Copyright © 2010 Allyn & Bacon This multimedia product and its contents are protected under copyright law. The following are prohibited by law: any public performance or display, including transmission over any network; preparation of any derivative work, including the extraction, in whole or part, of any images; any rental, lease, or lending of the program. ISBN: PowerPoint for Abnormal Psychology Fourteenth Edition James N. Butcher Susan Mineka Jill M. Hooley Prepared by Andy Pomerantz Southern Illinois University Edwardsville

Copyright © 2010 Allyn & Bacon Chapter 10 Personality Disorders

Copyright © 2010 Allyn & Bacon Clinical Features of Personality Disorders  Personality disorders are characterized by:  Chronic interpersonal difficulties  Problems with one’s identity or sense of self  Formerly known as “character disorders”  Personality disorders are characterized by:  Chronic interpersonal difficulties  Problems with one’s identity or sense of self  Formerly known as “character disorders” 3

Copyright © 2010 Allyn & Bacon Clinical Features of Personality Disorders  DSM criteria include enduring pattern of behavior that is  Pervasive and inflexible  Stable and of long duration  Cause clinically significant distress or impairment in functioning  Must manifest in at least two areas: cognition, affectivity, interpersonal functioning, or impulse control  DSM criteria include enduring pattern of behavior that is  Pervasive and inflexible  Stable and of long duration  Cause clinically significant distress or impairment in functioning  Must manifest in at least two areas: cognition, affectivity, interpersonal functioning, or impulse control 4

Copyright © 2010 Allyn & Bacon Clinical Features of Personality Disorders  Often cause significant problems in lives of others  Gradually develop inflexible and distorted personality and behavior patterns  Lifetime prevalence rate around 13% for at least one personality disorder  Coded on Axis II of DSM  Often cause significant problems in lives of others  Gradually develop inflexible and distorted personality and behavior patterns  Lifetime prevalence rate around 13% for at least one personality disorder  Coded on Axis II of DSM 5

Copyright © 2010 Allyn & Bacon 6 Clinical Features of Personality Disorders  Cluster A includes:  Paranoid  Schizoid  Schizotypal  Cluster B includes:  Histrionic  Narcissistic  Antisocial  Borderline  Cluster C includes:  Avoidant  Dependent  Obsessive-compulsive  Cluster A includes:  Paranoid  Schizoid  Schizotypal  Cluster B includes:  Histrionic  Narcissistic  Antisocial  Borderline  Cluster C includes:  Avoidant  Dependent  Obsessive-compulsive

Copyright © 2010 Allyn & Bacon 7 Clinical Features of Personality Disorders  Prevalence studies suggest that about 10-13% of the population meets criteria for at least one personality disorder at some point in their lives  In DSM, personality disorders are coded on Axis II, rather than Axis I where almost all other forms of mental illness are coded  About 75% of people with personality disorders also have an Axis I disorder  Prevalence studies suggest that about 10-13% of the population meets criteria for at least one personality disorder at some point in their lives  In DSM, personality disorders are coded on Axis II, rather than Axis I where almost all other forms of mental illness are coded  About 75% of people with personality disorders also have an Axis I disorder

Copyright © 2010 Allyn & Bacon 8 Difficulties Doing Research on Personality Disorders  Difficulties in diagnosing personality disorders  Difficulties in studying the causes of personality disorders  Difficulties in diagnosing personality disorders  Difficulties in studying the causes of personality disorders

Copyright © 2010 Allyn & Bacon 9 Difficulties in Diagnosing Personality Disorders  Difficulties in diagnosing personality disorders are caused by a number of factors, including:  Diagnostic criteria are not as sharply defined as for other Axis I categories  Diagnostic categories are not mutually exclusive  Personality characteristics are dimensional in nature  Difficulties in diagnosing personality disorders are caused by a number of factors, including:  Diagnostic criteria are not as sharply defined as for other Axis I categories  Diagnostic categories are not mutually exclusive  Personality characteristics are dimensional in nature

