Personality Disorders

Personality Disorders Abnormal Psychology Chapter 11 Mar 26-31, 2009 Classes #20-21

Personality Disorders • Diagnosed on AXIS-II of DSM-IV: • Cluster A: Odd; Eccentric • Paranoid personality disorder • Schizoid personality disorder • Schizotypal personality disorder • Cluster B: Dramatic; Erratic; Emotional • Antisocial Personality Disorder • Histrionic Personality Disorder • Narcissistic Personality Disorder • Borderline Personality Disorder • Cluster C: Anxious; Fearful • Avoidant Personality Disorder • Dependent Personality Disorder • Obsessive-Compulsive Personality Disorder

FEATURES OF PERSONALITY DISORDERS • Early onset • Evident at least since late adolescence • Stability • No significant period when not evident • Pervasive • Evident across a wide range of personal, social, and occupational situations • Clinically significant maladaptive behavior • Personal distress or impairment in social and occupational functioning

Etiology • The cause of personality disorders is unknown • Some links we’ll be given here

ODD OR ECCENTRIC BEHAVIOR • Paranoid personality disorder • Schizoid personality disorder • Schizotypal personality disorder

Paranoid Personality Disorder • Diagnosis • Paranoid personality disorder is characterized by a pervasive distrust of others and a constant suspicion that people around you have sinister motives

Onset and Prevalence • Usually begins by early adulthood and present in a variety of contexts • Males: 3.5% • Females: 2%

Complications • Since these individuals often keep to themselves and rarely become intimate with others, their unusual ideas often remain unnoticed • They rarely seek clinical help

Etiology • Unknown • Genetic link: • Incidence appears increased in families with a schizophrenia patient

Treatment • Treatment of paranoid personality disorder can be very effective in controlling the paranoia but is difficult because the person may be suspicious of the doctor • Medications for paranoid personality disorder are generally not encouraged, as they may contribute to a heightened sense of suspicion that can ultimately lead to patient withdrawal from therapy

Prognosis • Poor • Without treatment this disorder will be chronic • Long-term psychoanalysis can lead to some improvement

Schizoid Personality Disorder • People with schizoid personality disorder avoid relationships and do not show much emotion • They genuinely prefer to be alone and do not secretly wish for popularity • They tend to seek jobs that require little social contact • Withdrawn and reclusive • Their social skills are often weak and they do not show a need for attention or acceptance • They are perceived as humorless and distant and often are termed "loners

Onset and Prevalence • Late adolescence to early adulthood • Approximately 2% of total population with slight gender difference (M > F)

Etiology • Genetic link to schizophrenia

Treatment • People with the disorder rarely seek treatment • Treatment can be difficult because of initial reduced capacity or desire to form a relationship with a health professional • Medications are not effective

Prognosis • Poor • Survey results of psychologists: • About 75% felt either they couldn’t provide therapy/untreatable or felt that patients wouldn’t follow treatment recommendations

Schizotypal Personality Disorder • The disorder is characterized by odd forms of thinking, perceiving, and communicating • Individuals with this disorder often seek isolation from others • They sometimes believe they have extra sensory or magical abilities • They generally engage in eccentric behavior and have difficulty concentrating for long periods of time • Their speech is often over elaborate and difficult to follow • Individuals with this disorder often seek isolation from others

Onset and Prevalence • Usual onset is in early adulthood • About 3% of general population • Slightly M > F • Increased prevalence among relatives of people with schizophrenia

Complications • 30-50% also have major depressive disorder • Some may develop schizophrenia • Eating disorders are not uncommon with schizotypal

Etiology • Genetic link to schizophrenia

Treatments • Behavioral • Social skills training • Accept/adjust to solitary life style • Physiological • Some improvement with Haldol • Many stop due to side effects

Prognosis • Poor • Relatively stable • Very small proportion will go on to develop schizophrenia or another psychotic disorder

Dramatic or Emotional Personality Disorders • Antisocial Personality Disorder • Histrionic Personality Disorder • Narcissistic Personality Disorder • Borderline Personality Disorder

Antisocial Personality Disorder • Terminology • Psychopath; Sociopath; Antisocial Personality Disorder • Probably a universal disorder • Sex Difference: • 3% males • Less than 1% females • Occurs about equally in all ethnic groups, cultures, historical periods • Most research with criminals, but it may occur in non-forensic populations

Clinical Description of the Psychopath • Egocentric, arrogant, deceitful, shallow, impulsive individuals who callously use and manipulate others with very little or no sense of shame, guilt, remorse • Often violent • Unguided by dictates of "conscience" • Lack of empathy; only an abstract, intellectual awareness of others feelings • No loyalty to any person, group, code, organization, or philosophy; self-interest

