Personality Disorders

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Personality Disorders
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Personality Disorders (Axis II)

• Are long-standing, pervasive, inflexible
  patterns of behavior.
• Usually impair social occupational functioning.
• Are often comorbid with Axis I disorders.
•  
• Make treating an Axis I disorder more difficult.
  

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Personality disorder clusters in the DSM-IV

• Cluster A (paranoid, schizoid, schizotypal)
  odd/eccentric
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• Cluster B (antisocial, borderline, histrionic,
  narcissistic) dramatic/erratic
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• Cluster C (avoidant, dependent,
  obsessive-compulsive) anxious/fearful

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I. Odd/Eccentric Cluster

• 1. Paranoid Personality Disorder PPD
• Suspiciousness of others is hallmark of
  personality.
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• --secretiveness hostility anger
• --assume others are out to harm them
• --reluctant to confide in others
• --blame others when they are at fault
• --jealous accusatory
• -read hidden messages in others actions
• Prevalence (1) occurs mostly in men

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How does PPD differ from paranoid schizophrenia?

• Hallucinations other symptoms (negative) arent
  present in PPD.
• Impairment in functioning is less than in
  schizophrenia.
• Also differs from delusional disorder because
  delusions are not full-blown.

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2. Schizoid personality disorder

• People with this
• appear dull, bland, aloof
• -dont show warmth for or interest in others
• -report little enjoyment in life
• -are indifferent to praise, criticism
• -show flat affect are loners
• Prevalence (less than 1) occurs more in men

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3. Schizotypal personality disorder

• Have interpersonal problems of people with
  schizoid PD excessive social anxiety that does
  not diminish.
• These people
• -are superstitious (magical thinking)
• -think theyre clairvoyant telepathic
• -behavior dress oddly
• -may show paranoid ideation
• -may show flat affect
• Is like a mild version of schizophrenia
  prevalence-3 mostly in males

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Etiology of Odd/Eccentric cluster

• May be genetically linked.
• Relatives of schizophrenics patients with major
  depression are at increased risk for schizotypal
  personality disorder.
•  
• Family studies of PPD find higher rates of
  disorder in relatives of schizophrenics.
• No clear pattern has emerged for schizoid
  personality disorder. Is higher among relatives
  with schizotypal personality disorder.
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II. Dramatic/erratic cluster

• 1. Borderline personality disorder (BPD)
• Core features are impulsivity instability in
  relationships, mood, self-image.
• -attitudes, thoughts, emotions are erratic
• -emotions shift abruptly from idealization to
  contemptuous anger (angel to devil)
• -argumentative, irritable, sarcastic, defensive
• -indulge in self destructive behaviors (drugs,
  sex)
• -lack of coherent sense of self
• -self mutilation (cutting with razor/knife)
• -suicide attempts
• -intense fear of abandonment
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Borderline PD Facts

• Prevalence is 1 to 2 more common in women than
  in men.
• Treatment prognosis is very poor extremely
  difficult to treat.
• In a 7 year follow-up study, 50 of patients
  still had disorder.
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• Comorbidity with Axis I mood disorder, substance
  abuse, PTSD, and eating disorders

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Kellermans account

• The borderline patient is a therapists
  nightmare...because borderlines never really get
  better. The best you can do is help them coast,
  without getting sucked into their
  pathology...Theyre chronically depressed, the
  determinedly addictive, the compulsively
  divorced, living from one emotional disaster to
  the next. Bed hoppers, stomach pumpers, freeway
  jumpers, and sad-eyed bench-sitters with arms
  stitched up like footballs and psychic wounds
  that can never be sutured. Their egos are as
  fragile as spun sugar, their psyches
  irretrievably fragmented, like a jigsaw puzzle
  with crucial pieces missing. They play roles
  with alacrity, excel at being anyone but
  themselves, crave intimacy but repel it when they
  find it. Some of them gravitate toward stage or
  screen others do their acting in more subtle
  ways.
• Borderlines go from therapist to therapist,
  hoping to find a magic bullet for the crushing
  feelings of emptiness. They turn to chemical
  bullets, gobble tranquilizers and
  antidepressants, alcohol and cocaine. Embrace
  gurus and heaven-hucksters, any charismatic creep
  promising a quick fix for the pain. And they end
  up taking temporary vacations in psychiatric
  wards and prison cells, emerge looking good,
  raising everyones hopes. Until the next
  letdown, real or imagined, the next excursion
  into self-damage. What they dont do is change.

