5-Personality Disorders.pdf - PERSONALITY DISORDERS WHAT IS PERSONALITY A unique and long-term pa*ern of inner experience and outward behavior tends to

5-Personality Disorders.pdf - PERSONALITY DISORDERS WHAT IS...

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Unformatted text preview: 4/23/14 PERSONALITY DISORDERS ì WHAT IS PERSONALITY? ì  A unique and long-­‐term pa*ern of inner experience and outward behavior ì  tends to be consistent and is o5en described in terms of “traits” ì  These traits may be inherited, learned, or both ì  Also flexible ì  allows us to adapt to new environments ì  For those with personality disorders, however, that flexibility is usually missing WHAT IS PERSONALITY DISORDER? ì  An inflexible pa;ern of inner experience (thoughts & emoFons) and outward behavior ì  This pa*ern is seen in most interac<ons, differs from the experiences and behaviors usually expected, and conFnues for years ì  The rigid traits of people with personality disorders are maladap<ve for the individual or for people around him/her ì  These rigid pa*erns o5en lead to psychological pain for the individual and social or occupaFonal difficulFes ì  The disorder may also bring pain to others 1 4/23/14 CLASSIFICATION ì  Personality disorders are diagnosed on Axis II of the DSM-­‐IV-­‐TR ì  These pa*erns are not typically marked by changes in intensity or periods of clear improvement ì  Those diagnosed with personality disorders are o5en also diagnosed with an Axis I disorder ì  “Comorbidity” ì  Axis II disorders may predispose people to develop an Axis I disorder, or Axis I disorders may set the stage for Axis II disorders, or some biological condiFon may set the stage for both! ì  Research & clinical observaFons indicate that the presence of a personality disorder complicates and reduces a person’s chances for a successful recovery CLASSIFICATION ì  These are among the most difficult psychological disorders to treat ì  Many sufferers are not even aware of their personality disorder ì  It has been esFmated that 9% to 13% of all adults may have a personality disorder 2 4/23/14 CLASSIFICATION The DSM-­‐IV-­‐TR idenFfies ten personality disorders and separates these into three categories or “clusters”: CLUSTER A: Odd or eccentric behavior •  Paranoid, •  Schizoid, and •  Schizotypal personality disorders CLUSTER B: Drama<c, emo<onal, or erra<c behavior •  AnFsocial, •  Borderline, •  NarcissisFc, and •  Histrionic personality disorders CLUSTER C: Anxious or fearful behavior •  Avoidant, •  Dependent, and •  Obsessive-­‐ compulsive personality disorders CLASSIFICATION l  Cluster A: Odd-­‐Eccentric Personality Disorders l  Symptoms similar to those for schizophrenia, including inappropriate or flat affect, odd thought and speech pa*erns, paranoia. People with these disorders maintain their grasp on reality, however. l  Cluster B: DramaFc EmoFonal Personality Disorders l  ManipulaFve, volaFle(unbalanced), and uncaring in social relaFonships. Impulsive, someFmes violent behavior that show li*le regard for their own safety or the safety or needs of others l  Cluster C: Anxious-­‐Fearful Personality Disorders l  Extremely concerned about being criFcized or abandoned by others and thus have dysfuncFonal relaFonships with them. CLASSIFICATION Problems ì  Symptoms described are o5en only extreme versions of otherwise “normal” traits. ì  Diagnosing a personality disorder o5en requires informa<on that is hard for a clinician to obtain. ì  The various personality disorders overlap each other so much that it can be difficult to dis<nguish one from another ì  The frequent lack of agreement between clinicians and diagnosFcians has raised concerns about the validity (accuracy) and reliability (consistency) of these categories ì  It should be clear that diagnoses of such disorders can easily be overdone ì  Conceptualized as stable characteris<cs, yet they vary, so individuals go in and out of the diagnosis 3 4/23/14 CLASSIFICATION Problems ì  Difficul<es in diagnosing personality disorders are caused by a number of factors, including ì  DiagnosFc criteria are not as sharply defined as for other Axis I categories ì  DiagnosFc categories are not mutually exclusive ì  Personality characterisFcs are dimensional in nature CLASSIFICATION Problems ì  These difficulFes also lead to difficul<es in studying the causes of personality disorders: ì  The fact that such disorders have received consistent a*enFon only since DSM-­‐III was published in 1980 ì  The fact that these disorders are less amenable to thorough study ì  The fact that most studies to date are retrospec<ve “ODD”Personality Disorders CLUSTER A Odd or eccentric behavior •  Paranoid, •  Schizoid, and •  Schizotypal personality disorders 4 4/23/14 “ODD”Personality Disorders ì  People with these disorders display behaviors similar to, but not as extensive as, schizophrenia ì  Behaviors include extreme suspiciousness, social withdrawal, and peculiar ways of thinking and perceiving things ì  Such behaviors leave the person isolated ì  Some clinicians believe that these disorders