CHAPTER 12 NOTES PERSONALITY DISORDERS

 Basics of PD
o Overview
 O- openness
 C- conscientiousness
 E- extroversion
 A- agreeableness
 N- neuroticism
 Enduring pattern of behavior an inner experience
 Culturally deviant
 Manifested in 2+
 Thoughts
 Feelings
 Interpersonal
 Impulse control
 Ego-syntonic—relating to the self; goals in line with the behaviors,
values and feelings
o Facts and stats
 10% prevalence
 Gender differences vary (e.g., more males diagnosed with ASPD, more
women with DPD, equal rates in HPD)
 Comorbidity is the rule
 Cluster A- odd/eccentric
o Paranoid
 Pervasive and unjustified mistrust and suspicion
 Few meaningful relationships, sensitive to criticism
 Poor quality of life
 Causes:
 We do not know a lot
 Not well understood
 Possible link to learning that people and the world are dangerous
or deceptive
 Treatments:
 Few seek professional help on their own
 Treatment focuses on development of trust
 Lack of good outcomes studies
o Schizoid
 Detachment from social relationships
 Very limited range of emotions in interpersonal situations
 Significant overlap with autism spectrum
 Causes:
  Etiology is unclear due to scarcity of research
 Link to childhood shyness
 Some individuals experienced abuse or neglect in childhood
 Treatments:
 Few seek professional help on their own
 Focus on the value of interpersonal relationships
 Building empathy and social skills
o Schizotypal
 Behavioral and dress is odd and unusual
 Socially isolated and highly suspicious
 Magical thinking, ideas of reference and illusions
 Conceptualized by some as mild scz
 Causes:
 Mild expression of scz genes?
 Possible link to childhood maltreatment / trauma (especially for
men)
 Problems with learning or memory may be present
 Treatments:
 Combo: antipsychotics, CBT, and social skills training
 Comorbid depression common (focus of treatments)
 Cluster B- dramatic or erratic
o Antisocial PD
 Failure to comply with social norms
 Violation of the rights of others
 Irresponsible, impulsive, and deceitful
 Lack of a conscience, empathy and remorse
 Similar to concepts of “sociopathy” and “psychopathy”
 May be very charming, manipulative
 Causes:
 Early behavioral problems; inconsistent parenting; family
environment (violence, trauma)
 Neurobiological theories
o Cortical underarousal
o Cortical immaturity
o Grays model
o Fearlessness
 Treatments:
 Few seek professional help on their own (poor prognosis)
 Emphasis is placed on prevention and rehabilitation
 Incarceration common
o Borderline PD
  Unstable moods and relationships
 Impulsivity, fear of abandonment, poor self-image
 NSSI, SI gestures
 Comorbidity high (especially mood diagnosis)
 Causes:
 Strong genetic component
 Emotional reactivity
 Impaired functioning of limbic system
 Early trauma/abuse increase risk
 High levels of shame and low serotonin
 Treatment:
 Antidepressant medications- short term relief
 DBT
o Dialectic acceptance
o Interpersonal effectiveness
o Distress tolerance
o Histrionic PD
 Overly dramatic / sensational / center of attention
 May be sexually provocative
 Thoughts / emotions perceived as shallow
 Move often diagnosed in women
 Lack of research, unknown etiology
 Treatments:
 Attention seeking and long-term negative consequences
 Problematic interpersonal behaviors
 Little evidence that treatment is effective
o Narcissistic PD
 Exaggerated and unreasonable sense of self-importance
 Preoccupation with receiving attention
 Lack of sensitivity and compassion for other people
 Highly sensitive to criticism; envious and arrogant
 Etiology unknown
 Sociological view- product of the “me” generation
 Treatments:
 Grandiosity, empathy
 Realistic goals and coping skills for criticism
 Little evidence of efficacy
 Cluster C- anxious or fearful
o Avoidant PD
 Extreme sensitivity to the opinions of others
 Highly avoidant of most interpersonal relationships
 Interpersonally anxious and fearful of rejection
  Low self esteem
 May be linked to schizophrenia
 Experiences of early rejection
 Treatments:
 Similar to social phobia
 Social skills, exposures
 Good relationship with therapist is important
o Dependent PD
 Reliance on others to make major/minor decisions
 Unreasonable fear of abandonment
 Clingy and submissive
 Not well understood due to lack of research
 Linked to early disruptions in learning independence
 Treatments;
 Research on treatment efficacy is lacking
 Treatment progresses gradually due to lack of independence
o OCPD
 Rigid fixation on doing things the right way
 Highly perfectionistic, orderly, emotionally shallow
 Unwilling to delegate tasks because others will do them wrong
 Difficulty with spontaneity
 Etiology moderate genetic; early rejection
 Treatments:
 Cognitive reappraisal for rigidity
 Target rumination, procrastination, and feelings of inadequacy
 Summary
o Long-standing patterns of behavior
o Begin early in development; chronic course
o Disagreement exists over how to categorize PDs
 Dimensional V. categorical V. combo
o For most, little is known about causes or treatments
 Much more research needed