Ongoing patterns of relating to/thinking about the environment

Are exhibited in a wide range of social and personal contexts.

They are inflexible, maladaptive and cause significant functional impairment or subjective distress.

Personality Disorder Details:

1) Are they chronic?

2) What axis are they on?

3) What effect does comorbidity have?

1) Yes, they are chronic.

2) Axis II

3) People with personality disorders in addition to other psychological problems tend to do poorly in treatment.

Five-Factor Model

"Big Five"

What is it?

What dimensions does it measure?

Five-Factor Model is taken from work on normal personality and measures a person based on 5 dimensions.

Dimensions:

1) Extroversion

2) Agreeableness

3) Conscientiousness

4) Neuroticism

5) Openness to Experience

High: Austrian, Swiss, Dutch

Low: Danes, Malaysians and Telugu Indians

A: Odd/Eccentric

B: Dramatic/Emotional/Erratic

C: Anxious/Fearful

Odd/Eccentric includes:

Paranoid

Schizoid

Schizotypal

Cluster B includes:

Antisocial

Borderline

Histrionic

Narcissistic

Which disorders are included in Cluster C (Anxious/Fearful)?

Cluster C includes:

Avoidant PD

Dependent PD

Obsessive-Compulsive PD

Gender Differences:

Which are more commonly diagnosed in men?

In women?

Which show no difference?

*All differences show up in clinical pop., not general pop.

• More common in men:
  • Paranoid, Schizoid, Schizotypal
  • Antisocial, Narcissistic
  • Obsessive-Compulsive
• More common in females:
  • Borderline
• No difference:
  • Histrionic
  • Avoidant, Dependent

Criterion Gender Bias

vs.

Assessment Gender Bias

Criterion: The criteria for diagnosing a PD

Assessment: The way the criteria are judged/the attitudes of the psychologist assessing a patient

Paranoid Personality Disorder:

1) Description/Symptoms

2) Causes

3) Treatment

1) Pervasive, unjustified distrust. Discomfort around others, sensitive to criticism, excessive need for autonomy (control)

2) Largely uncertain, appears to be a strong role for genetics. May result from warnings in upbringing to be extra-cautious. Cultural factors--prisoners, refugees, people w/ hearing impairments, elderly.

3) Suspicious, so unlikely to seek help. Usually triggered by crisis. Usually use cognitive therapy to changer person's beliefs. Unlikely to continue long enough to be helped.

Schizoid Personality Disorder

1) Description

2) Causes

3) Treatment

1) Detachment from social relationships and restricted range of emotions. Little interest/pleasure in activities or personal relationships.

2) Childhood abuse, biological dysfunction relating to dopamine.

3) Therapist points out value of relationships. Patient goes through social-skills training. 

Schizotypal Personality Disorder

1) Description

2) Causes

3) Treatment

1) Discomfort with interpersonal relationships, unusual perceptual experiences (feeling someone's presence when they are alone). Paranoid thoughts & unusual behaviors

2) Some view it as one phenotype of a schizophrenia genotype. Environmental contributions such as mother's exposure to influenza while pregnant. 

3) Medical & Psychological: combine antipsychotics, community treatment and social skills training.

Antisocial Personality Disorder

Description/Symptoms

Disregard for & violation of rights of others

Law-breaking (no remorse)

Lying

Agressiveness/Impulsivity

Symptoms occur outside of schizophrenia or manic episode

History of conduct disorder.

Antisocial PD

Causes

Genetics create vulnerability

Environmental factors contribute

Neurobiological: 

Underarousal hypothesis (thrill-seeking because they have abnormally low cortical arousal).

Fearlessness hypothesis (higher threshold for fear). 

Malfunctioning of BIS

Psychological/Social:

Coercive family process (escalating arguments until parent withdraws all demands)

Stress (Ex: Vietnam vets)

Antisocial Personality Disorder

Treatment

Most clinicians are relatively pessimistic and suggest incarceration.

"Therapeutic Communities" resulted in more violent reoffenses

(probably because they used new social skills to better manipulate others)

Early on parental training can be used to reduce problem behavior

Borderline Personality Disorder

1) Description

2) Causes

1) Unstable relationships, self-image, affect and impulse-control. Self-destructive behavior. High comorbidity with mood disorders.

*One of the most common PDs & observed in every culture

2) Indications for genetic role. Mutation of serotonin transporter gene. Abuse may be predisposing factor. 

Borderline PD

Treatment

They ARE likely to seek help.

Anti-depressants/lithium--complicated by drug abuse.

Dialectical Behavior Therapy

• Priority is to change behaviors that result in harm
• Then behaviors that interfere with therapy
• Finally to behaviors that interfere with quality of life

Emphasize problem solving

Re-experience traumatic events to extinguish associated fears

Trust own responses w/o validation of others

Histrionic Personality Disorder

1) Description

2) Causes

3) Treatment

1) Description: pervasive pattern of excessive emotionality/attention seeking. Shallow, seductive, considers relationships more involved than they are

2) Causes: About 2/3 meet criteria for Antisocial as well. Suggests that the two disorders may be sex-typed expressions of the same underlying condition.

3) Treatment: Shown how short-term gain = long-term costs. 

Narcissistic Personality Disorder

1) Description

2) Causes

3) Treatment

1) Need for admiration, lack empathy for others, self-important, grandiose fantasies, attitude of entitlement, envious or believes others to be envious of them, arrogant.

2) Profound failure of parents to model empathy

*Increasing in prevalence--result of "me generation"

3) Treatment: focus on grandiosity, hypersensitivity to evaluation and lack of empathy. CogTh to replace fantasies with attainable pleasurable experiences. Help focus on feelings of others.

Avoidant Personality Disorder

1) Description

2) Causes

3) Treatment

1) Feel chronically rejected/unworthy, unwilling to get involved with others unless certain of being liked, negative self-view.

2) Difficult temperament may result in rejection by parents, which leads to low self-esteem & develop into APD

3) Techniques for managing anxiety and social skills, treatment similar to patients with social phobia. Relationship with therapist is important predictor of success. 

Dependent Personality Disorder

1) Description

2) Causes

3) Treatment

1) Need to be taken care of/have others make decisions, difficulty expressing disagreement, extremely low self-confidence

2) Traumatic events resulting in fear of abandonment

3) Eager to please so may appear to be ideal patient, but submissive nature negates goal of therapy (independence). Need to be careful that they do not become overly dependent on therapist.

Obsessive-Compulsive Personality Disorder:

1) Description

2) Causes

3) Treatment

1) Fixate on things being done "the right way," rigid ritualistic behaviors, perfectionistic, need to do things in such specific way keeps them from getting anything done, interferes with interpersonal relationships

2) Weak genetic contribution, predisposition + parental reinforcement for conformity/neatness

3) Treat fears that underlie need for orderliness, relaxation/distraction techniques (Cognitive-Behavioral Therapy)