are actually related to schizophrenia, and thus call them “schizophrenia-­‐spectrum disorders” “ODD”Personality Disorders Paranoid personality disorder Chronic and pervasive mistrust and suspicion of other people that is unwarranted and maladapFve. Weak Schizoid personality disorder Chronic lack of interest in and avoidance of interpersonal relaFonships, emoFonal coldness toward others. Schizotypal personality disorder Chronic pa*ern of inhibited or inappropriate emoFon and social behavior, aberrant (atypical) cogniFons, disorganized speech. Relationship to Schizophrenia Strong Paranoid Personality Disorders *Note: Four or more of the following Paranoid personality disorder symptoms must be met for an official diagnosis: 1) suspects, without sufficient basis that others are exploiFng, harming, or deceiving him or her 2) is preoccupied with unjusFfied doubts about the loyalty or trustworthiness of friends or associates 3) is reluctant to confide in others because of unwarranted fear that the informaFon will be used maliciously against him or her 4) reads hidden demeaning or threatening meanings into benign remarks or events 5) persistently bears grudges, i.e., is unforgiving of insults, injuries, or slights 6) perceives a*acks on his or her character or reputaFon that are not apparent to others and is quick to react angrily or to countera*ack 7) has recurrent suspicions, without jusFficaFon, regarding fidelity of spouse. 5 4/23/14 Paranoid Personality Disorders ì  This disorder is characterized by deep distrust and suspicion of others ì  Although inaccurate, the suspicion is usually not “delusional” – the ideas are not so bizarre or so firmly held as to clearly remove the individual from reality ì  As a result of their mistrust, people with paranoid personality disorder o5en remain cold and distant Paranoid Personality Disorders ì  They are cri<cal of weakness and fault in others, parFcularly at work ì  They are unable to recognize their own mistakes and are extremely sensiFve to criFcism ì  They o5en blame others for the things that go wrong in their lives and they repeatedly bear grudges ì  Between 0.5% and 3% of adults are believed to experience this disorder, apparently more men than women Paranoid Personality Disorders EXPLANATION ì  The proposed explanaFons of this disorder, like those of most other personality disorders, have received li*le systemaFc research ì  Psychodynamic theorists trace the pa*ern back to early interacFons with demanding parents ì  Cogni<ve theorists suggest that maladapFve assumpFons such as “People are evil and will a*ack you if given the chance” are to blame ì  Biological theorists propose geneFc causes and have looked at twin studies to support this model 6 4/23/14 Paranoid Personality Disorders TREATMENT ì  People with paranoid personality disorder do not typically see themselves as needing help ì  Few come to treatment willingly ì  Those who are in treatment o5en distrust and rebel against their therapists ì  As a result, therapy for this disorder, as for most of the other personality disorders, has limited effect and moves slowly Paranoid Personality Disorders TREATMENT ì  Object rela<ons therapists try to see past the paFent’s anger and work on the underlying wish for a saFsfying relaFonship ì  Behavioral and cogni<ve therapists try to help clients control anxiety and improve interpersonal skills ì  CogniFve therapists also try to restructure clients’ maladapFve assumpFons and interpretaFons ì  Drug therapy is of limited help Schizoid Personality Disorders *Note: Four or more of the following Schizoid personality disorder symptoms must be met for an official diagnosis. 1. Neither desires nor enjoys close relaFonships, including being part of a family 2. Almost always chooses solitary acFviFes 3. Has li*le, if any, interest in having sexual experiences with another person 4. Takes pleasure in few, if any, acFviFes 5. Lacks close friends or confidants other than first-­‐degree relaFves 6. Appears indifferent to the praise or criFcism of others 7. Shows emoFonal coldness, detachment, or fla*ened affect 7 4/23/14 Schizoid Personality Disorders ì  This disorder is characterized by persistent avoidance of social rela<onships and limited emo<onal expression ì  Withdrawn and reclusive, people with this disorder do not have close Fes with other people; they genuinely prefer to be alone ì  People with schizoid personality disorder focus mainly on themselves and are o5en seen as flat, cold, humorless, and dull ì  The disorder is esFmated to affect fewer than 1% of the populaFon ì  It is slightly more likely to occur in men than in women Schizoid Personality Disorders EXPLANATIONS ì  Many psychodynamic theorists, parFcularly object rela+ons theorists, link schizoid personality disorder to an unsa<sfied need for human contact ì  The parents of those with the disorder are believed to have been unaccepFng or abusive of their children ì  Cogni<ve theorists propose that people with schizoid personality disorder suffer from deficiencies in their thinking ì  Their thoughts tend to be vague and