Personality Disorders

Thomas G. Bowers, Ph.D.

Penn State Harrisburg

General Characteristics

• Long-standing, maladaptive patterns of behavior • • Generally recognizable by adolescence Tend to be inflexible, persistent, and resistant to change • Must also be associated with significant life problems

Three W’s: Wild, Weird and Withdrawn

• • Easier to remember than Clusters A, B, C Wild – 1. Borderline Personality Disorder – 2. Histrionic Personality Disorder – 3. Narcissistic Personality Disorder – 4. Antisocial Personality Disorder

Three W’s: Wild, Weird and Withdrawn

• Weird – 1. Paranoid Personality Disorder – 2. Schizoid Personality Disorder – 3. Schizotypal Personality Disorder

Three W’s: Wild, Weird and Withdrawn

• Withdrawn – Avoidant Personality Disorder – Dependent Personality Disorder – Obsessive-Compulsive Personality Disorder

Borderline Personality Disorder

• • Intense, unstable relationships Instability in mood, self-image – “Who am I?” • Unpredictable and impulsive behavior – Often self damaging, as gambling, sexual behavior, spending sprees

Borderline Personality Disorder

• • • • Intense fear of aloneness Extreme fears of abandonment Demand attention Alternate between idealization and devaluation • • Chronic feelings of emptiness and boredom Often suicidal feelings and gestures

Borderline Personality Disorder

• • Long interest from psychoanalytic field (as Kernberg) Thought to be “borderline” between psychosis and neurosis • Tend to decompensate into psychotic state under stress

Borderline Personality Disorder

• • Object relations theory Introjection of important values and images of other important people (as parents) may be faulty • Frequently see issues as a weak, ineffectual father (often totally absent, or even abandoning family) • Domineering mother

Borderline Personality Disorder

• • • • • Inconsistent provision of warmth and affection • Frequently reported childhood physical and sexual abuse Some biological relationships Respond positively to SSRI Familial, thought to be be genetic links Related to bipolar affective disorder

Borderline Personality Disorder

• Video assignment: “Fatal Attractions” note Glen Close in her role

Histrionic Personality Disorder

• • Overly dramatic, attention-seeking Display excessive emotion, but in fact are emotionally shallow • • Self-centered Inappropriately sexually provocative and seductive • Pseudohypersexuality

Narcissistic Personality Disorder

• • • • Grandiose and exaggerated sense of self Literary in love with themselves Require constant attention and admiration Lack of empathy, strong feelings of arrogance, entitlement • Take advantage of others

Antisocial Personality Disorder

• • • • Psychopathy (or sociopathy) Cleckly - The Mask of Sanity Emotional aloofness and detachment Hare - contemporary researcher – Psychopathy appears to be distinct from ASPD

Antisocial Personality Disorder

• • Little ability to profit from experience – In particular, ASPD individuals do not seem to learn well to aversive stimulus conditions Genetic factors appear to play a role, as do environmental factors – Lack of affection, severe rejection, inconsistent discipline, fathers often are antisocial

Antisocial Personality Disorder

• • Chronic cortical under arousal Impulsivity, difficulties in goal directed behavior • Noted increased slow wave activity, temporal region spikes on EEG

“Weird” Cluster

• Paranoid Personality – Highly suspicious of people, tends to mistrust others, expects to be mistreated – Extremely jealous • Schzoid Personality – Does not desire or enjoy social relationships – Bland, aloof, loners

“Weird” Cluster

• • • Schizotypal Personality Attenuated form of schizophrenia Interpersonally similar to schizoid, with eccentric nature • • Odd beliefs, magical thinking Illusions

“Weird” Cluster

• Etiology – May be a variant of schizophrenic range disorders – Family patterns noted

Withdrawn Cluster

• Dependent Personality – Lacks self-confidence, independence, self reliance – Passive and dependent stance – Intense need to be taken care of, unable to make demands on others – Tends to sacrifice needs of self for others – Fairly common

Withdrawn Cluster

• Avoidant Personality – Keenly sensitive to rejection, disapproval – Extremely restrained, easily embarrassed – Exaggerate risks, dangers

Withdrawn Cluster

• Obsessive Compulsive Personality – Perfectionistic, preoccupied with rules, details – Work excessively – Stubborn, rigid, demanding – Tend to be rigid and inflexible, moralistic

Diagnostic Issues

• • • Reliability problems been noted Structured interviews are now helpful Considerable comorbidity

Interrater and Test-retest Reliability

Diagnosis Paranoid Schzoid Schizotypal Borderline Histrionic Antisocial Dependent Interrater Test-Retest

.75

.83

.82

.89

.81

.88

.89

.57

NA .11

.56

.40

.84

.15

Treatment of Personality Disorders

• Psychodynamic therapy – Object relations therapy (Kernberg) • • • Focus on ego development Interpretative “Reality testing” – Dialectical behavior therapy • • Linehan - Empirically tested Client centered and cognitive methods

Treatment of Personality Disorders

• • Dynamic-Cognitive Therapy – Turner Cognitive Therapy – Beck – Negative schemata of world thought to operate

Treatment of Personality Disorders

• Psychopathy is very difficult to treat effectively – May be unsuitable for psychotherapy (or any type of personal relationship)