Personality Disorders

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Personality Disorders

• Lecture 5
• Cluster C
• Anxious-Fearful
• DSM-IV-TR

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ANXIOUS-FEARFULCluster C

• AVOIDANT
• DEPENDENT
• OBSESSIVE-COMPULSIVE

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AVOIDANT

• Hypersensitivity to situations which could lead
  to
• Criticism
• Rejection
• Disapproval
• Interactions with others

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• Terror of
• Making fools of themselves
• Saying something which will make them look stupid
  
• Doing something which will embarrass them in
  front of others

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• Personal picture of themselves
• Unworthy
• Inadequate
• Incompetent
• Lonely

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Contingent impact on behaviour

• Avoid social interactions
• Where such interaction unavoidable
• Experience major anxiety
• Nervousness
• Fear of being evaluated
• Fear of criticism
• Fear of not going to measure up to others
  abilities / expectations

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Impact continued

• Tend to seek out occupations where interactions
  are curbed to minimum e.g.
• Long distance lorry driver
• Book-keeper
• Sheep-farmer
• Light-house keeper!

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Impact continued

• Personal Isolation
• Desire relationships but
• Feel unworthy of them
• Lack belief in others wanting them to join in
• Tend to have few friends who are well established
  as not going to be critical, judgemental etc.

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Comorbidity and overlaps

• Depression
• Social Phobia condition
• Distinguished to some extent by Avoidant PD being
  more generally based anxiety (Cf Social phobia
  being focussed on particular thing e.g. public
  speaking)
• Schizoid PD
• Shares the desire to steer clear from social
  situations but Schizoids do not have the
  Avoidants feeling of inadequacy, incompetence,
  and unworthiness

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Status

• Prevalence
• 0.3 1
• (Though some studies have suggested as high as 7)

• Inter-rater reliability
• O.97

• FemalesMales

• Test-retest reliability
• 0.41

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Style vs Disorder

• Finds comfort in routine and habitual things in
  preference to the unknown
• Identifies with close family and few trusted
  friends
• Sensitive and tends to be self-conscious
• Very careful in dealing with other people
• Appears restrained/reserved and polite
• Tends to be absorbed in hobbies, books etc.

• Even ordinary/mildly new situations can engender
  feelings of risk and over perceptions of physical
  danger, negative personal social consequences
• Usually none or at most 2 close
  confidants/friends
• Very unlikely to interact unless certain to be
  liked. Very thin-skinned
• Ultra-easily embarrassed and anxious in company
• Ultra-reticent for fear of saying something wrong
• Can be underachievers but also can be good at job
  but just dont have self-belief they are good at
  it

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AETIOLOGY

• Very little known or researched on Avoidant PDs
  aetiology though such explanations which have
  been offered focus on childhood and family
• e.g.

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Psychodynamic / Psychoanalytic

• Avoidant behaviours seen as defence mechanisms to
  avoid feeling of humiliation rejection and
  failure
• Weak ego development stemming form
• Brought up to feel undervalued by significant
  objects
• Low or no levels of encouragement
• Know your place / speak when spoken to upbringing

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• Hence self-perceptions in adulthood
• Cant compete
• Physically and / or mentally defective
• Lack of confidence
• Self-esteem low
• Want love but all history shows not worthy of it
  because objects did not give it.

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Cognitive - Behavioural

• Very similar to the Psychoanalytic explanation
  but with cognitive focus rather than defence
  mechanisms
• Rejection by significant others in early life
  leads to dysfunctional belief system
• If my own parents dont like me then why should
  anyone else?
• I must be a bad person if my own Mum treats me
  like like Im a waste of space etc.

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• Such a cognitive orientation leads to
• Resistance to disconfirming evidence
• Self-perpetuating avoidance
• Beck and Freeman 1990

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DEPENDENT

• As with Avoidant major anxiety about
  interpersonal relationships
• But this stems
• not from fear of criticism
• Instead a profound need for being cared for by
  others

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• Consequently
• Deny and do not display any of their thoughts or
  feelings which they think might displease others
• Submission to even the most unreasonable demands
  of others (doormat)
• Will hang on to others frantically (Cling-ons)
• Dont take intiative or make own decisions
  (unless for some reason it will please others
  e.g. enact vandalistic act to get cred in the
  gang)

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Overlaps and contrasts

• Borderlines and Dependents both
• Have very strong fear of abandonment
• Need for others to reify their existence and
  allow them to function at some level
• However, the Dependents much more ready to submit
  to abuse and exploitation whereas the Borderlines
  are the exploiters and abusers
• Avoidants and Dependents both
• Fear social relationships in both cases
• However former feel they prefer to function
  without them, while the latter feel they cant
  exist without them

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Status

• Prevalence
• 1.9 2.5
• (Though some studies have suggested as high as
  6.7)

• Inter-rater reliability
• O.86

• FemalesgtMales

• Test-retest reliability
• 0.15

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Status

• Prevalence
• 1.9 2.5
• (Though some studies have suggested as high as
  6.7)