empty, and they have trouble scanning the environment for accurate percepFons Schizoid Personality Disorders TREATMENT ì  Their extreme social withdrawal prevents most people with this disorder from entering therapy unless some other disorder makes treatment necessary ì  Even then, paFents are likely to remain emoFonally distant from the therapist, seem not to care about treatment, and make limited progress ì  Cogni<ve-­‐behavioral therapists have someFmes been able to help people with this disorder experience more posi<ve emo<ons and more sa<sfying social interac<ons ì  ì  The cogniFve end focuses on thinking about emoFons The behavioral end focuses on the teaching of social skills ì  Group therapy is apparently useful as it offers a safe environment for social contact ì  Drug therapy is of li*le benefit 8 4/23/14 Schizotypal Personality Disorders *Note: Five or more of the following Schizotypal personality disorder symptoms must be met for an official diagnosis: 1. ideas of reference (excluding delusions of reference) 2. odd beliefs or magical thinking that influences behavior and is inconsistent with subcultural norms (e.g., supersFFousness, belief in clairvoyance, telepathy, or “sixth sense”; in children and adolescents, bizarre fantasies or preoccupaFons) 5. unusual perceptual experiences, including bodily illusions 6. odd thinking and speech (e.g., vague, circumstanFal, metaphorical, overelaborate, or stereotyped) 7. suspiciousness or paranoid ideaFon 8. inappropriate or constricted affect 9. behavior or appearance that is odd, eccentric, or peculiar 10. lack of close friends or confidants other than first-­‐degree relaFves 11. excessive social anxiety that does not diminish with familiarity and tends to be associated with paranoid fears rather than negaFve judgments about self Schizotypal Personality Disorders ì  This disorder is characterized by a range of interpersonal problems, marked by extreme discomfort in close rela<onships, odd (even bizarre) ways of thinking, and behavioral eccentrici<es ì  These symptoms may include ideas of reference and/or bodily illusions ì  People with the disorder o5en have great difficulty keeping their a;en<on focused; conversa<on is typically digressive (irrelevant) and vague, even sprinkled with loose associa<ons Schizotypal Personality Disorders ì  Socially withdrawn, people with schizotypal personality disorder seek isola<on and have few friends ì  It has been esFmated that 2% to 4% of all people (slightly more males than females) may have the disorder 9 4/23/14 Schizotypal Personality Disorders EXPLANATIONS ì  Because the symptoms of schizotypal personality disorder so o5en resemble those of schizophrenia, researchers have hypothesized that similar factors are at work in both disorders ì  Schizotypal symptoms are o5en linked to family conflicts and to psychological disorders in parents ì  Researchers have also begun to link schizotypal personality disorder to some of the same biological factors found in schizophrenia, such as high dopamine ac<vity ì  The disorder has also been linked to mood disorders, especially depression Schizotypal Personality Disorders TREATMENT ì  Therapy is as difficult in cases of schizotypal personality disorder, as in cases of paranoid and schizoid personality disorders ì  Most therapists agree on the need to help clients “reconnect” and recognize the limits of their thinking and powers ì  CogniFve-­‐behavioral therapists further try to teach clients to objec<vely evaluate their thoughts and percep<ons and provide speech lessons and social skills training ì  AnFpsychoFc drugs appear to be somewhat helpful in reducing certain thought problems “ODD”Personality Disorders Disorder Characteris<cs Paranoid Suspiciousness and mistrust of others; tendency to see self as blameless; on guard for perceived a*acks by others Schizoid Impaired social relaFonships; inability and lack of desire to form a*achments to others Schizotypal Peculiar thought pa*erns; oddiFes of percepFon and speech that interfere with communicaFon and social interacFon 10 4/23/14 “Drama<c”Personality Disorders CLUSTER B: Drama<c, emo<onal, or erra<c behavior •  AnFsocial, •  Borderline, •  NarcissisFc, and •  Histrionic personality disorders Drama<c Personality Disorders ì  The behaviors of people with these disorders are so dramaFc, emoFonal, or erraFc that it is almost impossible for them to have rela<onships that are truly giving and sa<sfying ì  These personality disorders are more commonly diagnosed than the others ì  Only anFsocial and borderline personality disorders have received much study ì  The causes of the disorders are not well understood ì  Treatments range from ineffecFve to moderately effecFve Antisocial Personality Disorders (A) There is a pervasive pa*ern of disregard for and violaFon of the rights of others occuring since age 15 years, as indicated by 3 or more of the following: 1) failure to conform to social norms with respect to lawful behaviors as indicated by repeatedly performing acts that are grounds for arrest 2) deceimulness, as indicated by repeated lying, use of aliases, or conning others for personal profit or pleasure 3) impulsivity or failure to plan ahead 4) irritability & aggressivenes, as indicated by repeated physical fights or assaults 5) reckless disregard for safety of self and others 6) consistent irresponsibility, as indicated by repeated failure to sustain consistent work behavior or honor financial obligaFons 7) lack of remorse as indicated by being indifferent to or raFonalizing having hurt, mistreated, or stolen from another. (B) The individual is at least 18 years old (C) There is evidence of Conduct Disorder with onset before age 15 years (D) The occurance is not during Schizophrenia or Manic Episode. 