealing, lying, or
cheating

Criminal
A legal term, not a
psychological concept.
Perspectives on
Antisocial Personality
BIOLOGICAL
– Various brain abnormalities
– Diminished autonomic response to
social stressors
– Possible genetic causes
Perspectives on
Antisocial Personality
PSYCHOLOGICAL
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Neurological deficits related to
psychopathic symptoms
Response modulation hypothesis
Unable to process information not
relevant to their primary goals
Low self-esteem
Perspectives on
Antisocial Personality
SOCIOCULTURAL
• Family variables
• Childhood abuse
• Childhood neglect
TREATMENT OF ANTISOCIAL
PERSONALITY DISORDER
• Address low self-esteem
• Confrontational techniques
• Group therapy
BORDERLINE PERSONALITY DISORDER
A personality disorder characterized
by pervasive instability with a
pattern of poor impulse control.
Instability is evident in mood, interpersonal
relationships, and self-image.
Often sufferers are confused about their own
identity or concept of who they are.
BORDERLINE
Observed characteristics:
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Intense interpersonal relationships
Splitting
Feelings of emptiness
Anger, rage
Identity confusion
Shifting goals, plans, partners
Poor boundaries with others
Risk taking, self injurious behaviors
Parasuicidal
PERSPECTIVES ON BORDERLINE
PERSONALITY
BIOPSYCHOSOCIAL
– Vulnerable temperament
– Traumatic early childhood experiences
– Triggering events in adulthood
BIOLOGICAL
– Hippocampus smaller
– Amygdala smaller
PERSPECTIVES ON BORDERLINE
PERSONALITY
PSYCHOLOGICAL
• Physical or sexual abuse
• Childhood caregiver interaction
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Emotionally unavailable
Inconsistent treatment
Failed to validate their thoughts and feelings
Failed to protect from abuse
Anxious attachment style with mother
PERSPECTIVES ON BORDERLINE
PERSONALITY
PSYCHODYNAMIC
• Poor ego development
• Caregiver overinvolved
yet inconsistent
• Distorted perception of
others
PERSPECTIVES ON BORDERLINE
PERSONALITY
COGNITIVE-BEHAVIORAL
• Splitting
• Low sense of selfefficacy
• Lack of confidence
• Low motivation
• Inability to seek longterm goals
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Modern pressures
on family
 Diminished social
cohesion and mental
cohesion
 Unstable family
patterns
TREATMENT OF BORDERLINE
PERSONALITY
• CHALLENGING AND COMPLEX
– Unlikely to remain in treatment long
– Unstable relationships with therapist
• TECHNIQUES
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Confrontive or
Supportive
Dialectical Behavioral Therapy
May need medication
HISTRIONIC
PERSONALITY
DISORDER
A personality disorder
characterized by
exaggerated emotional
reactions, approaching
theatricality, in
everyday behavior.
Melodramatic.
The term
histrionic is
derived from
a Latin word
meaning
“actor.”
HISTRIONIC
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Dramatic, attention-getting behavior
Fleeting, shifting emotional states
More commonly diagnosed in women
Flirtatious and seductive
Need for immediate gratification
Easily influenced by others
Lack analytical ability
Superficial relationships
VIEWS AND TREATMENT OF
HISTRIONIC PERSONALITY
 COGNITIVE-BEHAVIORAL
– Feelings of inadequacy and need for others
– Global nature of thinking underlies diffuse,
exaggerated and changing emotional states
• TREATMENT GOALS
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Learn how to think more objectively and precisely
Learn self-monitoring strategies
Learn impulse control
Acquire assertiveness skills
NARCISSISTIC
PERSONALITY
DISORDER
Personality disorder characterized by an
unrealistic, inflated sense of selfimportance and lack of sensitivity to other
people’s needs:
• egotistical
• arrogant
• exploitative of others
Named for Greek legend of Narcissus.
NARCISSISTIC SUBTYPES
Noting the many types of behaviors
involved, Millon and colleagues proposed
subtypes:
• elitist
• amorous
• unprincipled
• compensatory
THEORIES OF NARCISSISTIC
PERSONALITY
Freudian
– Stuck in early psychosexual stages
Cognitive-Behavioral
– Lack insight into or concern for feelings of others
– Grandiose sense of self clashes with real world
failures
TREATMENT OF NARCISSISTIC
PERSONALITY
PSYCHODYNAMIC and COGNITIVEBEHAVIORAL therapies overlap in their
goals for the client:
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Reduce grandiose thinking.
Develop more realistic view of self.
Develop more realistic view of others.
