PERSONALITY DISORDERS
Chronic, rigid, and maladaptive patterns of behaviour
- Cause personal distress, social problems, and occupational problems
- Interfere with a persons ability to leady a satisfying life.
- The personality disorder is ingrained in the individuals psychological
make-up
- Persons with personality disorders are generally not aware or have poor
insight that they are the cause of their own problems.
- Persons with personality disorders do not have frank psychotic
symptoms.
- They do not seek psychiatric help and are very resistant to change.
- Personality disorders originate in childhood and continue into the adult
years.
- Significant comorbidity:
- About half of the people diagnosed with a personality disorder
also meet the criteria for another personality disorder.
- Gender bias: Knowledge of whether the client is male or female can
influence whether a client receives one personality disorder diagnosis
over another.
-
- More females are diagnosed with a borderline and histrionic
personality disorders.
- More males are diagnosed with antisocial and narcissistic
personality disorders.
CLASSIFICATION
- Personality disorders with similar characteristics are categorized by the
DSM into clusters.
- Each cluster has its own
- hallmark characteristics and
- genetic/familial associations (e.g., relatives of people with PDs
have a higher likelihood of having certain disorders)
- The clusters:
- Cluster A includes 3 personality disorders: Paranoid, Schizoid,
and Schizotypal
- Hallmark characteristics:
- Avoids social relationships
- Peculiar but not psychotic
- Genetic/familial associations:
- Psychotic illnesses
- Cluster B includes 4 personality disorders: Histrionic,
Narcissistic, Borderline, and Antisocial
- Hallmark characteristics:
- Dramatic
- Emotional
- Inconsistent
- Genetic/familial associations:
- Mood disorders
- Substance abuse
- Somatoform disorders
- Cluster C include 3 personality disorders: Avoidant,
Dependent, and Obsessive-compulsive
- Hallmark characteristics:
- Fearful
- Anxious
- Genetic/familial associations:
- Anxiety disorders
- Not otherwise specified (NOS): passive-aggressive: a person with
a passive aggressive PD procrastinates and is inefficient. While
outwardly agreeable and compliant, he is inwardly angry and
defiant.
- For the DSM diagnosis, a personality disorder must be present by early
adulthood.
Cluster A personality disorders: Paranoid, Schizoid, Schizotypal
PARANOID PERSONALITY DISORDER
- Involves the symptoms of paranoia, in which the individual is distrustful,
suspicious, guarded, and vigilant toward other people
- Interprets the motives of others as malicious and believes that others
intend to do them harm.
- Blame others for their own problems
- Psychoanalytic explanations
- Heavily uses the defense mechanism called projection.
- Cognitive-behavioral perspective
- Paranoia is a product of the mistaken assumptions that
- Other people are potentially harmful
- Cognitive-behavioural therapy involves
- Countering the clients mistaken assumptions.
- Schizoid and Schizotypal personality disorders
- Involve schizophrenic-like qualities but without the very disturbed
thinking that characterizes schizophrenia itself.
- Some psychologists view these disorders as variants of
schizophrenia rather than as separate disorders.
- to schizophrenia.
SCHIZOID PERSONALITY DISORDER
- The schizoid individual
- Has an aversion to close relationships
- Feels detached from others
- Lacks empathy for the feelings of others
- Long-standing pattern of voluntary social withdrawal
- Usually leads an isolated and secluded lifestyle.
- Shows restricted emotions
- Has no thought disorder like in schizophrenia
- The individual with schizotypal personality disorder
- Has odd, bizarre, and unusual ways of reacting to others and viewing the
world.
- Has odd thought patterns
- Magical thinking (i.e., believing that ones thoughts can affect the
course of events)
- No frank psychosis such as in schizophrenia
- Treatment for the schizoid and schizotypal personality disorders is difficult
because of their avoidance of human interaction and their strange ways of
thinking.
Cluster B personality Disorders: Histrionic, Narcissistic, Borderline, and
Antisocial
HISTRIONIC PERSONALITY DISORDER
- Characterized by excesses of emotionality
- People with histrionic PD tend to be very theatrical, extroverted, and
enjoy being the center of attention. They are perceived as the life of
the party.
- Often they are flirtatious, sexually provocative, seductive, and vain.
- Their involvement with others tends to be very superficial and shallow,
and thus, they cannot maintain intimate relationships
- People with histrionic personality disorder exhibit stereotyped sex-role
behaviours.
NARCISSISTIC PERSONALITY DISORDER
- Narcissistic personality disorder is
- Characterized by excesses of egocentrism.
- Narcissistc individuals are self-centered, feel that they are privileged
people, have a sense of special entitlement, and expect to be the focus
of attention.
- Lacks empathy for others
- Psychodynamic theories explain that narcissistic people have unresolved
conflicts around sexuality.
- Psychodynamic therapy will focus on parents deficient or excess
attention for the individuals accomplishments as a child.
- The cognitive-behavioral therapist would try to reduce the clients
arrogance and increase the sense of empathy for others.
-
BORDERLINE PERSONALITY DISORDER
- Borderline personality disorder is
- Characterized by a poor sense of self or confused self-identity.
- Their view of people swings from idealization to devaluation
- Moody, and at times violent, acting in ways that are harmful to
themselves or others.
- Erratic, impulsive, unstable behaviour and mood
- Feeling bored, alone, and empty
- Attempts suicide for relatively trivial reasons
- e.g., self-mutilation by cutting or burning oneself
- Often comorbid with mood and eating disorders
- Has mini-psychotic episodes (i.e., brief periods of paranoia or
hallucinations)
- Theoretical explanations of borderline PD focus on problems in the early
childhood development of the self.
