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Chapter10 - Chapter 10 Chapter 10 Personality Disorders...

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Unformatted text preview: Chapter 10 Chapter 10 Personality Disorders Personality Disorders: Personality 0. Personality: person’s broad characteristic traits, coping styles and ways of interacting with social environment 0. Emerges during childhood 1. Crystallizes into established patterns by end of adolescence and early adulthood 2. Is relatively stable throughout adulthood Personality Disorders: Features 1. Personality disorders are characterized by 3. Chronic interpersonal difficulties 4. Problems with one’s identity or sense of self 5. Traits that are so inflexible and maladaptive that the person is unable to perform adequately in some of the varied roles expected of them in society Personality Disorders: Category 2. A category that is broad – encompassing behavioral problems that differ greatly in form and severity 3. Prevalence: 13% lifetime 4. Coded separately from Axis I on Axis II 6. 75% of time co­morbid with Axis I disorders Personality Disorders: Clinical Features Personality Disorders: Clinical Features (Criterion A) 5. The definition of personality disorders in DSM­IV­ TR is based on five criteria. 6. Criterion A: The pattern must appear in at least two of the following areas: 7. Cognition 8. Affectivity 9. Interpersonal functioning 10. Impulse control 11. E.g. maladaptive ways of perceiving, thinking about and relating to the world Personality Disorders: Clinical Features (Criterion B) 7. The definition of personality disorders in DSM­IV­ TR is based on five criteria. 8. Criterion B: The enduring pattern must be inflexible and pervasive across a broad range of personal and social situations 12. They do not seem to learn from previous mistakes Personality Disorders: Clinical Features (Criterion C) 9. The definition of personality disorders in DSM­IV­ TR is based on five criteria. 10.Criterion C: This pattern leads to clinically 10. significant distress or impairment of functioning 13. Cause at least as much difficulty in the lives of others as in their own lives 14. Behavior is exasperating, unpredictable and unacceptable Personality Disorders: Clinical Features (Criterion D) 11.The definition of personality disorders in DSM­IV­ TR is based on five criteria. 12.Criterion D: The pattern is stable and of long duration, and its onset can be traced back at least to adolescence or early childhood 15. Not due to stress but due to gradual development (may be worsened by stress) Personality Disorders: Clinical Features (Criterion E) 13.The definition of personality disorders in DSM­IV­ TR is based on five criteria. 14.Criterion E: The pattern is not better accounted for as a manifestation or consequence of another mental disorder 16. It may be co­morbid with Axis I disorders, but is not a function of those disorders Personality Disorders: Diagnosing 15.More misdiagnoses occur with this group than with 15. any other categories of disorders 16.Diagnostic criteria are not precise 17. Based on inferred traits (not objective behavioral standards) 18. Require greater clinical judgment 19. Low reliability in assessment Personality Disorders: Research Difficulties 17.Difficulties in diagnosing personality disorders are caused by a number of factors, including: 18.1. Diagnostic criteria are not as sharply defined as for other Axis I categories 19.2. Diagnostic categories are not mutually exclusive 20. Client may display characteristics of more than one disorder Personality Disorders: Research Difficulties 20.3. Personality characteristics are dimensional in nature 21. However, no general agreement on which dimensions 22. Yet, dimensions are a better alternative 21.Five factor model allows for assessment of up to 20 facets of personality 23. Would account for range of personality disorders beyond ten categories now listed Personality Disorders: Categories verses Personality Disorders: Categories verses Dimensions 22.Five factor model of personality: 24. 25. 26. 27. 