Enhance ability to relate to others
Avoid demands for special attention
The Eccentric Ones
Paranoid Personality
Schizoid Personality
Schizotypal Personality
PARANOID PERSONALITY
DISORDER
• SUSPICIOUSNESS
• GUARDEDNESS
• PROJECTION OF NEGATIVITY AND
DAMAGING MOTIVES ONTO OTHERS
• ATTRIBUTION OF THEIR PROBLEMS
TO OTHERS
• LOW SELF-EFFICACY
TREATMENT OF PARANOID
PERSONALITY
COGNITIVE BEHAVIORAL
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COUNTER ERRONEOUS THINKING
ESTABLISH TRUSTING RELATIONSHIP
INCREASE FEELINGS OF SELF-EFFICACY
REDUCE VIGILANT AND DEFENSIVE STANCE
INSIGHT INTO OTHERS’ PERSPECTIVES
APPROACH CONFLICT ASSERTIVELY
IMPROVE INTERPERSONAL SKILLS
SCHIZOID
PERSONALITY
DISORDER
Main characteristic: Indifference to social
relationships, as well as a very limited
range of emotional experience and
expression.
SCHIZOID
• INDIFFERENCE TO SOCIAL AND SEXUAL
RELATIONSHIPS
• SECLUSIVE; PREFER TO BE ALONE
• NO DESIRE TO LOVE OR BE LOVED
• COLD, RESERVED, WITHDRAWN
• INSENSITIVE TO FEELINGS OF OTHERS
TREATMENT:
Unlikely to seek or respond to therapy.
SCHIZOTYPAL
PERSONALITY
DISORDER
Main characteristic:
Peculiarities and
eccentricities of
thought, behavior,
appearance, and
interpersonal style.
SCHIZOTYPAL
PERSONALITY
DISORDER
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CONSTRICTED, INAPPROPRIATE
AFFECT
 IDEAS OF REFERENCE, MAGICAL
THINKING
 SOCIAL ISOLATION
 PECULIAR COMMUNICATION
TREATMENT: Parallels interventions
commonly used in treating schizophrenia.
The Anxious Ones
Avoidant Personality
Dependent Personality
Obsessive-Compulsive
AVOIDANT PERSONALITY DISORDER
Most prominent feature:
The individual desires, but is fearful of, any
involvement with other people and is
terrified at the prospect of being publicly
embarrassed.
AVOIDANT - THEORIES
COGNITIVE-BEHAVIORAL
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Hypersensitive due to parental criticism
Feel unworthy of others’ regard
Expect not to be liked
Avoid getting close to avoid expected
rejection
 Distorted perceptions of experiences with
others
TREATMENT OF AVOIDANT
PERSONALITY
COGNITIVE-BEHAVIORAL
– BREAK NEGATIVE CYCLE OF
AVOIDANCE
– CONFRONT AND CORRECT
DYSFUNCTIONAL ATTITUDES AND
THOUGHTS
– GRADUATED EXPOSURE TO SOCIAL
SITUATIONS
– LEARN SKILLS TO IMPROVE CHANCE OF
INTIMACY
DEPENDENT PERSONALITY
DISORDER
Main characteristic: This individual is
extremely passive and tends to cling to
other people to the point of being unable to
make any decisions or to take independent
action.
Others may characterize them as “clingy.”
DEPENDENT
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Fear of abandonment
Despondent without others
Unable to initiate activities
Insecure about making decisions without
others
• Go to extreme to get approval from others
• Devastated when relationships end
DEPENDENT - THEORIES
Theories
• PSYCHODYNAMIC
– Fixated at oral psychosexual stage because of
parental overindulgence or neglect
• OBJECT RELATIONS
– Insecure attachment to parents led to fear of
abandonment
– Low self-esteem leads them to rely on others
• COGNITIVE-BEHAVIORAL
– Thinking they are inadequate and helpless, they find
someone to take care of them
TREATMENT OF DEPENDENT
PERSONALITY
COGNITIVE-BEHAVIORAL
– Therapist and client develop structured
ways to increase client independence in
daily activities
– Identify skill deficits and improve
functioning
– Therapist must avoid becoming an
authority figure or making client
dependent on therapist
Main characteristic: Perfectionistic
So overwhelmed with their concern for
neatness and minor details that they have
trouble making decisions or getting things
accomplished.
OBSESSIVE-COMPULSIVE
• RIGID BEHAVIORAL PATTERNS
• FANATICAL CONCERN WITH
SCHEDULES
• STINGY WITH TIME AND MONEY
• TENDENCY TO HOARD WORTHLESS
OBJECTS
• LOW LEVEL OF EMOTIONALITY
THEORIES OF
OBSESSIVE-COMPULSIVE
• FREUDIAN
– Fixation at anal psychosexual stage
• OBJECT RELATIONS
– Insecure parent-child attachments
• COGNITIVE-BEHAVIORAL
– Distorted world view
– Unrealistic standard of perfection
TREATMENT: Difficult to treat. Therapy may
reinforce ruminative tendencies.
And in conclusion . . . ?
Personality disorders are
• Chronic and persistent
• Hard to explain
• Difficult to treat
• Subject to much further study