PERSONALITY DISORDERS:

1. PERSONALITY DISORDERS: An enduring (long-standing) pattern in two or more of the following areas: 1) Cognition(thoughts) - ways of interpreting and perceiving events 2) Affectivity(emotions) - range, intensity, lability, & appropriateness 3) Interpersonal functioning (behavior) 4) Impulse control (behavior)

2. Personality Traits vs. Disorders • Deviation from social & cultural norms – consider contribution of situational & cultural context • Inflexibility – rigid patterns of behaviors & responses • Pervasive – present in a variety of contexts • Clinically significant distress – for self or others • Impairment in functioning – highly maladaptive • Stable & long-lasting - onset by early adulthood, long-term pattern vs. occasional

3. Characterized by: Odd behavior, reactions, emotions Eccentric thoughts & behaviors – e.g. illusory or magical thinking, inappropriate social interactions Isolative behavior – social withdrawal Suspiciousness – paranoia Includes: Paranoid Personality Disorder Schizoid Personality Disorder Schizotypal Personality Disorder May represent mild variations of Schizophrenia, but reality testing is intact CLUSTER A PERSONALITY DISORDERS

4. PARANOID PERSONALITY DISORDER A. A pervasive pattern of distrusting, being suspicious of, and attributing malevolent intention to others B. Pattern of behavior is not due to Schizophrenia, a Mood Disorder with Psychotic Features, another Psychotic Disorder, the effects of a substance, or a general medical condition

5. PARANOID PERSONALITY DISORDER Indicated by 4 or more of the following 7: • Assuming others will exploit, harm, or deceive them • Continually doubting the loyalty or trustworthiness of friends or associates • Reluctance to confide in others because fear info will be used against them • Reading hidden demeaning or threatening meanings into benign remarks or events • Persistently bearing grudges • Often believing they have been attacked or slighted and are quick to react angrily or with counterattack • Continually suspecting spouse or sexual partner of being unfaithful

6. PARANOID PERSONALITY DISORDER What it looks like: • Chronically suspicious of others • Distrusting of others • Assuming the worst intention • Not open • Continually doubting loyalty of others • Unforgiving • Hold grudges

7. PARANOID PERSONALITY DISORDER Facts & Figures: • Prevalence – 0.5-2.5% in general population • Gender – more common in males • Onset – often first apparent in childhood and adolescence • Cultural Factors – need for caution in diagnosing members of minority, ethnic, immigrant, refugee groups Treatment Considerations: • Importance of developing trust & a solid therapeutic alliance • Cognitive therapy to counter mistaken assumptions and negative beliefs about others • No evidence that therapy is very successful

8. SCHIZOID PERSONALITY DISORDER A.Characterized by a pervasive pattern of: -detachment from social relationships -restricted range of emotional expression in interpersonal settings B. Pattern of behavior is not due to schizophrenia, a Mood Disorder with Psychotic Features, another Psychotic Disorder, or a Pervasive Developmental Disorder.

9. SCHIZOID PERSONALITY DISORDER Indicated by 4 or more of the following 7: 1. Neither desiring nor enjoying close relationships, including being part of a family • Almost always choosing solitary activities • Having little, if any, interest in sexual experiences/relationships 4. Taking pleasure in few, if any, activities 5. Lacking close friends or confidants 6. Indifference to praise or criticism 7. Emotional coldness, detachment, or flatness

10. SCHIZOID PERSONALITY DISORDER What it looks like: • Emotionally cold & distant • Great difficulty forming relationships • Social isolation – loner • Restricted affect – lack of emotional expressiveness • Lack of interest in people, relationships, & most activities

11. SCHIZOID PERSONALITY DISORDER Facts & Figures: • Prevalence – uncommon; <1% • Gender – slightly more common and impairing in males • Onset – often first apparent in childhood and adolescence • Cultural – need for caution in diagnosing people from different cultural backgrounds, environments, or immigrants

12. SCHIZOID PERSONALITY DISORDER • Contributing factors: • Childhood shyness • Genetics • Parenting: neglectful & cold parenting; intrusive mother; absent father • Lower density of dopamine receptors • Traumatic experiences • Treatment: • Modeling healthy relationship skills & emotional expression • Empathy training – teaching the person how to identify, express, & respond to emotion • Social skills training, including role playing • Building a support network