Copyright © 2010 Allyn & Bacon 10 Difficulties in Diagnosing Personality Disorders  The five-factor model of personality  PDs may represent extreme levels of normal personality traits. Examples:  Histrionic—high extraversion and neuroticism  Dependent—high agreeableness and neuroticism  Obsessive-compulsive—high conscientiousness  The five-factor model of personality  PDs may represent extreme levels of normal personality traits. Examples:  Histrionic—high extraversion and neuroticism  Dependent—high agreeableness and neuroticism  Obsessive-compulsive—high conscientiousness

Copyright © 2010 Allyn & Bacon 11 Difficulties in Studying the Causes of Personality Disorders  Little research has been conducted on causal factors  Difficulties in studying the causes of personality disorders spring from  The fact that such disorders have received consistent attention only since DSM-III was published in 1980  The fact that these disorders are less amenable to thorough study  The fact that most studies to date are retrospective  Little research has been conducted on causal factors  Difficulties in studying the causes of personality disorders spring from  The fact that such disorders have received consistent attention only since DSM-III was published in 1980  The fact that these disorders are less amenable to thorough study  The fact that most studies to date are retrospective

Copyright © 2010 Allyn & Bacon Cluster A Personality Disorders  Paranoid  Schizoid  Schizotypal  Paranoid  Schizoid  Schizotypal 12

Copyright © 2010 Allyn & Bacon Paranoid Personality Disorder  Suspiciousness and mistrust of others  Tendency to see self as blameless  On guard for perceived attacks by others  Suspiciousness and mistrust of others  Tendency to see self as blameless  On guard for perceived attacks by others 13

Copyright © 2010 Allyn & Bacon Schizoid Personality Disorder  Impaired social relationships  Inability and lack of desire to form attachments to others  Impaired social relationships  Inability and lack of desire to form attachments to others 14

Copyright © 2010 Allyn & Bacon Schizotypal Personality Disorder  Peculiar thought patterns  Oddities of perception and speech that interfere with communication and social interaction  Causal factors  Genetic abnormalities similar to schizophrenia  Peculiar thought patterns  Oddities of perception and speech that interfere with communication and social interaction  Causal factors  Genetic abnormalities similar to schizophrenia 15

Copyright © 2010 Allyn & Bacon Cluster B Personality Disorders  Histrionic Personality Disorder  Narcissistic Personality Disorder  Antisocial Personality Disorder  Borderline Personality Disorder  Histrionic Personality Disorder  Narcissistic Personality Disorder  Antisocial Personality Disorder  Borderline Personality Disorder 16

Copyright © 2010 Allyn & Bacon Histrionic Personality Disorder  Self-dramatization  Overconcern with attractiveness  Tendency of irritability and temper outbursts if attention seeking is frustrated  Self-dramatization  Overconcern with attractiveness  Tendency of irritability and temper outbursts if attention seeking is frustrated 17

Copyright © 2010 Allyn & Bacon Narcissistic Personality Disorder  Grandiosity  Preoccupation with receiving attention  Self-promoting  Lack of empathy  Grandiosity  Preoccupation with receiving attention  Self-promoting  Lack of empathy 18

Copyright © 2010 Allyn & Bacon Antisocial Personality Disorder  Lack of moral or ethical development  Inability to follow approved models of behavior  Deceitfulness  Shameless manipulation of others  History of conduct problems as a child  Lack of moral or ethical development  Inability to follow approved models of behavior  Deceitfulness  Shameless manipulation of others  History of conduct problems as a child 19

Copyright © 2010 Allyn & Bacon Borderline Personality Disorder  Impulsiveness  Inappropriate anger  Drastic mood shifts  Chronic feelings of boredom  Attempts at self-mutilation or suicide  Causal factors  Genetics, neurotransmitters, traumatic events  Impulsiveness  Inappropriate anger  Drastic mood shifts  Chronic feelings of boredom  Attempts at self-mutilation or suicide  Causal factors  Genetics, neurotransmitters, traumatic events 20

Copyright © 2010 Allyn & Bacon 21 Figure 10.1: Multidimensional Diathesis-Stress Theory of Borderline Personality Disorder

