You are on page 1of 9

Caraga State University

Butuan City
2nd Sem., AY 2021-2022

Psych 110 - Abnormal Psychology


Facilitator: Ruth E. Sanchez

9.2 PERSONALITY DISORDERS Part 2

CLUSTER B: DRAMATIC-EMOTIONAL PERSONALITY DISORDERS

People diagnosed with the dramatic-emotional personality disorders engage in behaviors that are
dramatic and impulsive, and they often show little regard for their own safety or the safety of others

 Borderline Personality Disorder


o This disorder is characterized by fundamental deficits in identity and in interpersonal
relationships.
o The self-concept of people with borderline personality disorder is unstable, with periods
of extreme self-doubt alternating with periods of grandiose self-importance and
accompanied by a need for others to support their self-esteem.
o People with this disorder are prone to transient dissociative states, in which they feel
unreal, lose track of time, and may even forget who they are.
o Their interpersonal relationships are extremely unstable-they can switch from idealizing
others to despising them without provocation.
o People with borderline personality disorder often describe an emptiness that leads
them to cling to new acquaintances or therapists in an attempt to fill their internal void.
o 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
 Cognitively, people with borderline personality disorder are hyperattentive to
negative emotional stimuli in the environment, their memories tend to be more
negative, and they tend to make negatively biased interpretations of situations
 Psychoanalytic theorists, particularly those in the object relations school suggest
that people with borderline personality disorder never learned to fully
differentiate their view of themselves from their view of others, making them
extremely reactive to others' opinions of them and to the possibility of
abandonment.
 They tend to see themselves and other people as either all good or all bad and
to vacillate between these two views, a process known as splitting.
 Neuroimaging studies show that the amygdala and hippocampus of people with
borderline personality disorder are smaller in volume than those of people
without the disorder
 In addition, people with borderline personality disorder have greater activation
of the amygdala in response to pictures of emotional faces, which may partly
explain the difficulty they have in regulating their moods
 Neuroimaging studies also have found structural and metabolic abnormalities in
the prefrontal cortex of patients with borderline personality disorder
 The neurobiological differences between people with borderline personality
disorder and healthy individuals could be due to genetic factors.
 The disorder runs in families and twin studies provide evidence that the
symptoms of borderline personality disorder are heritable
 Early abuse and maltreatment also are associated with changes in the structure
and organization of the brain, particularly the amygdala and hippocampus,
which may explain in part why child abuse could contribute to the deficits seen
in people with the disorder
o Treatment of Borderline Personality Disorder
 One of the first psychotherapies shown to have positive effects in patients with
borderline personality disorder was dialectical behavior therapy
 This therapy focuses on helping clients gain a more realistic and positive
sense of self, learn adaptive skills for solving problems and regulating
emotions, and correct dichotomous thinking.
 Cognitive therapy treatments for borderline personality disorder have also
proven helpful.
 Systems training for emotional predictability and problem solving
(STEPPS) is a group intervention for people with borderline personality
disorder that combines cognitive techniques challenging irrational and
maladaptive cognitions and behavioral techniques addressing self-
management and problem solving.
 Psychodynamically oriented therapies also show promise in the treatment of
borderline personality disorder.
 Transference-focused therapy uses the relationship between patient
and therapist to help patients develop a more realistic and healthier
understanding of themselves and their interpersonal relationships.
 Mentalization-based treatment is based on the theory that people with
borderline personality disorder have fundamental difficulty
understanding the mental states of themselves and others because of
traumatic experiences in childhood and poor attachment to their
caregivers
 The medications that have proven most useful in the treatment of borderline
personality disorder are the mood stabilizers aripriprazole and lamotrigine and
the atypical antipsychotics, such as olanzapine

 Histrionic Personality Disorder


o Histrionic personality disorder shares features with borderline personality disorder,
including rapidly shifting emotions and intense, unstable relationships.
o However, people with borderline personality disorder also show self-destructiveness,
angry disruptions in close relationships, and chronic feelings of inner emptiness, while
people with histrionic personality disorder behave in ways to draw attention to
themselves across situations.
o Individuals with histrionic personality disorder pursue others' attention by being highly
dramatic (e.g., gregarious, exaggerated emotional expression) and overtly seductive and
by flamboyantly emphasizing the positive qualities of their physical appearance.

o Theories of Histrionic Personality Disorder


 Although discussions of histrionic personalities date back to the ancient Greek
philosophers, little is known about causes or effective treatments.
 Family history studies indicate that histrionic personality disorder clusters in
families, along with borderline and antisocial personality and somatic symptom
disorders
o Treatment of Histrionic Personality Disorder
 Psychodynamic treatments focus on uncovering repressed emotions and needs
and helping people with histrionic personality disorder express these emotions
and needs in more socially appropriate ways.
 Cognitive therapy focuses on identifying clients' assumptions that they cannot
function on their own and helping them formulate goals and plans for their life
that do not rely on the approval of others

