Personality Disorder

(formerly: 'character disorders')

[Butcher, p. 373]

• Axis-II disorders

• Grouped into three clusters (next slide)

- Cluster A

- Cluster B

- Cluster C

"ingrained lifestyles or characteristic patters that are maldaptive and persist throughout the individuals lifetime"

• may co-occur with Axis-I disorders, 

as well as each other

• affect: cognition, affectivity, interpersonal functioning, impulse control.

Chapter 11 - Objective 1

• distorted behavioural patters

• maladaptive perception, thoughts, and relations

• pervasive

• inflexible

• stable

• long duration

-----------------

• 13% of pp'n meet criteria, at some point

• 3/4 of those dx also have an Axis-I disorder

-----------------

• Even with structured interviews, reliability of diagnosing _____ disorders typically is less than ideal

• most researchers agree that dimensional approach for assessing _____ disorders would be preferable

---------

• it is difficult to determin the causes of _____ disorders b/c most people with one _____ disorder have a comorbidity and most studies are retrospective.

Categories of ____ ____

• Cluster A

• Cluster B

• Cluster C

Types of Cluster A personalities include:

• _____

• _____

• _____

• odd or eccentric

• distrust

• suspiciousness

• social detachment

Types of Cluster B personalities include:

• x4

Cluster __ type personalities include:

• histrionic

• narcissistic

• antisocial

• boarderline

(Butcher, p. 376)

qualities of Cluster B personality disorder

qualities of Cluster __ personality disorder

• dramatic

Types of Cluster C personalities include: 

Types of Cluster __ personalities include:

• avoidant

• dependent

• OCD

qualities of Cluster C personality disorder

qualities of Cluster __ personality disorder

Personality Disorder, DSM-IV

(Butcher, p 376)

Chapter 11 - Objective 2

Compare and contrast the different types of personality disorders and identify the three clusters into which most personality disorders are grouped.

(Butcher, p. 376)

Chapter 11 - Objective 3

Summarize what is known about the biological, psychological, and sociocultural causal factors of personality disorders

(Butcher, p. 375)

• Biological

- temperament may predispose development of particular personality traits and disorders

• Psychologocial 

- learning-based habit patterns and maladaptive cognitive styles may cause _____ disorders

- may originate in disturbed parent-child attachments, rather than just differences in temperament

- physical & sexual abuse 

• Social Stressors

- societal changes

- cultural values

Chapter 11 - Objective 4

Discuss the difficulties of treating individuals with _____ disorders and describe the approaches to treatment

(Butcher, p. 393)

• because _____ disorders are enduring, pervasive, and inflexible patters of behaviour and inner experience

• individuals do not believe they need to change

• people who have both Axis I comorbidity do not do as well

Chapter 11 - Objective 5

Compare and contrast the DSM-IV concept of antisocial personality and Cleckley's concept of psychopathy

(p. 396)

Antisocial Personality Disorder

(ASPD)

[DSM-IV]

(p. 384, 395)

Continually violate and show disregard for the rights of others through deceitful, aggressive... behaviour... without remorse or loyalty to anyone.

• impulsive

• irritable

• agressive

• irresponsible

[S&S before age 15 = conduct disorder]

[image]

Borderline Personality Disorder

(BPD)

(DSM-IV)

(butcher, p. 385)

* affective instability

* anger (intense)

• implusivity

• instability

     - interpersonal

     - self-image

     - moods

** this dx no longer r/t schizophrenia**

• 10% > suicide

• self mutilation

• delusions

• hallucinations

• paranoid

• sever dissociative symptoms

• 75% of _____ are WOMEN

• Comorbidity with Axis I (panic, PTSD)

• Comorbidity with other personality disorders (histrionic, dependent, antisoc, 

• physiology: lowered serotonin (inhibits behavior responses)

• 90% of _____ report childhood abuse/neglect... separation > impulsivity & affective instability > hi risk _____

[image]

Avoidant Personality Disorder

[DSM-IV]

(Butcher, p. 388)

• extreme social inhibition

• extreme social introversion

• limited social relationships (lifelong)

