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Chapter 13 Personality Disorders
Ch 13
• Personality Disorders refer to long-standing, pervasive and inflexible patterns of behavior– Depart from cultural expectations– Impair social and occupational functioning– Cause emotional distress
• Personality disorders are coded on Axis II of the DSM– Personality disorders can be a co-morbid condition for
an Axis I disorder
Personality Disorders
Ch 13.1
Personality Disorders: Facts and
Statistics • Prevalence of Personality Disorders
– About 0.5% to 2.5% of the general population– Rates are higher in inpatient and outpatient settings
• Origins and Course of Personality Disorders– Thought to begin in childhood – Tend to run a chronic course if untreated
• 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 or assessment gender bias
• Personality disorders fall into three general clusters:– Persons in cluster A seem odd or eccentric
• Paranoid, schizoid, schizotypal
– Persons in cluster B seem dramatic, emotional or erratic
• Antisocial, borderline, histrionic, narcissistic
– Persons in cluster C appear as anxious or fearful• Avoidant, dependent, obsessive-compulsive
Personality Disorder Clusters
Ch 13.2
Odd/Eccentric Cluster
• Paranoid personality disorder (PD) involves suspicion of others, hostility, jealousy– No hallucinations and no full-blown delusions
are present in paranoid PD
• Paranoid PD occurs more frequently in men than in women
• Lifetime prevalence is about 1 percent
Ch 13.3
• Schizoid personality disorder (PD) involves– Reduced social relations and few friends– Reduced sexual desire and few pleasurable activities– Indifference to praise or criticism– Lonely life style
• Prevalence of schizoid PD is less than 1 percent and occurs more commonly in men than women
Odd/Eccentric Cluster
Ch 13.4
• Schizotypal personality disorder (PD) involves – An attenuated form of schizophrenia
• Odd beliefs and magical thinking• Recurrent illusions (things not present)• Ideas of reference (hidden meaning)• Behavior and appearance is eccentric
• Prevalence of schizotypal PD is about 3 percent and occurs slightly more commonly in men than women
Odd/Eccentric Cluster
Ch 13.5
Etiology of the Odd/Eccentric Cluster
• These disorders are linked to schizophrenia and may represent a less severe form of the disorder– Schizophrenia has clear genetic determinants– Family studies reveal that relatives of schizophrenic patients
are at increased risk for developing schizotypal PD as well as paranoid PD
• No clear pattern for schizoid PD
• Additional similarities for Schizotypal PD– Have cognitive and neuropsychological problems similar to
those found in individuals with schizophrenia.– Have enlarged ventricles and less temporal lobe gray matter.
Ch 13.6
• Borderline personality disorder (PD) involves – Impulsivity (gambling, spending, sexual sprees)
– Instability in relationships, mood and self-image
– Borderline PD persons are argumentative and difficult to live with
• Prevalence of Borderline PD is about 1-2 percent and occurs more commonly in women than men
• Linehan’s diathesis-stress theory– Difficulty controlling emotions (biological diathesis)
– Raised in “invalidating” family environment
Dramatic/Erratic Cluster
Ch 13.7
Figure 13.1 Linehan’s Diathesis-Stress theory: Etiology of borderline personality disorder
•Emotional dysregulation in child (diathesis) and a failure to validate the child’s feelings by the parents (stress) leads to a vicious cycle.
–The emotional dysregulation may be inadvertently reinforced by parents if it becomes one of the only times the child receives parental attention.