 Narcissistic Personality Disorder


o Most of us have encountered narcissists before - people who think they are better than
everyone else and should get their way in all circumstances and who will walk all over
others to accomplish their goals.
o The characteristics of narcissistic personality disorder are similar to those of histrionic
personality disorder.
o In both disorders, individuals act in a dramatic manner, seek admiration from others,
and are shallow in their emotional expressions and relationships with others. The
difference is that 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.
o In contrast to borderline personality disorder, they do not experience the same
abandonment concerns, despite needing the admiration of others

o Theories of Narcissistic Personality Disorder


 Psychodynamically oriented theorists suggest that the symptoms of narcissistic
personality disorder are maladaptive strategies for managing emotions and self-
views
 Cognitive theorists have argued that some people with narcissistic personality
disorder develop unrealistically positive assumptions about their self-worth as
the result of indulgence and overvaluation by significant others during
childhood
 Like borderline personality disorder, narcissistic personality disorder is
associated with a history of childhood adversity, including physical abuse and
neglect, and with having a parent who was abused or who had a mental health
problem
o Treatment of Narcissistic Personality Disorder
 People with narcissistic personality disorder tend not to seek treatment except
when they develop depression or are confronted with severe interpersonal
problems
 In general, they see any problems they encounter as due to the weakness and
problems of others.
 Not surprisingly, narcissistic personality traits pose significant challenges to the
development of a stable working alliance between a client and therapist.
 By emphasizing a collaborative therapeutic approach, a therapist using cognitive
techniques can help these clients develop more realistic expectations of their
abilities and more sensitivity to the needs of others by teaching them to
challenge their initially self-aggrandizing ways of interpreting situations

CLUSTER C: ANXIOUS-FEARFUL PERSONALITY DISORDERS

The cluster C anxious - fearful personality disorders - avoidant personality disorder, dependent
personality disorder, and obsessive - compulsive personality disorder-are characterized by a chronic
sense of anxiety or fearfulness and behaviors intended to ward off feared situations

 Avoidant Personality Disorder


o 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
o The two pathological personality traits that characterize them are negative affectivity
and detachment.
o When they must interact with others, people with avoidant personality disorder are
restrained, nervous, and hypersensitive to signs of being evaluated or criticized.
o They are terrified of saying something silly or doing something to embarrass themselves.
o While they may crave relationships with others, they feel unworthy of these
relationships and isolate themselves
o Theories of Avoidant Personality Disorder
 Twin studies show that genetics plays a role in avoidant personality disorder and
that the same genes likely are involved in avoidant personality disorder and
social anxiety disorder
 Unlike other personality disorders, avoidant personality disorders does not have
a strong relationship to sexual or physical abuse in childhood, although people
with this disorder do report higher rates of emotional neglect
 Cognitive theorists suggest that people with avoidant personality disorder
develop dysfunctional beliefs about being worthless as a result of rejection by
important others early in life

o Treatment of Avoidant Personality Disorder


 Cognitive and behavioral therapies have proven helpful for people with avoidant
personality disorder.
 These therapies have included graduated exposure to social settings,
social skills training, and challenges to negative automatic thoughts
about themselves and social situations.
 The serotonin reuptake inhibitors are sometimes used to reduce the social
anxiety of people with avoidant personality disorder, but little research on their
effectiveness in treating avoidant personality disorder has been done

 Dependent Personality Disorder


o 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.
o 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.
o In contrast to people with avoidant personality disorder, who avoid relationships unless
certain of being liked, people with dependent personality disorder can function only
within a relationship and will overly accommodate others to obtain care and support.

o Theories of Dependent Personality Disorder


 Dependent personality disorder runs in families, and one twin study estimated
the heritability of this disorder to be .81
 Children and adolescents with a history of separation anxiety disorder or
chronic physical illness appear to be more prone to developing dependent
personality disorder
 Cognitive theories argue that people with dependent personality disorder have
exaggerated and inflexible beliefs related to their depending needs, such as "I
am needy and weak/' which in turn drive their dependent behaviors.
o Treatment of Dependent Personality Disorder
 Unlike people with many of the other personality disorders, persons with
dependent personality disorder frequently seek treatment and are likely to
show greater insight and self-awareness.
 Although many psychosocial therapies are used in the treatment of this
disorder, none have been systematically tested for their effectiveness.
 Psychodynamic treatment focuses on helping clients gain insight into the early
experiences with caregivers that led to their dependent behaviors, often by
examining their relationship style with the therapist and interpreting the
transference process.
 Nondirective and humanistic therapies may be helpful in fostering autonomy
and self-confidence in persons with dependent personality disorder
 Cognitive-behavioral therapy for dependent personality disorder includes
behavioral techniques designed to increase assertive behaviors and decrease
anxiety, as well as cognitive techniques designed to challenge clients'
assumptions about the need to rely on others

