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Personality DisordersPersonality Disorders
Chapter 11Chapter 11
An Overview of Personality Disorders
• Personality disorders– Enduring maladaptive patterns of perceiving, relating
to, and thinking about the environment and oneself, exhibited in a wide range of contexts that cause significant functional impairment or subjective distress (some individuals do not feel distressed)
• Not well responsive to treatment• 0.5% to 2.5% of general population • Originate in childhood and continue into the
adult years• High comorbidity
An Overview of Personality Disorders
• Cluster A – The “odd” or “eccentric”– Paranoid– Schizoid– Schizotypal
• Cluster B – The “dramatic”, “emotional” or “erratic”– Antisocial– Borderline– Histrionic– Narcissistic
• Cluster C – The “anxious” or “fearful”– Avoidant– Dependent– Obsessive-compulsive
Paranoid Personality Disorder
• Involves pervasive distrust and suspiciousness of others (extends to people close to them, very sensitive to criticism)
• Combination of biological (more common among relatives of people suffering with schizophrenia), psychosocial (parents) and cultural (prisoners, refugees, people with hearing impairments, elderly) factors
• Unlikely to seek professional help
Schizoid Personality Disorder
• Pervasive pattern of detachment from social relationships and limited range of emotions in interpersonal situations
• Possibly caused by lower density of dopamine receptors in combination with psychological factors
• Treatment involves social skills training but very few would seek help
Schizotypal Personality Disorder
• Socially isolated but also behave in unusual ways, tend to be suspicious and have odd beliefs (small proportion develops schizophrenia)
• Possibly phenotype of schizophrenia genome (milder form)
• Caution – different cultural beliefs can lead to a mistaken diagnosis
• Almost a half suffers also from depression• Treatment often involves social skills training
and medication
Antisocial Personality Disorder
• Pervasive pattern of disregard for and violation of the rights of others, deceitful, irresponsible, impulsive, lack of empathy Y-Antisocial
• Psychopathy partially overlaps with APD but is defined in terms of personality traits (superficial charm, manipulative etc.) rather than overt behavior
• Not all people with psychopathy or APD are criminals (only about 15% predominantly low IQ)
• Interaction between genes and environmental influence• Neurobiological theories
– The Underarousal Hypothesis– The Fearlessness Hypothesis (conditioning)
• Treatment is not very successful but prevention programs (parenting skills, family support programs) are promissing
Borderline Personality Disorder
• Pervasive pattern of instability of interpersonal relationships, self-image, affects, lack of control over impulses (75% are women)
• Possible contribution of early trauma (abuse) – similar to PTSD in some individuals
• Treatment– Dialectical behavior therapy (learning to cope with
stressors)
Histrionic Personality Disorder
• Pervasive pattern of excessive emotional and attention seeking behavior
• Histrionic personality and antisocial personality may be sex-typed alternative expressions of the same underlying condition
• Treatment– Modification of the attention-seeking behavior
and improving relationships
Narcissistic Personality Disorder
• Pervasive pattern of grandiosity in fantasy or behavior, need for admiration, and lack of empathy
• Possible cause– Parent’s failure of empathic “mirroring” in
development• Increasing prevalence in Western cultures
(emphasis of short-term hedonism, individualism, competitiveness, and success)
• Therapy focuses on grandiosity, hypersensitivity to evaluation, lack of empathy, relaxation
Avoidant Personality Disorder
• Pervasive pattern of social inhibition, feelings of inadequacy, and hypersensitivity to criticism (fear of rejection)
• Difficult temperament combined with parental rejection (problem with retrospective studies)
• Treatment involves systematic desensitization and behavioral rehearsal
Dependent Personality Disorder
• Pervasive and excessive need to be taken care of (submissive and clinging behavior, fear of separation, need for reassurance etc.)
• Possible cause– Interruption of early bonding can cause people to be
anxious that they will lose people close to them
• Therapy focuses on learning to make decisions independently and developing confidence
Obsessive-Compulsive Personality Disorder
• Pervasive pattern of preoccupation with orderliness, perfectionism, and mental and interpersonal control at the expense of flexibility, openness, and efficiency (leads to procrastination)
• Many serial killers have obsessive-compulsive personality disorder (controlling all aspects of the crime)
• Weak genetic contribution, parental reinforcement