Borderline Personality Disorder Borderline Personality Disorder Unstable RelationshipsUnstable Relationships
– Avoid AbandonmentAvoid Abandonment
Poor Self-ImagePoor Self-Image– Mood Swings, Feel EmptyMood Swings, Feel Empty
ImpulsivityImpulsivity– Substance Abuse, Sex, SuicidalitySubstance Abuse, Sex, Suicidality
Unstable RelationshipsUnstable Relationships– Avoid AbandonmentAvoid Abandonment
Poor Self-ImagePoor Self-Image– Mood Swings, Feel EmptyMood Swings, Feel Empty
ImpulsivityImpulsivity– Substance Abuse, Sex, SuicidalitySubstance Abuse, Sex, Suicidality
Borderline Personality Disorder Borderline Personality Disorder CausesCauses
– Runs in FamiliesRuns in Families
– Connection With Mood DisordersConnection With Mood Disorders
– Contribution of Early AbuseContribution of Early Abuse
CausesCauses– Runs in FamiliesRuns in Families
– Connection With Mood DisordersConnection With Mood Disorders
– Contribution of Early AbuseContribution of Early Abuse
Borderline Personality Disorder Borderline Personality Disorder TreatmentTreatment
– Few Controlled StudiesFew Controlled Studies
– Dialectical Behavior Therapy (DBT)Dialectical Behavior Therapy (DBT)
– MedicationsMedications
Antidepressants , Mood Stabilizers, Antidepressants , Mood Stabilizers, AntipsychoticsAntipsychotics
TreatmentTreatment– Few Controlled StudiesFew Controlled Studies
– Dialectical Behavior Therapy (DBT)Dialectical Behavior Therapy (DBT)
– MedicationsMedications
Antidepressants , Mood Stabilizers, Antidepressants , Mood Stabilizers, AntipsychoticsAntipsychotics
• Histrionic personality disorder (PD) involves– People who are overly dramatic and attention seeking– People who exhibit emotional displays but are
emotionally shallow– People who are self-centered and overly concerned
about physical attractiveness
• Prevalence of histrionic PD is about 2-3 percent and occurs slightly more commonly in women than men
Dramatic/Erratic Cluster
Ch 13.8
• Narcissistic personality disorder (PD) involves – A grandiose view of the person’s own importance– A strong sense of entitlement– A lack of empathy for others
• Prevalence of narcissistic PD is less than 1 percent and this disorder co-occurs with borderline PD
Dramatic/Erratic Cluster
Ch 13.9
• Antisocial personality disorder (PD) involves– The presence of conduct disorder before the age of
fifteen • Conduct disorder includes truancy, lying, theft, arson, running
away from home and destruction of property
– The continuation of these behaviors into adulthood
• Prevalence of antisocial PD is about 3% of men and 1 % of women
Dramatic/Erratic Cluster
Ch 13.10
Etiology of Antisocial PD• Family issues may play a role in the development of antisocial PD
– Lack of affection– Severe parental rejection– Inconsistent (or no) discipline
• Twin studies show a greater concordance for antisocial PD in MZ twins relative to DZ twins
• Adoption studies (e.g., Cadoret et al., 1995)– Adverse adoptive environment may be the stressor triggering the ASPD
biological diathesis
• Psychopaths– Have reduced gray matter in frontal lobes– Perform more poorly on tests of frontal lobe functioning– These findings are supportive of a key role for impulsivity in psychopathy
Ch 13.11
Cluster B: Antisocial Personality Disorder
Figure 12.2 Barlow/Durand, 3rd. EditionOverlap and lack of overlap among antisocial personality disorder, psychopathy, and criminality
Cluster B: Antisocial Personality Disorder (cont.)
Figure 12.3 Barlow/Durand, 3rd. Edition
Lifetime course of criminal behavior in psychopaths and non-psychopaths
Fig 13.2
Figure 13.2 Skin-conductance responses of psychopathic and non-psychopathic men. Psychopathic men's response to distress stimuli is evidence of a lack
of empathy
Antisocial Personality Disorder Antisocial Personality Disorder Neurobiological InfluencesNeurobiological Influences
– Underarousal HypothesisUnderarousal Hypothesis
Low Corical Arousal or “Tuning it Out”?Low Corical Arousal or “Tuning it Out”?
