PERSONALITY DISORDERS

Chronic, rigid, and maladaptive patterns of behaviour

- Cause personal distress, social problems, and occupational problems

- Interfere with a persons ability to leady a satisfying life.

- The personality disorder is ingrained in the individuals psychological

make-up

- Persons with personality disorders are generally not aware or have poor

insight that they are the cause of their own problems.

- Persons with personality disorders do not have frank psychotic

symptoms.

- They do not seek psychiatric help and are very resistant to change.

- Personality disorders originate in childhood and continue into the adult

years.

- Significant comorbidity:

- About half of the people diagnosed with a personality disorder

also meet the criteria for another personality disorder.

- Gender bias: Knowledge of whether the client is male or female can

influence whether a client receives one personality disorder diagnosis

over another.

-
 - More females are diagnosed with a borderline and histrionic

personality disorders.

- More males are diagnosed with antisocial and narcissistic

personality disorders.

CLASSIFICATION
- Personality disorders with similar characteristics are categorized by the

DSM into clusters.

- Each cluster has its own

- hallmark characteristics and

- genetic/familial associations (e.g., relatives of people with PDs

have a higher likelihood of having certain disorders)

- The clusters:

- Cluster A includes 3 personality disorders: Paranoid, Schizoid,

and Schizotypal

- Hallmark characteristics:

- Avoids social relationships

- Peculiar but not psychotic

 - Genetic/familial associations:

- Psychotic illnesses

- Cluster B includes 4 personality disorders: Histrionic,

Narcissistic, Borderline, and Antisocial

- Hallmark characteristics:

- Dramatic

- Emotional

- Inconsistent

- Genetic/familial associations:

- Mood disorders

- Substance abuse

- Somatoform disorders

- Cluster C include 3 personality disorders: Avoidant,

Dependent, and Obsessive-compulsive

- Hallmark characteristics:

- Fearful

- Anxious

- Genetic/familial associations:
 - Anxiety disorders

- Not otherwise specified (NOS): passive-aggressive: a person with

a passive aggressive PD procrastinates and is inefficient. While

outwardly agreeable and compliant, he is inwardly angry and

defiant.

- For the DSM diagnosis, a personality disorder must be present by early

adulthood.

Cluster A personality disorders: Paranoid, Schizoid, Schizotypal

PARANOID PERSONALITY DISORDER

- Involves the symptoms of paranoia, in which the individual is distrustful,

suspicious, guarded, and vigilant toward other people

- Interprets the motives of others as malicious and believes that others

intend to do them harm.

- Blame others for their own problems

- Psychoanalytic explanations

- Heavily uses the defense mechanism called projection.

- Cognitive-behavioral perspective

- Paranoia is a product of the mistaken assumptions that

 - Other people are potentially harmful

- Cognitive-behavioural therapy involves

- Countering the clients mistaken assumptions.

- Schizoid and Schizotypal personality disorders

- Involve schizophrenic-like qualities but without the very disturbed

thinking that characterizes schizophrenia itself.

- Some psychologists view these disorders as variants of

schizophrenia rather than as separate disorders.

- to schizophrenia.

SCHIZOID PERSONALITY DISORDER

- The schizoid individual

- Has an aversion to close relationships

- Feels detached from others

- Lacks empathy for the feelings of others

- Long-standing pattern of voluntary social withdrawal

- Usually leads an isolated and secluded lifestyle.

- Shows restricted emotions

- Has no thought disorder like in schizophrenia

 - The individual with schizotypal personality disorder

- Has odd, bizarre, and unusual ways of reacting to others and viewing the

world.

- Has odd thought patterns

- Magical thinking (i.e., believing that ones thoughts can affect the

course of events)

- No frank psychosis such as in schizophrenia

- Treatment for the schizoid and schizotypal personality disorders is difficult

because of their avoidance of human interaction and their strange ways of

thinking.

Cluster B personality Disorders: Histrionic, Narcissistic, Borderline, and

Antisocial

HISTRIONIC PERSONALITY DISORDER

- Characterized by excesses of emotionality

- People with histrionic PD tend to be very theatrical, extroverted, and

enjoy being the center of attention. They are perceived as the life of

the party.

- Often they are flirtatious, sexually provocative, seductive, and vain.

 - Their involvement with others tends to be very superficial and shallow,

and thus, they cannot maintain intimate relationships

- People with histrionic personality disorder exhibit stereotyped sex-role

behaviours.

NARCISSISTIC PERSONALITY DISORDER

- Narcissistic personality disorder is

- Characterized by excesses of egocentrism.

- Narcissistc individuals are self-centered, feel that they are privileged

people, have a sense of special entitlement, and expect to be the focus

of attention.

- Lacks empathy for others

- Psychodynamic theories explain that narcissistic people have unresolved

conflicts around sexuality.

- Psychodynamic therapy will focus on parents deficient or excess

attention for the individuals accomplishments as a child.

- The cognitive-behavioral therapist would try to reduce the clients

arrogance and increase the sense of empathy for others.

-
 BORDERLINE PERSONALITY DISORDER
- Borderline personality disorder is

- Characterized by a poor sense of self or confused self-identity.

- Their view of people swings from idealization to devaluation

- Moody, and at times violent, acting in ways that are harmful to

themselves or others.

- Erratic, impulsive, unstable behaviour and mood

- Feeling bored, alone, and empty

- Attempts suicide for relatively trivial reasons

- e.g., self-mutilation by cutting or burning oneself

- Often comorbid with mood and eating disorders

- Has mini-psychotic episodes (i.e., brief periods of paranoia or

hallucinations)

- Theoretical explanations of borderline PD focus on problems in the early

childhood development of the self.

