Personality Disorders

1. Personality Disorders Thomas G. Bowers, Ph.D. Penn State Harrisburg

2. General Characteristics • Long-standing, maladaptive patterns of behavior • Generally recognizable by adolescence • Tend to be inflexible, persistent, and resistant to change • Must also be associated with significant life problems

3. Three W’s: Wild, Weird and Withdrawn • Easier to remember than Clusters A, B, C • Wild • 1. Borderline Personality Disorder • 2. Histrionic Personality Disorder • 3. Narcissistic Personality Disorder • 4. Antisocial Personality Disorder

4. Three W’s: Wild, Weird and Withdrawn • Weird • 1. Paranoid Personality Disorder • 2. Schizoid Personality Disorder • 3. Schizotypal Personality Disorder

5. Three W’s: Wild, Weird and Withdrawn • Withdrawn • Avoidant Personality Disorder • Dependent Personality Disorder • Obsessive-Compulsive Personality Disorder

6. Borderline Personality Disorder • Intense, unstable relationships • Instability in mood, self-image • “Who am I?” • Unpredictable and impulsive behavior • Often self damaging, as gambling, sexual behavior, spending sprees

7. Borderline Personality Disorder • Intense fear of aloneness • Extreme fears of abandonment • Demand attention • Alternate between idealization and devaluation • Chronic feelings of emptiness and boredom • Often suicidal feelings and gestures

8. Borderline Personality Disorder • Long interest from psychoanalytic field (as Kernberg) • Thought to be “borderline” between psychosis and neurosis • Tend to decompensate into psychotic state under stress

9. Borderline Personality Disorder • Object relations theory • Introjection of important values and images of other important people (as parents) may be faulty • Frequently see issues as a weak, ineffectual father (often totally absent, or even abandoning family) • Domineering mother

10. Borderline Personality Disorder • Inconsistent provision of warmth and affection • Frequently reported childhood physical and sexual abuse • Some biological relationships • Respond positively to SSRI • Familial, thought to be be genetic links • Related to bipolar affective disorder

11. Borderline Personality Disorder • Video assignment: “Fatal Attractions” note Glen Close in her role

12. Histrionic Personality Disorder • Overly dramatic, attention-seeking • Display excessive emotion, but in fact are emotionally shallow • Self-centered • Inappropriately sexually provocative and seductive • Pseudohypersexuality

13. Narcissistic Personality Disorder • Grandiose and exaggerated sense of self • Literary in love with themselves • Require constant attention and admiration • Lack of empathy, strong feelings of arrogance, entitlement • Take advantage of others

14. Antisocial Personality Disorder • Psychopathy (or sociopathy) • Cleckly - The Mask of Sanity • Emotional aloofness and detachment • Hare - contemporary researcher • Psychopathy appears to be distinct from ASPD

15. Antisocial Personality Disorder • Little ability to profit from experience • In particular, ASPD individuals do not seem to learn well to aversive stimulus conditions • Genetic factors appear to play a role, as do environmental factors • Lack of affection, severe rejection, inconsistent discipline, fathers often are antisocial

16. Antisocial Personality Disorder • Chronic cortical under arousal • Impulsivity, difficulties in goal directed behavior • Noted increased slow wave activity, temporal region spikes on EEG

17. “Weird” Cluster • Paranoid Personality • Highly suspicious of people, tends to mistrust others, expects to be mistreated • Extremely jealous • Schzoid Personality • Does not desire or enjoy social relationships • Bland, aloof, loners

18. “Weird” Cluster • Schizotypal Personality • Attenuated form of schizophrenia • Interpersonally similar to schizoid, with eccentric nature • Odd beliefs, magical thinking • Illusions

19. “Weird” Cluster • Etiology • May be a variant of schizophrenic range disorders • Family patterns noted

20. Withdrawn Cluster • Dependent Personality • Lacks self-confidence, independence, self-reliance • Passive and dependent stance • Intense need to be taken care of, unable to make demands on others • Tends to sacrifice needs of self for others • Fairly common

21. Withdrawn Cluster • Avoidant Personality • Keenly sensitive to rejection, disapproval • Extremely restrained, easily embarrassed • Exaggerate risks, dangers

22. Withdrawn Cluster • Obsessive Compulsive Personality • Perfectionistic, preoccupied with rules, details • Work excessively • Stubborn, rigid, demanding • Tend to be rigid and inflexible, moralistic

23. Diagnostic Issues • Reliability problems been noted • Structured interviews are now helpful • Considerable comorbidity

24. Interrater and Test-retest Reliability

25. Treatment of Personality Disorders • Psychodynamic therapy • Object relations therapy (Kernberg) • Focus on ego development • Interpretative • “Reality testing” • Dialectical behavior therapy • Linehan - Empirically tested • Client centered and cognitive methods

26. Treatment of Personality Disorders • Dynamic-Cognitive Therapy • Turner • Cognitive Therapy • Beck • Negative schemata of world thought to operate

27. Treatment of Personality Disorders • Psychopathy is very difficult to treat effectively • May be unsuitable for psychotherapy (or any type of personal relationship)