Essentials of Abnormal Psychology

1. Essentials of Abnormal Psychology Chapter 7 Personality Disorders

2. Personality Disorders Personality: the unique patterns of traits and behaviors that characterize individuals Involve inflexible and persistently maladaptive patterns of behavior, resulting in maladaptive ways of perceiving, thinking about and reacting to the world. Significantly impair at least one aspect of functioning Cause substantial distress Extremely resistant to treatment Often comorbid with Axis I disorders Discuss how these disorders: are gradually developed are not a reaction to an acute stressful situation are CHRONIC AND PERVASIVE Prevalence: hard to determine - some studies say 2-3% ; others say lifetime prevalence is 10-13%. Often comorbid with mood, anxiety, alcohol use, sexual deviations and delinquency. People with personality disorders often cause problems for others in their lifes and their behavior can be unpredictable, unacceptable and frustrating. They have problems with relationships and may suffer considerably - don�t seem to learn new behavior patterns. Seems that maladaptive cognitive styles and learning (environmental and social factors) may contribute to this disorder.Discuss how these disorders: are gradually developed are not a reaction to an acute stressful situation are CHRONIC AND PERVASIVE Prevalence: hard to determine - some studies say 2-3% ; others say lifetime prevalence is 10-13%. Often comorbid with mood, anxiety, alcohol use, sexual deviations and delinquency. People with personality disorders often cause problems for others in their lifes and their behavior can be unpredictable, unacceptable and frustrating. They have problems with relationships and may suffer considerably - don�t seem to learn new behavior patterns. Seems that maladaptive cognitive styles and learning (environmental and social factors) may contribute to this disorder.

3. DSMIV Criteria for a Personality Disorder Enduring pattern of inner experience and behavior that differs markedly from the expectations of the individual�s culture. Obvious in at least 2 of these areas: cognition, affectivity, interpersonal functioning or impulse control inflexible and pervasive in multiple situations Leads to clinically significant distress Stable and long duration; onset adolescence or early adulthood The pattern is not a result of another disorder Personality disorders are extremely difficult to diagnose because they are not sharply defined- tough to create both reliable and valid criteria. - the diagnostic categories do not seem to be mutually exclusive - that is, people tend to show characteristics of more than 1 personality disorder. And personality disorder NOS is overused. May be that the fact that it is easier to distinguish the fact that a person�s personality is maladaptive but more difficult to determine which symptom pattern it meets. Also, characteristics of personality disorders are present (to a lesser degree) in many normal individuals. Personality disorders are extremely difficult to diagnose because they are not sharply defined- tough to create both reliable and valid criteria. - the diagnostic categories do not seem to be mutually exclusive - that is, people tend to show characteristics of more than 1 personality disorder. And personality disorder NOS is overused. May be that the fact that it is easier to distinguish the fact that a person�s personality is maladaptive but more difficult to determine which symptom pattern it meets. Also, characteristics of personality disorders are present (to a lesser degree) in many normal individuals.

4. Categories of Personality Disorders Cluster A: Odd or Eccentric: Paranoid, Schizoid and Schizotypal Cluster B: Dramatic, Emotional and Erratic: Histrionic, Narcissistic, Antisocial and Borderline Impulsive, colorful behavior; likely to come in contact with mental health or legal authorities Cluster C: Anxious and fearful: Avoidant, Dependent and Obsessive-Compulsive These individuals are more likely to seek help

5. Paranoid Personality Disorder Pervasive suspiciousness and distrust of others Constantly expect trickery See self as blameless; blame others Preoccupied with doubts of others Likely to maintain grudges Not usually psychotic, thought they may experience transient psychotic symptoms Hypersensitive to perceived threats from others

6. Schizoid Personality Disorder Inability to form social relationships Lack of interest in forming social relationships Tend not to have good friends, except family Unable to express feelings; seem cold and distant Lack social skills; seen as loners/introverts Tend not to find many activities pleasurable, including sexual activity Appear Indifferent to praise or criticism Not generally emotionally reactive - tend to have solitary occupations and interests - neither desire nor enjoy relationships with others - don�t seem to need love, belonging or approval.Not generally emotionally reactive - tend to have solitary occupations and interests - neither desire nor enjoy relationships with others - don�t seem to need love, belonging or approval.

7. Schizotypal Personality Disorder Odd (peculiar) thought, perception and speech Generally in touch with reality, but tend to have unusual and superstitious thoughts May experience transient psychoses Often believe they have magical powers or engage in magical thinking or ideas of reference Genetically and biologically associated with schizophrenia, without the pervasive psychoses Tend to have problems socializing Often excessively introverted Have the same defecit in their ability to track a moving object that occurs in schizophrenia. Also show problems in attention and short term memory that are common in schizophrenia. - may be considered to be part of the schizophrenic spectrum. Often excessively introverted Have the same defecit in their ability to track a moving object that occurs in schizophrenia. Also show problems in attention and short term memory that are common in schizophrenia. - may be considered to be part of the schizophrenic spectrum.