– Fearlessness HypothesisFearlessness Hypothesis
Fail to Show Normal Fear
Fail to Avoid Punishment
Neurobiological InfluencesNeurobiological Influences– Underarousal HypothesisUnderarousal Hypothesis
Low Corical Arousal or “Tuning it Out”?Low Corical Arousal or “Tuning it Out”?
– Fearlessness HypothesisFearlessness Hypothesis
Fail to Show Normal Fear
Fail to Avoid Punishment
Antisocial Personality Disorder Antisocial Personality Disorder
TreatmentTreatment– Many Do Not Seek TreatmentMany Do Not Seek Treatment
– Poor PrognosisPoor Prognosis
– Focus on PreventionFocus on Prevention
TreatmentTreatment– Many Do Not Seek TreatmentMany Do Not Seek Treatment
– Poor PrognosisPoor Prognosis
– Focus on PreventionFocus on Prevention
• Avoidant personality disorder (PD) involves – People who are fearful in social situations – People who are keenly sensitive to criticism, rejection
or disapproval– People whose lives and job are restricted by their fear
of negative interactions
• Prevalence of Avoidant PD is about 1 percent and this disorder is co-morbid with dependent PD and borderline PD
Anxious/Fearful Cluster
Ch 13.12
Avoidant Personality Disorder Avoidant Personality Disorder TreatmentTreatment
– Several Well Controlled StudiesSeveral Well Controlled Studies
– Target Anxiety and Social SkillsTarget Anxiety and Social Skills
– Treatment Similar to Social PhobiaTreatment Similar to Social Phobia
Systematic DesensitizationSystematic Desensitization
Behavioral RehearsalBehavioral Rehearsal
TreatmentTreatment– Several Well Controlled StudiesSeveral Well Controlled Studies
– Target Anxiety and Social SkillsTarget Anxiety and Social Skills
– Treatment Similar to Social PhobiaTreatment Similar to Social Phobia
Systematic DesensitizationSystematic Desensitization
Behavioral RehearsalBehavioral Rehearsal
• Dependent personality disorder (PD) involves – A lack of self confidence– A lack of a sense of autonomy– A view that others are powerful while they are weak
• Prevalence of Dependent PD is about 1.5 percent and occurs slightly more commonly in women than men– May be related to insecure “anxious” attachment
Anxious/Fearful Cluster
Ch 13.13
• Obsessive-Compulsive personality disorder (PD) involves a person who – Is a perfectionist, but who does not complete projects– Is a ‘control freak” who must have their own way
• Prevalence of Obsessive-Compulsive PD is about 1 percent and this disorder is co-morbid with avoidant PD
Anxious/Fearful Cluster
Ch 13.14
Dimensional vs. Categorical– Problem of Degree?– Problem of Kind?
DSM-IV– Categorical View– Axis II– Ten Types
Dimensional vs. Categorical– Problem of Degree?– Problem of Kind?
DSM-IV– Categorical View– Axis II– Ten Types
Dimensional Approach to Personality Disorders
• Five-Factor Model (McRae & Costa, 1990)– Neuroticism
– Extroversion/introversion
– Openness to experience
– Agreeableness/antagonism
– Conscientiousness
• Relationship of PDs to FFM (Widiger & Costa, 1994)• Advantages of dimensional model
– Handles the comorbidity problem
– Makes a link between normal and abnormal personality
– Supported by behavior-genetic and statistical techniques
Therapies for Personality Disorders
• Therapists treating PD patients are concerned about co-morbid Axis I disorders
• Therapy modalities include:– Antianxiety or antidepressant drugs– Psychodynamic therapy aims to change the person’s understanding of the
childhood problems that underlie the PD– Behavioral and cognitive therapy focuses on specific symptoms and issues (e.g.
social skills)
• Overall therapeutic goal: change the “disorder’ into a “style”, except for ASPD (D&N, p.377)– Recent meta-analysis show promising results with CBT for younger
psychopaths.
Ch 13.15