Announcement

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Announcement

• For Wed., read 539 to 558 only
• Other pages are optional

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Personality

• What is personality?
• Personality disorders
• Rigid, maladaptive traits
• Adjustment problems, distress
• Axis 1 vs. Axis 2 of DSM-IV-TR
• 0.5 to 5 of population for each disorder

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Paranoid Personality Disorder

• Cluster A
• Odd
• Eccentric

• Whats paranoia?
• Unjustified distrust, suspicion
• Hidden meanings in others comments
• Spouses/partners fidelity

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Paranoid Personality Disorder

• Not as severe as paranoid schizophrenia
• No hallucinations, no cognitive disorganization
• Delusions are not full blown

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Prevalence Course

• Prevalence
• 0.5 to 2.5 of population
• Course
• Childhood Poor relationships, social anxiety,
  hypersensitivity, underachievement, teasing

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Causes Treatment

• Biological psychological unknown
• Parental teaching?
• Treatment seeking uncommon
• Cognitive restructuring?

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Schizoid Personality Disorder

• Detachment from social relationships
• Flat affect
• Prevalence
• Extremely uncommon
• Course
• Early childhood difficulties like paranoid PD

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Causes and Treatment

• Childhood shyness?
• Treatment seeking uncommon
• Social skills training
• Role playing

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Schizotypal Personality Disorder

• Symptoms
• Discomfort with close relationships
• Social anxiety
• Lack close friendships
• Cognitive or perceptual distortions
• Odd beliefs
• Odd thinking
• Paranoia
• Odd speech

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Prevalence Course

• Prevalence
• 3 of population
• Course
• Early childhood problems
• Stable

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Causes

• MZ correlations around .50 to .60 DZ around .25
  to .35
• Childhood hypersensitivity to criticism

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Treatment

• Depression treatment
• Antidepressants
• CBT
• Antipsychotics
• Accept solitary lifestyle?

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Cluster A Summary

• All involve odd or eccentric behavior
• Little known about causes or treatment
• Uncommon

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Cluster B

• Cluster B
• Dramatic
• Emotional
• Erratic

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Antisocial Personality Disorder

• Lack conscience, remorse
• Violation of social norms
• Must be 18

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Case Example George

• Comment on Georges overall demeanor/appearance
• How might you help him as his therapist?

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Prevalence Course

• Prevalence
• 3-5 of males
• 1 of females
• Course
• Childhood conduct problems (kicking, hitting)
• Chronic but may remit after 40

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Causes Genes Environments

• Genes 40 to 50
• Shared environment 15 to 20
• Unshared environment 30
• G x E interactions

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Genetic Influences
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Gene x Environment Interactions

• Sample Cadoret et al. (1983)
• 367 adoptees with biological vulnerabilities
  (separated at birth)
• Dependent measure
• Adoptive parent interviews about truancy, trouble
  with the law, lying

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Gene x Environment InteractionsCadoret et al.
(1983)

• Genetic variables
• Antisocial background in family
• Alcoholism background in family
• Environmental variables
• Adoptive parent psychopathology
• Adoptive parent divorces

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Gene x Environment InteractionsCadoret et al.
(1983)
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Treatment

• Treatment seeking uncommon
• Incarceration common
• Parent training based on operant conditioning
• Improved behavior
• High dropouts

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Borderline Personality Disorder

• Instability of
• Affect (emotions, moods)
• Interpersonal relationships
• Self-image
• Views of others

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BPD

• Self-Injury Common
• Suicidal thoughts
• Suicide attempts (6 to 9 commit suicide!)
• Cutting
• Impulsivity

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BPD Commorbidity

• Drug abuse common
• Major depression common
• Many Bulimics have BPD

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Prevalence Course

• Prevalence
• 2 to 3 of population
• Female male ratio is 31
• Course
• Some improvement during 30s and 40s
• After ten years, half may not meet diagnostic
  criteria

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Causes

• 91 recall childhood abuse!
• Form of PTSD?
• Biological causes unknown

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Treatment

• Little known
• Antidepressants ineffective
• Any treatment with marginal utility is welcome

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Treatment

• Marsha Linehans dialectical behavior therapy
• Dialectic philosophy Value of synthesizing
  natural tensions to bring change
• Thesis
• Antithesis
• Synthesis

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DBT for BPD

• Diathesis x stress model
• Biological diathesis to emotional instability
• Invalidating child environment
• BPD is a disorder of emotion regulation

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DBT for BPD

• Therapist validation
• Mindfulness focus
• As needed 24 hour phone contact
• Except within 24 hour of self-injury

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DBT Outcomes

• Seven independent randomized controlled trials
  reductions in
• Self-injurious behavior
• Suicidal behavior
• Suicidal ideation
• Hopelessness
• Depression
• Anger

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Case Example of DBT for BPD Hannah (hand-out)

• How does the therapist balance the thesis
  (change) and anti-thesis (acceptance)?
• Look for examples of each

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Histrionic Personality Disorder

• Excessive emotionality
• Attention seeking
• Interpersonal manipulation
• Prevalence
• 2-3 of population
• Comorbidity
• 67 also have antisocial personality disorder

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Causes and Treatment

• Little known
• Modify attention-seeking behavior (Kass et al.,
  1972)?
• Operant conditioning
• Show long-term costs of interpersonal
  manipulation (Beck Freeman, 1990)?

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Narcissistic Personality Disorder

• Excessive unstable self-worth
• Need for admiration
• Lack of empathy
• Sense of entitlement
• Tendency to lash out when self is threatened

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Prevalence Course

• Prevalence
• Less than 1 of population
• 50 to 75 of those with antisocial PD are male
• Course
• Begins in early childhood, continues in adulthood

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Causes Treatment

• Poor parental modeling of empathy (Kohut, 1971)?
• Cognitive therapy
• Accept criticism
• Empathy
• Little known about treatment effectiveness

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Cluster B Summary

• Dramatic, emotional, or erratic
• Beginning to learn about etiology and treatment

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Cluster C

• Cluster C
• Anxious
• Fearful

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Avoidant Personality Disorder

• Social inhibition
• Inadequacy
• Hypersensitivity to criticism

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Prevalence Course

• 0.5 to 1.0 of population
• Course
• Starts as childhood shyness
• Increases during adolescence
• May remit with age (later in adulthood)

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Causes

• Parent rejection
• Those with avoidant PD recall rejecting,
  unaffectionate parents
• Low self-esteem?
• Biological?

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Treatment

• Behavioral treatments used for social phobia
• Systematic desensitization
• Behavioral rehearsal
• Intentional social mishaps
• Cognitive restructuring
• Significant but modest improvement

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Dependent Personality Disorder

• Excessive need to be taken care of
• Submissiveness, clinging

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Prevalence and Couse

• Prevalence
• 2 to 3 of population
• Course
• Begins in childhood, continues in adulthood

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Causes and Treatment

• Early death of a parent?
• Fear of abandonment
• Treatment effects unknown