13. SCHIZOTYPAL PERSONALITY DISORDER A. A pervasive pattern of social and interpersonal deficits marked by: -acute discomfort with close relationships -a reduced capacity for close relationships -cognitive or perceptual distortions -eccentric behaviors B. Pattern is not due to schizophrenia, a Mood Disorder with Psychotic Features, another Psychotic Disorder, or a Pervasive Developmental Disorder

14. SCHIZOTYPAL PERSONALITY DISORDER Indicated by 5 or more of the following 9: 1. Ideas of reference 2. Odd beliefs or magical thinking 3. Unusual perceptual experiences 4. Odd thinking & speech • Suspiciousness or paranoid ideation 6. Inappropriate or constricted affect 7. Odd, eccentric or peculiar behavior or appearance 8. Lack of close friends or confidants 9. Excessive social anxiety that does not diminish with familiarity and tends to be associated with paranoid fears

15. SCHIZOTYPAL PERSONALITY DISORDER What it looks like: • Social impairment & isolation • Social discomfort & anxiety • Variety of odd beliefs & cognitions • Unusual perceptions & perceptual experiences • Odd speech & presentation • Eccentric & peculiar behavior • Inappropriate or blunted affect

16. SCHIZOTYPAL PERSONALITY DISORDER Facts & Figures: • Prevalence – 3-5% of general population • Gender – slightly more common in males • Onset – often first apparent in childhood and adolescence • Course – chronic; some go on to develop Schizophrenia • Cultural – need to consider cultural context when evaluating symptoms

17. SCHIZOTYPAL PERSONALITY DISORDER Contributing Factors: • Biological and genetic factors have been emphasized – Schizotypal PD as a milder variant of schizophrenia Treatment Considerations: • Psychotropic medication – antidepressants, antipsychotics • Cognitive-behavioral therapy • Social skills training

18. Cluster A Scenario • An individual receives an invitation to attend the birthday party of a supervisor at work. This supervisor is not well known to the individual, in fact, they have only spoken on a couple of occasions.

19. Cognitions include: This person reached their position through dishonesty or fraud – they are not to be trusted. My colleagues are out to get me – it will not be safe to be in an unfamiliar setting with them. My job security is being threatened. Behaviors include: Approaching the supervisor to research these suspicions in a hostile and accusatory manner Finding an excuse to not attend the birthday party Increased irritability in the workplace Hypervigilance for “suspicious” behavior from colleagues Paranoid Personality Disorder

20. Cognitions Include: Not wanting to go to the party I would rather be alone. This party won’t be enjoyable. Behaviors include: Not attending the party Telling the supervisor she won’t attend in a cold, detached way Schizoid Personality Disorder

21. Cognitions Include: I was meant to go to this birthday party because something supernatural will occur I wonder why the supervisor chose me? Will I be prepared to handle what is to come? Behaviors Include: Wearing an unusual ceremonial costume to the party Remaining detached from others at the party Speaking to others in an elaborate way Schizotypal Personality Disorder

22. Characteristics: Dramatic Emotional Erratic behavior Impulsiveness Reduced capacity for empathy Unstable emotions & relationships Includes: Antisocial Personality Disorder Borderline Personality Disorder Histrionic Personality Disorder Narcissistic Personality Disorder CLUSTER B PERSONALITY DISORDERS

23. ANTISOCIAL PERSONALITY DISORDER • Pervasive pattern of disregard for and violation of the basic rights of others • Beginning in childhood or early adolescence (must have evidence of Conduct Disorder prior to 15 years) • Continuing into adulthood (must be at least 18 years) • Occurrence of antisocial behavior is not exclusively during a course or Schizophrenia or Mania

24. ANTISOCIAL PERSONALITY DISORDER Indicated by 3 or more of the following 7: • Failure to conform to social norms and laws, e.g. repeatedly performing acts that are grounds for arrest • Deceitfulness & manipulation, e.g. repeated lying, using aliases, or conning others for personal profit or pleasure • Impulsivity or failure to plan ahead • Irritability and aggressiveness, e.g. repeated physical fights or assaults • Reckless disregard for safety of self or others • Consistently & extremely irresponsible, e.g. repeated failure to sustain consistent work or honor financial obligations • Lack of remorse, e.g. being indifferent to or rationalizing having hurt, mistreated, or stolen from another

25. ANTISOCIAL PERSONALITY DISORDER What you see: • Aggressiveness • Superficial charm • Self-centered • Bore easily, high need for stimulation, sensation-seeking, thrill-seeking • Lie easily • Conning, manipulative • Relationships of “utility” • Lack of remorse – little or no guilt about the harm they cause others • Lack of empathy – may seem cold & insensitive • Enjoy testing, provoking, pushing, “playing with” others • Criminal behavior – feel rules don’t apply to them

