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Personality Disorders

Overview The Nature of Personality Disorders

Enduring and relatively stable predispositions(i.e., ways of relating and thinking)

Predispositions are inflexible andmaladaptive, causing distress and/orimpairment

Coded on Axis II of the DSM-IV and DSM-IV-TR

Categorical vs. Dimensional Views ofPersonality Disorders

Overview DSM-IV and DSM-IV-TR Personality

Disorder Clusters Cluster A – Odd or eccentric cluster (e.g.,

paranoid, schizoid) Cluster B – Dramatic, emotional, erratic

cluster (e.g., antisocial, borderline)

Cluster C – Fearful or anxious cluster (e.g.,avoidant, obsessive-compulsive)

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Facts and Statistics Prevalence of Personality Disorders

Affect about 0.5% to 2.5% of the generalpopulation

Rates are higher in inpatient andoutpatient settings

Origins and Course of PersonalityDisorders Thought to begin in childhood Tend to run a chronic course if untreated

Facts and Statistics Co-Morbidity Rates are High Gender Distribution and Gender Bias in

Diagnosis Gender bias exists in the diagnosis of

personality disorders Such bias may be a result of criterion

and/or assessment gender bias

Cluster A: Paranoid PD Clinical Features

Pervasive andunjustified mistrust andsuspicion

The Causes Biological and

psychologicalcontributions are unclear

May result from earlylearning that people andthe world is a dangerousplace

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Cluster A: Paranoid PD Treatment Options

Few seek professional help on their own Treatment focuses on development of trust

Cognitive therapy to counter negativisticthinking

Lack good outcome studies showing thattreatment is efficacious

Cluster A: Schizoid PD Overview and Clinical Features

Pervasive pattern of detachment from socialrelationships

Very limited range of emotions in interpersonalsituations

The Causes Etiology is unclear

Preference for social isolation in schizoid personalityresembles autism

Cluster A: Schizoid PD Treatment Options

Few seek professional help on their own

Focus on the value of interpersonalrelationships, empathy, and social skills

Treatment prognosis is generally poor

Lack good outcome studies showing thattreatment is efficacious

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Name that personalitydisorder…

Cluster A: Schizotypal Clinical Features

Behavior and dress is odd orunusual

Socially isolated and may behighly suspicious of others

Magical thinking, ideas ofreference, and illusions

Risk for developingschizophrenia is high

The Causes A phenotype of a

schizophrenia genotype? Left hemisphere and more

generalized brain deficits

Cluster A: Schizotypal Treatment Options

Main focus is on developing social skills Treatment also addresses comorbid depression Medical treatment is similar to that used for

schizophrenia Treatment prognosis is generally poor

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Warning Signs of… Schizotypal Personality Disorder

Discomfort with close interpersonal relationships (as opposedto a lack of interest)

Eccentric behavior (e.g., mumbling; odd dress) Having frequent “feelings” or illusions Often misinterpreting casual incidents as having particular or

unusual meaning for themselves Belief in paranormal experiences, telekinesis, telepathy, etc. Suspicious and paranoid thoughts Express little emotion - “flat” in social situations

Cluster B: Antisocial PD Clinical Features

Failure to comply with social normsand violation of the rights of others

Irresponsible, impulsive, anddeceitful

Lack a conscience, empathy, andremorse

Many have early histories ofbehavioral problems, includingconduct disorder

Many come from families withinconsistent parental discipline andsupport

Families often have histories ofcriminal and violent behavior

One of the nation’s most……notorious serial killers, Jeffrey Dahmer was born and raised in Bath Township, Ohio, a middle-class suburb of Akron.Much has been made of his childhood tendencies - including cases of cruelty to animals - but to outward appearances, atleast, he seemed to be a normal child. As an adult he was always gainfully employed and was perceived as quiet andpolite by co-workers.