11 4/23/14 An<social Personality Disorders ì  SomeFmes described as “psychopaths” or “sociopaths,” people with anFsocial personality disorder persistently disregard and violate others’ rights ì  Aside from substance-­‐related disorders, this is the disorder most linked to adult criminal behavior ì  The DSM-­‐IV-­‐TR requires that a person be at least 18 years of age to receive this diagnosis ì  Most people with an anFsocial personality disorder displayed some pa*erns of misbehavior before they were 15 years old An<social Personality Disorders ì  People with the disorder are likely to lie repeatedly, be reckless, sexually promiscuous, and impulsive ì  They have a disregard for other individuals, and can be cruel, sadis<c, aggressive, and violent An<social Personality Disorders ì  Surveys indicate that 2% to 3.5% of people in the U.S. meet the criteria for this disorder ì  The disorder is 4 <mes more common in men than women ì  Because people with this disorder are o5en arrested, researchers frequently look for people with anFsocial pa*erns in prison popula<ons ì  Studies indicate higher rates of alcoholism and other substance-­‐related disorders among this group 12 4/23/14 An<social Personality Disorders ì  Children with a conduct disorder and an accompanying a*enFon-­‐deficit hyperacFvity disorder apparently have a heightened risk of developing anFsocial personality disorder An<social Personality Disorders EXPLANATIONS ì  Psychodynamic theorists propose that this disorder begins with an absence of parental love, leading to a lack of basic trust ì  Many behaviorists have suggested that anFsocial symptoms may be learned through modeling or uninten<onal reinforcement ì  The cogni<ve view says that people with the disorder hold aotudes that trivialize the importance of other people’s needs An<social Personality Disorders EXPLANATIONS ì  A number of studies suggest that biological factors may play a role ì  Lower levels of serotonin, impacFng impulsivity and aggression ì  Deficient funcFoning in the frontal lobes of the brain ì  Lower levels of anxiety and arousal, leading them to be more likely than others to take risks and seek thrills 13 4/23/14 An<social Personality Disorders TREATMENT ì  Treatments are typically ineffecFve ì  A major obstacle is the individual’s lack of conscience or desire to change ì  Most have been forced to come to treatment ì  Some cogni<ve therapists try to guide clients to think about moral issues and the needs of other people ì  Hospitals and prisons have a*empted to create therapeuFc communiFes ì  An<psycho<c drugs also have been tried but systemaFc studies are sFll needed Borderline Personality Disorders A pervasive pa*ern of instability of interpersonal rela<onships, self-­‐image, and affects, and a marked impulsiveness beginning by early adulthood and present in a variety of contexts, as indicated by 5 of the following: 1) franFc efforts to avoid real or imagined abandonment 2) a pa*ern of unstable and intense interpersonal relaFonships characterized by alternaFng between extremes of idealizaFon and devaluaFon 3) idenFty disturbance: markedly & persistently unstable self-­‐image or sense of self 4) impulsivity in a least 2 areas that are potenFally self-­‐damaging ( spending, sex, substance abuse, reckless driving, binge eaFng (not including # 5 items) 5) recurrent suicidal behavior, gestures, or threats, or self-­‐muFlaFng behavior 6) affecFve instability due to a marked reacFvity of mood (intense episodic dysphoria, irritability, or anxiety usually lasFng a few hours & rarely days) 7) chronic feelings of empFness 8) inappropriate, intense anger or difficulty controlling anger (frequent displays of temper, constant anger, recurrent fights) 9) transient, stress related paranoid ideaFon or severe dissociaFve symptoms. Borderline Personality Disorders ì  People with this disorder display great instability, including major shi5s in mood, an unstable self-­‐image, and impulsivity ì  Interpersonal rela+onships are also unstable ì  People with borderline personality disorder are prone to bouts of anger, which someFmes result in physical aggression and violence ì  Just as o5en, however, they direct their impulsive anger inward and harm themselves ì  Many of the paFents who come to mental health emergency rooms are individuals with the disorder who have intenFon...
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