Transcript Slide 1

Personality Disorders
Abnormal Psychology
Chapter 11
Mar 26-31, 2009
Classes #20-21
Personality Disorders


Diagnosed on AXIS-II of DSM-IV:
Cluster A: Odd; Eccentric




Cluster B: Dramatic; Erratic; Emotional





Paranoid personality disorder
Schizoid personality disorder
Schizotypal personality disorder
Antisocial Personality Disorder
Histrionic Personality Disorder
Narcissistic Personality Disorder
Borderline Personality Disorder
Cluster C: Anxious; Fearful



Avoidant Personality Disorder
Dependent Personality Disorder
Obsessive-Compulsive Personality Disorder
FEATURES OF
PERSONALITY DISORDERS




Early onset
 Evident at least since late adolescence
Stability
 No significant period when not evident
Pervasive
 Evident across a wide range of personal, social, and
occupational situations
Clinically significant maladaptive behavior
 Personal distress or impairment in social and
occupational functioning
Etiology

The cause of personality disorders is
unknown

Some links we’ll be given here
ODD OR ECCENTRIC BEHAVIOR



Paranoid personality disorder
Schizoid personality disorder
Schizotypal personality disorder
Paranoid Personality Disorder

Diagnosis

Paranoid personality disorder is characterized by
a pervasive distrust of others and a constant
suspicion that people around you have sinister
motives
Onset and Prevalence



Usually begins by early adulthood and
present in a variety of contexts
Males: 3.5%
Females: 2%
Complications


Since these individuals often keep to
themselves and rarely become intimate
with others, their unusual ideas often
remain unnoticed
They rarely seek clinical help
Etiology

Unknown

Genetic link:

Incidence appears increased in families with a
schizophrenia patient
Treatment


Treatment of paranoid personality disorder can be
very effective in controlling the paranoia but is
difficult because the person may be suspicious of
the doctor
Medications for paranoid personality disorder are
generally not encouraged, as they may contribute
to a heightened sense of suspicion that can
ultimately lead to patient withdrawal from therapy
Prognosis

Poor


Without treatment this disorder will be
chronic
Long-term psychoanalysis can lead to some
improvement
Schizoid Personality Disorder

People with schizoid personality disorder avoid
relationships and do not show much emotion



They genuinely prefer to be alone and do not secretly wish
for popularity
They tend to seek jobs that require little social contact
Withdrawn and reclusive


Their social skills are often weak and they do not show a
need for attention or acceptance
They are perceived as humorless and distant and often are
termed "loners
Onset and Prevalence


Late adolescence to early adulthood
Approximately 2% of total population with
slight gender difference (M > F)
Etiology

Genetic link to schizophrenia
Treatment



People with the disorder rarely seek
treatment
Treatment can be difficult because of
initial reduced capacity or desire to form
a relationship with a health professional
Medications are not effective
Prognosis

Poor

Survey results of psychologists:
 About 75% felt either they couldn’t provide
therapy/untreatable or felt that patients
wouldn’t follow treatment recommendations
Schizotypal Personality Disorder






The disorder is characterized by odd forms of
thinking, perceiving, and communicating
Individuals with this disorder often seek isolation
from others
They sometimes believe they have extra sensory or
magical abilities
They generally engage in eccentric behavior and
have difficulty concentrating for long periods of time
Their speech is often over elaborate and difficult to
follow
Individuals with this disorder often seek isolation
from others
Onset and Prevalence




Usual onset is in early adulthood
About 3% of general population
Slightly M > F
Increased prevalence among relatives
of people with schizophrenia
Complications



30-50% also have major depressive
disorder
Some may develop schizophrenia
Eating disorders are not uncommon
with schizotypal
Etiology

Genetic link to schizophrenia
Treatments

Behavioral



Social skills training
Accept/adjust to solitary life style
Physiological


Some improvement with Haldol
Many stop due to side effects
Prognosis

Poor


Relatively stable
Very small proportion will go on to develop
schizophrenia or another psychotic disorder
Dramatic or Emotional
Personality Disorders




Antisocial Personality Disorder
Histrionic Personality Disorder
Narcissistic Personality Disorder
Borderline Personality Disorder
Antisocial Personality
Disorder

Terminology


Psychopath; Sociopath; Antisocial Personality
Disorder
Probably a universal disorder

Sex Difference:




3% males
Less than 1% females
Occurs about equally in all ethnic groups,
cultures, historical periods
Most research with criminals, but it may
occur in non-forensic populations
Clinical Description of the
Psychopath





