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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
2000 • Biological predisposition re temperament + ineffective parenting lead to PD e. or overprotective) • Different combinations of temperament & parenting lead to different PDs Anxious & fearful Avoidant or Schizoid Impulsive & AggressiveBorderline & Antisocial Labile & overemotionalBorderline & Histrionic Odd or Eccentric Cluster • Similar symptoms to schizophrenia.g.g. l t overharsh. deceived. friends • Preoccupied with doubts about the loyalty of friends. h h overindulgent.Biopsychosocial Model Millon et al. • Bears grudges. but not psychotic. child is born with a difficult temperament & parents are unable bl to t handle h dl it (either ( ith neglect. 2 . odd behavior. or exploited by others. • Pathologically jealous.. • Read hidden meaning into benign remarks or events. speech or beliefs. e. • 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. flat affect or chronic suspicion..
Etiology and Treatment • Biological – Small increased risk in families with schizophrenia. Socially isolated . • Cognitive – Over-intellectualized beliefs. Little pleasure in any activities. – Low density DA receptors? – Inheritance of low sociability y & warmth. Etiology and Treatment • Biological – Some genetic link with schizophrenia.7% • More common in males.loners. Appear dull or bland. Restricted range of emotion (flatness.4% to 1. • Treatment – Increasing awareness of own feelings and increasing social skills and contacts. coldness). • Prevalence = . • Cognitive g – Distorted belief that people are evil & deceptive. Schizoid Personality Disorder Key Clinical Features • • • • • Extreme detachment from social relationships. 3 . • Treatment – Cognitive therapy to correct mistaken assumptions.
Odd and peculiar appearance or behavior. 4 . emotional and impulsive behaviour reflected in disturbed relationships. Excessive social anxiety. • Some evidence of increased dopamine & enlarged ventricles. some cognitive therapy Dramatic. social skills. Emotional.Schizotypal Personality Disorder Key Clinical Features • Cognitive and perceptual distortions. • Behaviours show lack of concern for their own safety or needs of others: • Manipulative. & Erratic Cluster • Erratic. Lack of close friends. group therapy. • Problems with attention and focus. and potentially violent • Reasons for impulsive/dramatic behaviour vary with the disorder • Linked with increased violence (ASPD) and suicidal (BPD) behaviours. • Treatment – similar to schizophrenia • Antipsychotics. attention-seeking. volatile. • • • • Paranoia or suspiciousness Ideas of reference Magical thinking Illusions • • • • Inappropriate/constricted affect. Etiology and Treatment • Biological – strong family link with schizophrenia • Genetic transmission of vulnerability.
ASPD & somatization Theories and Treatment • Psychodynamic . g . selfcentred behaviour that reflects lack of concern for other’s needs ( (e..g. & behaviour designed to seek attention or approval • e.g.1% Generally women Increased risk of depression..3 – 2. dramatic and seductive • Want attention rather than being self-doubting (like BPD) • Seen as self-centred..maladaptive assumptions – “I am inadequate” • Biopsychosocial (e. and demanding • • • • Prevalence: 1. 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 . anxiety & suicide Runs in families with BPD. g .g. unstable relationships. Millon) – High need for stimulation + many changes as adult • Treatment . arrogant g & exploitative).deep dependency needs have been unmet & emotions are repressed – Attention seeking & shallowness • Cognitive . shallow.find reason for dramatics and replace with socially acceptable behavior Narcissistic Personality Disorder Key Features • Grandiose thoughts & overvaluing one’s worth.Histrionic Personality Disorder Key Features • Shifting moods.
Theories and Treatment • Psychodynamic . • Inborn biological temperament of emotional vulnerability with an emotionally invalidating environment.over-evaluation of child’s worth by parents replicated • Cognitive . physical (59%). inappropriate expressions of anger Transient episodes of dissociation Etiologic Factors • Early childhood trauma & unstable attachments.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.. 1997).unreliable parent leads child to only rely on self – Parental rejection results in low self-esteem • Social Learning g Theory y . and sexual (61%) abuse (Zarini et al. 6 . – Results in an increased perception of threat in interpersonal situations. – High rates of abuse including emotional (73%).
Leads to social avoidance and nervousness. 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. feelings of inadequacy. fear of rejection/criticism.AnxiousAnxious -Fearful Cluster • Extreme concern about criticism or abandonment. • Hypersensitive to evaluation and criticism. • 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. • Usually depressed and lonely but feel unworthy of relationships. social skills. • Similar to Social Phobia. challenge negative thoughts about social situations 7 .
. severe. ti ) • Detail-oriented and self-controlled • Humorless. overprotective parents • Treatment – Must reduce dependency – Usually CBT – assertiveness.6 – 6. Leading to dependence on and submission to others.Dependent Personality Disorder Key Clinical Features • Ongoing self-sacrifice. extreme perfectionism..g.4% • More males 8 .g. need to be cared for and fear of abandonment. challenging faulty assumptions Obsessive-Compulsive Personality Disorder Key Clinical Features • Excessive rigidity in behaviour and relationships (e. emotionally restricted • Prevalence – 1. h and d constricted t i t d emotions). • Similar to Separation Anxiety & Dysthymia • Cling to others and indecisive • Need relationship to function and high risk for abuse • Prevalence – 1. intolerance for and anxiety about change. stress management.7 – 6. exposure.7% • Mainly women • Increased risk for major depression and chronic anxiety Theories and Treatment • Psychodynamic – Fixation in oral stage • Biopsychosocial (e. Millon) – Fearful temperament + warm.
e.Theories and Treatment • Biological – No genetic link with OCD • Psychodynamic – Fixation in anal stage • Biopsychosocial (e.g.. 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 .
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