Copyright © 2010 Allyn & Bacon Cluster C Personality Disorders  Avoidant Personality Disorder  Dependent Personality Disorder  Obsessive-Compulsive Personality Disorder  Avoidant Personality Disorder  Dependent Personality Disorder  Obsessive-Compulsive Personality Disorder 22

Copyright © 2010 Allyn & Bacon Avoidant Personality Disorder  Hypersensitivity to rejection or social derogation  Shyness  Insecurity in social interaction and initiating relationships  Causal factors  inhibited temperament  Hypersensitivity to rejection or social derogation  Shyness  Insecurity in social interaction and initiating relationships  Causal factors  inhibited temperament 23

Copyright © 2010 Allyn & Bacon Dependent Personality Disorder  Difficulty in separating in relationships  Discomfort at being alone  Subordination of needs in order to keep others involved in a relationship  Indecisiveness  Causal factors  Inheritance of high neuroticism and agreeableness  Difficulty in separating in relationships  Discomfort at being alone  Subordination of needs in order to keep others involved in a relationship  Indecisiveness  Causal factors  Inheritance of high neuroticism and agreeableness 24

Copyright © 2010 Allyn & Bacon Obsessive-Compulsive Personality Disorder  Excessive concern with order, rules, and trivial details  Perfectionism  Lack of expressiveness and warmth  Difficulty in relaxing and having fun  Excessive concern with order, rules, and trivial details  Perfectionism  Lack of expressiveness and warmth  Difficulty in relaxing and having fun 25

Copyright © 2010 Allyn & Bacon Provisional Categories of Personality Disorder in DSM-IV-TR  Passive-aggressive  Negativistic attitudes and passive resistance to adequate performance expressed through indirect means such as complaining, being sullen and argumentative, expressing envy and resentment toward those who are more fortunate  Depressive  Pervasive depressive cognitions; persistent unhappiness or dejection; feeling of inadequacy, guilt, and self-criticism  Passive-aggressive  Negativistic attitudes and passive resistance to adequate performance expressed through indirect means such as complaining, being sullen and argumentative, expressing envy and resentment toward those who are more fortunate  Depressive  Pervasive depressive cognitions; persistent unhappiness or dejection; feeling of inadequacy, guilt, and self-criticism 26

Copyright © 2010 Allyn & Bacon General Sociocultural Causal Factors for Personality Disorders  Is our emphasis on impulse gratification, instant solutions, and pain-free benefits leading more people to develop the self- centered lifestyles that we see in more extreme forms in personality disorders? 27

Copyright © 2010 Allyn & Bacon 28 Treatments and Outcomes for Personality Disorders  Personality disorders are generally very difficult to treat  Goals may vary  Clients may believe there is no need to change  Relationships, including therapist/client relationships, can be difficult to form  Personality disorders are generally very difficult to treat  Goals may vary  Clients may believe there is no need to change  Relationships, including therapist/client relationships, can be difficult to form

Copyright © 2010 Allyn & Bacon 29 Adapting Therapeutic Techniques to Specific Personality Disorders  Therapeutic techniques may need to be adapted for each personality disorder  Settings can have an impact  Inpatient  Partial hospitalization  Outpatient  Cognitive therapy attempts to change biased and dysfunctional schemas of PD clients  Therapeutic techniques may need to be adapted for each personality disorder  Settings can have an impact  Inpatient  Partial hospitalization  Outpatient  Cognitive therapy attempts to change biased and dysfunctional schemas of PD clients

Copyright © 2010 Allyn & Bacon 30 Treating Borderline Personality Disorder  Regarding treatment, borderline has received more clinical and research attention than the other PDs  Antidepressant medications (SSRIs)  Dialectical behavior therapy (DBT)  A unique kind of cognitive and behavioral therapy adapted specifically for borderline  Systematic research supports DBT  Regarding treatment, borderline has received more clinical and research attention than the other PDs  Antidepressant medications (SSRIs)  Dialectical behavior therapy (DBT)  A unique kind of cognitive and behavioral therapy adapted specifically for borderline  Systematic research supports DBT

