1 / 49

Chapter 12 Personality Disorders

Chapter 12 Personality Disorders. 0. Personality Disorders: An Overview. 0. Enduring and pervasive predispositions Perceiving Relating Thinking Inflexible and maladaptive Distress Impairment Coded on Axis II. Personality Disorders. 0. 10 specific personality disorders

edan
Download Presentation

Chapter 12 Personality Disorders

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Chapter 12Personality Disorders 0

  2. Personality Disorders: An Overview 0 • Enduring and pervasive predispositions • Perceiving • Relating • Thinking • Inflexible and maladaptive • Distress • Impairment • Coded on Axis II

  3. Personality Disorders 0 • 10 specific personality disorders • Several under review for DSM-V • 3 clusters • High comorbidity with Axis I disorders • Poorer prognosis • Therapist reactions • Countertransference

  4. Personality Disorders: An Overview 0 • Categorical vs. Dimensional Views • “Kind” vs. “Degree” • DSM is categorical • Reifies concepts • Less flexible • Loss of individual information • Sometimes arbitrary

  5. Personality Disorders: An Overview 0 • Five factor model of personality (“Big Five”) • Openness to experience • Conscientiousness • Extraversion • Agreeableness • Emotional stability

  6. DSM Personality Disorder Clusters 0 • Cluster A • Odd or eccentric • Paranoid, schizoid, schizotypal • Cluster B • Dramatic, emotional, erratic • Antisocial, borderline, histrionic, narcissistic • Cluster C • Fearful or anxious • Avoidant, dependent, obsessive-compulsive

  7. Personality Disorders: Facts and Statistics 0 • Prevalence = 0.5 - 2.5%, may be closer to 10% • Outpatient = 2 - 10% • Inpatient = 10 – 30% • Origins and Course • Begin in childhood • Chronic course • High comorbidity

  8. Personality Disorders: Gender Differences 0 • Differences in diagnostic rates • Borderline (75% female) • Clinician bias • Assessment bias • Measures • Criterion bias • Histrionic = extreme “stereotypical female” • No “macho” disorder

  9. Personality Disorders: Gender Differences 0

  10. Personality Disorders Under Study 0 • Individual disorders • Sadistic • Self-defeating • Categories of disorders • Depressive • Negativistic • Passive aggressive

  11. Cluster A: Paranoid Personality Disorder 0 • Clinical Description • Mistrust and suspicion • Pervasive • Unjustified • Few meaningful relationships • Volatile • Tense • Sensitive to criticism

  12. Cluster A: Paranoid Personality Disorder 0 • Causes • Possible relationship to schizophrenia • Possible role of early experience • Trauma • Abuse • Learning • “World is dangerous”

  13. Cluster A: Paranoid Personality Disorder 0 • Treatment • Unlikely to seek on own • Crisis • Focus on developing trust • Cognitive therapy • Assumptions • Negative beliefs • No empirically-supported treatments

  14. Cluster A: Schizoid Personality Disorder 0 • Clinical Description • Appear to neither enjoy nor desire relationships • Limited range of emotions • Appear cold, detached • Appear unaffected by praise, criticism • Unable or unwilling to express emotion • No thought disorder

  15. Cluster A: Schizoid Personality Disorder 0 • Causes • Limited research • Precursor: childhood shyness • Possibly related to: • Abuse/neglect • Autism • Dopamine

  16. Cluster A: Schizoid Personality Disorder 0 • Treatment • Unlikely to seek on own • Crisis • Focus on relationships • Social skills therapy • Empathy training • Role playing • Social network building • No empirically-supported treatments

  17. Cluster A: Schizotypal Personality Disorder 0 • Clinical Description • Psychotic-like symptoms • Magical thinking • Ideas of reference • Illusions • Odd and/or unusual • Behavior • Appearance • Socially isolated • Highly suspicious

  18. Cluster A: Schizotypal Personality Disorder 0 • Causes • Schizophrenia phenotype? • Lack full biological or environmental contributions • Preserved frontal lobes • Cognitive impairments • Left hemisphere? • More generalized?

  19. Cluster A: Schizotypal Personality Disorder 0 • Treatment Options • Treatment of comorbid depression • Multidimensional approach • Social skill training • Antipsychotic medications • Community treatment

  20. Cluster B: Antisocial Personality Disorder 0 • Clinical Description • Noncompliance with social norms • “Social Predators” • Violate rights of others • Irresponsible • Impulsive • Deceitful • Lack a conscience, empathy, and remorse

  21. Cluster B: Antisocial Personality Disorder 0 • Nature of psychopathy • Glibness/superficial charm • Grandiose sense of self-worth • Proneness to boredom/need for stimulation • Pathological lying • Conning/manipulative • Lack of remorse • Overlap with ASPD, criminality • Intelligence

  22. Cluster B: Antisocial Personality Disorder 0

  23. Cluster B: Antisocial Personality Disorder 0

  24. Cluster B: Antisocial Personality Disorder 0 • Developmental considerations • Early histories of behavioral problems • Conduct disorder • Families history of: • Inconsistent parental discipline • Variable support • Criminality • Violence

