Personality Disorders Symptoms Diagnosis Frequency

 Personality: enduring patterns of thinking and behavior that define the person and distinguish him or her from other people.  Personality disorder - emphasizes the duration of the pattern and the social impairment associated with the traits in question.  Disorders characterized by extreme and rigid personality traits that cause impairment  Axis II disorders  Ego syntonic

 The concept of social dysfunction plays an important role.  If the personality characteristics typically interfere with the person’s ability to get along with other people and perform social roles, they become more than just a collection of eccentric traits or peculiar habits.

 Social Motivation  Motives describe the way that the person would like things to be, and they help to explain why people behave in a particular fashion.  Two of the most important motives in understanding human personality are affiliation—the desire for close relationships with other people. power—the desire for impact, prestige, or dominance.

 Social Motivation  Many of the symptoms of personality disorders can be described in terms of maladaptive variations with regard to needs for affiliation and power.

 Cognitive Perspectives Regarding Self and Others  One central issue involves our image of ourselves. Is the self-image stable? Is self-esteem maintained by external validation?

 Prevalence in Community and Clinical Samples  The overall lifetime prevalence for having at least one personality disorder varies between 10% and 14%.  Highest prevalence rates for OCPD, ASPD, and APD.  75% of patients with Axis II disorder also have Axis I disorder.  Low rates for NPD may not recognize the nature of their own problems.

 Gender Differences  The overall prevalence of personality disorders is approximately equal in men and women.  Antisocial personality disorder: 5% reported for men and 1% for women  Gender Bias and Diagnosis Critics contend that the definitions of some categories are based on sex role stereotypes and therefore are inherently sexist.

 Stability of Personality Disorders over Time  Temporal stability is one of the most important assumptions about personality disorders.  The long-term prognosis is less optimistic for schizotypal and schizoid personality disorders. People with these diagnoses are likely to remain socially isolated and occupationally impaired.

 Cluster A are people who are perceived as odd or eccentric Includes paranoid, schizoid, and schizotypal personality disorders

Cluster B are people whose behavior is overly dramatic, emotional, or erratic  Includes antisocial, borderline, histrionic and narcissistic personality disorders

Cluster C are people who often appear anxious or fearful Includes avoidant, dependent, and obsessive- compulsive personality disorders

Paranoid Personality Disorder Personality traits involving extreme distrust and suspiciousness.

Paranoid Personality Disorder  Includes four or more of the following:  Suspiciousness of others  Unjustified doubts about disloyalty  Reluctance to confide in others  Reading threatening meanings into benign events  Persistent tendency to bear grudges  Tendency to feel attacked and counterattack  Unjustified suspiciousness about infidelity of partner

 Schizoid Personality Disorder Personality traits involving detachment from social relationships and a restricted range of emotional expression

 Schizoid Personality Disorder  Include four or more of the following:  Neither desires nor enjoys close relationships  Almost always chooses solitude  Little if any interest in sexual relationships  Takes pleasure in few activities  Lacks close friends  Indifferent to praise or criticism  Emotional coldness, detachment or flatness

 Schizotypal Personality Disorder Personality traits involving eccentricities of behavior, cognitive or perceptual distortions, and acute discomfort in close relationships

 Schizotypal Personality Disorder Five or more of the following: Ideas of reference Odd beliefs or magical thinking Unusual perceptual experiences Odd thinking and speech Suspiciousness or paranoid ideas Inappropriate or constricted affect Odd, eccentric or peculiar behavior or appearance Lack of close friends Excessive social anxiety

 Antisocial Personality Disorder  Personality traits involving profound disregard for, and violation of, the rights of others

Antisocial Personality Disorder Includes three or more of the following:  Failure to conform to lawful behavior  Deceitfulness  Impulsivity  Irritability or aggressiveness  Reckless disregard for safety of self and others  Consistent irresponsibility  Lack of remorse

 Borderline Personality Disorder Personality traits involving instability in interpersonal relationships, self-image, and emotions, impulsivity, and self-destructive behavior

