PERSONALITY DISORDERS

PERSONALITYDISORDERS Chapter 14

Personality Disorders • Personality trait: An enduring pattern of perceiving, relating to, and thinking about the environment and others. • Personality disorders: Ingrained patterns of relating to other people, situations, and events with a rigid and maladaptive pattern of inner experience and behavior. • Dating back to adolescence or early adulthood

The Nature of Personality Disorders • Behavior patterns must manifest themselves in at least two of the following four areas: • Cognition • Affectivity • Interpersonal functioning • Impulse control As a result of these behaviors, the individual experiences distress or impairment

DSM-5 Personality Disorder Clusters • The DSM-5 groups the 11 diagnoses into three clusters based on shared characteristics: • Cluster A • includes paranoid, schizoid, and schizotypal personality disorders, which share the features of odd and eccentric behavior. • Cluster B • includes antisocial, borderline, histrionic, and narcissistic personality disorders, which share overdramatic, emotional, and erratic or unpredictable attitudes and behaviors. • Cluster C • includes avoidant, dependent, and obsessive-compulsive personality disorders, which share anxious and fearful behaviors.

Cluster APersonality Disorders • Cluster A of the personality disorders in DSM-5 include those disorders characterized by eccentric behavior. • In other words, individuals with these disorders show characteristics that might lead others to view them as slightly odd, unusual, or peculiar.

Paranoid PersonalityDisorder • A personality disorder whose outstanding feature is that the individual is unduly suspicious of others and is always on guard against potential danger or harm. • Impossible to trust people • Project blame onto others • Refuse to seek professional help

Schizoid Personality Disorder • Indifference to social and sexual relationships • Prefer to be alone • No desire to love or be loved • Cold, reserved, withdrawn • Insensitive to feelings of others

Schizotypal Personality Disorder • A personality disorder that primarily involves odd beliefs, behavior, appearance, and interpersonal style. • Such individuals lack a clear sense of direction or motivation, and do not have a clear set of standards against which to measure their behavior • People with this disorder may have peculiar ideas, such as magical thinking and beliefs in psychic phenomena. • They lack a clear sense of direction or motivation, and do not have a clear set of standards against which to measure their behavior.

Schizotypal Personality Disorder • Social isolation • Eccentricity • Peculiar communication • Poor social adaptation • Treatment • Parallels interventions commonly used in treating schizophrenia

Cluster BPersonality Disorders These behaviors include impulsivity, an inflatedsense of self, and a tendency to seek stimulation. include those that are marked by dramatic, emotional, or erratic behaviors.

Antisocial Personality Disorder • A personality disorder characterized by a lack of regard for society’s moral or legal standards and an impulsive and risky lifestyle. • Psychopathy:A personality type characterized by a cluster of traits that constitutes the core of what is now called antisocial personality disorder. • Based upon large scale studies of forensic populations: • Core psychopathic personality traits • Antisocial lifestyle

Antisocial Personality Disorder • The diagnostic criteria in the DSM-5 require that an individual show a pervasive pattern of three out of seven possible behaviors: • Failure to conform to social norms • Deceitfulness • Impulsivity • Aggressiveness • Disregard for safety of self or others • Irresponsibility • Lack of remorse

Important Distinctions • There is a difference between antisocial personality disorder and antisocial behavior. • Antisocial behavior • Illegal or immoral behavior such as stealing, lying, or cheating • Criminal • A legal term, not a psychological concept • Antisocial personality disorder may manifest itself in behaviors such as job problems, promiscuity, and aggressiveness. • Maturation hypothesis:The proposition that people with antisocial personality and the other Cluster B disorders become better able to manage their behaviors as they age.

Perspectives onAntisocial Personality • Biological • Possible genetic causes • Various brain abnormalities • Monoamine oxidase A - An enzyme coded by the MAOA gene. • A mutation in this gene results in insufficient amounts of monoamine oxidase in the nervous system, which results in abnormally high levels of dopamine, serotonin, and norepinephrine. • Hippocampus, the brain structure involved in short-term memory processing, functions abnormally in individuals with psychopathy. • People high in psychopathy have deficits in frontal lobe functioning.

