Personality Disorders

1. Personality Disorders A Closer Look at Psychological Disorders

2. Personality Disorders • Personality disorders are a class of disorders marked by extreme, long-standing, inflexible personality traits that cause subjective distress or impaired social and occupational functioning. • They are not so much severe mental disorders as dysfunctional styles of living. • They impair social functioning – sufferers seem unable to establish meaningful relationships with other people, to assume social responsibilities, or to adapt to their social environment. • The behavior patterns are usually evident by adolescence and obvious to others, but the person with the disorder often does not recognize the problem exists, which makes treatment difficult.

3. The DSM-IV lists 10 personality disorders, divided into three “clusters,” or categories. Classification of Personality Disorders

4. Cluster A Odd or Eccentric Behaviors (Paranoid, Schizoid, and Schizotypal Personality Disorders)

5. Paranoid Personality Disorder • Paranoid personality disorder is characterized by a deep distrust of others and a constant suspicion that people around you have sinister motives. • They search for hidden meanings in everything and read hostile intentions into the actions of others. • This suspiciousness gets in the way of personal connections, so they have few, if any, meaningful relationships. • They are quick to challenge the loyalties of friends and loved ones and often appear cold and distant to others. They usually shift blame to others and tend to carry long grudges. They are described as being tense, volatile, and sensitive to criticism. • Causes: • Possible relationship to schizophrenia • Possible role of early experience • Trauma • Abuse • Learning • “World is dangerous”

6. Schizoid Personality Disorder • Detached from social relationships, their social skills are often weak. They are the true hermits, preferring the life of the loner and avoiding intimate interactions with others at all costs. • They genuinely prefer to be alone and do not secretly wish for popularity. They do not show a need for attention or acceptance. • They tend to seek jobs that require little social contact and are perceived as humorless and distant. • They show a limited range of emotion and appear cold and detached. • They appear unaffected by both praise and criticism. • No disorder in thought. • Causes: • Limited research • Precursor: childhood shyness • Possibly related to: • Abuse/neglect • Autism • Dopamine

7. Schizotypal Personality Disorder • Some people believe that schizotypal personality disorder is a mild form of schizophrenia. • Psychotic-like symptoms (they do have disorder in thought) • Magical thinking – the irrational belief that one can bring about a circumstance or event by thinking about it or wishing for it; normal in preschool children. Superstitions, preoccupations with the paranormal or “magical.” • Ideas of reference - the belief that casual events, people's remarks, etc. are referring to oneself when, in fact, they are not. • Illusions - having illusions, or attributing a particular event to some mysterious force or person who is not present. Affected people may also feel they have special powers to influence events or predict an event before it happens. • Odd and/or unusual • Appearance – Their personal appearance may look unkempt—clothing choices that do not "fit together," clothes may be too small or large, or clothes may be noticeably unclean. • Behavior – odd perceptions, beliefs, behaviors and thoughts (often unconventional beliefs such as being convinced of having extra sensory abilities).

8. Schizotypal Personality Disorder, cont. • Socially isolated • Detachment from, and great discomfort in, social relationships • Highly suspicious • Often suspicious of others and display paranoid tendencies. • Causes: • Schizophrenia phenotype (possibly related to schizophrenia) • People with schizotypal PD, like patients with schizophrenia, may be quite sensitive to interpersonal criticism and hostility, and there is now evidence to suggest that parenting styles, early separation and early childhood neglect can lead to the development of schizotypal traits

9. Drawings done by patients diagnosed with schizotypal personality disorder Drawing done by a 15 year old with schizotypal personality disorder. Said he felt as though he had a “two-sided personality.” Titled “Birth, Death, Anger, tick, tick, tick…Soul taker”

10. Cluster B Dramatic, Emotional, or Impulsive Behaviors (Narcissistic, Histrionic, Borderline, and Antisocial Personality Disorders)

11. Narcissistic Personality Disorder • Characteristics of someone with Narcissistic PD: • Exaggerated and unreasonable sense of self-importance • Extreme sensitivity to criticism • A constant need for attention • A tendency to arrogantly overestimate personal abilities and achievements. • Self-centered and envious. • They exaggerate their achievements, expecting others to recognize them as being superior. • They tend to be choosy about picking friends, since they believe that not just anyone is worthy of being their friend. • They are generally uninterested in the feelings of others and may take advantage of them.

