Transcript Personality Disorders

Personality Disorders
Chapter 9
General Symptoms
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Problems must be part of an enduring pattern of inner experience
and behavior that deviates significantly from the expectations of the
individual’s culture.
Patterns must be evident in two or more of the following domains:
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Pattern of maladaptive experience and behavior must also be:
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Cognition-ways of thinking of self and others
Emotional Responses
Interpersonal Functioning
Impulse Control
Inflexible and pervasive across a broad range of personal and social
situations.
Source of clinically significant distress or impairment in social,
occupational or other important areas of functioning.
Stable and of long duration, with an onset that can be traced back at
least to adolescence or early adulthood.
Similar observations in all subsets of
the disorder
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Behavioral patterns associated with significant social and occupational impairment.
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Presence of pathological personality traits during adolescence is associated with an
increased risk for development of other mental disorders later in life.
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Negative emotionality-predicts onset of depression or anxiety disorder
Impulsive or antisocial personality traitspredicts increased risk of alcohol abuse.
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Personality disorder represent the early onset of more serious forms of pathology:
Presence of co-morbid personality disorder can interfere with the treatment of
other disorders.
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Ego-syntonic vs. Ego-dystonic
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Ego-dystonic-person with the disorder is distressed by their symptoms and uncomfortable
with their situation.
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Ego-syntonic-(personality disordered)-do not see themselves as disturbed and their ideas
or impulses are acceptable to them, primarily due to a lack of insight.
General Definition
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Over-all definition is difficult as the personality
disorders by nature are:
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Controversial
Difficult to Reliably Identify
Poorly understood Etiology
Little evidence of successful treatment
Personality (def)-enduring pattern of thinking
and behavior that define the person and
distinguish him or her from other people,
including expressing \emotion as well as hw one
thinks about themselves and other people.
Typical Symptoms and Associated
Features
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Social Motivation
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can be described in terms of maladaptive variations
with regard to needs for affiliation and power.
Affiliation-the desire for close relationships with other
people
Power-the desire for impact, prestige or dominance
Cognitive Perspective of Self and Others
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Distortions of our perceptions of self and others.
Inappropriate evaluation of relationships
Lack of empathy
Temperament and Personality Traits
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Temperament refers to a person’s most basic,
characteristic styles of relating to the world,
especially those styles that are evident during
the first year of life.
Five Factor Model of Personality
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Neuroticism
Extraversion
Openness to Experience
Agreeableness
Conscientiousness
Context and Personality
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Development and Persistence of
individual differences have two important
qualifications:
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Differences may not be evident in all
situations.
People with personality disorders do not
always exhibit the traits associated with the
disorder.
Consequences of exhibiting certain traits
in a social context.
. Classification
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Organized into three basic clusters on the basis
of broadly defined characteristics
Cluster A: includes people who often appear
odd, eccentric or asocial.
. Cluster B: includes people who appear
dramatic, emotional or erratic behavior and all
are associated with difficulty sustaining
interpersonal relationships.
Cluster C: includes people who often appear
anxious or fearful
Cluster A: subtypes
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Paranoid Personality Disorder -characterized by the
pervasive tendency to be inappropriately suspicious
of other people’s motives and behaviors.
Schizoid Personality Disorder -defined by a
pervasive pattern of indifference to other people.
Schizotypal Personality Disorder -peculiar patterns
of behavior rather than emotional restriction and
social withdrawal associated with schizoid
personality disorder.
Cluster B: Subtypes
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Anti-social Personality Disorder-persistent pattern of
irresponsible behavior that begins during childhood or
adolescence and continues into adulthood.
Borderline Personality Disorder-diffuse category whose
defining feature is a pervasive pattern of instability of
mood and interpersonal relationships.
Histrionic-characterized by pervasive pattern of
excessive emotionality and attention seeking behavior.
Narcissistic Personality Disorder-pervasive pattern of
grandiosity
Cluster C: Subtypes
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Avoidant Personality Disorder-pervasive
pattern of social discomfort.
Dependent Personality Disorder-pervasive
pattern of submissive and clinging behavior
Obsessive Personality Disorder-pervasive
pattern of orderliness, perfectionism, and
mental and interpersonal control at the
expense of flexibility, openness and
efficiency.
Personality Disorder Not Otherwise
Specified
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Allows for a non-specific diagnosis in
addition to the 10 specific subtypes.