Perspectives onAntisocial Personality • Psychological • Neuropsychological deficits • Passive avoidance • Response modulation hypothesis • Antisocial personality disorder causes neuropsychological deficits reflected in abnormal patterns of learning and attention. • Passive avoidance - Correct responses involve learning to avoid responding to a previously punished stimulus. • Response modulation hypothesis attempts to explain the failure of individuals high in psychopathy to learn from negative experience and to process emotional information. • Individuals high on the trait of psychopathy are unable to pay enough attention to secondary cues to switch their attention when necessary.

Treatment of Antisocial Personality Disorder • Problems of working with these individuals • Seeming lack of motivation to change • Tendency toward deception and manipulation • Lack of deep or lasting emotion • Treatment goals: • Measure the effectiveness of therapy in terms of re-arrest or recividism. • Focus on changes in job performance, relationships with others, and involvement in noncriminal activities.

Borderline Personality Disorder • Pervasive pattern of poor impulse control and instability in mood, interpersonal relationships, and self-image • BPD’s central feature is that of instability • The way that people with BPD relate to others is termed “splitting”

Borderline personality disorder - bpd • BPDrests on the individual’s demonstration of at least five out of a possible nine behaviors: • Frantic efforts to avoid abandonment • Unstable and intense relationships • Identity disturbance • Impulsivity in areas such as sexuality, spending, or reckless driving • Recurrent suicidal behavior • Affective instability • Chronic feelings of emptiness • Difficulty controlling anger • Occasional feelings of paranoia or dissociative symptoms. • Splitting: A defense, as being all good or all bad, usually resulting in disturbed interpersonal relationships.

Perspectives on Borderline Personality • Biological • High heritability • Abnormalities in: • Amygdala and prefrontal cortex • Neurotransmitters and hormones • Childhood sexual abuse may alter sympathetic nervous system that leads to hypersensitivity and impulsivity in adulthood. • BPD symptoms are tied to a number of biological factors: • High heritability. • Abnormalities in the amygdala and prefrontal cortex, areas of the brain involved in emotional processing and regulation. • People with BPD may also have abnormalities in neurotransmitters and hormones involved in regulating emotional responses and sensitivity to pain.

Perspectives on Borderline Personality • Psychological • Emotional dysregulation • Lack of awareness, understanding, or acceptance of emotions. • Inability to control the intensity or duration of emotions. • Unwillingness to experience emotional distress as an aspect of pursuing goals. • Inability to engage in goal-directed behaviors when experiencing distress. • Distress tolerance • Experiential avoidance • Childhood neglect or traumatic experiences • Marital or psychiatric difficulties

Treatment of Borderline Personality • Dialectical behavior therapy (DBT):Reduce the frequency of self-destructive acts and to improve the client’s ability to handle disturbing emotions, such as anger and dependency. • Using a process called core mindfulness, DBT clinicians teach their clients to balance their emotions, reason, and intuition as they approach life’s problems. • Transference-focused psychotherapy uses the client-clinician relationships as the framework for helping clients achieve greater understanding of their unconscious feelings and motives.

Needs Involved in Basic Principles of Effective Treatment for Clients with BPD • Need for clinicians to: • Take over a primary role in treatment • Provide a therapeutic structure • Support the client • Involve the client in the therapeutic process • Take an active role in treatment • Deal with the client’s suicidal threats or self-harming acts • Be self-aware and ready to consult with colleagues

Histrionic Personality Disorder • Attention-seeking is one of the pathological personality traits. • Exaggerated emotionalreactions, approaching theatricality, in everyday behavior. • Show extreme pleasure as the center of attention and who behave in whatever way necessary to ensure that this happens. • They are excessively concerned with their physical appearance, often trying to draw attention to themselves in such extreme ways that their behavior seems ludicrous.

Histrionic Personality Disorder • They want immediate gratification of their wishes and overreact to even minor provocations, usually in an exaggerated way, such as by weeping or fainting. • Although their relationships are superficial, they assume them to be intimate and refer to acquaintances as “dear” friends • Flirtatious and seductive • Demand reassurance, praise, approval of others • Need for immediate gratification • Easily influenced by others • Lack analytical ability

Narcissistic Personality Disorder • Unrealistic, inflated sense of self-importance and lack of sensitivity to other people’s needs • Sense of entitlement translates into personality traits of grandiosity, and their desire for admiration leads them to seek out recognition whenever possible. • Individuals with NPD may have a truly inflated and grandiose sense of self. • Clinicians refer to them as high on grandiose narcissism. • Vulnerable narcissism - Who rely excessively on other people to confirm their worth.

