Personality & Impulse-Control Disorders

1. Personality & Impulse-Control Disorders

2. I. Personality: the consistent ways in which one person’s behavior differs from that of others, especially in social contexts. A. Trait: a consistent, long-lasting tendency in behavior, such as sociability, shyness or assertiveness. B. State: a temporary activation of a particular behavior.

3. Personality Disorders I. Personality Disorders:overly rigid and maladaptive patterns of behavior and ways of relating to others that reflect extreme variations of underlying personality traits, such as undue suspiciousness, excessive emotionality, and impulsivity. It’s estimated that 10% - 15% of the population has a personality disorder. A. Ego Syntonic:referring to behaviors or feelings that are perceived as natural parts of the self. B. Ego Dystonic:referring to behaviors or feelings that are perceived not to be part of one’s self-identity.

4. C. Personality Disorder Clusters 1) Cluster A: people who are perceived as odd or eccentric. This cluster includes paranoid, schizoid, and schizotypal personality disorders. People with these disorders display behaviors similar to, but not as extensive as, schizophrenia. 2) Cluster B: people whose behavior is overly dramatic, emotional, or erratic. This grouping consists of antisocial, borderline, histrionic, and narcissistic personality disorders. The behaviors of people with these disorders make it almost impossible for them to have relationships that are truly giving and satisfying.

5. 3) Cluster C: people who often appear anxious or fearful. This cluster includes avoidant, dependent, and obsessive–compulsive personality disorders. Although many of the symptoms are similar to those of anxiety and depressive disorders, researchers have found no direct links between this cluster and those diagnoses. D. Genetic Factors II. Paranoid Personality Disorder: characterized by deep distrust and suspicion of others. Although inaccurate, the suspicion is usually not delusional. The ideas are not so bizarre or so firmly held as to clearly remove the individual from reality.

6. They are critical of weakness and fault in others, particularly at work. They are unable to recognize their own mistakes and are extremely sensitive to criticism. About 2% of adults are believed to experience this disorder, apparently more men than women. A. Evolutionary Perspective 1) The Fearful Protector III. Schizoid Personality Disorder: characterized by persistent avoidance of social relationships and limited emotional expression.

7. People with this disorder do not have close ties with other people; they genuinely prefer to be alone. People with this disorder focus mainly on themselves and are often seen as flat, cold, humorless, or dull. The disorder is estimated to affect less than 1% of the population. IV. Schizotypal Personality Disorder: characterized by a range of interpersonal problems, marked by extreme discomfort in close relationships, odd (even bizarre) ways of thinking, and behavioral eccentricities. Symptoms may include ideas of reference and/or bodily illusions.

8. People with the disorder often have great difficulty keeping their attention focused; conversation is typically digressive and vague, even sprinkled with loose associations. It has been estimated that 3% of all people (slightly more males than females) have the disorder. A. Biological Perspective Researchers have begun to link schizotypal personality disorder to some of the same biological factors found in schizophrenia, such as high dopamine activity. V.Antisocial Personality Disorder: a chronic psychiatric condition characterized by behavior, possibly criminal, that manipulates, exploits, or violates the rights of others (a.k.a. the sociopath or the psychopath).

9. A. Other Key Features 1) Lack the ability to experience fear. 2) Often will break social rules or norms. 3) Aggressive or hostile behavior. 4) Engage in reckless and irresponsible behavior. 5) Lack of truthfulness. 6) Prone to impulsive behavior. 7) Lack the ability to feel guilt, remorse, or empathy for others.

10. 8) Lack of a “Conscience”: internal standards of behavior, which usually control one’s conduct and produce emotional discomfort when violated. 9) Often remarkably charming. 10)Often excel atself-monitoring. 11) Some poor decision making skills. 12)Having Conduct Disorder prior to age 18 is often a precursor to Antisocial Personality Disorder. 13) Mostly found among men between the ages of 18 and 40. 14) More than five times as common among men as among women. 15) About 4% of the population has this disorder.

