CHAPTER 14 PERSONALITY DISORDERS Copyright © 2014 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education

PERSONALITY DISORDERS Personality trait: An enduring pattern of perceiving, relating to, and thinking about the environment and others. Personality disorders: Ingrained patterns of relating to other people, situations, and events with a rigid and maladaptive pattern of inner experience and behavior. Dating back to adolescence or early adulthood Copyright © 2014 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education

THE NATURE OF PERSONALITY DISORDERS Behavior patterns must manifest themselves in at least two of the following four areas: 1.Cognition 2.Affectivity 3.Interpersonal functioning 4.Impulse control Copyright © 2014 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education

DSM-5 PERSONALITY DISORDER CLUSTERS The DSM-5 groups the 11 diagnoses into three clusters based on shared characteristics: Cluster A - The odd and eccentric behaviors Cluster B - The dramatic and emotional behaviors Cluster C - The anxious and fearful behaviors Copyright © 2014 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education

GENERAL CRITERIA FOR A PERSONALITY DISORDER IN SECTION 3 Copyright © 2014 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education

ALTERNATIVE PERSONALITY DISORDER DIAGNOSTIC SYSTEM IN SECTION 3 OF THE DSM-5 Personality disorders are included in both Section II and Section III of the DSM- 5 due to the complexity of the disorder and various points of view on the disorder. Section II includes the updated diagnostic criteria. Section III includes the proposed research model for personality disorder diagnosis where it will receive further study and be revisited in the future. Within this framework, clinicians would have evaluated all clients on a consistent set of five personality traits. Copyright © 2014 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education

PERSONALITY DOMAINS IN THE DSM-5 SECTION 3 RATING SYSTEM Copyright © 2014 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education

DSM-5 SECTION 3 PERSONALITY DISORDER FRAMEWORK Copyright © 2014 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education

DSM-5 SECTION 3 PERSONALITY DISORDER FRAMEWORK Copyright © 2014 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education

CLUSTER A PERSONALITY DISORDERS Cluster A of the personality disorders in DSM-5 include those disorders characterized by eccentric behavior. In other words, individuals with these disorders show characteristics that might lead others to view them as slightly odd, unusual, or peculiar. Copyright © 2014 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education

PARANOID PERSONALITY DISORDER A personality disorder whose outstanding feature is that the individual is unduly suspicious of others and is always on guard against potential danger or harm. Impossible to trust people Project blame onto others Refuse to seek professional help Copyright © 2014 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education

SCHIZOID PERSONALITY DISORDER Indifference to social and sexual relationships Prefer to be alone No desire to love or be loved Cold, reserved, withdrawn Insensitive to feelings of others Copyright © 2014 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education

SCHIZOTYPAL PERSONALITY DISORDER A personality disorder that primarily involves odd beliefs, behavior, appearance, and interpersonal style. Such individuals lack a clear sense of direction or motivation, and do not have a clear set of standards against which to measure their behavior Copyright © 2014 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education

SCHIZOTYPAL PERSONALITY DISORDER Social isolation Eccentricity Peculiar communication Poor social adaptation Treatment Parallels interventions commonly used in treating schizophrenia Copyright © 2014 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education

CLUSTER B PERSONALITY DISORDERS THESE BEHAVIORS INCLUDE IMPULSIVITY, AN INFLATED SENSE OF SELF, AND A TENDENCY TO SEEK STIMULATION. Copyright © 2014 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education

ANTISOCIAL PERSONALITY DISORDER A personality disorder characterized by a lack of regard for society’s moral or legal standards and an impulsive and risky lifestyle. History Hervey Cleckley (1941) Psychopathy Robert Hare (1997) Psychopathy Checklist Copyright © 2014 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education

ANTISOCIAL PERSONALITY DISORDER The diagnostic criteria in the DSM-5 require that an individual show a pervasive pattern of three out of seven possible behaviors: 1.Failure to conform to social norms 2.Deceitfulness 3.Impulsivity 4.Aggressiveness 5.Disregard for safety of self or others 6.Irresponsibility 7.Lack of remorse Copyright © 2014 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education

IMPORTANT DISTINCTIONS There is a difference between antisocial personality disorder and antisocial behavior. Antisocial behavior Illegal or immoral behavior such as stealing, lying, or cheating Criminal A legal term, not a psychological concept Copyright © 2014 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education

PERSPECTIVES ON ANTISOCIAL PERSONALITY Biological Possible genetic causes Various brain abnormalities Copyright © 2014 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education

PERSPECTIVES ON ANTISOCIAL PERSONALITY Psychological Neuropsychological deficits Passive avoidance Response modulation hypothesis Copyright © 2014 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education

TREATMENT OF ANTISOCIAL PERSONALITY DISORDER Problems of working with these individuals Seeming lack of motivation to change Tendency toward deception and manipulation Lack of deep or lasting emotion Copyright © 2014 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education