Egocentric, arrogant, deceitful, shallow, impulsive
individuals who callously use and manipulate
others with very little or no sense of shame, guilt,
remorse
Often violent
Unguided by dictates of "conscience"
Lack of empathy; only an abstract, intellectual awareness
of others feelings
No loyalty to any person, group, code,
organization, or philosophy; self-interest
Clinical Description of the
Psychopath

Human predators


Look for places where there is opportunity
for easy money, power, control, prestige


Others exist only as emotional, psychical, and financial
prey with no rights of their own
Prey on the vulnerable
Psychopathy is associated with pleasure and
thrill-seeking behavior
Ted Bundy:
The classic example
Physiological Explanations

Brain activity

Deficient Arousal Activity



Genetic Influence


Relative immunity to stimulation
Stressful situations are nothing to them
Psychologists are unsure
Neurochemistry

Low levels of serotonin
Behavioral Explanations

Family Relationships



Early parental loss
Parental rejection
Childhood history of conduct disorder
Treatments
• Intensive individual psychotherapy or cognitive
behavioral therapy is used
• Try to get patient to develop a sense of trust
• Usually doesn’t happen
• Group psychotherapy
• Try to get patient to develop a sense of trust
• Usually doesn’t happen
• Medications are not effective
Prognosis

Poor


No treatments are effective
Usually a lifetime disorder
Histrionic Personality Disorder





These people show a pattern of emotionality
and attention-seeking
Begins in early adulthood
Use physical appearance to draw attention to
oneself
The cause of this disorder is unknown, but
learned and inherited characteristics may play
a role
Gender difference:

F>M
Etiology

Behavioral link:



There has been evidence and research clearly
indicating past history of sexual abuse and/or
being alienated by parents as a child
This alienation usually takes the form of
emotional alienation, and that love is really not
there for them
These children grow up seeking and
desperately needing attention at all costs
Treatments

Long-Term Psychotherapy



These individuals do not want to address or
deal with their issues because their issues have
provided them some secondary gain
It is very difficult to stop maladaptive behavior
when it does reward or give the individual
something back
Medication is generally not prescribed and is of
minimal benefit
Prognosis




Poor
Treatment is very difficult
Confrontation in therapy is not unusual
A high rate of these individuals will drop out
of therapy
Narcissistic Personality Disorder



A disorder of the personality characterized by selfcenteredness, being self-absorbed, and an inability
to empathize with the effects of one’s behavior on
others
This disorder usually begins by early adulthood
Gender difference:


M>F
The cause of this disorder is unknown
Etiology

Unknown

At present there are two major theories about
the origin and nature of NPD


Neglectful parents (behavioral)
The other regards it as a young child's defense
against psychological pain (psychodynamic)
Treatments

Long-term Psychotherapy


Individual
Group therapy



Goal here is to achieve empathy
Therapist should be less authoritative in these
sessions but address a patients grandiosity in
next individual setting
Note: Drug treatments not effective
Prognosis

Very slow process
Borderline Personality Disorder



An individual trait that reflects ingrained, inflexible,
and maladaptive patterns of behavior
characterized by impulsive and unpredictable
actions, mood instability, and unstable
interpersonal relationships
They view themselves as victims of circumstances
and take little responsibility for themselves or for
their problems
The person with a borderline personality is
impulsive in areas that have a potential for selfdestruction
Prevalence

Officially recognized as a diagnosis in 1980

Estimated to occur in 3%-5% of the general
population
 Tends to occur more often in women
 Some research indicates twice as often
Defining Characteristic…

Instability





Interpersonal relationships
 Very stormy and that’s putting it mildly
Emotionally
 Major mood shifts
Identity
 Endless search for self
Behaviorally
 Unstable in every way
Thought processes
 Unusual perceptions
Symptoms

Kernberg (1975)



They view the whole world as "all good" or "all bad“
All people, all experiences, and their self are viewed in
extremes
They cannot grasp the concepts of moderation or
something being "all right", OK, average, or ordinary
Causes

The exact cause of borderline personality
disorder is not known

However, several psychological hypotheses
rely on biological, social, and psychological
factors to understand people with this disorder
Behavioral Explanations

Attachment experiences in early childhood




Parent or parent’s not paying enough attention
to the child’s feelings
Parental abuse (sexual and physical)
Divorce
Alcoholism
Physiological Explanation