12. Narcissistic Personality Disorder, cont. • Other examples of narcissists: • Do Facebook and other social networking sites make us more narcissistic? http://www.youtube.com/watch?v=71xHUBWLC1k • Causes • Deficits in early childhood learning • Altruism • Empathy • Sociological view • Increased individual focus • “Me generation” Spencer Pratt: http://www.youtube.com/watch?v=InH9mQ2Mw1w

13. Histrionic Personality Disorder • Common diagnosis in females • Emotional shallowness and overly dramatic behavior. • Vague, superficial speech • They need to be the center of attention all the time, often interrupting others in order to dominate the conversation. • They may dress provocatively or exaggerate illnesses in order to gain attention. • They also tend to exaggerate friendships and relationships, believing that everyone loves them • Other characteristics: Excessively emotional, sensational, sexually provocative, impulsive, appearance-focused, impressionistic • Causes • Little research • Links with antisocial personality

14. Borderline Personality Disorder • A better name would be “emotionally unstable disorder” – the term borderline goes back to when sufferers were thought to be borderline schizophrenic (docs now know they’re often not) • Lack of stability in interpersonal relationships, self-image, and emotion. • Impulsivity • An intense fear of abandonment • Very poor self-image • Turbulent relationships • People with this disorder are prone to constant mood swings and bouts of anger. • They are quick to anger when their expectations are not met. • They will take their anger out on themselves, causing themselves injury (self-mutilation) • Suicidal threats and actions are not uncommon

15. Borderline Personality Disorder, cont. • Comorbid disorders • Depression – 24-74% • Suicide – 6% • Bipolar – 4-20% • Substance abuse – 67% • Eating disorders • 25% of bulimics have BPD • Causes • Genetic/biological components • Serotonin • Frontolimbic circuit (volume loss of the hippocampus and the amygdala) • Cognitive biases • Early childhood experience • Neglect • Trauma • Abuse

16. Antisocial Personality Disorder • Formerly known as psychopathic or sociopathic personality disorder • It is the most dramatic and troubling of all the personality disorders.

17. Symptoms of Antisocial Personality Disorder • This disorder is more likely to occur in males than females, and usually develops by adolescence. • It is characterized by a lack of conscience, empathy, and remorse for wrongdoing, even toward friends and family members. • People with this disorder exhibit a persistent disregard for and violation of others’ rights (“social predators”). They treat people as objects – as things to be used for gratification and cast aside coldly when no longer wanted. • They live for the moment and take action without thinking about consequences. • They seek thrills, they are often aggressive • Getting caught does not bother them, either. No matter how many times they are punished or jailed, they never learn to stay out of trouble. • However, interestingly enough, they can get away with destructive behavior because they are intelligent, entertaining, and able to feign emotions they do not feel. • They win affection and confidence from others of whom they then take advantage.

18. More on Antisocial Personality Disorder • People with this disorder are prone to criminal behavior, believing that their victims are weak and deserving of being taken advantage of. • Nature of psychopathy • Grandiose sense of self-worth • Proneness to boredom/need for stimulation • Pathological lying • Manipulative • Lack of remorse Overlap and lack of overlap among antisocial personality disorder, psychopathy, and criminality.

