Chapter 9: Personality Disorders

-The general criteria for a personality disorder specify that an individual’s personality
pattern must deviate markedly from the expectations of his or her culture as shown
in styles of thinking about oneself, others, or events; emotional experience and
expression; interpersonal functioning; and/or impulse control. An individual’s
personality pattern must be pervasive and inflexible across situations, be stable over
time, have an onset in adolescence or early adulthood, and lead to significant
distress or functional impairment.

CLUSTER A: ODD-ECCENTRIC PERSONALITY DISORDERS

-People with these disorders have symptoms similar to those of people with
schizophrenia, including inappropriate or flat affect, odd thought and speech
patterns, and paranoia. People with these disorders maintain their grasp on reality

Paranoid Personality Disorder

-The defining feature of paranoid personality disorder is a pattern of pervasive

distrust and suspiciousness of others such that their motives are interpreted as
malevolent. People diagnosed with this disorder believe that other people are
chronically trying to deceive or exploit them, and they are preoccupied with concerns
about being victimized or mistreated by others. They are hypervigilant for evidence
confirming their suspicions. Often they are penetrating observers of situations, noting
details most other people miss.

Schizoid Personality Disorder

-People diagnosed with schizoid personality disorder show a pervasive pattern of

detachment from social relationships and a restricted range of emotional expression
in their interactions with others. They seem indifferent to opportunities to develop
close relationships and derive little, if any, pleasure from family or social interactions.
Their experience and expression of positive emotions are very low, and their interest
in having sexual experiences with another person is typically very limited. Other
people describe them as emotionally aloof or cold, “loners,” or “bland,” uninteresting,
and humorless.

Schizotypal Personality Disorder

-People diagnosed with schizotypal personality disorder show symptoms similar to

those of schizophrenia but in milder form. Like schizoid and paranoid personality
disorders, people with schizotypal personality disorder tend to be socially isolated, to
have a restricted range of emotions, and to be uncomfortable in interpersonal
interactions

CLUSTER B: DRAMATIC-EMOTIONAL PERSONALITY DISORDERS

-People with these disorders tend to be manipulative, volatile, and uncaring in social
relationships. They are prone to impulsive, sometimes violent behaviors that show
little regard for their own safety or the safety or needs of others.

Theories of Borderline Personality Disorder

-Given the emotional instability characteristic of borderline personality disorder, it is

not surprising that several theorists have argued that people with this disorder have
fundamental deficits in regulating emotion. People with borderline personality
disorder score higher than healthy subjects on measures of difficulty in regulating
emotion and in laboratory tasks assessing unwillingness to tolerate emotional
distress in order to reach a goal.

Histrionic Personality Disorder

-Histrionic personality disorder shares features with borderline personality disorder,

including rapidly shifting emotions and intense, unstable relationships. A person with
borderline personality disorder may desperately cling to others as an expression of
self-doubt and unstable identity, but a person with histrionic personality disorder
simply wants flattering nurturance and preferential attention.

Narcissistic Personality Disorder

-The characteristics of narcissistic personality disorder are similar to those of

histrionic personality disorder. In both disorders, individuals act in a dramatic
manner, seek admiration from others, and are shallow in their emotional expressions
and relationships with others. Whereas people with histrionic personality disorder
look to others for approval, people with narcissistic personality disorder rely on their
inflated self-evaluations and see dependency on others as weak and threatening. As
the name implies, grandiosity is a distinguishing feature, as they are preoccupied
with thoughts of their self-importance and with fantasies of power and success, and
they view themselves as superior to most other people.

CLUSTER C: ANXIOUS-FEARFUL PERSONALITY DISORDERS

-People with these disorders are extremely concerned about being criticized or
abandoned by others and thus have dysfunctional relationships with others.

Avoidant Personality Disorder

-People with avoidant personality disorder have low self-esteem, are prone to
shame, and are extremely anxious about being criticized by others and thus avoid
interactions in which there is any possibility of being criticized
Dependent Personality Disorder

-People with dependent personality disorder are anxious about interpersonal

interactions, but their anxiety stems from a deep need to be cared for by others,
rather than from a concern that they will be criticized. Their desire to be loved and
taken care of by others leads people with dependent personality disorder to deny
any of their own thoughts and feelings that might displease others and result in
disagreements, to submit to even the most unreasonable or unpleasant demands,
and to cling frantically to others.

Obsessive-Compulsive Personality Disorder

- People with this disorder base their self-esteem on their productivity and on
meeting unreasonably high goals. They are compulsive; preoccupied with rules,
details, and order; and perfectionistic. They tend to persist in a task even when their
approach is failing, leading them to experience negative affect.