Clinical Description of the Psychopath • Human predators • Others exist only as emotional, psychical, and financial prey with no rights of their own • Look for places where there is opportunity for easy money, power, control, prestige • Prey on the vulnerable • Psychopathy is associated with pleasure and thrill-seeking behavior

Ted Bundy: The classic example

Physiological Explanations • Brain activity • Deficient Arousal Activity • Relative immunity to stimulation • Stressful situations are nothing to them • Genetic Influence • Psychologists are unsure • Neurochemistry • Low levels of serotonin

Behavioral Explanations • Family Relationships • Early parental loss • Parental rejection • Childhood history of conduct disorder

Treatments • Intensive individual psychotherapy or cognitive behavioral therapy is used • Try to get patient to develop a sense of trust • Usually doesn’t happen • Group psychotherapy • Try to get patient to develop a sense of trust • Usually doesn’t happen • Medications are not effective

Prognosis • Poor • No treatments are effective • Usually a lifetime disorder

Histrionic Personality Disorder • These people show a pattern of emotionality and attention-seeking • Begins in early adulthood • Use physical appearance to draw attention to oneself • The cause of this disorder is unknown, but learned and inherited characteristics may play a role • Gender difference: • F>M

Etiology • Behavioral link: • There has been evidence and research clearly indicating past history of sexual abuse and/or being alienated by parents as a child • This alienation usually takes the form of emotional alienation, and that love is really not there for them • These children grow up seeking and desperately needing attention at all costs

Treatments • Long-Term Psychotherapy • These individuals do not want to address or deal with their issues because their issues have provided them some secondary gain • It is very difficult to stop maladaptive behavior when it does reward or give the individual something back • Medication is generally not prescribed and is of minimal benefit

Prognosis • Poor • Treatment is very difficult • Confrontation in therapy is not unusual • A high rate of these individuals will drop out of therapy

Narcissistic Personality Disorder • A disorder of the personality characterized by self-centeredness, being self-absorbed, and an inability to empathize with the effects of one’s behavior on others • This disorder usually begins by early adulthood • Gender difference: • M > F • The cause of this disorder is unknown

Etiology • Unknown • At present there are two major theories about the origin and nature of NPD • Neglectful parents (behavioral) • The other regards it as a young child's defense against psychological pain (psychodynamic)

Treatments • Long-term Psychotherapy • Individual • Group therapy • Goal here is to achieve empathy • Therapist should be less authoritative in these sessions but address a patients grandiosity in next individual setting • Note: Drug treatments not effective

Prognosis • Very slow process

Borderline Personality Disorder • An individual trait that reflects ingrained, inflexible, and maladaptive patterns of behavior characterized by impulsive and unpredictable actions, mood instability, and unstable interpersonal relationships • They view themselves as victims of circumstances and take little responsibility for themselves or for their problems • The person with a borderline personality is impulsive in areas that have a potential for self-destruction

Prevalence • Officially recognized as a diagnosis in 1980 • Estimated to occur in 3%-5% of the general population • Tends to occur more often in women • Some research indicates twice as often

Defining Characteristic… • Instability • Interpersonal relationships • Very stormy and that’s putting it mildly • Emotionally • Major mood shifts • Identity • Endless search for self • Behaviorally • Unstable in every way • Thought processes • Unusual perceptions

Symptoms • Kernberg (1975) • They view the whole world as "all good" or "all bad“ • All people, all experiences, and their self are viewed in extremes • They cannot grasp the concepts of moderation or something being "all right", OK, average, or ordinary

Causes • The exact cause of borderline personality disorder is not known • However, several psychological hypotheses rely on biological, social, and psychological factors to understand people with this disorder

Behavioral Explanations • Attachment experiences in early childhood • Parent or parent’s not paying enough attention to the child’s feelings • Parental abuse (sexual and physical) • Divorce • Alcoholism

Physiological Explanation • Need more research here but it seems there is too much brain activity with these individuals • Dopamine levels too high

Psychodynamic Treatments • These therapists try “face to face” psychotherapy three times a week continually ranging over several years • Emphasis on present behavior in beginning of sessions rather than childhood experiences • Be careful of transference

Cognitive-Behavioral Treatment • Dialectical Behavior Therapy • See handout

Drug Therapy • Make use of various types of medication… • Mood stabilizers such as lithium • Antidepressants • Low-dose neuroleptics • These drugs reduce brain activity • Reduce dopamine levels • Medication is mildly effective by itself

Prognosis • Poor outcome… • Tend to remain the same over time • Borderline’s with high socioeconomic status along with intensive treatment tend to improve in their interpersonal relationships • Most will attempt suicide • 8%-10% will commit suicide • Alcohol abuse is high among those with borderline personality disorders

Personality Disorders