11. B. Criminal Activity 1) Most people with Antisocial Personality Disorder do NOT commit crimes. 2) Most people with Antisocial Personality Disorder that do commit crimes are NOT murderers. 3) Serial killers are often diagnosed with Antisocial Personality Disorder and are often highly intelligent. a) Examples... C. Learning Perspective Children and adolescents who develop antisocial personalities may be “unsocialized” because their early learning experiences lack the consistency and predictability that help other children and adolescents connect their behavior with rewards and punishments.

12. ASPD may be the result of a lack of reinforcement for good behavior and a lack of punishment for bad behavior in childhood and adolescence. ASPD may also result from a crossing of reinforcement and punishment. D. Family Perspective Childhood abuse, particularly physical and emotional abuse and neglect, is quite common among those with ASPD. E. Biological Perspective 1) Lack of Emotional Responsiveness People with antisocial personalities have lower galvanic skin response levels when they are expecting painful stimuli than do normal controls.

13. 2) The Craving-for-Stimulation Model Perhaps they require a higher-than-normal threshold of stimulation to maintain an optimum state of arousal. People with ASPD generally have global under arousal in brain activity. Low levels of the neurotransmitters dopamine and serotonin and the stress hormone cortisol have been linked to ASPD. 3) The Brain Structures Abnormalities Model Brain imaging links antisocial personality disorder to dysfunctions in parts of the brain involved in regulating emotions and restraining impulsive behaviors, especially aggressive behaviors. Areas of the brain most directly implicated are the prefrontal cortex (gray matter deficiency) and deeper brain structures in the limbic system such as the amygdala (underactive).

14. F. Biopsychosocial Perspective 1) Nature and Nurture ASPD is activated by genetic predispositions/biological factors in conjunction with negative environmental influences. Adopted Children Removed From Biological Mothers At Birth Long Duration in Orphanage Short Duration in Orphanage High Prevalence of ASPD Low Prevalence of ASPD Biological Mother With ASPD Biological Mother Without ASPD Very Low Prevalence of ASPD Very Low Prevalence of ASPD

15. G. Evolutionary Perspective 1) The Fearless Leader VI.Borderline Personality Disorder: characterized by features such as a deep sense of emptiness, an unstable self-image, a history of turbulent and unstable relationships, dramatic mood changes, impulsivity, difficulty regulating negative emotions, self-injurious behavior, and recurrent suicidal behaviors. BPD is at least three times more common in women than in men. About 3% - 4% of the population has this disorder.

16. A. Emotional Swings They experience a full rainbow of extreme emotional swings. B.Harming Others and Self Their overwhelming anger can result in physical aggression and violence. Just as often, however, they direct their impulsive anger inward and harm themselves. They may engage in impulsive acts of self-mutilation, such as cutting themselves, perhaps as a means of temporarily blocking or escaping from deep, emotional pain.

17. 1) Other impulsive, self-destructive behavior can include... a) Alcohol and substance abuse. b) Suicidal threats and actions. c) Reckless behavior, including driving and unsafe sex. C. The BPD Relationship Cycle: Live, Die, Repeat People with BPD may cling desperately to others whom they first idealize, but then shift abruptly to utter contempt when they perceive the other as rejecting them or failing to meet their emotional needs. The centerpiece is a conflicting need for intimacy and recurrent fears of impending abandonment.

18. D. Psychodynamic Perspective 1) Otto Kernberg From this perspective, borderline individuals cannot synthesize contradictory (positive and negative) elements of themselves and others into complete, stable wholes. Rather than viewing important people in their lives as sometimes loving and sometimes rejecting, they shift back and forth between pure idealization and utter hatred. This rapid shifting back and forth between viewing others as either “all good” or “all bad” is referred to as splitting. E. Family Perspective Childhood abuse, particularly sexual abuse coupled with neglect, is quite common among those with BPD. F. Biological Perspective: Brain Structures Abnormalities

19. VII.Histrionic Personality Disorder: characterized by excessive emotionality, a desire to be the center of attention, excessive concern with one’s appearance, excessive flirtatiousness and seductiveness, demanding of praise and approval, and becoming furious if rejected. People with histrionic personality disorder tend to be dramatic and emotional, but their emotions seem shallow, exaggerated, and volatile. A. Other Key Features 1) They become unusually upset by news of a sad event and exude exaggerated delight at a pleasant occurrence.