28. Neuroticism Extraversion and introversion Openness to experience Agreeableness and antagonism Conscientiousness 23.Allows for assessment of multiple facets of personality and can account for range of personality disorders Personality Disorders: Research Difficulties 24.4. Such disorders have received consistent attention only since DSM­III was published in 1980 25.5. These disorders are less amenable to thorough study 26.6. Most studies to date are retrospective Personality Disorders: Clusters DSM­IV­TR personality disorders are grouped into three clusters: Cluster A: paranoid, schizoid, schizotypal Cluster B: histrionic, narcissistic, antisocial, borderline Cluster C: avoidant, dependent, obsessive­compulsive Clusters Clusters Prevalence Categories of Personality Disorders: Cluster A 27.Cluster A includes: 29. Paranoid: pervasive suspicions, distrust of others, chronically on guard, preoccupied with doubts about loyalty of others 30. Schizoid: unable to form social relationships, lack of social interest, apathetic mood 31. Schizotypal: excessively introverted, pervasive social and interpersonal deficits, cognitive & perceptual distortions, eccentricities, superstitious thinking Categories of Personality Disorders: Cluster A 28.People with these disorders tend to be 32. Distrustful and suspicious 33. Socially detached 29.Dimensions (Five factor model) 34. Paranoid: antagonism & neuroticism 35. Schizoid: introversion & lack of openness 36. Schizotypal: similar in impairments to schizophrenia Personality Disorders: Personality Disorders: Cluster A Categories of Personality Disorders: Cluster B 30.Cluster B includes 37. Histrionic: excessive need for attention, dramatic, seductive, manipulative 38. Narcissistic: exaggerated sense of self­importance, preoccupied with being admired 39. Antisocial: violent, disregard for rights of others, deceitful, aggressive 40. Borderline: impulsive, unstable in relations with others Categories of Personality Disorders: Cluster B 31.Dimensions (Five factor model) 41. 42. 43. 44. Histrionic: neuroticism, extraversion Narcissistic: antagonism Antisocial: aggressiveness, deceitfulness Borderline: neuroticism, antagonism 32.People with these disorders tend to be 45. Dramatic, Emotional, Erratic Personality Disorders: Cluster B Categories of Personality Disorders: Cluster Categories of Personality Disorders: Cluster C 33.Cluster C includes 46. Avoidant: extreme social inhibition and introversion, hypersensitivity to criticism 47. Dependent: extreme need to be taken care of, clinging, submissive, fear of rejection 48. Obsessive­compulsive: perfectionism, excessive concern for maintaining order Categories of Personality Disorders: Cluster C 34.Dimensions: (Five factor model) 49. 50. 51. Avoidant: inhibited Dependent: neuroticism, agreeableness Obsessive­compulsive: conscientiousness 35.People with these disorders tend to be 52. Anxious 53. Fearful Personality Disorders: Cluster C Categories of Personality Disorders: Provisional 36.Provisional categories include 54. Passive­aggressive: negativistic, passive 54. resistance, argumenitiveness 55. Depressive: pattern of depression that is pervasive and chronic, unhappy Personality Disorders: Provisional Personality Disorders Personality Disorders: General Socio­ cultural Causal Factors 37.Is our emphasis on impulse gratification, instant solutions, and pain­free benefits leading more people to develop the self­centered lifestyles that we see in more extreme forms in personality disorders? 56. Problem of entitlement 57. However, PD appears to occur across cultures Personality Disorders: Treatments and Outcomes 38.Personality disorders are generally very difficult to treat 58. Traits are relatively enduring 59. Person doesn’t believe need to change 60. Person often will not take responsibility for problems 60. – attribute to (blame) others or external factors Personality Disorders: Treatments and Outcomes 39.A new form of behavior therapy (dialectical behavior therapy) shows promise for treating borderline personality disorder, which is in Cluster B 61. 62. 63. 64. Learn to tolerate negative affect Decrease suicidal behavior Improve behavior in therapy Increase behavioral skills Personality Disorders: Treatment and Outcomes 40.Difference in outcomes across clusters 65. Treatment of the Cluster C disorders seems most promising (cognitive therapy for fears and anxiety) 66. Treatment of Cluster A disorders is most difficult (problems in relating to therapist due to poor interpersonal skills) Antisocial Personality and Psychopath: Features 41.Individuals 18 and over may be diagnosed with antisocial personality disorder if the following criteria are met: 67. At least three behavioral problems occurring after 67. age 15 68. At least three instances of deviant behavior before