8. Histrionic Personality Disorder Excessive attention seeking behavior Excessive emotionality Tend to feel unappreciated if they are not the center of attention Excessively dramatic, extraverted and sexual Highly suggestible and consider relationships to be closer than they really are Self-centered and vain; unstable relationships Others get tired of having to provide so much attention May attempt to control others through emotional manipulation Tend to be overconcerned about the approval of other ; see others as shallow and insincere. When they don�t get the attention they desire, irritability and temper outbursts usually follow. more common in womenOthers get tired of having to provide so much attention May attempt to control others through emotional manipulation Tend to be overconcerned about the approval of other ; see others as shallow and insincere. When they don�t get the attention they desire, irritability and temper outbursts usually follow. more common in women

9. Narcissistic Personality Disorder Exaggerated sense of self-importance Preoccupation with being admired Lack of empathy for others Grandiose; overestimate their accomplishments and underestimate those of others Sense of entitlement Attempt to associate with �high status� people Likely to take advantage of others Behave as a stereotypical �braggart� - making references to himself and bragging - think only other high status people like themselves can understand them Can�t see things from others� point of view Often arrogant, haughty or snobbish - but may be envious of others or believe others are envious of them. Most researchers believe their personality disorder is actually an attempt to compensate for a very fragile self-esteem. Seem sensitive to criticism. Some studies show this is more common in men. - not likely to seek treatment. Prevalence: 1% Overlaps, to some extent, with histrionicBehave as a stereotypical �braggart� - making references to himself and bragging - think only other high status people like themselves can understand them Can�t see things from others� point of view Often arrogant, haughty or snobbish - but may be envious of others or believe others are envious of them. Most researchers believe their personality disorder is actually an attempt to compensate for a very fragile self-esteem. Seem sensitive to criticism. Some studies show this is more common in men. - not likely to seek treatment. Prevalence: 1% Overlaps, to some extent, with histrionic

10. Antisocial Personality Disorder Continually violate and show disregard for the rights of others through deceit and aggression Loyal to no one; generally irresponsible Must have occurred since age 15 with conduct disorder present before age 15; must be 18 to be diagnosed; likely to engage in criminal activity Little regard for safety; little or no remorse May be superficially charming Often seem charming but callously use others to their own ends - live in the present - no consideration of consequences. In chronic form, it may be negatively related to intelligence. Unable to keep close friends - egocentric - likely to engage in manipulative and exploitive sexual relationships or be violent towards family memers Psychopathy (sociopathy) is defined as lack of empathy, inflated and arrogant self-appraisal and glib and superficial charm. Antisocial impulsive and socially deviant behavior (more closely related to the DSM IV definition of antisocial personality disorder) lack or remorse, callous, selfish and exploitive (psychopathy)Often seem charming but callously use others to their own ends - live in the present - no consideration of consequences. In chronic form, it may be negatively related to intelligence. Unable to keep close friends - egocentric - likely to engage in manipulative and exploitive sexual relationships or be violent towards family memers Psychopathy (sociopathy) is defined as lack of empathy, inflated and arrogant self-appraisal and glib and superficial charm. Antisocial impulsive and socially deviant behavior (more closely related to the DSM IV definition of antisocial personality disorder) lack or remorse, callous, selfish and exploitive (psychopathy)

11. Borderline Personality Disorder Instability and impulsivity in interpersonal relationships, self-image and moods Serious disturbance in identity (sense of self) Frantic efforts to avoid abandonment History of intense, stormy relationships Low tolerance for frustration Chronic feelings of emptiness Suicide attempts and self mutilation possible Manipulative -studies suggest that 3 to 9 percent of borderlines complete suicide May experience transient symptoms of being out of contact with reality or transient psychoses or dissociative symptoms - these symptoms are more likely in the inpatient population Prevalence: 2% of general population - but make up a greater proportion of the inpatient population - 15% and 8% outpatient - 75% of borderlines are women. Often cormorbid with mood, anxiety, eating and substance abuse disorders or with other personality disorders (histrionic, dependent, antisocial and schizotypal) Can be thought of as a borderline condition of both mood and personality Manipulative -studies suggest that 3 to 9 percent of borderlines complete suicide May experience transient symptoms of being out of contact with reality or transient psychoses or dissociative symptoms - these symptoms are more likely in the inpatient population Prevalence: 2% of general population - but make up a greater proportion of the inpatient population - 15% and 8% outpatient - 75% of borderlines are women. Often cormorbid with mood, anxiety, eating and substance abuse disorders or with other personality disorders (histrionic, dependent, antisocial and schizotypal) Can be thought of as a borderline condition of both mood and personality

