1. Chapter 10 Personality Disorders
ABNORMAL PSYCHOLOGY, SIXTEENTH EDITION James N. Butcher/ Jill M. Hooley/ Susan Mineka
Chapter 10
Personality Disorders
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2. Clinical Features of Personality Disorders
Personality disorders, formerly known as “character disorders”
Chronic interpersonal difficulties
Problems with identity or sense of self
Formerly known as “character disorders”
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3. Clinical Features of Personality Disorders
DSM criteria include enduring behavior pattern
Pervasive and inflexible
Stable and of long duration
Clinically significant distress or impairment in functioning
Manifested in at least two areas
Manifested in at least two areas: cognition, affectivity, interpersonal functioning, or impulse control
Often cause significant problems in lives of others
Gradually develop inflexible and distorted personality and behavior patterns
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4. Enduring behavior pattern
Manifested in at least two areas: cognition, affectivity, interpersonal functioning, or impulse control
Often cause significant problems in lives of others
Gradually develop inflexible and distorted personality and behavior patterns
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5. 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
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6. Clinical Features of Personality Disorders
Prevalence
Ranges from 4.4% to 14.8%
About 75% comorbidity
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7. Difficulties Doing Research on Personality Disorders
Diagnosing
Studying causes
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8. Difficulties in Diagnosing Personality Disorders
Diagnostic criteria not sharply defined
Diagnostic categories not mutually exclusive
Dimensional personality characteristics
Difficulties in diagnosing personality disorders are caused by a number of factors, including:
Diagnostic criteria are not sharply defined
Diagnostic categories are not mutually exclusive
Personality characteristics are dimensional in nature
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9. Difficulties in Diagnosing Personality Disorders
Five-factor model of personality: see p.335
Openness to experience
Conscientiousness
Extraversion
Agreeableness
Neuroticism
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10. Difficulties in Diagnosing Personality Disorders
PDs may represent extreme levels of normal personality traits
Histrionic: Hi Ex & Neuroticism
Dependent: Hi Agreeab & Neu
Obsessive-compulsive: Hi Con
Histrionic—high extraversion and neuroticism
Dependent—high agreeableness and neuroticism
Obsessive-compulsive—high conscientiousness
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11. Difficulties in Studying the Causes of Personality Disorders
Limited research on causal factors
Relatively new area of study (1980)
Less amenability to thorough study
Retrospective approaches
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
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12. Cluster A Personality Disorders
Paranoid
Schizoid
Schizotypal
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13. Paranoid Personality Disorder
Suspiciousness and mistrust of others
Tendency to see self as blameless
On guard for perceived attacks by others
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14. Schizoid Personality Disorder
Impaired social relationships
Inability and lack of desire to form attachments to others
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15. 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
Oddities of perception and speech that interfere with communication and social interaction
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16. Schizotypal Personality Disorder
Causal factors
Genetic abnormalities similar to schizophrenia; it has been suggested that it might be a milder form of schizophrenia
Prevalence: 2-3%
Maintain contact with reality, but under severe stress might experience transient psychotic symptoms.