Category used for people that meet the
general diagnostic criteria for a
personality disorder without meeting the
specific criteria for one of the subtypes.
May be the most frequently used
diagnosis
Epidemiology
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Prevalence-over-all life-time prevalence for
having at least one Axis II disorder is between
10-14%.
Gender Differences
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Stability over life time.
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Schizotypal Personality Disorder
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Criteria
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Symptoms of schizotypal Personality disorder represent early
manifestations of the predisposition to develop the full-blown
disorder (Schizophrenia )
Pervasive pattern of social and interpersonal deficits marked by
acute discomfort with, and reduced capacity for, close
relationships as well as cognitive and perceptual distortions,
and eccentricities of behavior beginning by early adulthood and
present in a variety of contexts as indicated by five (or more) of
the traits listed in table 9-3. For example:
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-Odd thinking and speech
--Suspiciousness or paranoid ideation
--Inappropriate emotional responses such as uncontrolled
giggling
at a funeral
--Lack of close friends
--Excessive Social anxiety
Etiology
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Primarily genetic.
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First degree relatives of schizophrenic
patients are considerably more likely than
people in the general population to exhibit
schizotypal personality disorders.
Treatment
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People with these disorders do not seek
treatment because they do not see their own
behavior as a source of distress (ego-syntonic)
A relatively high proportion of patients drop out
of treatment before it is completed.
Therapeutic effects of medication are positive,
but tend to be modest. Usually treated with antipsychotic drugs to alleviate cognitive problems
and social anxiety.
Do not respond well to insight oriented therapy.
Borderline Personality Disorder
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Criteria
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Faulty Development of the ego structure.
Splitting-tendency to see people and events alternately as
entirely good or entirely bad.
Pervasive pattern of instability in self image, in interpersonal
relationships, and mood.
Significant overlap with symptoms of histrionic, narcissistic,
paranoid, dependent and avoidant personality disorders.
Poor impulse control
Substance abuse
Co-morbidity with Depression
Etiology
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Most common theory focuses on the
environment, specifically the negative
consequences of parental loss or neglect
during childhood.
Animal literature supports this assertion
in observed behavior of monkeys
separate from mothers as infants (Harlow)
Childhood sexual abuse
Treatment
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Psychodynamic therapy to include transference
relationship
Emphasis on therapist acceptance of the patient,
both personally and as a client.
Medication-broad spectrum of drugs used to treat
specific symptoms such as antipsychotics, antidepressants, lithium and anticonvulsants.
No evidence that drug therapy is particularly
effective for treatment of any of the borderline
features.
Anti-social Personality Disorder
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Criteria
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Impulsive, self centered, pleasure seeking people
who seemed completely lacking in certain primary
emotions such as anxiety, shame and guilt.
Often intelligent, superficially charming, as well
as chronically deceitful, unreliable and incapable
of learning from experience.
Required presence of conduct disorder prior to
age 15
Etiology
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Biological Factors
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Social Factors
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Interaction of genetic and environmental factors based on adoption
studies.
Physical abuse and childhood neglect
Children whose response style is characterized by high levels of
negative emotion or excessive activity may be especially irritating to
parents and care givers, and may evoke maladaptive reactions from
parents who are poorly equipped to deal with this type of behavior.
Limited range of social skills
Consequences of antisocial behavior.
Psychological Factors
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Emotionally impoverished-lack of anxiety and fear.
Do not show exaggerated startle response indicative of fear of
aversive stimuliUnable to shift attention to consider the possible negative
consequences of their behavior.
Treatment
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Treatment relatively un-effective due to
inability to form intimate trusting
relationships which are essential to any
treatment program.
Seldom seek treatment unless forced by
legal system.
Dependent Personality Disorder
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Criteria
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Assume a submissive role in relationships with other
people
Require an extraordinary level of reassurance and support
Cling to others who will take care of them.
Preference for affiliation that reflects motivation to remain
close to people who will provide security and comfort
Fear of criticism and rejection leads to a lack of self
confidence
Etiology
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Over-protective authoritarian parents
Bowlby’s attachment theory-insecurely
attached babies who have little confidence
that attachement figures will be responsive
when they need something.
Treatment
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No literature on treatment outcome
Cognitive therapy predicted to be beneficial
when teaching problem solving abilities,
coupled with practice making decisions.
Medication not thought to be helpful for
disorder itself, many times prescribed for comorbid diagnosis such as anxiety and
depression.