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Causes of BPD

• 1. Object-Relations Theory
• Adverse childhood experiences (receiving praise,
  but not warmth) cause children to develop
  insecure egos.
•  
• Patients engage in splitting where they lump
  objects into all good or all bad categories
  (black-n-white thinking). 
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• Evidence
• BPD patients report low level of maternal care
• families are emotionally unexpressive, high in
  conflict.
• childhood sexual physical abuse common

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Linehans Diathesis-Stress theory

• BPD occurs when people with a biological
  diathesis (possibly genetic) of emotion
  dysregulation are raised in a family environment
  that is invalidating.
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• An invalidating environment-the persons wants and
  feelings are discounted and disrespected.
• (child abuse)
•  dysregulation invalidation interact in a
  dynamic system.
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2. Histrionic personality disorder (HPD)

• Applies to people who are overly dramatic
  attention seeking.
•  
• Symptoms
• -attention to physical appearance
• -may act inappropriately sexual
• -needs to be center of attention
• -displays of emotion are extravagant shallow
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• Prevalence (2-3 ), occurs more in women than
  men.

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3. Narcissistic personality disorder (NPD)

• Core feature they are the center of the
  universe
• -grandiose view of ones own importance
• -great fantasies of success
• -extremely self-centered
• -require constant attention admiration
• -lack empathy for others expect special
  considerations
• -malignant arrogance
• Prevalence (less than 1)

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Causes of NPD

• Parents did not provide unconditional love
  empathy they needed.
• Rather, parents placed their own needs above the
  needs of the child.
• People with NPD spend lives trying to bolster low
  sense of self, through endless quests for love
  attention.

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4. Antisocial Personality Disorder (APD)

• DSM diagnosis
• 1. The presence of a conduct disorder before the
  age of 15
• Truancy running away from home
• Theft compulsive lying
• Arson vandalism
• 2. The continuation of this pattern of behavior
  into adulthood.

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APD features

• Irresponsible antisocial behavior
• Criminality (breaking laws)core feature
• Irritability
• Physically aggressive
• Default on debts
• Impulsivity
• Pathological lying
• Lack of remorse Not necessary for diagnosis
• Prevalence 3 of males 1 of females

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Psychopaths

• Core features-
• Psychopaths lack remorse
• Poverty of emotions (positive negative)
• Psychopaths are
• Superficially charming
• Pathological liars cheaters
• Impulsive sensations seekers
• Manipulative, will change story to fit facts
• Less responsive to fear/anxiety
• Immoral
• Prevalence greater among men

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Psychopaths identified by Hare checklist

• Two clusters
• 1. Emotional detachment cluster (a selfish
  remorseless individual with inflated self-esteem
  who exploits others.)
• 2. Antisocial lifestyle cluster- marked by
  impulsivity irresponsibility.

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Problems with diagnosis of APD

• 1. You cant trust reports made by antisocial
  personalities (they are chronic liars).
• 2. Many researchers believe psychopathology
  should not be synonymous with criminality.
• 3. Lack of remorse, a core symptom of
  psychopathy is not required for diagnosis of APD.
  

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Causes of APD Psychopathy

• Family
• Lack of affection severe parental rejection
  may cause psychopathic behavior (McCord McCord,
  1964)
• Fathers of psychopaths likely to be antisocial
  themselves.

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Genetic factors APD

• 1. Higher concordance rate for MZ twins than for
  DZ twins.
• 2. Higher rate of antisocial behavior in adopted
  children of biological parents with APD.

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Emotions Psychopathy

• Psychopaths feel emotions less intensely than
  normal individuals.
• Psychopaths not under-aroused compared to normal
  Ss, but are better at tuning out unpleasant
  stimuli.
• They lack empathy

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III. Anxious/Fearful Cluster

• 1. Dependent Personality Disorder
• Core feature lack of self-confidence autonomy
• --need to be taken care of
• --uncomfortable with self
• --intense fear of abandonment
• --need to be in relationships

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2. Obsessive-compulsive Personality disorder

• Core featureperfectionist person preoccupied
  with details, schedules, rules.
• --work oriented
• --difficulty making decisions
• --poor interpersonal relationships
• --stubborness need to control events
• --rigid thinkingoverly moralistic
• Does not include obsessions compulsions