1. Personality Disorders
Chapter 10
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2. 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
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3. The Nature of Personality Disorders
Behavior patterns must manifest themselves in at least two of the following four areas:
Cognition
Affectivity
Interpersonal functioning
Impulse control
As a result of these behaviors, the individual experiences distress or impairment.
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4. DSM-IV Personality Disorder Clusters
The DSM-IV-TR groups the 11 diagnoses into three clusters based on shared characteristics
Cluster A - The eccentric ones
Cluster B - The dramatic ones
Cluster C - The anxious ones
Cluster A includes paranoid, schizoid, and schizotypal personality disorders, which share the features of odd and eccentric behavior.
Cluster B includes antisocial, borderline, histrionic, and narcissistic personality disorders, which share overdramatic, emotional, and erratic or unpredictable attitudes and behaviors.
Cluster C includes avoidant, dependent, and obsessive-compulsive personality disorders, which share anxious and fearful behaviors.
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5. DSM-5 Personality Disorder Framework
Antisocial
Avoidant
Borderline
Narcissistic
Obsessive-compulsive personality disorder
Schizotypal personality disorder
Flaws:
There were too many fine distinctions that the diagnoses required.
It did not allow for the possibility of a client’s “somewhat” antisocial or narcissistic behavior.
Clinicians will make their diagnoses on the basis of three sets of criteria.
Personality functioning - Identity and self-direction
Interpersonal functioning - Empathy and intimacy
Personality traits
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6. Table 10.2 - Criteria for a Personality Disorder
Behavioral indicators specify each level of personality functioning.
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7. Table 10.3 - Personality Domains in the DSM-5
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8. Antisocial Personality Disorder
Characterized by a lack of regard for society's moral or legal standards
Synonymous in the past with “psychopaths” or “sociopaths.”
The DSM-IV-TR defined people who receive the diagnosis of antisocial personality disorder as highly impulsive and lacking in the capacity for regret over their actions.
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9. Antisocial Personality Disorder
History
Hervey Cleckley (1941)
Psychopathy
Robert Hare (1997)
Psychopathy Checklist
Psychopathy: A personality type characterized by a cluster of traits that constitutes the core of what is now called antisocial personality disorder.
Based upon large scale studies of forensic populations, Hare developed the PCL-R, which has two factors:
Core psychopathic personality traits
Antisocial lifestyle
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10. Antisocial Personality Disorder
Associated behaviors
Failure to conform to social norms
Deceitfulness
Impulsivity
Aggressiveness
Disregard for safety of self or others
Irresponsibility
Lack of remorse
The changes in DSM-5’s diagnostic system for personality disorders will result in organizing the seven DSM-IV-TR criteria into the categories of:
Personality functioning
Interpersonal functioning
Personality traits
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11. Important Distinctions
Antisocial behavior
Illegal or immoral behavior such as stealing, lying, or cheating
Criminal
A legal term, not a psychological concept
Antisocial personality disorder may manifest itself in behaviors such as job problems, promiscuity, and aggressiveness.
Maturation hypothesis: The proposition that people with antisocial personality and the other Cluster B disorders become better able to manage their behaviors as they age.
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12. Perspectives on Antisocial Personality
Biological
Possible genetic causes
Various brain abnormalities
Monoamine oxidase A - An enzyme coded by the MAOA gene.
A mutation in this gene results in insufficient amounts of monoamine oxidase in the nervous system, which results in abnormally high levels of dopamine, serotonin, and norepinephrine.
Hippocampus, the brain structure involved in short-term memory processing, functions abnormally in individuals with psychopathy.
People high in psychopathy have deficits in frontal lobe functioning.
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13. Perspectives on Antisocial Personality
Psychological
Neuropsychological deficits
Passive avoidance
Response modulation hypothesis
Antisocial personality disorder causes neuropsychological deficits reflected in abnormal patterns of learning and attention.
Passive avoidance - Correct responses involve learning to avoid responding to a previously punished stimulus.
Response modulation hypothesis attempts to explain the failure of individuals high in psychopathy to learn from negative experience and to process emotional information.
Individuals high on the trait of psychopathy are unable to pay enough attention to secondary cues to switch their attention when necessary.
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14. 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
Treatment goals:
Measure the effectiveness of therapy in terms of re-arrest or recividism.
Focus on changes in job performance, relationships with others, and involvement in noncriminal activities.
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15. 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
People with avoidant personality disorder become extremely sensitive to rejection and ridicule, interpreting the most innocent remark as criticism.
Withdrawn, unlikely to experience intimacy, and unable to feel pleasure.
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16. 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
The psychodynamic perspective focuses on fear of attachment.
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17. 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
Interventions are successfully accomplished after the client comes to trust the therapist.
Therapists must be extremely patient in their attempts to build a therapeutic relationship.
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18. 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”
BPD rests on the individual’s demonstration of at least five out of a possible nine behaviors:
Frantic efforts to avoid abandonment
Unstable and intense relationships
Identity disturbance
Impulsivity in areas such as sexuality, spending, or reckless driving
Recurrent suicidal behavior
Affective instability
Chronic feelings of emptiness
Difficulty controlling anger
Occasional feelings of paranoia or dissociative symptoms.
Splitting: A defense, as being all good or all bad, usually resulting in disturbed interpersonal relationships.