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17. Cluster B Personality Disorders
Histrionic Personality Disorder
Narcissistic Personality Disorder
Antisocial Personality Disorder
Borderline Personality Disorder
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18. Histrionic Personality Disorder
Self-dramatization
Overconcern with attractiveness
Irritability and temper outbursts if attention seeking is frustrated
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19. Narcissistic Personality Disorder
Grandiosity
Preoccupation with receiving attention
Self-promoting
Lack of empathy
Vulnerable narcissists have unstable self-esteem
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20. Vulnerable narcissists have unstable self-esteem
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21. 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
History of conduct problems as a child
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22. 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
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23. Borderline Personality Disorder
Instability and impulsivity partially heritable
Lowered functioning of serotonin
Hyperresponsive noradrenergic system
Decreased activation in brain areas that inhibit aggressive behavior (orbital prefrontal and medial prefrontal cortex)
Reductions in volume of the hippocampus and amygdala (aggression & impulsivity)
Negative & traumatic events in childhood: abuse and neglect, and separation and loss
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24. Figure 10.1: Multidimensional Diathesis-Stress Theory of Borderline Personality Disorder
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25. Cluster C Personality Disorders
Avoidant Personality Disorder
Dependent Personality Disorder
Obsessive-Compulsive Personality Disorder
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26. Avoidant Personality Disorder
Hypersensitivity to rejection or social derogation
Shyness
Insecurity in social interaction and initiating relationships
Causal factors
inhibited temperament
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27. Dependent Personality Disorder
Difficulty in separating in relationships
Discomfort at being alone
Subordination of needs to keep others involved in a relationship
Indecisiveness
Causal factors
Inheritance of high neuroticism and agreeableness
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28. Obsessive-Compulsive Personality Disorder
Excessive concern with order, rules, and trivial details
Perfectionism
Lack of expressiveness and warmth
Difficulty in relaxing and having fun
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29. General Sociocultural Causal Factors for Personality Disorders
What do you think?
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?
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30. Treatments and Outcomes for Personality Disorders
Difficulties
Treatment difficulties
Varied goals
Clients resistance to change
Relationships formation challenges
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
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31. Adapting Therapeutic Techniques to Specific Personality Disorders
Therapeutic technique adaptation
Settings: in/outpatient, partial hospit.
Cognitive therapy
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
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32. Treating Borderline Personality Disorder
Antidepressant medications (SSRIs)
Dialectical behavior therapy (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
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33. Antidepressant medications (SSRIs)
Regarding treatment, borderline has received more clinical and research attention than the other PDs
Antidepressant medications (SSRIs)
Dialectical behavior therapy (DBT) p. 351
A unique kind of cognitive and behavioral therapy adapted specifically for borderline
Systematic research supports DBT
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34. Other treatments of BPD
Kernberg et al (1985, 1996) have developed a more directive type of psychodynamic psychotherapy
Primary goal: strengthen the weak ego with particular focus on DM of splitting which leads them to black-and white, all-or-none thinking, as well as to rapid shifts in their reactions to themselves & to other people as “all good” or “all bad.” Help them see the shades of gray between these 2 extremes and integrate + and – views of themselves and others into more nuanced view
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35. Treating Other Personality Disorders
Few controlled studies of treatment
Antipsychotic or antidepressant medication
Schizotypal PD
Cognitive-behavioral treatment and antidepressant medication
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
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36. Antisocial Personality Disorder and Psychopathy
Diagnostic Criteria
Age 18 years and over
At least three behavioral problems occurring after age 15
At least three instances of deviant behavior before age 15
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37. Psychopathy and ASPD
Dimensions of Psychopathy
Affective/interpersonal core : lack of remorse, lack of empathy, glibness/charm, etc
Behavior: need for stimulation, poor behavior controls, parasitic lifestyle, irresponsibility
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
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38. The Clinical Picture in Psychopathy and Antisocial Personality Disorder
Inadequate conscience development
Irresponsible and impulsive behavior
Ability to impress and exploit others
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39. Causal Factors in Psychopathy and Antisocial Personality
Genetic influences
Low levels of fear; poor conditioning of fear
More general emotional deficits
Early parental loss
Parental rejection
Inconsistent discipline
Low levels of fear; poor conditioning of fear
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40. Developmental Perspective on Psychopathy and Antisocial Personality
True or false?
Antisocial behavior in childhood is the single best predictor of antisocial personality disorder in adulthood.
True.
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
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41. The younger the antisocial behavior starts, the higher the risk
True.
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
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42. Figure 10.4: Family Context and Antisocial Behavior
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43. Treatments and Outcomes in Psychopathic and Antisocial Personality
Cognitive-behavioral treatments offer some promise
Treatment of psychopaths is difficult
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44. Unresolved Issues
In the future, the DSM may include a dimensional component in addition to or instead of the categorical system
In what ways would this radically different approach affect the way these disorders are diagnosed and treated?
What dimensions should be used?
DSM-IV-TR was a categorical system
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