26. ANTISOCIAL PERSONALITY DISORDER Facts & Figures: • Prevalence: 3% males; <1% females • Gender: more common in males • SES: associated with low SES & urban settings; important to consider the social and economic context for behaviors • Course: chronic, but symptoms tend to lessen or remit by 4th decade of life

27. Antisocial Personality Disorder Contributing Factors: • Strong biological roots: • Genetic influence • Low levels of 5HT • Low arousability • Excessive theta waves • Poor impulse control • Fearlessness • Environmental factors: • Parenting: harsh, inconsistent, neglectful, uninvolved, abusive • Chronic stress, trauma Treatment: • Psychotherapy is not very effective; often court-mandated • Lithium & SSRI’s may help control impulsive, aggressive behaviors

28. BORDERLINE PERSONALITY DISORDER A pervasive pattern of marked impulsivity and unstable relationships, self image, and emotions Indicated by 5 or more of the following 9: • Frantic efforts to avoid real or imagined abandonment • A pattern of unstable and intense interpersonal relationships – shifts from extreme idealization to devaluation 3. Identity disturbance – sudden & dramatic shifts in self image, e.g. goals, values, career plans & aspirations, sexual identity, types of friends

29. BORDERLINE PERSONALITY DISORDER 4. Impulsive behavior that is potentially self-damaging, e.g. spending, sex, substance abuse, reckless driving, binge eating 5. Recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior 6. Affective instability due to highly reactive mood, e.g. episodes of dysphoria, anxiety, panic, irritability, anger, despair 7. Chronic feelings of emptiness 8. Inappropriate, intense anger or difficulty controlling anger; e.g. frequent temper, biting sarcasm, enduring bitterness, verbal outbursts, recurrent fights 9. Transient, stress-related paranoia or dissociative symptoms, such as depersonalization

30. BORDERLINE PERSONALITY DISORDER What it looks like: • Unstable mood & emotions – lack control over emotions • Unstable self-concept • Unstable interpersonal relationships • Poor impulse control • Self-destructive • Good at splitting • Vacillating between extremely positive & negative evaluations of self & others

31. BORDERLINE PERSONALITY DISORDER Facts & Figures: • Prevalence: 1-3% of general population • Gender: 75% female • Completed suicide rate: 6-10% • Course: • greater instability, impairment, and suicide risk in adolescence & young adulthood • symptoms gradually wane with advancing age • by 30’s & 40’s, most attain greater stability in relationships and vocational functioning

32. BORDERLINE PERSONALITY DISORDER • Contributing Factors: • Biological factors – low levels of serotonin • Family history of mood disorders • Environmental factors – invalidating & neglectful parenting; history of abuse; trauma • Treatment: • Drug therapies – SSRI’s for dysphoria; mood stabilizers for mood instability • Long-term therapy • Dialectical Behavior Therapy • Trauma work

33. HISTRIONIC PERSONALITY DISORDER A pervasive pattern of excessive emotionality and attention-seeking behavior Indicated by 5 or more of the following 8: • Feels uncomfortable or unappreciated when not the center of attention • Inappropriately seductive or provocative behavior • Displays rapidly shifting and shallow emotions

34. HISTRIONIC PERSONALITY DISORDER • Consistently uses physical appearance to draw attention to self • Have strong opinions & impressions, but can’t back up with facts, details, examples, evidence • Is overly dramatic, theatrical and emotionally expressive • Is suggestible, i.e. easily influenced by others, fads, or circumstances • Considers relationships to be more intimate than they actually are

35. HISTRIONIC PERSONALITY DISORDER What it looks like: • Flamboyant self expression & presentation • Over-blown, overly dramatic emotional rxns • Needy & solicitous of others • Require excessive approval & reassurance • Frequently dependent • Impressionistic & superficial • Overly concerned with appearance • Seductive & charming

36. HISTRIONIC PERSONALITY DISORDER Facts & Figures: • Prevalence: 2-3% in general population • Gender: diagnosed more frequently in women; prevalence may be equal for males & females • Sex role stereotypes influence the behavioral expression of the disorder • Aging presents special difficulties • Course: chronic, but sx may improve with age Contributing Factors: • Unmet needs for attention & success

37. NARCISSISTIC PERSONALITY DISORDER Pervasive pattern of grandiosity in fantasy or behavior, need for admiration, and lack of empathy Indicated by 5 or more of the following 9: • Grandiose sense of self importance, e.g. overestimating one’s abilities, exaggerating one’s accomplishments, underestimating/devaluing others. • Fantasies about unlimited success, power, brilliance, beauty, or love. • Belief that one is special, superior, or unique.

