Professional Documents
Culture Documents
Chapter 12
Chapter 12
Personality Disorders
Personality Disorders: An Overview
Coded on Axis II
Personality Disorders
Therapist reactions
Countertransference
Personality Disorders: An Overview
DSM is categorical
Reifies concepts
Less flexible
Loss of individual information
Sometimes arbitrary
Personality Disorders: An Overview
Cluster A
Odd or eccentric
Paranoid, schizoid, schizotypal
Cluster B
Dramatic, emotional, erratic
Antisocial, borderline, histrionic, narcissistic
Cluster C
Fearful or anxious
Avoidant, dependent, obsessive-compulsive
Personality Disorders: Facts and Statistics
Individual disorders
Sadistic
Self-defeating
Categories of disorders
Depressive
Negativistic
Passive aggressive
Cluster A: Paranoid Personality Disorder
Clinical Description
Mistrust and suspicion
Pervasive
Unjustified
Few meaningful relationships
Volatile
Tense
Sensitive to criticism
Cluster A: Paranoid Personality Disorder
Causes
Possible relationship to schizophrenia
Possible role of early experience
Trauma
Abuse
Learning
“World is dangerous”
Cluster A: Paranoid Personality Disorder
Treatment
Unlikely to seek on own
Crisis
Focus on developing trust
Cognitive therapy
Assumptions
Negative beliefs
No empirically-supported treatments
Cluster A: Schizoid Personality Disorder
Clinical Description
Appear to neither enjoy nor desire relationships
No thought disorder
Cluster A: Schizoid Personality Disorder
Causes
Limited research
Precursor: childhood shyness
Treatment
Unlikely to seek on own
Crisis
Focus on relationships
Social skills therapy
Empathy training
Role playing
Social network building
No empirically-supported treatments
Cluster A: Schizotypal Personality Disorder
Clinical Description
Psychotic-like symptoms
Magical thinking
Ideas of reference
Illusions
Odd and/or unusual
Behavior
Appearance
Socially isolated
Highly suspicious
Cluster A: Schizotypal Personality Disorder
Causes
Schizophrenia phenotype?
Lack full biological or environmental
contributions
Preserved frontal lobes
Cognitive impairments
Left hemisphere?
More generalized?
Cluster A: Schizotypal Personality Disorder
Treatment Options
Treatment of comorbid depression
Multidimensional approach
Social skill training
Antipsychotic medications
Community treatment
Cluster B: Antisocial Personality Disorder
Clinical Description
Noncompliance with social norms
“Social Predators”
Violate rights of others
Irresponsible
Impulsive
Deceitful
Lack a conscience, empathy, and remorse
Cluster B: Antisocial Personality Disorder
Nature of psychopathy
Glibness/superficial charm
Grandiose sense of self-worth
Proneness to boredom/need for stimulation
Pathological lying
Conning/manipulative
Lack of remorse
Developmental considerations
Early histories of behavioral problems
Conduct disorder
Gene-environment interaction
Genetic predisposition
Environmental triggers
Arousal hypotheses
Underarousal
Fearlessness
Causes of Antisocial Personality
Genetic vulnerability
Neurotransmitters
Environmental factors
Family stress
Reinforcement of antisocial behaviors
Alienation from good role models
Poor occupational/social function
Antisocial Personality Disorder
Treatment
Unlikely to seek on own
High recidivism
Incarceration
Early intervention
Parent training
Prevention
Rewards for pro-social behaviors
Skills training
Improve social competence
Cluster B: Borderline Personality Disorder
Clinical Description
Patterns of instability
Labile, intense moods
Turbulent relationships
Impulsivity
Fear of abandonment
Very poor self-image
Self-mutilation
Suicidal gestures
Cluster B: Borderline Personality Disorder
Comorbid disorders
Depression – 24-74%
Suicide – 6%
Bipolar – 4-20%
Substance abuse – 67%
Eating disorders
25% of bulimics have BPD
Cluster B: Borderline Personality Disorder
Causes
Genetic/biological components
Serotonin
Frontolimbic circuit
Cognitive biases
Treatment
Highly likely to seek treatment
Antidepressant medications
Dialectical behavior therapy
Reduce “interfering” behaviors
Self-harm
Treatment
Quality of life
Outcomes
Demonstrated efficacy
Cortical activation changes
Cluster B: Borderline Personality Disorder
Cluster B: Histrionic Personality Disorder
Clinical Description
Overly dramatic
Sensational
Sexually provocative
Impulsive
Attention-seeking
Appearance-focused
Impressionistic
Vague, superficial speech
Common diagnosis in females
Cluster B: Histrionic Personality Disorder
Causes
Little research
Links with antisocial personality
Sex-typed alternative expression?
Cluster B: Histrionic Personality Disorder
Treatment
Problematic interpersonal behaviors
Attention seeking
Long-term consequences of behavior
Clinical Description
Exaggerated and unreasonable sense of self-importance
Require attention
Lack sensitivity and compassion
Sensitive to criticism
Envious
Arrogant
Cluster B: Narcissistic Personality Disorder
Causes
Deficits in early childhood learning
Altruism
Empathy
Sociological view
Increased individual focus
“Me generation”
Cluster B: Narcissistic Personality Disorder
Clinical Description
Extreme sensitivity to opinions
Avoid most relationships
Interpersonally anxious
Fearful of rejection
Cluster C: Avoidant Personality Disorder
Causes
Sub-schizophrenia disorder?
Difficult temperament
Early parental rejection
Treatment
Similar to social phobia
Increase social skills
Reduce anxiety
Importance of therapeutic alliance
Clinical Description
Rely on others for major and minor decisions
Unreasonable fear of abandonment
Clingy
Submissive
Timid
Passive
Feelings of inadequacy
Sensitivity to criticism
High need for reassurance
Cluster C: Dependent Personality Disorder
Causes
Little research
Early experience
Death of a parent
Rejection
Attachment
Cluster C: Dependent Personality Disorder
Treatment
Limited empirical support
Clinical Description
Fixation on doing things the “right way”
Rigid
Perfectionistic
Orderly
Preoccupation with details
Poor interpersonal relationships
Causes
Limited research
Weak genetic contributions
Predisposed to favor structure?
Cluster C: Obsessive-Compulsive Personality Disorder
Treatment
Similar to OCD
Address fears related to the need for orderliness
Decrease:
Rumination
Procrastination
Feelings of inadequacy