- Psychodynamic theorists

- BPD results from inadequate parenting in which the individual

was not nurtured as a separate, autonomous (independent) being.

 - Some researchers believe that childhood neglect and abuse is

linked to the development of BPD.

- From a cognitive-behavioral perspective

- People with BPD hold unrealistic views of themselves and others

as either all good or all bad.

- Treatment of people with BPD is difficult and challenging, sometimes requiring

inpatient care.

- There is debate about whether to focus more on confrontational or

supportive approaches.

- Most clinicians agree that therapy should

- Help the client become more emotionally stable and predictable

- Help the client establish a sense of identity

- Help the client abandon self-destructive behaviors.

 ANTISOCIAL PERSONALITY DISORDER
- A person with antisocial personality disorder

- Disregards or refuses to conform to social norms, laws, and moral

standards of society

- Shows no concern for others

- Engages in criminal behaviour.

- Associated with conduct disorder in childhood and criminal behaviour

(sociopathy) in adulthood

- Biological theories propose that people with antisocial personality

disorder are physiologically different from others in

- their ability to learn from the negative consequences of their

behaviour, and

- in their physiological arousal patterns.

- May run in the genes

- Many antisocial individuals grew up in homes with

- inconsistent discipline,

- an impoverished standard of living, or

- an absentee parent.

- Antisocial PD cannot be diagnosed until age 18.

- Prior to this age, the diagnosis is conduct disorder.

 - Treatment of antisocial personality disorder is very difficult

- They lack of incentive to seek help voluntarily.

- When such individuals do come to treatment, the clinicians goal is

to help them develop empathy or sensitivity for others.

Cluster C personality disorders: Avoidant, Dependent, and Obsessive-compulsive

- Avoidant and Dependent personality disorders

- Represent two extremes of relating to people.

- The avoidant individual shuns contact with others, while the

dependent individual cannot survive without other peoples help and

support.

AVOIDANT PERSONALITY DISORDER

- The avoidant personality

- Harbours feelings of inferiority

- Is easily offended by criticism and rejection, and

- Socially withdraws from others

- Both schizoid and avoidant personalities avoid interaction with people.

The difference is that

 - For the avoidant personality, it is due to a fear of criticism and

rejection by others

- For the schizoid personality, he is comfortable being alone and

does not care whether people criticize or reject him

DEPENDENT PERSONALITY DISORDER

- Dependent individuals rely excessively on other people, thus they may lack

the skills and abilities to handle problems and life tasks on their own.

- Allows other people to make decisions for them

- Poor self-confidence, fear of being left on her own

- For fear of being abandoned, she may even tolerate abuse by

domestic partner

- Psychodynamic therapists believe that there was a disturbance in the

individuals early attachment patterns with his or her caregivers.

- Cognitive-behavioral therapy involves breaking the negative cycles of

erroneous beliefs.
OBSESSIVE-COMPULSIVE PERSONALITY DISORDER
- Obsessive-compulsive and passive-aggressive personality disorders have

conflicts regarding the issue of control. While obsessive-compulsive

personalities are control freaks, passive-aggressive personalities resist

being controlled.

- Individuals with obsessive-compulsive personality disorder are

- Perfectionistic

- Orderly

- Inflexible and stubborn.

- Unreasonably concerned about unimportant details of life.

- The individual becomes set on rigid rules and routines

- Indecisive, unable to make decisions without a great deal of

vacillation and uncertainty, and may therefore become

inefficient at accomplishing tasks

- People with obsessive-compulsive personality disorder fear

the consequences of making a mistake, because their self-

esteem hinges on seeing themselves a perfect.

- People with obsessive-compulsive personality disorder fear

the consequences of making a mistake, because their self-

esteem hinges on seeing themselves a perfect. Treatment of

 obsessive-compulsive personality disorder can be successful if

the therapist can avoid feeding into the clients ruminative

tendencies.

OTHER PERSONALITY DISORDERS

- Personality Change due to Another Medical Condition

- In the past, clinicians have also described 4 other personality disorders:

passive-aggressive (negativistic), sadistic, self-defeating, and depressive

personality disorders

- Passive-aggressive (Negativistic):

- Unlike people who are obsessive-compulsive about

complying with rules and regulations, people who are

passive-aggressive ignore rules and regulations, and like to

do things at their own time and in their own way.

- Negativistic or Passive-aggressive individuals experience a

great deal of anger but express their anger indirectly,

usually causing considerable annoyance to other people.

 - According to the cognitive-behavioral perspective, people

with passive-aggressive personality disorder have a fear of

being rejected if anger is expressed directly.

- Negativistic or Passive-aggressive personality disorder

is more difficult to treat, because the individual constantly

thwarts the therapists best efforts.

- Sadistic personality disorder has been suggested for persons

who receive pleasure by inflicting pain on others.

- Self-defeating personality disorder has been suggested for

persons who are overly passive and accept the pain and suffering

imposed by others.

- Depressive personality disorder includes persons that

experience self-criticism, self-dejection, a judgmental stance

toward others, and a tendency to feel guilt.

- Both the cognitive-behavioral and psychodynamic approaches offer the most

viable and reasonable explanations for the understanding of personality

disorders.

- Biological research on temperament suggests that personality disorders

may have a physical or genetic basis.

- For those who seek help, individual and group psychotherapy may be useful.

- Pharmacotherapy also can be used to treat symptoms, such as depression and

anxiety, which may be associated with the PDs.