12. Avoidant Personality Disorder Extreme social inhibition and introversion Lifelong pattern of limited social relationships Reluctance to enter into social interactions Hypersensitivity and fear of criticism Desire affection and are often lonely or bored Low self-esteem, excessive self-consciousness Extreme need to avoid potentially embarrassing situations People with avoidant personality disorder don�t enjoy being alone but experience great anxiety because of their inability to relate to other people., They may interpret other people�s actions as ridicule when not intended and have an extreme need to avoid situations where they might be embarrassed, in spite of the fact that they actually desire relationships with others. Shy and insecure, not cold and aloof (schizoid) Frequently co-occurs with dependent personality disorder, but is distinguished from it because it involves fear of criticism, rather than inability to take care of oneself. May be seen as a more severe form of social phobia. Evidence that it may b e a biologically based disorder beginning in infancy and reinforced through learning exists.People with avoidant personality disorder don�t enjoy being alone but experience great anxiety because of their inability to relate to other people., They may interpret other people�s actions as ridicule when not intended and have an extreme need to avoid situations where they might be embarrassed, in spite of the fact that they actually desire relationships with others. Shy and insecure, not cold and aloof (schizoid) Frequently co-occurs with dependent personality disorder, but is distinguished from it because it involves fear of criticism, rather than inability to take care of oneself. May be seen as a more severe form of social phobia. Evidence that it may b e a biologically based disorder beginning in infancy and reinforced through learning exists.

13. Dependent Personality Disorder Extreme dependence on other people Need to be taken care of; clingy and submissive Unable to tolerate separation or being alone May form unhealthy relationships to avoid being alone; may function well if not on their own Lack self confidence and may be unable to make even simple decisions without assistance Center their lives around other people Passive - allow others to make decisions for them and appear selfless and bland - don�t feel they are justified in expressing themselves or being individual Often comorbid with anxiety disorders Reacts with submissiveness and tries to appease the rejecting individual if left - borderline reacts with rage and emptiness - dependent person immediately seeks a new relationship - will stay in a relationship if possible - doesn�t have the intense, stormy pattern that borderlines have - Passive - allow others to make decisions for them and appear selfless and bland - don�t feel they are justified in expressing themselves or being individual Often comorbid with anxiety disorders Reacts with submissiveness and tries to appease the rejecting individual if left - borderline reacts with rage and emptiness - dependent person immediately seeks a new relationship - will stay in a relationship if possible - doesn�t have the intense, stormy pattern that borderlines have -

14. Obsessive-Compulsive Personality Disorder Perfectionism and excessive concern with order NOT obsessions and compulsions Preoccupied with mental and interpersonal control Vigilant about avoiding mistakes; careful attention to rules and schedules Excessively conscientious; deliberate, disciplined, competent, achievement oriented, organized Difficulty getting rid of old items; stingy, miserly Only 6 to 16% of OCD patients also have OCPD OCPD are rigid and have difficulty delegating tasks to others May be comorbid with dependent and avoidant PDs Often quite self-critical Has difficulty forming interpersonal relationships because of excessive devotion to work and difficulty expressing emotionOnly 6 to 16% of OCD patients also have OCPD OCPD are rigid and have difficulty delegating tasks to others May be comorbid with dependent and avoidant PDs Often quite self-critical Has difficulty forming interpersonal relationships because of excessive devotion to work and difficulty expressing emotion

15. Treatment and Cause Increasing evidence for genetics for some Abuse and neglect may be a factor though most children who experience abuse and neglect do not develop personality disorders Little is known about causal factors Very resistant to treatment; Important to tailor the therapy to fit the particular type of characteristic of each personality. Cognitive approaches are promising 1st note that depressive (chronic, pervasive patterns of depressive cognitions and behaviors) (Why not dysthymia? Is disorder of personality) And passive-aggressive (shows a pervasive pattern of passive resistance to demands in social or work situations with negative attitude and complaints of being misunderstood or unappreciated) THESE TWO diagnoses are provisional and controversial Example: cluster C, anxious fearful, be sure not to criticize, make patient uncomfortable, be sure not to be manipulated by borderline, narcissist or antisocial - 1st note that depressive (chronic, pervasive patterns of depressive cognitions and behaviors) (Why not dysthymia? Is disorder of personality) And passive-aggressive (shows a pervasive pattern of passive resistance to demands in social or work situations with negative attitude and complaints of being misunderstood or unappreciated) THESE TWO diagnoses are provisional and controversial Example: cluster C, anxious fearful, be sure not to criticize, make patient uncomfortable, be sure not to be manipulated by borderline, narcissist or antisocial -