1. Personality Disorders Definition = maladaptive ways of interacting *Rigid *Pervasive Common Ego syntonic -> don’t seek tx -> less motivated to change

2. “Medical Students’ Disease” Continuum of characteristics Disorder = greater degree & impairment Course Originate in childhood & persists

3. Sex Differences 1.Histrionic, dependent = women 2.Current research: Either > in males or equal Males = Paranoid, Schizoid, Schizotypal, Antisocial, Narcissistic, Obsessive- compulsive Equal = Histrionic, Avoidant, Dependent Females = Borderline

4. Sex Bias: Ford & Widiger Histrionic/Antisocial case histories: male diagnosed Antisocial PD female diagnosed Histrionic PD Simple gender differences … bias But Histrionic PD may brand stereotypic women as mentally ill

5. Categories vs. Dimensions –Currently, categories –Possible move to dimensions –Reduces stigma –Reflects actual clients

6. Cluster A: Odd, eccentric Paranoid PD = Excessively suspicious/mistrustful Causes Slight genetic evidence of link to schizophrenia Cognitive errors Parental teaching Certain groups more susceptible

7. Treatment Only seek for crisis Therapist provides trust (cognitive therapy for errors) No clear evidence of change

8. Schizoid PD Solitary, uninterested in others Not from fear But some are sensitive Extreme social deficiencies No unusual/bizarre thoughts

9. Causes - unknown Isolation resembles autism -> maybe shared biological mechanism Treatment Help develop interest in relationships Little optimism

10. Schizotypal PD Social isolation + unusual behaviors & thoughts Not full-blown hallucinations, but “as if”

11. Causes - little known Genetic link to schizophrenia Probable environmental stressors Treatment Social skills to improve relationships Help adjust to solitary life Antipsychotics (but side effects)

12. Cluster B: Dramatic, emotional Antisocial PD Disregard for social norms No remorse Substance abuse/sensation-seeking Age 18

13. Causes a)Genetic influence on nonviolent criminality b)Neurobiology: NOT brain damage i.Low cortical arousal - stimulation-seeking behaviors - slower brain waves/heart rate ii.Fearlessness hypothesis - higher threshold for fear & worse at detecting danger cues iii.Inhibition vs. reward systems: weak inhibition & strong reward(BAS vs. BIS)

14. c)Aggression learned at home - parents reward kid’s aggression - inconsistent discipline - low SES

15. Treatment Behavior dies down by age 40 But difficult to treat Manipulate therapist Few positive outcomes Focus: childhood prevention via parent training

16. Borderline PD *No sense of self Instability in relationships -> fear abandonment All-or-none thinking Unstable moods Poor self-image(“empty”) Impulsive

17. Causes Possible genetics – mood disorders Childhood trauma Psychodynamic: Abandonment fears poor separation/individuation from mom

18. Treatment Extremely difficult But: Linehan — help dev. identity Support/constancy, coping, identify & regulate emotions Medication (for depression & anxiety) - poor compliance, abuse meds

19. Histrionic PD Dramatic, self-centered, shallow Singers, actors

20. Causes Learn appearance & performance -> attention

21. Treatment Focus on problematic relationships Reward for appropriate & fine for inappropriate/attention-getting behavior

22. Narcissistic PD Grandiose, exaggerated sense of own importance Preoccupation with gaining attention Lack sensitivity/compassion, exploit others

23. Causes Inadequate admiration from parents Damaged sense of self Grandiosity = façade Current society (“me,” instant gratification) -> increases prevalence

24. Treatment: Cognitive i. Replace grandiose fantasies - attainable daily pleasures ii.Coping with criticism iii.Understand others’ feelings iv.Treat depression

25. Cluster C: Anxious, fearful Avoidant PD Extreme sensitivity to rejection Actively avoid relationships Low opinion of self

26. Causes May be more “difficult” infants -> inadequate early unconditional positive regard -> alienated & unworthy

27. Treatment - many good studies Behavioral therapy for anxiety & social skills problems Systematic desensitization for specific situations

28. Dependent PD Excessive reliance on others for everyday decisions Abandonment fears Submissive/agreeable to avoid rejection

29. Causes Childhood assertiveness punished Parental overprotection Early parental loss/rejection -> abandonment fears

30. Treatment - little research Appear to be ideal therapy clients -> danger of over-dependence on therapist Develop independence & responsibility

31. Obsessive-Compulsive PD Preoccupation with the “right way” Inflexible, perfectionistic, rigid Relationships often poor Only distantly related to OCD

32. Causes Possible genetic basis, but weak Strong parental discipline & over-control No real understanding of causes

33. Treatment - little research Attack fears underlying perfectionism Deal with possible anxiety regarding inadequacy Relaxation/distraction

34. For all PDs, therapy involves Insight into how they affect other people & are perceived Insight into how their behavior causes them problems

35. Ethical Issues Therapy with Personality Disorders Very resistant to treatment Rarely seek treatment on own -> When is treatment justifiable?

36. Adopting a Potential Sociopath Strong genetic basis for APD/sociopathy => Should adoptive parents be told if child is offspring of sociopath? => Is revealing this information to prospective parents fair to the child?

37. Interpersonal Psychotherapy Rationale General style of interacting Most are flexible In people with personality disorders, style is rigid & pervasive Goal of interpersonal psychotherapy = help people be more flexible

38. Therapy Pull from usual part of circle to opposite Act in complementary manner to goal behavior Meta-communicate