• reluctance to enter social interactions

    - fear criticism, rebuff

• do not seek out other people

* desire affection > often lonely and bored

• Avoid novel situations and (even +ve) emotions

• deficits in ability to experience pleasure

• fear of being -ve evaluated is moderately hereditary 

[image]

Dependant Personality Disorder

[DSM-IV]

(butcher, p. 390)

• clinging & submissive

• fail to get appropriately angry with others because of a fear of losing their support

• comorbidity Dx: mood, anxiety, and avoidant disorders

• 2 to 4% of the pop'n 

• common in women

* one or two individuals they do NOT avoid

[image]

Depressive Personality Disorder

[provisional category DSM-IV]

(Butcher, p. 392)

* PROVISIONAL category in DSM-IV-TR

• depressive cognitions and behaviours > pervasive

- unhappiness

- gloom

- dejection (not = sadness)

- inadequacy

- worthless

- remorsefull

- guilty

- pessamistic

- prone to worry

- distorted cognitions 

- distored interpersonal traits

• do not meet criteria for dysthymia (mood reg'n incl: sadness, depressed, vegetative)

Histrionic personality disorder

[DSM-IV]

(Butcher, p. 378, 80-3)

• Cluster B (dramatic, emotional, erratic)

- excessive attention seeking

- feel unappreciated if not centre of attention

- lively, dramatic, excessively extraverted

- self-dramatization;

     - over concern with attractiveness;

     - tendency to irritability and temper outbursts if attention seeking is frustrated

• prevalence = 2-3%

• males = females

[image]

Narcisstic personality disorder 

 [DSM-IV]

(Butcher, p. 382)

• exaggerated sense of self-importance

• preoccupation with being admired

• lock empathy for feelings of others

* grandiosity

• overestimate abilities

• believe understood only by high-status people

• unwilling to forgive

• instable sense 

* unwilling/unable to take the perspective of others

• hypercritical or retaliatory of criticism

• men > women

• Prevalence: 1% (rare)

• [image]

Obsessive-Compulsive PD

[DSM-IV]

(Butcher, p. 391)

• preoccupation maintaining mental and interpersonal control

* rigidity

* stubborness

* reluctance to delegate

• WITHOUT true obsessions or compulsive rituals > extreme anxiety/distress (as in Axis I Obsessive-Cumpulsive disorder)

• highly perfectionist > problem finishing

• ungenerous with self and others 

[image]

Paranoid PD

[DSM-IV]

(Butcher, p. 376)

• pervasive suspiciousness and distrust > interpersonal conflicts

• see self as blameless

• NOT usually psychotic: so, clear contact with reality

• partial genetic transmission

[image]

Passive-Aggressive PD

[Provisional dx DSM-IV]

(Butcher, p. 392)

• provisional dx of ____-____ pd

• aka: negativistic pd

• passive resistance to demands in social or work

negativist attitudes unrelated to any concurrent depression

• c/o personal misfortunes

• c/o being misunderstood

• c/o being unappreciated

Psychopathy (or socipathy)

(Butcher, p. 395-6)

• Cleckley first described _____ in 1940's

• Prevalence: 1%

• 2 dimensions

    - first dimension: affective and interpersonal core of the disorder > lack of remorse/guilt, callousness/lack empathy, glibness/superficial charm, grandiose self-worth, pathological lying

    - second dimension > antisocial, impulsive, deviant, need stimulation, poor bhvr ctrl, irresponsibility, parasitic lifestyle.

• dx of _____ appears to be the single best predictor we have of violence and recidivism.  

Schizoid PD

[DSM-IV]

(Butcher, p. 377)

• unable to form social relationships

• lack interest in forming social relationships

• solitary interests

• solitary occupations

• low sexual activity

• cognitive perspective: dysfunctional belief "I am basically alone"

[image]

Schizotypal PD

[DSM-IV]

(Butcher, p. 379)

* oddities in thinking / talking

* oddities in behaviours

- excessively introverted

- interpersonal deficits

• ALSO > cognitive and perceptual disortions

• magical powers

• prevalence: 3%

• moderate heritable 

[image]