Personality Disorders

When Our Patterns of Relating are Maladaptive

What Are Personality Disorders?
Personality Disorders isorders:
– Long-standing, maladaptive, inflexible ways of relating to the environment. • E.g., E g maladaptive personality traits. traits • Begin early and tend to be stable. • Difficult to diagnose and treat. • A deviant way of life
vs. a deviation from one’s way of life.

DSMDSM -IV Personality Disorders
• DSM recognizes PDs as different from symptom disorders, placing them on Axis II. • Cluster A: OddOdd-Eccentric
• Paranoid, Schizoid, & Schizotypal

• Cluster B: Dramatic Dramatic-Emotional
• Antisocial, Borderline, Histrionic, & Narcissistic

• Cluster C: AnxiousAnxious-Fearful
• Avoidant, Dependent, & Obsessive-compulsive

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or overprotective) • Different combinations of temperament & parenting lead to different PDs Anxious & fearful Avoidant or Schizoid Impulsive & AggressiveBorderline & Antisocial Labile & overemotionalBorderline & Histrionic Odd or Eccentric Cluster • Similar symptoms to schizophrenia.g. but not psychotic. friends • Preoccupied with doubts about the loyalty of friends. • Bears grudges. flat affect or chronic suspicion. child is born with a difficult temperament & parents are unable bl to t handle h dl it (either ( ith neglect. deceived. speech or beliefs. • Read hidden meaning into benign remarks or events. • Part of the “schizophrenia spectrum” • Paranoid PD – weak relationship • Schizoid PD – moderate relationship • Schizotypal PD – strong relationship Paranoid Personality Disorder Key Clinical Features • Expects to be harmed. • Pathologically jealous. e. 2000 • Biological predisposition re temperament + ineffective parenting lead to PD e.g. odd behavior.Biopsychosocial Model Millon et al. l t overharsh. or exploited by others. h h overindulgent. 2 ...

Socially isolated .4% to 1.7% • More common in males. – Low density DA receptors? – Inheritance of low sociability y & warmth. • Treatment – Increasing awareness of own feelings and increasing social skills and contacts. Restricted range of emotion (flatness.loners. Little pleasure in any activities. coldness).Etiology and Treatment • Biological – Small increased risk in families with schizophrenia. Etiology and Treatment • Biological – Some genetic link with schizophrenia. Schizoid Personality Disorder Key Clinical Features • • • • • Extreme detachment from social relationships. Appear dull or bland. • Prevalence = . • Cognitive g – Distorted belief that people are evil & deceptive. • Cognitive – Over-intellectualized beliefs. 3 . • Treatment – Cognitive therapy to correct mistaken assumptions.

group therapy. Odd and peculiar appearance or behavior. Lack of close friends. 4 . and potentially violent • Reasons for impulsive/dramatic behaviour vary with the disorder • Linked with increased violence (ASPD) and suicidal (BPD) behaviours. & Erratic Cluster • Erratic. attention-seeking. Etiology and Treatment • Biological – strong family link with schizophrenia • Genetic transmission of vulnerability. • • • • Paranoia or suspiciousness Ideas of reference Magical thinking Illusions • • • • Inappropriate/constricted affect. • Problems with attention and focus. emotional and impulsive behaviour reflected in disturbed relationships. social skills. Emotional. volatile. Excessive social anxiety. • Some evidence of increased dopamine & enlarged ventricles. some cognitive therapy Dramatic.Schizotypal Personality Disorder Key Clinical Features • Cognitive and perceptual distortions. • Treatment – similar to schizophrenia • Antipsychotics. • Behaviours show lack of concern for their own safety or needs of others: • Manipulative.

.g. g . arrogant g & exploitative). p ) • Dismissive of other’s opinions • Over-inflated self-worth • Make unreasonable demands on others • Sense of entitlement and superiority • Prevalence: less than 1% • Mostly male 5 . shallow.. anxiety & suicide Runs in families with BPD.maladaptive assumptions – “I am inadequate” • Biopsychosocial (e.g.3 – 2. ASPD & somatization Theories and Treatment • Psychodynamic . dramatic and seductive • Want attention rather than being self-doubting (like BPD) • Seen as self-centred. and demanding • • • • Prevalence: 1.g. g .1% Generally women Increased risk of depression. Millon) – High need for stimulation + many changes as adult • Treatment . & behaviour designed to seek attention or approval • e. unstable relationships.Histrionic Personality Disorder Key Features • Shifting moods..find reason for dramatics and replace with socially acceptable behavior Narcissistic Personality Disorder Key Features • Grandiose thoughts & overvaluing one’s worth.deep dependency needs have been unmet & emotions are repressed – Attention seeking & shallowness • Cognitive . selfcentred behaviour that reflects lack of concern for other’s needs ( (e.