38. NARCISSISTIC PERSONALITY DISORDER 4. Need for excessive admiration and/or constant attention 5. Sense of entitlement, i.e. expecting especially favorable treatment or automatic compliance from others 6. Conscious or unwitting exploitation of others 7. Lack of empathy for others; e.g. insensitivity, emotional coldness, lack of interest in others 8. Envying others; believing others envy them 9. Arrogant, haughty, patronizing, snobby, or disdainful behaviors or attitudes

39. NARCISSISTIC PERSONALITY DISORDER What it looks like: • Self-enhancing, self-aggrandizing • Self-centered, self-absorbed • Readily dismiss opinions of others • Need to feel special • Love to receive special treatment • Can become rageful & attacking in response to perceived threat

40. NARCISSISTIC PERSONALITY DISORDER Facts & Figures: • Prevalence: <1% in general population • Gender: up to 75% male • Age: narcissistic traits are particularly common in adolescents • Course: the aging process presents special difficulties; may improve over time

41. NARCISSISTIC PERSONALITY DISORDER • Causes: • Parental factors: failure in modeling empathy; rejecting, abandoning, or cold; capricious, unreliable; treating the child as an extension of themselves; overvaluation; lack of genuine, sincere affection • Treatment: • Usually seek treatment at insistence of family member or as a result of a major life crisis • Coping skills to improve ability to accept criticism & rejection and to help person develop a more realistic view of their abilities and talents • Empathy building • Addressing depression & other underlying problems that may exist

42. Cluster B Scenario • An individual sees someone they occasionally date out at the movies with another date.

43. Cognitions Include: Thoughts about what could be done to ensure that they are the one selected for the date next time – it is, after all, a dog eat dog world. Behaviors Include: Socially unacceptable or unlawful behavior to interrupt the date (calling in a bomb threat to the movie theatre) Starting rumors about the person who their romantic interest was on a date with, or about the romantic interest themselves. Antisocial Personality Disorder

44. Cognitions Include: She must hate me now. I am worthless. I will never have a relationship. My life is over. I was in love with her. Behaviors Include: An emotional outburst Self injurious behavior Calling attention to himself impulsively in the moment Borderline Personality Disorder

45. Cognitions Include: I can’t stand that person (either the romantic interest or the date). Didn’t someone tell me he was promiscuous? We were in love. Behaviors Include: A dramatic outburst Sexually seductive behavior Excessive emotional response that is prolonged and involves many people Histrionic Personality Disorder

46. Cognitions Include: A brief thought of being rejected Thoughts of being superior to the other date Thoughts that the date would be envious if they knew who she was Behaviors Include: Loudly discussing accomplishments in the movie theatre so the romantic interest and date are sure to hear Showing how well known they are by greeting every acquaintance in the movie theater Approaching the romantic interest and asking them to call or actually starting up a conversation Narcissistic Personality Disorder

47. Characterized by: Anxious behavior Chronic fears Perfectionism Constant self-doubt Includes: Avoidant Personality Disorder Dependent Personality Disorder Obsessive- Compulsive Personality Disorder Cluster C Personality Disorders

48. AVOIDANT PERSONALITY DISORDER • A pervasive pattern of social inhibition, feeling inadequate, and hypersensitivity to negative evaluation Indicated by 4 or more of the following 7: 1. Avoid work or school activities involving significant interpersonal contact because fear disapproval, criticism, or rejection 2. Resist getting involved with people without assurance that they will be liked and accepted without criticism 3. Are restrained in intimate relationships because fear being shamed or ridiculed

49. AVOIDANT PERSONALITY DISORDER Continued: 4. Are preoccupied with being criticized or rejected in social situations (confirmatory bias) 5. Inhibited in new interpersonal situations due to feeling inadequate & having low self-esteem 6. See self as socially inept, unappealing, or inferior to others 7. Unusual reluctance to take personal risks or engage in any new activities because these may prove embarrassing

50. AVOIDANT PERSONALITY DISORDER What it looks like: • Feel inadequate • Low self-esteem • Socially incompetent • Worry about being criticized • Avoid situations, activities, relationships, and people where there is any potential for them to be criticized, rejected, ridiculed, embarrassed, or disapproved of