  25. Causes of Antisocial Personality 0 • Gene-environment interaction • Genetic predisposition • Environmental triggers • Arousal hypotheses • Underarousal • Fearlessness

  26. Causes of Antisocial Personality 0 • Gray’s model of brain functioning • Behavioral inhibition system (BIS) • Low • Reward system (REW) • High • Fight/flight system (F/F)

  27. Causes of Antisocial Personality 0 • Interactive, integrative model • Genetic vulnerability • Neurotransmitters • Environmental factors • Family stress • Reinforcement of antisocial behaviors • Alienation from good role models • Poor occupational/social function

  28. Antisocial Personality Disorder 0 • Treatment • Unlikely to seek on own • High recidivism • Incarceration • Early intervention • Parent training • Prevention • Rewards for pro-social behaviors • Skills training • Improve social competence

  29. Cluster B: Borderline Personality Disorder 0 • Clinical Description • Patterns of instability • Labile, intense moods • Turbulent relationships • Impulsivity • Fear of abandonment • Very poor self-image • Self-mutilation • Suicidal gestures

  30. Cluster B: Borderline Personality Disorder 0 • Comorbid disorders • Depression – 24-74% • Suicide – 6% • Bipolar – 4-20% • Substance abuse – 67% • Eating disorders • 25% of bulimics have BPD

  31. Cluster B: Borderline Personality Disorder 0 • Causes • Genetic/biological components • Serotonin • Frontolimbic circuit • Cognitive biases • Early childhood experience • Neglect • Trauma • Abuse

  32. Cluster B: Borderline Personality Disorder 0 • Treatment • Highly likely to seek treatment • Antidepressant medications • Dialectical behavior therapy • Reduce “interfering” behaviors • Self-harm • Treatment • Quality of life • Outcomes • Demonstrated efficacy • Cortical activation changes

  33. Cluster B: Borderline Personality Disorder 0

  34. Cluster B: Histrionic Personality Disorder 0 • Clinical Description • Overly dramatic • Sensational • Sexually provocative • Impulsive • Attention-seeking • Appearance-focused • Impressionistic • Vague, superficial speech • Common diagnosis in females

  35. Cluster B: Histrionic Personality Disorder 0 • Causes • Little research • Links with antisocial personality • Sex-typed alternative expression?

  36. Cluster B: Histrionic Personality Disorder 0 • Treatment • Problematic interpersonal behaviors • Attention seeking • Long-term consequences of behavior • Little empirical support

  37. Cluster B: Narcissistic Personality Disorder 0 • Clinical Description • Exaggerated and unreasonable sense of self-importance • Require attention • Lack sensitivity and compassion • Sensitive to criticism • Envious • Arrogant

  38. Cluster B: Narcissistic Personality Disorder 0 • Causes • Deficits in early childhood learning • Altruism • Empathy • Sociological view • Increased individual focus • “Me generation”

  39. Cluster B: Narcissistic Personality Disorder 0 • Treatment focuses on: • Grandiosity • Lack of empathy • Hypersensitivity to evaluation • Co-occurring depression • Little empirical support

  40. Cluster C: Avoidant Personality Disorder 0 • Clinical Description • Extreme sensitivity to opinions • Avoid most relationships • Interpersonally anxious • Fearful of rejection

  41. Cluster C: Avoidant Personality Disorder 0 • Causes • Sub-schizophrenia disorder? • Difficult temperament • Early parental rejection • Interpersonal isolation and conflict

  42. Cluster C: Avoidant Personality Disorder 0 • Treatment • Similar to social phobia • Increase social skills • Reduce anxiety • Importance of therapeutic alliance • Moderate empirical support

  43. Cluster C: Dependent Personality Disorder 0 • Clinical Description • Rely on others for major and minor decisions • Unreasonable fear of abandonment • Clingy • Submissive • Timid • Passive • Feelings of inadequacy • Sensitivity to criticism • High need for reassurance

  44. Cluster C: Dependent Personality Disorder 0 • Causes • Little research • Early experience • Death of a parent • Rejection • Attachment

  45. Cluster C: Dependent Personality Disorder 0 • Treatment • Limited empirical support • Caution: dependence on therapist • Gradual increases in: • Independence • Personal responsibility • Confidence

  46. Cluster C: Obsessive-Compulsive Personality Disorder 0 • Clinical Description • Fixation on doing things the “right way” • Rigid • Perfectionistic • Orderly • Preoccupation with details • Poor interpersonal relationships • Obsessions and compulsions are rare

  47. Cluster C: Obsessive-Compulsive Personality Disorder 0 • Causes • Limited research • Weak genetic contributions • Predisposed to favor structure?

  48. Cluster C: Obsessive-Compulsive Personality Disorder 0 • Treatment • Similar to OCD • Address fears related to the need for orderliness • Decrease: • Rumination • Procrastination • Feelings of inadequacy • Limited efficacy data

  49. Personality Disorders: Future Directions 0 • Completely rethinking personality disorders • Dimensional models

More Related