Theories of Narcissistic Personality • Freudian • Stuck in early psychosexual stages • Psychodynamic • Empathy • Cognitive behavioral • Maladaptive ideas • Grandiose ideas clash with their experiences of failure

Theories of Narcissistic Personality • Theorists regard the narcissistic individual as having failed to form a cohesive, integrated, sense of self. • Narcissistic personality disorder is expressed as the adult’s expression of this childhood insecurity and need for attention. • Clinicians who work within the psychodynamic perspective use empathy to support the client’s search for recognition and admiration. • As therapists increasingly support them, they become less grandiose and self-centered. • Cognitive-behavioral theorists focus on the maladaptive ideas that they are exceptional people who deserve far better treatment than ordinary humans.

Treatment of Narcissistic Personality • Most effective approach • Provide reassurance and develop a more realistic view of themselves and other people • People with NPD are difficult to treat • Tend not to have insight into their disorder • Extreme perfectionism can obstruct treatment

Cluster C personality disorders They tend to be inner-directed and may draw little attention to themselves, in contrast to those individuals with personality disorders in Cluster B.

Avoidant Personality Disorder • The individual desires, but is fearful of, any involvement with other people and isterrified at the prospect of being publicly embarrassed • People with avoidant personality disorder become extremely sensitive to rejection and ridicule, interpreting the most innocent remark as criticism. • Withdrawn, unlikely to experience intimacy, and unable to feel pleasure.

Avoidant - Theories • Cognitive-behavioral • Hypersensitive due to parental criticism • Feel unworthy of other people’s regard • Expect not to be liked • Avoid getting close to avoid expected rejection • Distorted perceptions of experiences with others • The psychodynamic perspective focuses on fear of attachment.

Treatment of Avoidant Personality • Cognitive-behavioral • Break negative cycle of avoidance • Confront and correct dysfunctional attitudes and thoughts • Graduated exposure to social situations • Learn skills to improve chance of intimacy • Interventions are successfully accomplished after the client comes to trust the therapist. • Therapists must be extremely patient in their attempts to build a therapeutic relationship.

Dependent Personality Disorder • The individual is extremely passive • Tends to cling to other people to the point of being unable to make any decisions • Without others near them, people with dependent personality feel despondent and abandoned.

Obsessive-Compulsive Personality Disorder • A personality disorder involving intense perfectionism and inflexibility manifested in worrying, indecisiveness, and behavioral rigidity. • OCPD is a disturbance of personality, not a disturbance involving anxiety or even out-of-control behaviors • OCPD do not experience obsessions and compulsions. OCPD refers to this rigidly compulsive personality tendency and also obsessive concern with perfectionism.

Obsessive-Compulsive Disorder • Sense of self and self-worth in terms of work productivity • Pathological personality trait - Rigid perfectionism • Quality of perseveration • Obsessive-compulsive personality disorder: Intense perfectionism and inflexibility manifested in worrying, indecisiveness, and behavioral rigidity. • Quality of perseveration - Experience a great deal of negative affect and tend to go back over and over what they’ve done, looking for flaws. • People with OCPD do not experience obsessions and compulsions.

Theories ofObsessive-Compulsive • Freudian • Fixation at anal psychosexual stage • Cognitive-behavioral • Unrealistic standard of perfection • Ruminative tendency • Metacognitive interpersonal therapy • Think about their thinking • Failure to achieve their unrealistic standard of perfection makes them feel worthless. • Person with OCPD tends to intellectualize, to ruminate over past actions, and to worry about making mistakes.

Biopsychosocial Perspective • Disorders represent: • Mix of long-standing personal dispositions and behavior patterns • Disturbances in identity and interpersonal relationships

And in conclusion . . . ? Personality disorders are • Chronic and persistent • Hard to explain • Difficult to treat • Subject to much further study

PERSONALITY DISORDERS