BORDERLINE PERSONALITY DISORDER Pervasive pattern of poor impulse control and instability in mood, interpersonal relationships, and self-image BPD’s central feature is that of instability The way that people with BPD relate to others is termed “splitting” Copyright © 2014 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education

PERSPECTIVES ON BORDERLINE PERSONALITY Biological High heritability Abnormalities in: Amygdala and prefrontal cortex Neurotransmitters and hormones Copyright © 2014 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education

PERSPECTIVES ON BORDERLINE PERSONALITY Psychological Emotional dysregulation Distress tolerance Experiential avoidance Childhood neglect or traumatic experiences Marital or psychiatric difficulties Copyright © 2014 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education

TREATMENT OF BORDERLINE PERSONALITY Dialectical behavioral therapy Core mindfulness Transference-focused psychotherapy Copyright © 2014 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education

NEEDS INVOLVED IN BASIC PRINCIPLES OF EFFECTIVE TREATMENT FOR CLIENTS WITH BPD Need for clinicians to: Take over a primary role in treatment Provide a therapeutic structure Support the client Involve the client in the therapeutic process Take an active role in treatment Deal with the client’s suicidal threats or self-harming acts Be self-aware and ready to consult with colleagues Copyright © 2014 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education

HISTRIONIC PERSONALITY DISORDER Exaggerated emotional reactions, approaching theatricality, in everyday behavior. Show extreme pleasure as the center of attention and who behave in whatever way necessary to ensure that this happens. They are excessively concerned with their physical appearance, often trying to draw attention to themselves in such extreme ways that their behavior seems ludicrous. Copyright © 2014 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education

HISTRIONIC PERSONALITY DISORDER Flirtatious and seductive Demand reassurance, praise, approval of others Need for immediate gratification Easily influenced by others Lack analytical ability Copyright © 2014 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education

NARCISSISTIC PERSONALITY DISORDER Unrealistic, inflated sense of self-importance and lack of sensitivity to other people’s needs Copyright © 2014 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education

THEORIES OF NARCISSISTIC PERSONALITY Freudian Stuck in early psychosexual stages Psychodynamic Empathy Cognitive behavioral Maladaptive ideas Grandiose ideas clash with their experiences of failure Copyright © 2014 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education

TREATMENT OF NARCISSISTIC PERSONALITY Most effective approach Provide reassurance and develop a more realistic view of themselves and other people People with NPD are difficult to treat Tend not to have insight into their disorder Extreme perfectionism can obstruct treatment Copyright © 2014 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education

CLUSTER C PERSONALITY DISORDERS DISORDERS THAT INVOLVE PEOPLE WHO APPEAR ANXIOUS OR FEARFUL AND MAY SEEM HIGHLY RESTRICTED Copyright © 2014 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education

AVOIDANT PERSONALITY DISORDER The individual desires, but is fearful of, any involvement with other people and is terrified at the prospect of being publicly embarrassed Copyright © 2014 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education

AVOIDANT - THEORIES Cognitive-behavioral Hypersensitive due to parental criticism Feel unworthy of other people’s regard Expect not to be liked Avoid getting close to avoid expected rejection Distorted perceptions of experiences with others Copyright © 2014 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education

TREATMENT OF AVOIDANT PERSONALITY Cognitive-behavioral Break negative cycle of avoidance Confront and correct dysfunctional attitudes and thoughts Graduated exposure to social situations Learn skills to improve chance of intimacy Copyright © 2014 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education

DEPENDENT PERSONALITY DISORDER The individual is extremely passive Tends to cling to other people to the point of being unable to make any decisions Copyright © 2014 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education

OBSESSIVE-COMPULSIVE PERSONALITY DISORDER A personality disorder involving intense perfectionism and inflexibility manifested in worrying, indecisiveness, and behavioral rigidity. OCPD is a disturbance of personality, not a disturbance involving anxiety or even out-of-control behaviors OCPD do not experience obsessions and compulsions. OCPD refers to this rigidly compulsive personality tendency and also obsessive concern with perfectionism. Copyright © 2014 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education

OBSESSIVE-COMPULSIVE DISORDER Sense of self and self-worth in terms of work productivity Pathological personality trait - Rigid perfectionism Quality of perseveration Copyright © 2014 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education

THEORIES OF OBSESSIVE-COMPULSIVE Freudian Fixation at anal psychosexual stage Cognitive-behavioral Unrealistic standard of perfection Ruminative tendency Metacognitive interpersonal therapy Think about their thinking Copyright © 2014 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education

BIOPSYCHOSOCIAL PERSPECTIVE Disorders represent: Mix of long-standing personal dispositions and behavior patterns Disturbances in identity and interpersonal relationships Copyright © 2014 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education

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