Personality Disorders

1. Personality Disorders Definition of Personality? Definition of Personality Disorder Manifest across many life areas Inflexible Maladaptive Cause either significant impairment or distress to self or others

2. Personality Disorders Dimensions or Categories? DSM-IV Consided as Categories (not dimensions) Axis II of the multiaxial system Not usually primary diagnosis Ten Specific Labels Cluster A: “Odd / Eccentric” Cluster B: “Dramatic / Emotional” Cluster C: “Anxious / Fearful” High Rates of Comorbidity Gender Bias in Diagnosis?

4. Paranoid Personality Disorder Excessively Mistrustful Excessively Suspicious Without Justification Treatment Options Few seek professional help on their own Treatment focuses on development of trust Cognitive therapy to counter negativistic thinking Lack good outcome studies

5. Schizoid Personality Disorder Extreme Social Detachment (Loner) Appear Aloof, Cold, Indifferent Limited Range of Emotions Treatment Options Few seek professional help on their own Focus on the value of interpersonal relationships, empathy, and social skills Treatment prognosis is generally poor Lack good outcome studies

6. Schizotypal Personality Disorder Also Socially Isolated BUT Behavior Is More Unusual Often Considered Odd or Bizarre Ideas of Reference Magical Thinking Illusions Apparent Connection to Schizophrenia (but be careful!) Treatment Options Developing social skills Treatment also addresses comorbid depression Medical treatment is similar to that used for schizophrenia Treatment prognosis is generally poor

7. Antisocial Personality Disorder Long Histories of Violating Cultural Norms Violating Rights of Others Impulsivity & Aggressiveness Lack of Remorse, Conscience, Empathy Not Always Criminal Relation Between ASPD, Conduct Disorder, and Early Behavior Problems

8. Antisocial Personality Neurobiological Theories Underarousal, Fearlessness, & Behavioral Inhibition Treatment Few seek treatment on their own Antisocial behavior is predictive of poor prognosis, even in children Emphasis is placed on prevention and rehabilitation Often incarceration is the only viable alternative

9. Borderline Personality Disorder Unstable Relationships Love/Hate Behavior Fear of Abandonment Poor Self-Image Mood Swings, Feel Empty Impulsivity Substance Abuse, Sex, Suicidality Self-mutilation

10. Borderline Personality Disorder Runs in families Early trauma and abuse seem to play some role Treatment Options Few good treatment outcome studies Antidepressant medications provide some short-term relief Dialectical behavior therapy is the most promising psychosocial approach

11. Histrionic Personality Disorder Overly Dramatic Center of Attention Emphasis on Appearance Emotions are Shallow Seductive & Provocative Treatment Options Few good treatment outcome studies Treatment focuses on attention seeking and long-term negative consequences Targets may also include problematic interpersonal behaviors Little evidence that treatment is effective

12. Narcissistic Personality Disorder Grandiose Sense of Self Exaggerated Self-Importance Preoccupied with Attention Requires Admiration Little Empathy Highly Sensitive to Criticism Treatment Options Focuses on grandiosity, lack of empathy, unrealistic thinking Treatment may also address co-occurring depression Little evidence that treatment is effective

13. Avoidant Personality Disorder Sensitive to Other’s Opinions Avoid Social Relationships Extreme Low Self-Esteem Takes Few Risks Socially Inhibited & Anxious Treatment Options Several well-controlled treatment outcome studies exist Treatment is similar to that used for social phobia Treatment targets include social skills and anxiety

14. Dependent Personality Disorder Excessive Reliance on Others Submissive & Passive Rely on Others to Make Even Minor Decisions Fear Abandonment Clingy Treatment Options Research on treatment efficacy is lacking Therapy typically progresses gradually Treatment targets include skills that foster independence

15. Obsessive-Compulsive Personality Disorder NOT same thing as OCD Fixation on Doing Things “The Right Way” Preoccupation with Perfectionism Control Orderliness, Details, and Rules Obsessions and Compulsions Are Rare Treatment Options Data supporting treatment are limited Treatment may address fears related to the need for orderliness Other targets include rumination, procrastination, and feelings of inadequacy

16. Problems with Personality Disorders The Causes of Personality Disorders Are Difficult to Pinpoint Treatment of Personality Disorders Is Often Difficult Often Comorbid Issues Egosyntonic (vs. Egodystonic)