- Psychodynamic theorists
- BPD results from inadequate parenting in which the individual
was not nurtured as a separate, autonomous (independent) being.
- Some researchers believe that childhood neglect and abuse is
linked to the development of BPD.
- From a cognitive-behavioral perspective
- People with BPD hold unrealistic views of themselves and others
as either all good or all bad.
- Treatment of people with BPD is difficult and challenging, sometimes requiring
inpatient care.
- There is debate about whether to focus more on confrontational or
supportive approaches.
- Most clinicians agree that therapy should
- Help the client become more emotionally stable and predictable
- Help the client establish a sense of identity
- Help the client abandon self-destructive behaviors.
ANTISOCIAL PERSONALITY DISORDER
- A person with antisocial personality disorder
- Disregards or refuses to conform to social norms, laws, and moral
standards of society
- Shows no concern for others
- Engages in criminal behaviour.
- Associated with conduct disorder in childhood and criminal behaviour
(sociopathy) in adulthood
- Biological theories propose that people with antisocial personality
disorder are physiologically different from others in
- their ability to learn from the negative consequences of their
behaviour, and
- in their physiological arousal patterns.
- May run in the genes
- Many antisocial individuals grew up in homes with
- inconsistent discipline,
- an impoverished standard of living, or
- an absentee parent.
- Antisocial PD cannot be diagnosed until age 18.
- Prior to this age, the diagnosis is conduct disorder.
- Treatment of antisocial personality disorder is very difficult
- They lack of incentive to seek help voluntarily.
- When such individuals do come to treatment, the clinicians goal is
to help them develop empathy or sensitivity for others.
Cluster C personality disorders: Avoidant, Dependent, and Obsessive-compulsive
- Avoidant and Dependent personality disorders
- Represent two extremes of relating to people.
- The avoidant individual shuns contact with others, while the
dependent individual cannot survive without other peoples help and
support.
AVOIDANT PERSONALITY DISORDER
- The avoidant personality
- Harbours feelings of inferiority
- Is easily offended by criticism and rejection, and
- Socially withdraws from others
- Both schizoid and avoidant personalities avoid interaction with people.
The difference is that
- For the avoidant personality, it is due to a fear of criticism and
rejection by others
- For the schizoid personality, he is comfortable being alone and
does not care whether people criticize or reject him
DEPENDENT PERSONALITY DISORDER
- Dependent individuals rely excessively on other people, thus they may lack
the skills and abilities to handle problems and life tasks on their own.
- Allows other people to make decisions for them
- Poor self-confidence, fear of being left on her own
- For fear of being abandoned, she may even tolerate abuse by
domestic partner
- Psychodynamic therapists believe that there was a disturbance in the
individuals early attachment patterns with his or her caregivers.
- Cognitive-behavioral therapy involves breaking the negative cycles of
erroneous beliefs.
OBSESSIVE-COMPULSIVE PERSONALITY DISORDER
- Obsessive-compulsive and passive-aggressive personality disorders have
conflicts regarding the issue of control. While obsessive-compulsive
personalities are control freaks, passive-aggressive personalities resist
being controlled.
- Individuals with obsessive-compulsive personality disorder are
- Perfectionistic
- Orderly
- Inflexible and stubborn.
- Unreasonably concerned about unimportant details of life.
- The individual becomes set on rigid rules and routines
- Indecisive, unable to make decisions without a great deal of
vacillation and uncertainty, and may therefore become
inefficient at accomplishing tasks
- People with obsessive-compulsive personality disorder fear
the consequences of making a mistake, because their self-
esteem hinges on seeing themselves a perfect.
- People with obsessive-compulsive personality disorder fear
the consequences of making a mistake, because their self-
esteem hinges on seeing themselves a perfect. Treatment of
obsessive-compulsive personality disorder can be successful if
the therapist can avoid feeding into the clients ruminative
tendencies.
OTHER PERSONALITY DISORDERS
- Personality Change due to Another Medical Condition
- In the past, clinicians have also described 4 other personality disorders:
passive-aggressive (negativistic), sadistic, self-defeating, and depressive
personality disorders
- Passive-aggressive (Negativistic):
- Unlike people who are obsessive-compulsive about
complying with rules and regulations, people who are
passive-aggressive ignore rules and regulations, and like to
do things at their own time and in their own way.
- Negativistic or Passive-aggressive individuals experience a
great deal of anger but express their anger indirectly,
usually causing considerable annoyance to other people.
- According to the cognitive-behavioral perspective, people
with passive-aggressive personality disorder have a fear of
being rejected if anger is expressed directly.
- Negativistic or Passive-aggressive personality disorder
is more difficult to treat, because the individual constantly
thwarts the therapists best efforts.
- Sadistic personality disorder has been suggested for persons
who receive pleasure by inflicting pain on others.
- Self-defeating personality disorder has been suggested for
persons who are overly passive and accept the pain and suffering
imposed by others.
- Depressive personality disorder includes persons that
experience self-criticism, self-dejection, a judgmental stance
toward others, and a tendency to feel guilt.
- Both the cognitive-behavioral and psychodynamic approaches offer the most
viable and reasonable explanations for the understanding of personality
disorders.
- Biological research on temperament suggests that personality disorders
may have a physical or genetic basis.
- For those who seek help, individual and group psychotherapy may be useful.
- Pharmacotherapy also can be used to treat symptoms, such as depression and
anxiety, which may be associated with the PDs.