Need more research here but it seems there
is too much brain activity with these
individuals

Dopamine levels too high
Psychodynamic
Treatments

These therapists try “face to face”
psychotherapy three times a week
continually ranging over several years


Emphasis on present behavior in beginning of
sessions rather than childhood experiences
Be careful of transference
Cognitive-Behavioral Treatment

Dialectical Behavior Therapy

See handout
Drug Therapy

Make use of various types of medication…

Mood stabilizers such as lithium
 Antidepressants
 Low-dose neuroleptics
 These drugs reduce brain activity
 Reduce dopamine levels
Medication is mildly effective by itself

Prognosis

Poor outcome…

Tend to remain the same over time




Borderline’s with high socioeconomic status along
with intensive treatment tend to improve in their
interpersonal relationships
Most will attempt suicide
8%-10% will commit suicide
Alcohol abuse is high among those with
borderline personality disorders
Anxious or Fearful Disorders

Personality disorders characterized by
anxious or fearful behaviors…



Avoidant Personality Disorder
Dependent Personality Disorder
Obsessive-Compulsive Personality Disorder
Avoidant Personality Disorder

Avoidant personality disorder (APD) is considered
to be an active-detached personality pattern






Relatively new disorder having been added to DSM in
1980
Avoidants purposefully avoid people due to fears of
humiliation & rejection
They usually have low self-esteem
The usual onset for APD is early adulthood
Less than 1% of general population
No gender difference
Characteristics

Speechlessness



Becoming quiet can be one sign of fear
When they do speak, avoidants may use frequent
pauses & speak slowly
Over talkative

In rarer cases sometimes they are so fearful they
can’t stop talking
Characteristics

Interpersonal Conduct


Avoidants often test others to determine
whether or not they are being sincere in their
friendliness
Because they may frequently see rejection
where it does not exist, people will tend to fail
these tests & then later be avoided
Characteristics

Cognitive Style: Hypervigilance


Avoidants excessively monitor the situation to the extent
that they are trying to process so much information,
they are no longer paying sufficient attention to the
interaction itself
Affective Expression


People with APD may exhibit little affect due to the fear
that showing their emotions will make them vulnerable
to rejection or humiliation
To observers, avoidants may appear tense & anxious
Etiology

Unknown

Behavioral link:

Many persons diagnosed with avoidant personality
disorder have had painful early experiences of
chronic parental criticism and rejection
Treatment


The general goal of treatment in avoidant
personality disorder is improvement of selfesteem and confidence
As the patient's self-confidence and social
skills improve, he or she will become more
resilient to potential or real criticism by
others
Prognosis


People with this disorder usually have some
ability to relate to others appropriately, and
with treatment prognosis is improved
More research needed
Dependent Personality Disorder


The disorder usually appears in early adulthood
Allow others to make major decisions for them



Actively avoid taking responsibility
Easy to get along with


Avoid making decisions themselves
Afraid of jeopardizing relationships
Avoid being alone

Feel uncomfortable or helpless
Etiology

Unknown

Some researchers believe an authoritarian or
overprotective parenting style can lead to the
development of dependent personality traits in
people who are susceptible to the disorder
Treatments

There is no specific treatment for this
disorder…



Psychotherapy may be useful in gradually
helping people to make choices that affect their
own life
Group therapy also used with these individuals
Medication may also be helpful (more research
needed)
Prognosis


Improvements are usually seen only with
long-term therapy
Difficult and frustrating process
Obsessive-Compulsive
Personality Disorder

A pervasive pattern of preoccupation with
orderliness, perfectionism, and mental and
interpersonal control, at the expense or
flexibility, openness, and efficiency,
beginning by early adulthood


Occurs in about 1% of population
Gender difference:

Twice as prevalent among males
SYMPTOMS


Preoccupied with details, rules, lists, order,
organization, or schedules to the extent that the
major point of the activity is lost
Shows perfectionism that interferes with task
completion (e.g., is unable to complete a project
because his or her own overly strict standards are
not met)
Etiology

Unknown

Behavioral link:

Patients with OCPD often recall their parents as being
emotionally withholding and either overprotective or
over-controlling
Prognosis

Another difficult one to treat but some hope
especially with cognitive/behavior therapies
Credits:

Note: Some information in this presentation found on the following web sites:
http://health.yahoo.com/health/encyclopedia/001531/1.html
http://www.minddisorders.com/Kau-Nu/Narcissistic-personality-disorder.html