19. Examples of People who have Antisocial Personality Disorder • Serial killers who have no regard for the victims (“I think of killing like smoking a cigarette, like another habit”) • Alfred Jack Oakley – a con-artist who met women through personal ads claiming to be a millionaire movie producer, pilot, and novelist. He used his smooth-talking charm to steal all of their possessions. When convicted, Oakley complimented the prosecutor’s skills and the jury’s wisdom and claimed remorse. This may be what got him probation instead of jail time. • Some leaders of religious sects or cults are believed to be suffering from antisocial personality disorder. • Movies/books featuring APD: A Clockwork Orange, Fight Club, In Cold Blood, The Dark Knight, Silence of the Lambs (Hannibal Lector) Girl, Interrupted (Lisa) and American Psycho

20. Etiology of Antisocial Personality Disorder • Developmental considerations • Early histories of behavioral problems • Conduct disorder • Family history of: • Inconsistent parental discipline • Variable support • Criminality • Violence • Brain differences • PET scans of 41 murderers revealed reduced activity in the frontal lobes. In a follow-up study, repeat offenders had 11% less frontal lobe activity (Raine et al., 1999; 2000). • Gene-environment interaction • Genetic predisposition • Environmental triggers • Family stress • Reinforcement of antisocial behaviors • Alienation from good role models • Poor occupational/social function • Arousal hypotheses • Underarousal hypothesis – Cortical arousal is too low • Fearlessness hypothesis – Fail to respond to danger cues Normal Murderer

21. Cluster C Anxious or Fearful Behaviors (Avoidant, Dependent, and Obsessive-Compulsive Personality Disorders)

22. Avoidant Personality Disorder • They are so sensitive about being rejected that personal relationships become difficult. • Similar to social phobia in the sense that these people tend to be “loners” with a long-standing pattern of avoiding social situations and of being particularly sensitive to criticism or rejection. • They consider themselves to be socially inept or personally unappealing, and avoid social interaction and relationships for fear of being ridiculed or humiliated. • Causes • Difficult temperament • Early parental rejection • Interpersonal isolation and conflict

23. Dependent Personality Disorder • Characterized by a pervasive psychological dependence on other people. • They behave in clingy, submissive ways and display a strong need to have others take care of them. • They display helplessness and a difficulty in making even minor decisions without an excessive amount of advice and reassurance from others. • They also have an unreasonable fear of abandonment, feelings of inadequacy, extreme sensitivity to criticism, and a timid, passive demeanor. • Causes • Little research • Early experience • Death of a parent • Rejection • Attachment

24. Obsessive-Compulsive Personality Disorder • Characterized by a general psychological inflexibility, rigid conformity to rules and procedures, perfectionism, and excessive orderliness. • People with OCPD tend to stress perfectionism above all else, and feel anxious when they perceive that things aren't "right". • They have a preoccupation with details, orderliness, perfection (doing things the “right way”), and control • Poor interpersonal relationships • Obsessions and compulsions are rare • Causes • Limited research • Weak genetic contributions • Predisposed to favor structure?

25. The Three Clusters of Personality Disorders - Recap • Cluster A: Odd or Eccentric • Schizoid – defective in capacity for forming social relationships • Schizotypal – social deficits and oddities in thinking, perception, and communication • Paranoid – pervasive and unwarranted suspiciousness and mistrust. • Cluster B: Dramatic, Emotional, or Impulsive • Histrionic – overly dramatic, tending to exaggerate expressions of emotion • Narcissistic – grandiosely self-important, lacking interpersonal empathy • Borderline – unstable in self-image, mood, and interpersonal relationships • Antisocial – chronically violating the rights of others, non-accepting of social norms, inability to form attachments. • Cluster C: Anxious or Fearful • Avoidant – excessively sensitive to potential rejection, humiliation or shame • Dependent – excessively lacking in self-reliance and self-esteem • Obsessive-compulsive – preoccupied with organization, rules, schedules, lists, and trivial details. • Specific personality disorders are poorly defined, and there is much overlap among them…some theorists propose replacing the current categorical approach with a dimensional one.

26. Table 14-2, p. 580