20. 2) They tend to demand more than others. 3) They are intolerant of delays of gratification. 4) They grow quickly restless with routine and crave novelty and stimulation. 5) Their attention-getting behaviors are so extreme that they appear to be “on stage”. 6) Approval and praise are the lifeblood of these individuals. 7) They often dress in a flamboyant way. 8) Found equally in men and women and in about 3% of the population.

21. B. Family Perspective Inconsistent attention from parents causes children to not take it for granted and continually strive for it. Social learning theory would suggest that they may be modeling their parents’ dramatic and attention-seeking behavior. Excessive sibling rivalry may motivate one to compete in dramatic ways for attention. VIII.Narcissistic Personality Disorder: characterized by inflated or grandiose sense of themselves and an extreme need for admiration.

22. A. Other Key Features 1) They expect others to notice their special qualities, even when their accomplishments are ordinary. They often appear arrogant. 2) They are self-absorbed and lack empathy for others. 3) They tend to be preoccupied with fantasies of success and power, ideal love, or recognition for brilliance or beauty. 4) They seek the company of flatterers and, although they are often superficially charming and friendly, their interest in people is one-sided. 5) They have feelings of entitlement that lead them to exploit others. 6) Around 1% of adults (3 times as many men as women) display Narcissistic Personality Disorder.

23. B. Narcissistic Wound:a blow to the narcissist’s false sense of importance that may never heal. C. Psychodynamic Perspective 1) Hans Kohut Early childhood involves a normal stage of healthy narcissism. Infants feel powerful, as though the world revolves around them. Empathic parents reflect their children’s inflated perceptions by making them feel that anything is possible and by nourishing their self-esteem. Lack of parental empathy and support, however, sets the stage for pathological narcissism. D. Family Perspective Narcissistic Personality Disorder may develop when people are treated too positively rather than too negatively in early life. Those with the disorder have been taught to “overvalue their self-worth”.

24. IX.Avoidant Personality Disorder: these people are very uncomfortable and inhibited in social situations, overwhelmed by feelings of inadequacy, and extremely sensitive to negative evaluation. The disorder is similar to social anxiety disorder, and many people with one disorder experience the other. Similarities between the two disorders include a fear of humiliation and low self-confidence. A key difference is that people with social anxiety disorder mainly fear social circumstances, while people with avoidant personality disorder tend to fear close social relationships. As many as 2% of adults have avoidant personality disorder, men as frequently as women.

25. A. Family Perspective Overly critical and punitive parental control may lead to feelings of inadequacy. X.Dependent Personality Disorder: these people have a pervasive, excessive need to be taken care of. The central feature of the disorder is a difficulty with separation. They are clinging and obedient, fearing separation from their loved ones. They rely on others so much that they cannot make the smallest decision for themselves. Many people with this disorder feel distressed, lonely, and sad. Often they dislike themselves.

26. They are at risk for depression, anxiety, and eating disorders and may be especially prone to suicidal thoughts. They have a very strong external locus of control. Studies suggest that 2% of the population experience the disorder with men and women affected equally. A. Family Perspective Children who are regularly discouraged from speaking their minds or exploring their environments may develop a dependent behavior pattern. Early parental loss or rejection may prevent normal experiences of attachment and separation, leaving some children with lingering fears of abandonment. Other theorists argue that parents were overinvolved and overprotective, increasing their children’s dependency.

27. Parents of those with dependent personality disorder unintentionally rewarded their children’s clinging and “loyal” behavior while punishing acts of independence. XI.Obsessive-Compulsive Personality Disorder:people with this disorder are perfectionists (a.k.a. control freaks). They are inflexible in personal habits, demand orderliness, stick to established procedures and patterns, and are very detail oriented. They seek total control of themselves and their environment.

28. They are meticulousness in work habits. They set unreasonably high standards for themselves and others and, fearing a mistake, may be afraid to make decisions. They may have trouble expressing affection and their relationships are often stiff and superficial. They may exhibit extreme emotional outbursts to intimidate others and may become physically violent if someone attempts to change their behavior or lifestyle. Around 5% of adults (twice as many men as women) display Obsessive-Compulsive Personality disorder. A. Family Perspective Children whose behavior is rigidly controlled and punished by parents, even for slight transgressions, may develop inflexible, perfectionistic standards.