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19. Perspectives on Borderline Personality
Biological
High heritability
Abnormalities in:
Amygdala and prefrontal cortex
Neurotransmitters and hormones
Childhood sexual abuse may alter sympathetic nervous system that leads to hypersensitivity and impulsivity in adulthood.
BPD symptoms are tied to a number of biological factors:
High heritability.
Abnormalities in the amygdala and prefrontal cortex, areas of the brain involved in emotional processing and regulation.
People with BPD may also have abnormalities in neurotransmitters and hormones involved in regulating emotional responses and sensitivity to pain.
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20. Perspectives on Borderline Personality
Psychological
Emotional dysregulation
Distress tolerance
Experiential avoidance
Childhood neglect or traumatic experiences
Marital or psychiatric difficulties
Emotional dysregulation:
Lack of awareness, understanding, or acceptance of emotions.
Inability to control the intensity or duration of emotions.
Unwillingness to experience emotional distress as an aspect of pursuing goals.
Inability to engage in goal-directed behaviors when experiencing distress.
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21. Treatment of Borderline Personality
Dialectical behavioral therapy
Core mindfulness
Transference-focused psychotherapy
Dialectical behavior therapy (DBT): Reduce the frequency of self-destructive acts and to improve the client’s ability to handle disturbing emotions, such as anger and dependency.
Using a process called core mindfulness, DBT clinicians teach their clients to balance their emotions, reason, and intuition as they approach life’s problems.
Transference-focused psychotherapy uses the client-clinician relationships as the framework for helping clients achieve greater understanding of their unconscious feelings and motives.
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22. 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
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23. Narcissistic Personality Disorder
Unrealistic, inflated sense of self-importance and lack of sensitivity to other people’s needs
Sense of entitlement translates into personality traits of grandiosity, and their desire for admiration leads them to seek out recognition whenever possible.
Individuals with NPD may have a truly inflated and grandiose sense of self.
Clinicians refer to them as high on grandiose narcissism.
Vulnerable narcissism - Who rely excessively on other people to confirm their worth.
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24. Histrionic Personality Disorder
Exaggerated emotional reactions, approaching theatricality, in everyday behavior
Attention-seeking is one of the pathological personality traits.
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25. Theories of Narcissistic Personality
Freudian
Stuck in early psychosexual stages
Psychodynamic
Empathy
Cognitive behavioral
Maladaptive ideas
Grandiose ideas clash with their experiences of failure
Theorists regard the narcissistic individual as having failed to form a cohesive, integrated, sense of self.
Narcissistic personality disorder is expressed as the adult’s expression of this childhood insecurity and need for attention.
Clinicians who work within the psychodynamic perspective use empathy to support the client’s search for recognition and admiration.
As therapists increasingly support them, they become less grandiose and self-centered.
Cognitive-behavioral theorists focus on the maladaptive ideas that they are exceptional people who deserve far better treatment than ordinary humans.
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26. 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
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27. Obsessive-Compulsive Disorder
Sense of self and self-worth in terms of work productivity
Pathological personality trait - Rigid perfectionism
Quality of perseveration
Obsessive-compulsive personality disorder: Intense perfectionism and inflexibility manifested in worrying, indecisiveness, and behavioral rigidity.
Quality of perseveration - Experience a great deal of negative affect and tend to go back over and over what they’ve done, looking for flaws.
People with OCPD do not experience obsessions and compulsions.
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28. 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
Failure to achieve their unrealistic standard of perfection makes them feel worthless.
Person with OCPD tends to intellectualize, to ruminate over past actions, and to worry about making mistakes.
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29. Schizotypal Personality Disorder
Main characteristic: Peculiarities and eccentricities of thought, behavior, appearance, and interpersonal style
People with this disorder may have peculiar ideas, such as magical thinking and beliefs in psychic phenomena.
They lack a clear sense of direction or motivation, and do not have a clear set of standards against which to measure their behavior.
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30. Schizotypal Personality Disorder
Social isolation
Eccentricity
Peculiar communication
Poor social adaptation
Treatment
Parallels interventions commonly used in treating schizophrenia
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31. Dropped Personality Disorders
Dependent personality disorder
Histrionic personality disorder
Paranoid personality disorder
Schizoid personality disorder
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32. Dependent Personality Disorder
The individual is extremely passive
Tends to cling to other people to the point of being unable to make any decisions
Without others near them, people with dependent personality feel despondent and abandoned.
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33. Histrionic Personality Disorder
Flirtatious and seductive
Demand reassurance, praise, approval of others
Need for immediate gratification
Easily influenced by others
Lack analytical ability
They want immediate gratification of their wishes and overreact to even minor provocations, usually in an exaggerated way, such as by weeping or fainting.
Although their relationships are superficial, they assume them to be intimate and refer to acquaintances as “dear” friends.
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34. Paranoid Personality Disorder
Suspicious
Narrowly focused
Impossible to trust people
Project blame onto others
Refuse to seek professional help
Paranoid personality disorder: Outstanding feature is that the individual is extremely suspicious of others and is always on guard against potential danger or harm.
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35. Schizoid Personality Disorder
Indifference to social relationships:
Very limited range of emotional experience and expression
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36. 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
Self-imposed isolation and emotional constriction is maladaptive to their social functioning.
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37. Biopsychosocial Perspective
Disorders represent:
Mix of long-standing personal dispositions and behavior patterns
Disturbances in identity and interpersonal relationships
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