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