age 15 69. The antisocial behavior is not a symptom of another mental disorder Antisocial Personality and Psychopath: Life Pattern 42.Typically a life­long pattern of: 43.Disregarding and violating rights of others 44.Deceitfulness and aggressiveness 45.Un­socialized and irresponsible Antisocial Personality and Psychopath: Life Pattern 46.Begins in childhood (conduct disorder) 70. School bully 71. Troublemaker 47.Problematic childhood behavior extends into adolescence and adulthood 72. Punishment and consequences do not change behavior Antisocial Personality and Psychopath: Clinical Picture 48.Clinical picture: 49.Deceitful and manipulative 73. Use others to own ends 50.Inadequate conscience development 50. 74. (although normal IQ) Antisocial Personality and Psychopath: Clinical Picture 51.Clinical picture: 52.Irresponsible and impulsive behavior 75. Take what they want 76. Thrill seeking, immediate pleasure 53.Ability to impress and exploit others 77. Charming, likable, seems to have insight Hannibal Lecter: Silence of the Lambs Antisocial Personality and Psychopath: Differences 54.ASPD (Bleckley) vs. psychopath (Hare) 78. Criminal behavior 55.The following characteristics are typical of psychopaths: 79. 80. 81. Lifelong pattern of violating rights of others Deceitful and aggressive Un­socialized and irresponsible Antisocial Personality and Psychopath: Differences 56.Differences between ASPD and psychopath: 56. 57.ASPD may be predatory without breaking law 58.Psychopath likely to offend and reoffend violating law Antisocial Personality and Psychopath: Causal Factors 59.Causal factors include 82. Genetic influences – moderately heritable 83. Constitutional factors 0. Low trait anxiety; poor conditioning of fear 1. Behavioral inhibition/activation 2. Passive/active avoidance 84. Learning of antisocial behavior 85. Adverse environmental factors Antisocial Personality and Psychopath: Causal Factors 60.Theory of dysfunctional behavioral inhibition/activation systems: 61.Neurological system is not available to inhibit responses that lead to punishment 86. (no passive avoidance system) 62.Overactive behavioral activation system 87. Focus on obtaining reward 88. Active avoidance of punishment by lying Antisocial Personality and Psychopath: Antisocial Personality and Psychopath: Developmental Perspective 63.Psychopath & ASPD begin early in childhood 89. Early conduct disorders – theft, truancy 90. History of oppositional defiant disorder 3. Hostile and defiant by age 6 91. ADHD plus conduct disorder results in high likelihood of ASPD 92. Contributed to by aversive social environment (poverty, parental stress, ineffective parenting) Antisocial Personality and Psychopath: Developmental Perspective 64.Two significant patterns in development: 65.Difficulty in learning to regulate emotions 66.Lack of development of conscience ASPD/Psychopath: Devel. Persp. Antisocial Personality and Psychopath: Treatments and Outcomes 67.Treatment of psychopaths is difficult 93. They are not in distress and don't believe need for change 68.Cognitive­behavioral treatments offer some promise 94. Problem is lifestyle, not just behavior 95. Increase self­control and victim awareness 95. 96. Anger management, change attitudes Antisocial Personality and Psychopath: Treatments and Outcomes 69.Burned­out psychopaths 97. APSD and psychopathology tend to decline after age 40 (noted by decline in criminal behavior after 40) 70.Need for prevention 98. Since treatment is difficult if not impossible 99. Dealing with at­risk children and mothers of at­risk children 100. Involvement in school environment working with teachers and parents Personality Disorders: Improving the Category 71.Differentiation 101. Differentiate between prototypes: Problem: people don't fit prototypes 72.Unreliability 102. Discrete categories: Problem: personality processes are dimensional and discrete cutoffs imply discontinuity 73.Variability 103. Specify symptoms:Problem: variety of symptoms assigned to categories Personality Disorders: Dimensions (Pros Personality Disorders: Dimensions (Pros and cons) 74.Reject dimensions because: 104. 105. Medical community likes categories Hard to measure and justify dimensions 75.Accept dimensions because: 106. Dimensions describe disorders 107. Allow for distinguishing between disorders 108. Assist in understanding coomorbidity and overlap End of Chapter 10 ...
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