. 6 . and sexual (61%) abuse (Zarini et al.Theories and Treatment • Psychodynamic .unrealistic assumptions of self-worth due to early indulgence • Treatment – usually CBT – Challenge unrealistic thoughts – Develop sensitivity to others Borderline Personality Disorder Key Clinical Features • • • • • • • • • Frantic efforts to avoid abandonment Unstable relationships Impulsive Persistently unstable self-image Intense mood swings Recurring self-harming or suicidal gestures Chronic feelings of emptiness Intense.unreliable parent leads child to only rely on self – Parental rejection results in low self-esteem • Social Learning g Theory y . – High rates of abuse including emotional (73%). physical (59%).over-evaluation of child’s worth by parents replicated • Cognitive . – Results in an increased perception of threat in interpersonal situations. • Inborn biological temperament of emotional vulnerability with an emotionally invalidating environment. inappropriate expressions of anger Transient episodes of dissociation Etiologic Factors • Early childhood trauma & unstable attachments. 1997).

• Usually depressed and lonely but feel unworthy of relationships. • Prevalence: 1% • No gender differences in rates • Increased risk for mood disorders & anxiety disorders Theories and Treatment • Biological – transmission of shy or fearful temperament – high physiological arousal level • Cognitive – Dysfunctional attitudes about worthlessness due to early rejection – “I must be a bad person for mom to treat me bad” • Treatment – typically CBT – Exposure to social settings. challenge negative thoughts about social situations 7 .AnxiousAnxious -Fearful Cluster • Extreme concern about criticism or abandonment. social skills. Leads to social avoidance and nervousness. • Hypersensitive to evaluation and criticism. feelings of inadequacy. leading to dysfunctional relationships – lack self-confidence and chronic self-doubt • Chronic anxiety and fear – not to same level as anxiety disorders • Behaviour designed to ward off feared situations – reasons for anxiety vary with disorder Avoidant Personality Disorder Key Clinical Features • Ongoing anxiety. fear of rejection/criticism. • Similar to Social Phobia.

7 – 6. stress management. need to be cared for and fear of abandonment. ti ) • Detail-oriented and self-controlled • Humorless. Millon) – Fearful temperament + warm. challenging faulty assumptions Obsessive-Compulsive Personality Disorder Key Clinical Features • Excessive rigidity in behaviour and relationships (e. exposure.Dependent Personality Disorder Key Clinical Features • Ongoing self-sacrifice. • Similar to Separation Anxiety & Dysthymia • Cling to others and indecisive • Need relationship to function and high risk for abuse • Prevalence – 1. extreme perfectionism. h and d constricted t i t d emotions).6 – 6. severe.g.4% • More males 8 . intolerance for and anxiety about change. Leading to dependence on and submission to others. overprotective parents • Treatment – Must reduce dependency – Usually CBT – assertiveness..g.. emotionally restricted • Prevalence – 1.7% • Mainly women • Increased risk for major depression and chronic anxiety Theories and Treatment • Psychodynamic – Fixation in oral stage • Biopsychosocial (e.

.Theories and Treatment • Biological – No genetic link with OCD • Psychodynamic – Fixation in anal stage • Biopsychosocial (e. the belief that behaviours are due to personality traits rather than situational factors • Problem of gender bias in criteria and diagnosis Alternatives • Theories of “normal” personality have been increasingly used to explain PDs • Five Factor Model • Interpersonal I t l Ci Circumplex l Model M d l • Theories are dimensional not categorical. Millon) – Overcontrolling punishment for mistakes + lack of praise for successes • Treatment – CBT for compulsive behaviour and supportive therapy for emotionally corrective experience Critique Concept of personality disorders is controversial: • Pathologize the continuum of “normal” personality • Overlap in diagnostic criteria • Vague V criteria i i & lowest l diagnostic di i reliability li bili of f any of the disorders • Fundamental attribution error i.. and allow for prediction and development of new PDs 9 .e.g.

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