29. B. Evolutionary Perspective 1) The Maintainer of Order XII. Recently Abandoned Personality Disorders A. Sadistic Personality Disorder 1) Humiliates or demeans people in the presence of others. 2) Is amused by, or takes pleasure in, the psychological or physical suffering of others (including animals). 3) Has lied for the purpose of harming or inflicting pain on others (not merely to achieve some other goal).

30. B. Self-Defeating Personality Disorder (a.k.a. Masochistic Personality Disorder) 1) Chooses people and situations that lead to disappointment, failure, or mistreatment even when better options are clearly available. 2) Following positive personal events (e.g., new achievement), responds with depression, guilt, or a behavior that produces pain (e.g. an accident). 3) Uninterested in or rejects people who consistently treat them well (e.g. is not attracted to caring sexual partners.)

31. XIII. Treatment of Personality Disorders A. Psychodynamic Approaches Psychodynamic approaches are often used to help people diagnosed with personality disorders become aware of the roots of their self-defeating behavior patterns and learn more adaptive ways of relating to others. B. Cognitive-Behavioral Approaches Cognitive behavior therapists focus on changing clients’ maladaptive behaviors and dysfunctional thought patterns rather than their personality structures. They may use techniques such as modeling and reinforcement to help clients develop more adaptive behaviors. C. Biological Approaches Drug therapy does not directly treat personality disorders. Antidepressants or antianxiety drugs are sometimes used to treat associated depression or anxiety in people with personality disorders.

32. XIV. Personality Disorders: Categories or Dimensions?

33. A. Costa and McCrae’s “Big Five” Personality Traits 1) Neuroticism:the tendency to experience emotional instability: anxiety, hostility, depression, self-consciousness, impulsiveness, and vulnerability very easily. 2) Extraversion:the tendency to seek stimulation and enjoy the company of other people. 3) Agreeableness:the tendency to be trusting and compassionate rather than distrustful of and antagonistic towards others. 4) Conscientiousness:the tendency to show self-discipline, to be reliable, and to strive for competence and achievement. 5) Openness to Experience: the tendency to enjoy new experiences and new ideas.

34. B. Issues with the “Big Five” Personality Traits

35. Impulse-Control Disorders I. Impulse-Control Disorders:a category of psychological disorders characterized by failure to control impulses, temptations, or drives, resulting in harm to oneself or others. A. Kleptomania:characterized by repeated acts of compulsive stealing. The stolen objects are typically of little value or use to the person. The person may give them away, return them secretly, discard them, or just keep them hidden at home. In most cases, people with kleptomania can easily afford the items they steal.

36. B. Intermittent Explosive Disorder (IED): characterized by repeated episodes of impulsive, uncontrollable aggression in which people strike out at others or destroy property. People with IED have episodes of violent rage in which they suddenly lose control and hit or try to hit other people or smash objects. Typically, people with IED attempt to justify their behavior, but they also feel genuine remorse or regret because of the harm their behavior causes. Low levels of serotonin may be associated with this disorder as antidepressants have shown promising results in terms of reducing IED behavior. C. Pyromania:characterized by repeated acts of compulsive fire setting in response to irresistible urges. People with pyromania feel a sense of release or psychological relief when setting fires and report feeling empowered as the result of prompting firefighters to rush to the scene of the blaze.

37. D. Gambling Disorder: characterized by repeated acts of compulsive gambling in which an individual has extreme difficulty disengaging from their gambling behavior. The urge to gamble remains regardless of any patterns of winning or losing although losing increases the strength of the urge. Many compulsive gamblers have very low self-esteem and were abused as children. The thrill of winning may boost their self-esteem as they see themselves as winners. However, the inevitable losses quickly shatter that self-esteem boost. They often become severely depressed and suicidal. The prevalence rate is about 1% and more common in men than women.

38. 1) Compulsive Gambling as a Nonchemical Addiction 2) Treatment of Compulsive Gambling Antidepressants have proven to be moderately effective. Attending self-help groups like Gamblers Anonymous (GA) can also be helpful. E. Compulsive Shopping??? F. Compulsive Internet Use??? G. Cybersex Addiction???