Personality Disorders Thomas G. Bowers, Ph.D. Penn State Harrisburg

General Characteristics Long-standing, maladaptive patterns of behavior Generally recognizable by adolescence Tend to be inflexible, persistent, and resistant to change Must also be associated with significant life problems

Three W’s: Wild, Weird and Withdrawn Easier to remember than Clusters A, B, C Wild –1. Borderline Personality Disorder –2. Histrionic Personality Disorder –3. Narcissistic Personality Disorder –4. Antisocial Personality Disorder

Three W’s: Wild, Weird and Withdrawn Weird –1. Paranoid Personality Disorder –2. Schizoid Personality Disorder –3. Schizotypal Personality Disorder

Three W’s: Wild, Weird and Withdrawn Withdrawn –Avoidant Personality Disorder –Dependent Personality Disorder –Obsessive-Compulsive Personality Disorder

Borderline Personality Disorder Intense, unstable relationships Instability in mood, self-image –“Who am I?” Unpredictable and impulsive behavior –Often self damaging, as gambling, sexual behavior, spending sprees

Borderline Personality Disorder Intense fear of aloneness Extreme fears of abandonment Demand attention Alternate between idealization and devaluation Chronic feelings of emptiness and boredom Often suicidal feelings and gestures

Borderline Personality Disorder Long interest from psychoanalytic field (as Kernberg) Thought to be “borderline” between psychosis and neurosis Tend to decompensate into psychotic state under stress

Borderline Personality Disorder Object relations theory Introjection of important values and images of other important people (as parents) may be faulty Frequently see issues as a weak, ineffectual father (often totally absent, or even abandoning family) Domineering mother

Borderline Personality Disorder Inconsistent provision of warmth and affection Frequently reported childhood physical and sexual abuse Some biological relationships Respond positively to SSRI Familial, thought to be be genetic links Related to bipolar affective disorder

Borderline Personality Disorder Video assignment: “Fatal Attractions” note Glen Close in her role

Histrionic Personality Disorder Overly dramatic, attention-seeking Display excessive emotion, but in fact are emotionally shallow Self-centered Inappropriately sexually provocative and seductive Pseudohypersexuality

Narcissistic Personality Disorder Grandiose and exaggerated sense of self Literary in love with themselves Require constant attention and admiration Lack of empathy, strong feelings of arrogance, entitlement Take advantage of others

Antisocial Personality Disorder Psychopathy (or sociopathy) Cleckly - The Mask of Sanity Emotional aloofness and detachment Hare - contemporary researcher –Psychopathy appears to be distinct from ASPD

Antisocial Personality Disorder Little ability to profit from experience –In particular, ASPD individuals do not seem to learn well to aversive stimulus conditions Genetic factors appear to play a role, as do environmental factors –Lack of affection, severe rejection, inconsistent discipline, fathers often are antisocial

Antisocial Personality Disorder Chronic cortical under arousal Impulsivity, difficulties in goal directed behavior Noted increased slow wave activity, temporal region spikes on EEG

“Weird” Cluster Paranoid Personality –Highly suspicious of people, tends to mistrust others, expects to be mistreated –Extremely jealous Schzoid Personality –Does not desire or enjoy social relationships –Bland, aloof, loners

“Weird” Cluster Schizotypal Personality Attenuated form of schizophrenia Interpersonally similar to schizoid, with eccentric nature Odd beliefs, magical thinking Illusions

“Weird” Cluster Etiology –May be a variant of schizophrenic range disorders –Family patterns noted

Withdrawn Cluster Dependent Personality –Lacks self-confidence, independence, self- reliance –Passive and dependent stance –Intense need to be taken care of, unable to make demands on others –Tends to sacrifice needs of self for others –Fairly common

Withdrawn Cluster Avoidant Personality –Keenly sensitive to rejection, disapproval –Extremely restrained, easily embarrassed –Exaggerate risks, dangers

Withdrawn Cluster Obsessive Compulsive Personality –Perfectionistic, preoccupied with rules, details –Work excessively –Stubborn, rigid, demanding –Tend to be rigid and inflexible, moralistic

Diagnostic Issues Reliability problems been noted Structured interviews are now helpful Considerable comorbidity

Interrater and Test-retest Reliability

Treatment of Personality Disorders Psychodynamic therapy –Object relations therapy (Kernberg) Focus on ego development Interpretative “Reality testing” –Dialectical behavior therapy Linehan - Empirically tested Client centered and cognitive methods

Treatment of Personality Disorders Dynamic-Cognitive Therapy –Turner Cognitive Therapy –Beck –Negative schemata of world thought to operate

Treatment of Personality Disorders Psychopathy is very difficult to treat effectively –May be unsuitable for psychotherapy (or any type of personal relationship)