Chapter 11 : Disruptive, Impulse-Control, and Conduct Disorders

- The disorders discussed in this chapter all involve disruptive, impulsive, and
antisocial behavior that violates major social norms. You’ve no doubt observed that
people vary in how cooperative they are with social norms and in how empathetic
and caring they are toward other people.

CONDUCT DISORDER AND OPPOSITIONAL DEFIANT DISORDER

The behaviors of children with conduct disorder fall into four categories: (1)
aggression to people and animals, (2) destruction of property, (3) deceitfulness or
theft, and (4) serious violations of rules. Approximately 3 to 7 percent of children and
adolescents exhibit behaviors serious enough to warrant a diagnosis of conduct
disorder. These children are highly likely to engage in violent and criminal behavior.

• Have you ever pulled a knife or a gun on another person?

• Have you ever forced someone into sexual activity at knifepoint?

• Have you ever deliberately set a fire with the hope of damaging someone’s
property?

• Have you ever broken into someone else’s car or house with the intention of
stealing?

Many young people who have conduct disorder answer yes to these questions and
engage in other serious transgressions of societal norms for behavior. These
children have a chronic pattern of unconcern for the basic rights of others.
Contributors to Conduct Disorder and Oppositional Defiant Disorder

-The risk factors for conduct disorder and oppositional defiant disorder are largely
the same, so we discuss them together, referring primarily to conduct disorder
because the majority of the research has focused on this disorder.

- Biological Factors

Children with conduct disorder are more likely than children without the disorder to
have parents with a history of antisocial behavior.

-Social Factors

-Conduct disorder and oppositional defiant disorder are found more frequently in
children in lower socioeconomic classes and in urban areas than in children in higher
socioeconomic classes and in rural areas.

Treatments for Conduct Disorder and Oppositional Defiant Disorder

Psychological and social treatments can reduce violent and disruptive behavior in
children with these disorders. Some children are also given medications to decrease
their emotional dysregulation and difficult behaviors.

Psychological and Social Therapies

-Most psychotherapies for conduct disorder are cognitive-behavioral in focus and

aim to change children’s ways of interpreting interpersonal interactions by teaching
them to take and respect the perspectives of others, to use self-talk to control
impulsive behaviors, and to use more adaptive ways of solving conflicts than
aggression.

Drug Therapies

-Non-pharmacological treatment is considered the “first-line” treatment for conduct

disorder and oppositional defiant disorder, but many children who exhibit severely
aggressive behavior have been prescribed a variety of drugs. Stimulants are the
most widely prescribed drugs for conduct disorder in the United States,Canada, and
many other countries, in part because conduct disorder often is comorbid with
ADHD.

ANTISOCIAL PERSONALITY DISORDER

-People like Bundy who exhibit chronic antisocial behaviors are diagnosed as having
antisocial personality disorder (ASPD). ASPD diagnostic criteria are presented in the
“Personality Disorders” chapter in the DSM-5, but ASPD is also dual-coded as a
conduct disorder in DSM-5. ASPD is reviewed in this chapter because it is very
closely connected to the spectrum of disruptive, impulse-control, and conduct
disorders, including in its developmental origins, while still sharing the key features of
a personality disorder.

Contributors to Antisocial Personality Disorder

-Because most adults diagnosed with antisocial personality disorder have exhibited
antisocial tendencies since childhood, the biological and psychosocial factors
associated with this disorder are similar to those associated with conduct disorder.
People with antisocial personalities tend to show deficits in verbal skills and in the
executive functions of the brain: the ability to sustain concentration, abstract
reasoning, concept and goal formation, the ability to anticipate and plan, the capacity
to program and initiate purposive sequences of behavior, self-monitoring and self-
awareness, and the ability to shift from maladaptive patterns of behavior to more
adaptive ones.

INTERMITTENT EXPLOSIVE DISORDER

-Children with conduct disorder and adults with anti-social personality disorder often
engage in aggressive acts, which may be impulsive outbursts or premeditated
behavior that unfolds over a longer period of time.

-The diagnosis of intermittent explosive disorder is given to individuals age 6 and

older who engage in relatively frequent impulsive acts of aggression

Treatments for Antisocial Personality Disorder

People with antisocial personality disorder tend to believe they do not need
treatment. They may submit to therapy when forced to because of marital discord,
work conflicts, or incarceration, but they are prone to blaming others for their current
situation rather than accepting responsibility for their actions. As a result, many
clinicians do not hold much hope for effectively treating persons with this disorder
through psychotherapy.