Personality Disorders

1. Personality Disorders

2. What is meant by the concept of Personality?

3. Aspects to the concept ‘Personality’ • Identity • Social skill • Impression created in others • Temperament • Essence • Patterns of perceiving,understanding and behaving in a social context

4. Definition and Theory of ‘Personality’ • “personality is defined by the particular concepts that are part of the theory of personality used by the observer” Hall and Lindzey (1957, p. 9)

5. Goals of Personality Theory • Kluckhohn & Murry (1953) • every human being is (1) like every other human being; (2) like some other human beings; and (3) like no other human being

6. Personality Disorders • Clinical Features of Personality Disorders: • social, interpersonal concept • chronic, persistent and pervasive • often do not see themselves as having a problem • involve others

7. Personality Disorders • Clinical Features of Personality Disorders: • inability to bring themselves into harmony with the social world, and use rigid, maladaptive behviour/interpersonal patterns to avoid negative emotions • lack authentic, straight-forward expressions of needs and desires

8. Five Criteria • Two of the following areas must be disrupted: cognition, affectivity, interpersonal, or impulse control. • Enduring, inflexible and pervasive • Distress • Early onset • Not better accounted for by an other mental disorder

9. DSM-IV Definition • “an enduring pattern of inner experience and behaviour that deviates markedly from the expectations of the individual’s culture, is pervasive and inflexible, has an onset in adolescence or early adulthood, is stable over time, and leads to distress or impairment”

10. Reliability

11. Paranoid Personality Disorder • Suspiciousness • Not seen in therapy very often • may have a genetic link to schizophrenia

12. Schizotypal Personality Disorder • Odd, socially eccentric • Unusual thoughts/beliefs/perceptions

13. Schizoid Personality Disorder • Social detachment, flat affect • Anhedonia • Does not seem to be biologically related to Schizophrenia

14. Borderline Personality Disorder • Difficulties establishing a secure self-identity • Extreme ambivalence towards others • Impulsive, and self-destructive behaviour • Poor emotional regulation

15. Histrionic Personality Disorder • Self-dramatization • Exaggerated display of emotion • See themselves as “sensitive” often perceived by others to be “shallow/insecure”

16. Narcissistic Personality Disorder • Grandiose sense of self importance • Overly concerned with how others view them

17. Avoidant Personality Disorder • Social withdrawal (want to be loved, but expect to be rejected)

18. Dependent Personality Disorder • Fearful and incapable of making independent decisions/actions • Self-effacement

19. Obsessive-Compulsive Personality Disorder • Preoccupation with orderliness, perfectionism, efficiency and control • Little spontaneity and experienced pleasure

20. Comorbidity • Rare in general population, but common in clinical population • Most do not seek help for PD • Treatment is sought for specific problem, and PD is identified during treatment

21. Understanding Personality Disorders

22. Meta-Approaches to understanding personality disorders • Extreme variation of normal personality • Less acute versions of Axis I disorders • Origin of Axis I disorders • Personality and Psychopathology Theory

23. Extreme variation of normal personality • Five factor dimensional model of personality • Extroversion • Agreeableness • Conscientiousness • Neuroticism • Openness

24. Less acute versions of Axis I disorders • Early stages or less severe • Schizotypal and Schizophrenia

25. Origin of Axis I disorders • Personality disorders are the root of all other Axis I difficulties

26. Psychodynamic Approach • Disturbed object relations (representations of self and others) and unstable sense of self • Weak ego functioning • Kohut (Narcissistic Personality Disorder) • lack love, approval and empathic responses from caretakers

27. Psychodynamic Approach • Kernberg (Borderline Personality Disorder) • splitting • Individuation • Introjection

28. Research inspired by psychodynamic theory • Feldman et al. (1999) • maternal synchrony with infant affect at 3 months and mutual synchrony at 9 were related to self-control at 2 years (stronger relation seen in difficult infants) • Weston et al. (1990); Nigg et al. (1992) • individuals with BPD remember and perceive themes of malevolence

29. Cognitive Approach • Negative beliefs about self, other and environment • eg Beliefs of an individual with BPD include: the world is dangerous and malevolent, I am vulnerable and powerless, I am unacceptable to others. • Unlike Axis I disorders these schemas develop early

30. Cognitive Approach • Unlike psychodynamic approach, less emphasis on how, or why maladaptive schemas arise • Padesky (1987) • avoidant personality disorder- past history of critical and shaming parents - “I must be a bad, undesirable person to be treated so badly.” “If my parents don’t love me nobody will.”

31. Differences between Psychodynamic and Cognitive Explanations • Content of experience vs Constituting of experience • Different concept of self: • Negative view of self vs Unstable, incoherent experience of self as an entity, and as a perspective from which to view the world.

32. Family Systems Approach • Poor parenting (lack of affection, inconsistent and rejecting) • Retrospective and Prospective studies • Caution

33. Behavioural Approach • Defective capacity to learn • Failure to develop social skills and emotional regulation skills • Learn dysfunctional behaviours

34. Biological Approach • Biological abnormalities • Family studies suggest genetic involvement in Schizotypal and Borderline (equivocal) • Look at genetic and neurotransmitter involvement in traits like impulsivity and sociability

35. Integrative Causal Models • Millon (1983) Biosocial Model • constitutional differences set the stage for subsequent learning and experiences • how caretakers respond to a child’s disposition (dimensional) is critical