Personality Disorders - enduring thoughts and perceptions that are inflexible and maladaptive, and cause significant functional

impairment or subjective distress

Conceptualization of Personality Disorders Aspects: it is chronic, ongoing and affects almost every minute of life the affected person may not feel subjective distress BUT their actions can cause somebody else to feel it **sometimes that somebody else may need to decide whether the disorder is causing significant dysfunction to the person with the disorder Many do poorly in treatment in Axis II of DSM because as a group, they are distinct; can be diagnosed alongside an Axis I disorder

Categorical and Dimensional Models: Categorical Model: disorders are ways of relating that are different from psychologically healthy behavior Pros: Convenient Cons: Simplification allows clinicians to make the disorder seem real. Is it?

Dimensional Model: disorders are extreme versions of otherwise normal personality variations ??? Which one is better ??? Categorical: seeing gender as male or female Dimensional: seeing gender in dimensions by measuring hormone levels; results in continuum

DSM IV essentially uses categories to diagnose Five-Factor Model: people can be rated on a series of personality dimensions, and the combo of 5 components describes why people are so different. Extroversion (talkative) vs Introversion (shy) Agreeableness (Kind,trusting) vs Hostile, Selfish, Mistrustful Conscientiousness (organized, thorough) vs Careless, Negligent, Unreliable Nueroticism (even-tempered) vs Nervous, Moody, Temeramental Openness to Experience (Imaginative) vs Shallow, Imperceptive Pros: More universal across cultures

Personality Disorder Clusters Cluster A: odd or eccentric Paranoid PD Excessively mistrustful and suspicious of others without justification Unjustified assumption that others mean them harm or to trick them

Leads people to: Argue Complain Become quiet

People appear tense; ready to pounce Sensitive to criticism Excessive need for autonomy Ideas of Reference: belief that insignificant events pertain to them

Causes strong role of genetics related to schizophrenia Maladaptive thinking: People are malevolent and will attack if they get the chance; I must be on my toes Cultural factors may alter how harmless actions are interpreted (laughter, whispers)

Treatment What leads these people to treatment? Usually a crisis in life or other problems (anxiety, depression) Cognitive therapy: counters the persons mistaken assumptions about others Clinicians: Only 11% will continue therapy long enough to be helped

Book example: Jake grew up believing he was experimented on with drugs in childhood by CIA.

Schizoid PD Seem neither to desire nor to enjoy closeness with other, including romantic or sexual relationships They appear cold and detached and unaffected by praise or criticism

Some are sensitive to opinions but cant seem to express or are unwilling to express their emotions

Homelessness Similar to Paranoid PD; but more Extreme! Precursors childhood neglect and abuse childhood shyness

Autism: parents likely to have Schizoid PD; Children are likely to have autism? Link?? Biological: Schizoid PD can develop with certain genes along with early childhood problems (learning, relationships) Dopamine levels affect social aloofness

Tx Begins (usu) only person experiences crisis Therapist (re)teaches feeling/emotions/empathy experience by others; value of relationships

Schizotypal Personality Disorders Socially isolated, act unusually (to normal people), tend to be suspicious and have odd beleifs; dress oddly, tend to show little emotion Less severe than schizophrenia: no delusions, hallucinations also they can sometimes recognize their illogical thoughts

Psychotic-like symptoms: everything relates to them Magical thinking; think they are telepathic Mumble to themselves Perceptual experiences; feel like someone is in a room with them alone (They do not see the person...that is schizophrenia)

Precursors As children tend to be passive; unengaged Hypersensitive to criticism

Culture: some speak in tongues,etc. and can be misdiagnosed

Cluster B: dramatic, emotional or erratic Antisocial DSM Criteria Borderline DSM Criteria pervasive pattern of instability of relationships, self image, and affects; marked impulsivity appears in early adulthood frantic efforts to avoid abandonment Unstable relationships; marked by alternating between extremes of idealization and devaluation Causes link to mood disorders prevalent if another family member has is Serotonin Transporter gene mutation Frontolimbic network: emotion regulation Cognitive factors: research underway; how they process information Early sex or physical abuse: girls more vulnerable to be sex abused:: more likely develop BPD Tx More likely to seek treatment than APD and Mood disordered people SSRIs work for some Difficult to remember childhood abuse when they are asked Chronic feeling of emptiness Self dangerous impulsivity: substance abuse, reckless driving Inappropriate, intense anger or difficulty controlling At least 18 who has shown pervasive disregard for and violation of peoples rights Failure to conform to norms; e.g. breaking the law Deceitfulness; lying, using aliase; conning others for profit Impulsive; failure to plan ahead Irritable, Aggressive; e.g. frequent fighting Disregard for the safety of others Financial and employment irresponsibility (paying bills) Lack of remorse Evidence of conduct disorder with onset prior to the age of 15 Does not occur exclusively during the course of schizophrenia or a manic episode

Temperament issues and Neurological impairments paired with parenting styles Rapid cultural changes

Linehans Dialectical Behavior Therapy (DBT) Helps to cope with stressors that trigger suicidal behavior Treatment is prioritized: 1. Suicidal-causing behavior 2. Therapy-interfering behavior (those that interfere w/ therapy) 3. Quality of life-interfering behavior

Taught emotion regulation Emphasize problem solving: allows effective handling of difficulties Similar to PTSD therapy: prior traumatic events re-experienced to extinguish associated fears

Final stage: Learning to trust their own responses; less dependence on validation from others; Done by imagining themselves not reacting to criticism

RESULTS: Less suicide attempts Less treatment dropouts Less hospitalization

Histrionic & Narcissistic Personality Disorders

Cluster C: anxious, fearful Avoidant, Dependent Obsessive-Compulsive Personality Disorders fixed on things being done the right way

Statistics >>>>>>>>>> [ Fill in notes ] Gender Differences Borderline PD: diagnosed more? Men Histrionic and Dependent PD: diagnosed more? Equal (used to be women) Clinician bias may cause unequal diagnosis between genders; Or, if the disorder in its criteria are biased, it may reflect societys inherent bias against females and expectations of them (e.g. Histrionic PD = overdramtization, vanity, seductiveness, etc.). Criterion Bias vs Assessment Gender Bias: criteria vs assessment measures

Comorbidity 10% of population has at least one personality disorder BPD: comorbid with Paranoid, Schizotypal, antisocial, narcissistic, avoidant, and dependent personality

Personality Disorders under Study Sadistic Personality: receive pleasure by inflicting pain on others Self-Defeating Personality: people who are overly passive and accept the pain and suffering imposed by others Depressive Personality: includes self criticism, dejection, a judgmental stance toward others, and tendency toward guilt different from dysthymic mood disorder

Negativistic Personality: passive aggression in which people adopt a negative attitude to resist routing demands and expectations

This category is an expansion of DSM III category, Passive-Aggressive Personality May be a subtype of narcissistic PD