 Obsessive-Compulsive Personality Disorder


o Self-control attention to detail, perseverance, and reliability are highly valued in many
societies, including U.S. society.
o Some people, however, develop these traits to an extreme and become rigid,
perfectionistic, dogmatic, ruminative, and emotionally blocked.
o These people are said to have obsessive-compulsive personality disorder.
o People with this disorder base their self-esteem on their productivity and on meeting
unreasonably high goals.
o This disorder shares features with obsessive-compulsive disorder (OCD) and has a
moderately high comorbidity with OCD
o But obsessive-compulsive personality disorder involves a more general way of
interacting with the world than does obsessive-compulsive disorder, which often
involves only specific obsessional thoughts and compulsive behaviors.
o While people with obsessive-compulsive disorder will be focused on very specific
thoughts, images, ideas, or behavior and may feel very anxious if they do not engage in
these (e.g., becoming anxious if they cannot check whether they have turned off the
stove), people with obsessive-compulsive personality disorder will be more generally
prone to being perfectionistic, rigid, and concerned with order.

o Theories of Obsessive-Compulsive Personality Disorder


 Cognitive theories suggest that people with this disorder harbor beliefs such as
"Flaws, defects, or mistakes are intolerable."
 Obsessive-compulsive personality disorder appears to be related to genetic
factors similar to those found in obsessive-compulsive disorder
 People with obsessive-compulsive personality disorder have a slightly greater
history of physical neglect than people with no disorder
o Treatment of Obsessive-Compulsive Personality Disorder
 There are no controlled psychological treatment studies focusing primarily on
obsessive-compulsive personality disorder, and only one medication trial.
 Supportive therapies may assist people with this disorder in overcoming the
crises that bring them in for treatment, and behavioral therapies can decrease
their compulsive behaviors

ALTERNATIVE DSM-5 MODEL FOR PERSONALITY DISORDERS

The alternative DSM-5 model characterizes personality disorders in terms of impairments in personality
functioning and pathological personality traits.

 The first step in diagnosing a personality disorder is determining an individual's level of


functioning in terms of their sense of self (or identity) or their relationships with others on a
scale.
o Disturbances in self and interpersonal functioning are at the core of personality
psychopathology and are evaluated on a continuum based on the Level of Personality
Functioning Scale.
o Note that there are five levels of impairment, ranging from little or no impairment (Level
0, healthy adaptive functioning) to extreme impairment (Level 4).
o By definition, a moderate level of impairment (Level 2) is required for the diagnosis of a
personality disorder
 The second step in diagnosing a personality disorder is determining whether the individual has
any pathological personality traits.
o One fundamental trait is the extent to which people tend to be even-tempered and
calm, secure, and able to handle stress or emotionally labile, insecure, and overreactive
to stress, a dimension referred to in personality theories as neuroticism or in DSM-5
alternative model terms as negative affectivity.
o A second core personality trait domain involves the extent to which people are
appropriately outgoing and trusting of others or tend to be withdrawn, avoidant, and
untrusting, a dimension the alternative DSM-5 model labels detachment.
o The third dimension, which the DSM-5 calls antagonism, is anchored at the positive end
by characteristics such as honesty, appropriate modesty, and concern for others and at
the negative end by characteristics such as deceitfulness, grandiosity, and callousness.
o A fourth core personality trait domain, called disinhibition, ranges from a tendency to
be responsible, organized and cautious to a tendency to be impulsive, risk-taking, and
irresponsible.
o The alternative DSM-5 model includes a fifth dimension, psychoticism, that captures
personality characteristics that are relatively rare in the general population but are
important aspects of certain types of dysfunction
o Taken together, the alternative DSM-5 model specifies that, in order to diagnose an
individual with a personality disorder, he or she must show significant difficulties in
identity and interpersonal functioning and significant pathological personality traits.
o In addition, these difficulties and traits must be unusual for the individual's
developmental stage and sociocultural environment.
o Finally, these difficulties and pathological traits cannot be due to ingesting a substance,
such as hallucinatory perceptions while on a narcotic, or to a medical condition, such as
a blow to the head, or better explained by another mental disorder
o Although the DSM-5 explicitly incorporates a continuum approach into its general
criteria in the alternative model for a personality disorder, it also includes six specific
personality disorders with which individuals may be diagnosed: antisocial, avoidant,
borderline, narcissistic, obsessive-compulsive, and schizotypal.
 The third step in the diagnosis of personality disorders is determining whether individuals meet
the criteria for any of these six disorders.
o If an individual doesn't meet the criteria for any of these disorders but still has
significant difficulties in his or her sense of self and relationships together with
pathological personality traits, the diagnosis personality disorder trait specified is given.
 This hybrid dimensional-categorical model and its components aim to address the significant
limitations of a purely categorical approach to personality disorders.
 The authors of the DSM-5 included the model in a separate section of the manual to encourage
research that might support the model in the diagnosis and care of people with personality
disorders, as well as contribute to improved understanding of the causes and treatments of
personality pathology.

Thank you!

You might also like