At the time of his arrest he had been working at a chocolate factory in Milwaukee and living alone in a small one-bedroomapartment. Dahmer's home was searched on July 22, 1991, after a young man fled his apartment and flagged down apolice car. An investigation revealed that the apartment contained the remains of 11 young men, most of them black,Hispanic, or Asian. The bodies had been dismembered, and Dahmer confessed that he had cooked and eaten some of theremains. Asked why he committed such heinous acts, Dahmer told police that he killed because he was "lonely" and didnot want his victims to leave him. He explained that he would meet potential victims in bars, shopping malls, or adultbookstores, and invite them back to his apartment where, in exchange for money or beer, he would photograph themnaked. He would then drug the beer and, once the victim was unconscious, strangle and dismember the body. Dahmer'svictims ranged in age from 14 to 33.

On February 15, 1992, Dahmer was found guilty on 15 murder counts in Wisconsin. He was subsequently convicted ofanother killing in his Ohio hometown. Charges linking him to other murders were dropped for lack of evidence. He wassent to prison in Wisconsin with 15 mandatory life sentences to serve. The first year of his sentence, Dahmer was isolatedfrom the general prison on population for his own protection. In 1994 he was sent to a maximum security facility in Portageand was allowed some contact with the other inmates. He died after a brutal bludgeoning attack on November 28, 1994,by a fellow inmate who claimed God had instructed him to murder Jeffrey Dahmer.

Even after Dahmer's death, legal battles continue over his estate. Several families of his victims sued him and wereawarded millions of dollars in restitution. Those families have since been trying to gain control of the contents of Dahmer'sapartment, including a 55-gallon vat he used to decompose bodies and the refrigerator where he stored his victims' hearts.

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Psychopathy Psychopathy incorporates affective/ personality

traits to a greater degree Most psychopaths meet criteria for ASPD, but

most individuals with ASPD are NOTpsychopaths

Psychopathy Hare Psychopathology Checklist (personality profile of

the psychopath) Glibness/superficial charm Grandiose sense of self-worth Need for stimulation/proneness to boredom Pathological lying Conning/manipulative Lack of remorse of guilt- callous and lacking empathy Shallow affect Parasitic lifestyle Poor behavior controls Promiscuous sexual behavior Early behavior problems Lack of realistic, long-term plans Impulsivity and irresponsibility

Lifetime course of criminal behavior inpsychopaths and nonpsychopaths

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Early Behavior in ASPD Many have early histories of behavioral

problems, including conduct disorder Many come from families with

inconsistent parental discipline andsupport

Families often have histories of criminaland violent behavior

Neurobiological Contributions toASPD

Prevailing Neurobiological Theories Underarousal hypothesis – Cortical arousal

is too low

Cortical immaturity hypothesis – Cerebralcortex is not fully developed

Fearlessness hypothesis – Psychopaths failto respond with fear to danger cues

Treatment of ASPD Treatment

Few seek treatment on their own

Antisocial behavior is predictive of poorprognosis, even in children

Emphasis is placed on prevention andrehabilitation

Often incarceration is the only viablealternative

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Cluster B: Borderline PD Clinical Features

Unstable moods and relationships Impulsivity, fear of abandonment,

coupled with a very poor self-image

Self-mutilation and suicidalgestures

Most common personalitydisorder in psychiatric settings

High comorbidity

The Causes Runs in families - genetics? Early trauma and abuse

Cluster B: Borderline PD Treatment Options

Few good treatment outcome studies Antidepressant medications provide some

short-term relief Dialectical behavior therapy is the most

promising psychosocial approach

Cluster B: Histrionic PD Clinical Features

Overly dramatic,sensational, andsexually provocative

Need to be thecenter of attention

Perceived as shallow The Causes

Unknown Female variant of

antisocialpersonality?