Copyright © 2010 Allyn & Bacon 31 Treating Other Personality Disorders  In general, few controlled studies of the treatment of most PDs have been conducted  Antipsychotic or antidepressant medication may help with schizotypal PD  Cognitive-behavioral treatment and antidepressant medication may help with avoidant PD  In general, few controlled studies of the treatment of most PDs have been conducted  Antipsychotic or antidepressant medication may help with schizotypal PD  Cognitive-behavioral treatment and antidepressant medication may help with avoidant PD

Copyright © 2010 Allyn & Bacon Antisocial Personality Disorder and Psychopathy  Individuals 18 and over may be diagnosed with antisocial personality disorder if the following criteria are met:  At least three behavioral problems occurring after age 15  At least three instances of deviant behavior before age 15  The antisocial behavior is not a symptom of another mental disorder  Individuals 18 and over may be diagnosed with antisocial personality disorder if the following criteria are met:  At least three behavioral problems occurring after age 15  At least three instances of deviant behavior before age 15  The antisocial behavior is not a symptom of another mental disorder 32

Copyright © 2010 Allyn & Bacon Psychopathy and ASPD  The following characteristics are typical of psychopaths as described by Cleckley:  Inadequate conscience development  Irresponsible and impulsive behavior  Ability to impress and exploit others  The following characteristics are typical of psychopaths as described by Cleckley:  Inadequate conscience development  Irresponsible and impulsive behavior  Ability to impress and exploit others 33

Copyright © 2010 Allyn & Bacon 34 Psychopathy and ASPD  Psychopathy has two dimensions:  Affective/interpersonal core of the disorder: lack of remorse, lack of empathy, glibness/charm, etc.  Behavior: need for stimulation, poor behavior controls, irresponsibility, parasitic lifestyle  Psychopathy has two dimensions:  Affective/interpersonal core of the disorder: lack of remorse, lack of empathy, glibness/charm, etc.  Behavior: need for stimulation, poor behavior controls, irresponsibility, parasitic lifestyle

Copyright © 2010 Allyn & Bacon 35 The Clinical Picture in Psychopathy and Antisocial Personality Disorder  Inadequate conscience development  Irresponsible and impulsive behavior  Ability to impress and exploit others  Inadequate conscience development  Irresponsible and impulsive behavior  Ability to impress and exploit others

Copyright © 2010 Allyn & Bacon Causal Factors in Psychopathy and Antisocial Personality  Causal factors include:  Genetic influences  Low levels of fear; poor conditioning of fear  More general emotional deficits  Early parental loss, parental rejection, and inconsistent discipline  Causal factors include:  Genetic influences  Low levels of fear; poor conditioning of fear  More general emotional deficits  Early parental loss, parental rejection, and inconsistent discipline 36

Copyright © 2010 Allyn & Bacon A Developmental Perspective on Psychopathy and Antisocial Personality   Antisocial behavior in childhood is the single best predictor of antisocial personality disorder in adulthood   The younger the antisocial behavior starts, the higher the risk   Antisocial personality disorder is often preceded by conduct disorder, oppositional defiant disorder, or ADHD   Antisocial behavior in childhood is the single best predictor of antisocial personality disorder in adulthood   The younger the antisocial behavior starts, the higher the risk   Antisocial personality disorder is often preceded by conduct disorder, oppositional defiant disorder, or ADHD 37

Copyright © 2010 Allyn & Bacon 38 Figure 10.4: Family Context and Antisocial Behavior

Copyright © 2010 Allyn & Bacon Treatments and Outcomes in Psychopathic and Antisocial Personality  Treatment of psychopaths is difficult  Cognitive-behavioral treatments offer some promise  Treatment of psychopaths is difficult  Cognitive-behavioral treatments offer some promise 39

Copyright © 2010 Allyn & Bacon 40 Unresolved Issues  DSM-IV-TR is a categorical system  In the future, Axis II of DSM-IV-TR may include a dimensional component in addition to or instead of the categorical system  What dimensions should be used?  Will the use of dimensions aid diagnosis?  DSM-IV-TR is a categorical system  In the future, Axis II of DSM-IV-TR may include a dimensional component in addition to or instead of the categorical system  What dimensions should be used?  Will the use of dimensions aid diagnosis?

Copyright © 2010 Allyn & Bacon End of Chapter 10