• Inter-rater reliability
• O.83

• FemalesltMales

• Test-retest reliability
• 0.52

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Style vs Disorder

• Open to the suggestions and opinions of others
  but still have executive control
• Promote smooth relationships with tact, respect,
  agreeableness
• Prefers to be team member rather than leader but
  can take decisions when needed
• Highly tolerant of others even when inconvenient
  or tedious to do so

• Incapable of decision making without huge amount
  of advice from others and even then prefer others
  to take decisions for them
• Pathologically compliant outwardly agree with
  others even when privately dont just to avoid
  being rejected
• Unable to do things on their own need to be
  fully directed/instructed
• Will undertake demeaning unpleasant things to get
  others to like them

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Style vs Disorder

• Prefers company rather than being alone
• Strong commitment to relationships and works hard
  to maintain them
• Can not only take criticism but can if necessary
  act on it

• Anxiety/Insecurity experienced when alone go to
  excessive lengths to avoid being solitary
• Devastation when a relationship ends / fear of
  abandonment
• Crushed by criticism or disapproval

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AETIOLOGY

• Psychodynamic and Psychoanalytic
• Dependency a function of childhood characterized
  by
• Over-involvement of the object (e.g. Mother)
• Undue reward given for blind loyalty
• Rejection and/or intrusion from object/s whenever
  separation or independence was attempted

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• Leading to the combined effects
• First to cause the child to grow to be unduly in
  need of taking cues from others
• Second to obtain and crave validation from
  significant others
• Third to not want to say anything which might
  offend
• Deep seated resentment at not being allowed to
  grow as own entity is masked by outward display
  of being ultra-supine

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AETIOLOGY

• Cognitive-Behavioural
• Usual focus on cognitions
• Dependents see themselves as being
• Helpless
• Inadequate
• Living in a dangerous world
• Need help to negotiate it
• Need company to fight it

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• Exacerbated by tendency towards dichotomous
  thinking patterns
• Totally alone vs Totally involved with someone
• Hence correspondingly extreme devastation when
  relationship ends
• Totally competent vs Totally in need if direction
• Hence since no-one is infallible the only thing
  to do is retreat to need for total direction

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Obsessive Compulsive

• Shares features with Obsessive Compulsive
  Disorder (OCD) but Obsessive Compulsive
  Personality Disorder (OCPD) is different in that
• OCPD Refers to generalized way of relating to the
  world
• As opposed to specific constraints of obsessions
  and compulsions which characterizes OCD

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OCPD

• Lacks sponeity
• Buttoned-up emotionally
• Austere and humourless
• Calvinistic in their attitude to work
• Puritanical in their attitude to pleasure
• Little interest in warm friendships

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• Others find them
• Stubborn
• Stingy
• Possessive
• Officious
• Moralistic
• Sanctimonious
• Hierarchically oriented
• Obsequious to superiors
• Dismissive and authoritarian to what they would
  see as inferiors

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Status

• Prevalence
• 1.01.9
• (Though some studies have suggested as high as
  7.7)

• Inter-rater reliability
• O.83

• FemalesltMales

• Test-retest reliability
• 0.52

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Style vs Disorder

• Likes to do a job well, properly thoroughly etc.
• Attention to detail
• Has some tolerance of alternative approaches but
  like things just so
• Dedicated to their jobs, focussed
• Weighs-up carefully consequences before acting,
  deliberate in style

• Perfectionism so exessive ot can prevent
  completion of task
• Loses overall objective in over-attention to
  minutiae of rules, details, lists, procedures
  etc.
• Unreasonable insistence that things done their
  way by themselves and by others
• Work becomes all-consuming to the exclusion of
  friends, leisure activity
• Indecision, procrastination and avoidance through
  need to avoid imperfect outcome (not through
  waiting for advice from others or fear of making
  a fool of themselves)

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Style vs Disorder

• Strong moral code and adherence to what they see
  as the doing the right thing
• Reserved but clear-minded
• Cautious and un-extravagant but capable of some
  measured sharing
• Tendency to hang on to things in case they might
  come in useful some day

• Overdoes the concern for morality, ethics of
  things
• Sanctimonious stance on others
• Very tight-fisted and canny
• Chronic hoarder of almost anything and everything

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AETIOLOGY

• Psychodynamic Psychoanalytic
• Freud (1923) The Anal Personality
• Overly strict and punitive potty training
• Fromm (1992) Upbringing authoritarian

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AETOLOGY

• Cognitive- Behavioural
• Cognitive orientation
• Perfectionism
• Need for certainty
• Pursuit of single right solution approach to
  any given task

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• Automatic thought ideations
• Flaws, defects and mistakes are intolerable
• If I dont do this project it wont be done
  properly
• The person disobeyed and therefore must take
  the punishment

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• Where come from?
• Guideno and Liotti (1993)
• Contradictary messages from one or both parents
• Strive for clarity excessively