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Cluster B: Histrionic PD Treatment Options

Few good treatment outcome studies Treatment focuses on attention seeking and

long-term negative consequences Targets may also include problematic

interpersonal behaviors Little evidence that treatment is effective

Cluster B: Narcissistic PD Clinical Features

Exaggerated andunreasonable sense of self-importance

Preoccupation with receivingattention

Lack empathy Highly sensitive to criticism Envious and arrogant

The Causes Early failure to learn

empathy as a child Sociological view – A

product of the “me”generation?

Cluster B: Narcissistic PD Treatment Options

Extremely limited treatment research Treatment focuses on grandiosity, lack of

empathy, unrealistic thinking Treatment may also address co-occurring

depression Little evidence that treatment is effective

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Cluster C: Avoidant PD Overview and Clinical

Features Extreme sensitivity to the

opinions of others

Highly avoidant of mostinterpersonal relationships

Are interpersonally anxiousand fearful of rejection

The Causes Numerous factors have been

proposed

Early development – Adifficult temperamentproduces early rejection

Cluster C: Avoidant PD Treatment Options

Several well-controlled treatment outcomestudies exist

Treatment is similar to that used for socialphobia

Treatment targets include social skills andanxiety

Cluster C: Dependent PD Clinical Features

Excessive reliance onothers to make major andminor life decisions

Fear of abandonment

Clingy and submissive

The Causes Still largely unclear

Early disruptions inlearning independence

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Cluster C: Dependent PD Treatment Options

Research on treatment efficacy is lacking

Therapy typically progresses gradually

Treatment targets include skills that fosterindependence

Cluster C: Obsessive-Compulsive PD

Clinical Features Excessive and rigid

fixation on doing thingsthe right way

Highly perfectionistic,orderly, andemotionally shallow

Obsessions andcompulsions are rare

The Causes Are largely unknown

Cluster C: Obsessive-Compulsive PD

Treatment Options Data supporting treatment are limited

Treatment may address fears related to theneed for orderliness

Other targets include rumination,procrastination, and feelings of inadequacy

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Summary of PersonalityDisorders

Personality Disorders Long-standing, ingrained ways of thinking,

feeling, and behaving

Disagreement Exists Over How toCategorize Personality Disorders Categorical vs. dimensional, or some

combination of both

Summary of PersonalityDisorders

DSM-IV and DSM-IV-TR Includes 10Personality Disorder Personality disorders fall in one of three

clusters – Cluster A, B, or C

The Causes of Personality Disorders AreDifficult to Pinpoint

Treatment of Personality Disorders IsOften Difficult

Identify the PersonalityDisorder…

Theo is quite a loner. He walks to class by himself, does nottalk to anyone and appears indifferent to other people. It isclear that Theo neither desires nor enjoys closeness withothers. He does not act in any obviously unusual ways nordoes he appear to possess strange beliefs about the world.

Amy quickly becomes the center of attention when she entersa room. She is a tall and attractive young woman whogenerally wears something striking. Amy is known as a flirtand acts in a seductive manner around men. When Amyspeaks, she uses very exaggerated terms, even whendescribing relatively ordinary situations.

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Identify the PersonalityDisorder…

You are waiting to board a plane when you hear that the flighthas been delayed due to a passing thunderstorm. The mansitting next to you says, "Passing thunder storm, sure! That'sJim again, he's been doing everything to make me miss thismeeting because he's trying to get me fired!"

Nicole has difficulty maintaining relationships because shegoes back and forth from being a best friend to hating peoplein her life quite often. Her romantic relationships are alwayscharacterized by incredible loving passion alternating withepisodes of horrible fighting and sometimes she becomesviolent. At times Nicole becomes so upset that she cuts herselfand reports that this makes her feel better emotionally.

Identify the PersonalityDisorder…

Vince is extremely impressed with himself. Although he hasonly achieved a moderate amount of success, he thinks ofhimself as being uniquely special and deserving of the best ofeverything. Vince fantasizes frequently about great wealth andfame and does not really pay much attention to other peopleexcept to note how they react to him.