 Borderline Personality Disorder Five or more of the following: Frantic efforts to avoid abandonment Unstable and intense relationships Unstable self image Impulsivity (self destructive) Suicidal behavior Affective instability Chronic feelings of emptiness Inappropriate, intense anger

 One of the most perplexing, most disabling, and most frequently treated forms of PD.  Otto Kernberg (1967, 1975)  BPD refers to a set of personality features or deficiencies that can be found in individuals with various disorders.  Common features/abnormal behaviors of BPD  Splitting- alternately seeing people as entirely good or entirely bad.  Impulse control problems  See Figure 9-1

 Treatment  Most difficult to treat.  Between 1/2 to 2/3 of all patients with BPD discontinue treatment prematurely.  Marsha Linehan – Dialectical Behavioral Therapy (DBT) Emphasis: Learning to be more comfortable with strong emotions. Emphasis: Therapist’s acceptance of the patient and their negative behaviors.

 Women treated with DBT tend to drop out of treatment at a lower rate; tend to experience more improvement than women in control groups.  Medication is frequently used adjunctively. Antipsychotics Antidepressants Lithium Anticonvulsants.

 Histrionic Personality Disorder Personality traits involving excessive, superficial emotionality and attention seeking

 Histrionic Personality Disorder Five or more of the following:  Uncomfortable if not the center of attention  Inappropriately seductive or provocative  Rapidly shifting and shallow emotions  Use of appearance to draw attention  Speech is impressionistic and lacking in detail  Self-dramatization, theatricality  Suggestibility  Considers relationships more intimate than they are

 Narcissistic Personality Disorder Personality traits involving extreme grandiosity, need for admiration, and lack of empathy

 Narcissistic Personality Disorder  Five or more of the following: Grandiose sense of self-importance Preoccupied with fantasies of unlimited success, power, brilliance, etc. Belief that he or she is “special” Requires excessive admiration Sense of entitlement Interpersonally exploitative Lacks empathy Often envious Arrogant or haughty

Personality traits involving social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation Avoidant Personality Disorder

 Avoidant Personality Disorder Four or more of the following: Avoids activities due to fear of criticism, disapproval or rejection Unwilling to get involved with people unless certain of being liked Restrained in relationships due to fear of being shamed or ridiculed Preoccupied with criticism or rejection in social situations Inhibited in new situations due to feelings of inadequacy Views self as inept, unappealing, inferior Reluctant to take personal risks

 Dependent Personality Disorder Personality traits involving submissive and clinging behavior related to an excessive need to be cared for by others

 Dependent Personality Disorder Five or more of the following: Excessive need for advice and reassurance to make decisions Needs others to assume responsibility for most areas of life Difficulty expressing disagreement Difficulty initiating or doing things on own Goes to excessive lengths for nurturance or support Feels helpless when alone, due to exaggerated fears of being unable to care for self Urgently seeks new relationship if close relationship ends Preoccupied with fears of being left to care for self

CAUSESTREATMENT  Little research on the etiology of DPD.  Overprotective, authoritarian parents are likely to foster development of dependency.  Insecurely or anxiously attached children are likely to become dependent.  Virtually no literature on the outcome of treatment for DPD.  Enter therapy for other reasons, such as depression, anxiety or substance use disorder.  Cognitive therapy  Psychopharmacology is typically not used.

 Obsessive-Compulsive Personality Disorder Personality traits involving preoccupation with orderliness, perfectionism, and control at the expense of spontaneity, flexibility, and enjoyment

 Obsessive-Compulsive Personality Disorder Four or more of the following: Preoccupation with rules, lists, order, schedules, etc. Perfectionism Excessive devotion to work and productivity Over-conscientious, scrupulous, inflexible about morality Inability to discard worn-out or worthless objects Reluctance to delegate tasks or work with others unless they submit to exactly his or her way of doing things Miserly spending style Rigidity and stubbornness