Title: Personality%20Disorders
1Personality Disorders
2 Bo r d e r l i n e
- Neurotic Beh
- Anxiety-based
- No distortions in reality
- Recognizes problem
- No great personality disorganization
- Psychotic
- Gross distortions in reality (e.g., perception)
- Some personality disorganization
- Does not recognize problem
3Personality Disorders
- When behaviour patterns become inflexible and
maladaptive to the point of causing distress or
social/occupation impairment can say have
Personality Disorder
4Personality Disorders
- Dont stem from reactions to stress but from
gradual development of inflexible and distorted
personality - Maladaptive ways of perceiving, thinking,
relating to world
5Personality Disorders
- Excessively rigid patterns of behaviour or ways
to relating to others that prevents people from
adjusting to external demands and, thus, become
self-defeating. - Have always been there for an individual
6Personality Disorders
- Mild Function reasonably well, viewed as
troublesome, eccentric, etc. - Severe Extreme or unethical behaviour, may be
incarcerated.
7Quote From Lorna Benjamin (1996)
- A great way to come down with a case of medical
student disease (syndrome) is to read a survey
of personality disorders
8Some Trait Pattern Example
- Suspiciousness
- Excessive Self-regard
- Fear of Rejection
- Come to dominate reactions to new situations
- Repetitive maladaptive behaviour
9Difference between DSMs Clinical Syndromes PD
- Clinical Syndrome? specific symptom clusters,
time limited, ego-distonic (viewed as separate
from self, unacceptable, objectionable and alien) - E.g., depression, anxiety disorders, psychotic
disorders
10Continued
- Personality Disorder? Individual with PD are
perceived as ego-syntonic (e.g., personality
issues are acceptable, unobjectionable and part
of the self). Tend to blame others for problems
in their lives.
11Difficulties with Diagnosis of Personality
Disorder
- Need to infer traits to make diagnosis, do not
have specific behaviours clinician can judge - Disorders and criteria are relatively new,
therefore not as much research has been done on
them - Great deal of overlap among the disorders
- Hard to draw a line between disorder and normal
behaviour
12Personality Disorder Clusters
- Cluster One Odd-Eccentric
- Behaviours similar to schizophrenia,
suspiousness, withdrawal, peculiar thinking
13The Odd Eccentric PD Group
- 1. Paranoid Personality Disorder
- 2. Schizoid Personality Disorder
- 3. Schizotypal Personality Disorder
-
14Paranoid Personality Disorder
Reverend Jim Jones Peoples Temple
15Paranoid Personality Disorder
- suspicious of others motives
- interprets actions of others as deliberately
demeaning/threatening - expectation of being exploited
- see hidden messages in benign comments
- easily insulted/ bears grudges
- appear cold and serious
16Paranoid Personality Disorder Example
- Undergraduate student/patient who followed
17Schizoid Personality Disorder
Theodore Kaczynski Unabomber
18Schizoid
- indifferent to relationships
- limited social range (some are hermits)
- aloof, detached, called loners
- no apparent need of friends, sex
- solitary activities
- seem to be missing the human part
19Schizotypal
- peculiar patterns of thinking and behaviour
- perceptual and cognitive disturbances
- magical thinking
- not psychotic
- perhaps a distant cousin of schizophrenia
20Personality Disorder Clusters
- Cluster Two Dramatic-Emotional
- Behaviours are so dramatic, emotional, or erratic
that it is almost impossible to have truly giving
and satisfying relationships - More commonly diagnosed than other PDs
-
21The Dramatic-Emotional PD Group
- 1. Antisocial Personality Disorder (Dissocial)
- 2. Borderline Personality Disorder
- 3. Histrionic Personality Disorder
- 4. Narcissistic Personality Disorder
22Antisocial Personality Disorder
- pattern of irresponsibility, recklessness,
impulsivity beginning in childhood or adolescence
(e.g., lying, truancy) - adulthood
- criminal behaviour
- little adherence to societal norms,
- little anxiety
- conflicts with others
- callous/exploitive
23- Difficulties in establishing secure identity
- Distrust
- Impulsive and self-destructive behavior
- Difficulty in controlling anger and other emotions
24Narcissistic Personality Disorder
- grandiose, sense of self-importance
- lack of empathy
- hyper-sensitive to criticism
- exaggerate accomplishments/ abilities
- special and unique
- entitlement
- below surface is fragile self-esteem
25Armand Hammer
- There has never been anyone like me, and my
likes will never be seen again.
26Armand Hammer - Again
The brilliance of my mind can only be described
as dazzling. Even I am impressed by it.
27Histrionic Personality Disorder
- excessive emotional displays/ dramatic behaviour
- attention-seeking, victim stance
- seek re-assurance, praise
- shallow emotions, flamboyant, self-centred
- very seductive, life of the party
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29Personality Disorder Clusters
- Cluster Three Anxious-Fearful
- Display anxiety and fear typically
- Similar to anxiety and depressive disorders but
no real connection
30The Anxious-Fearful Group
- 1. Avoidant Personality Disorder
- 2. Dependent Personality Disorder
- 3. Obsessive-Compulsive Personality
- Disorder (Anankastic)
31Avoidant Personality Disorder
- over-riding sense of social discomfort
- easily hurt by criticism
- always need emotional support
- occasionally try to socialize
- so distressing they retreat into loneliness
32Dependent Personality Disorder
- submissive, clingy behaviour
- fear of separation
- easily hurt by criticism
-
33Obsessive Compulsive Personality Disorder
- excessive control and perfectionism
- inflexible
- preoccupied with trivial details
- judgmental/moralistic
- workaholic/ignore family members
- often humourless
34Focus on Borderline PD
35Borderline Personality Disorder
- marked instability of mood, relationships,
self-image - intense, unstable relationships
- uncertainty about sexuality
- everything is good or bad
- chronic feeling of emptiness
- recurrent threats of self-harm/ slashers
36- Single White Female (Jennifer Jason Leigh) or
Fatal Attraction (Glen Close).
37Good Depictions of BPD
38Borderline Personality Disorder
- Therapist killers (not really killers)
- Very difficult to treat
- Tend to be avoided by many clinicians
- Takes lots of training and experience to treat
effectively - Lots of turmoil in treatment
39Borderline Personality Disorder Four Core
Elements
- Difficulties in establishing secure
self- identity - Distrust Splitting
- Impulsive and Self Destructive Behaviour
- Difficulty in controlling anger and other
emotions
40Borderline Examples From Therapist
- First experience with BPD under my supervision
41Identity Disturbance
- In terms of identity disturbance, she relied
heavily on a sort of reflected identity from
others and saw herself as she believed others saw
her. - With respect to her poor ego boundaries and the
melding of her identity with my own, one
particularly surprising thing she said to me was
that she had googled my name on the internet and
found out that I had won a presitious academic
award. She said she felt really sad because she
did not have an award herself.
42Distrust and Splitting
- She vascillated quite wildly between idealizing
me (including telling me that she loved me and at
times wanted us to sit together on the couch so I
could hold her) and devaluing me (lots of anger
in session, and a fairly caustic email that said
"Ain't it so nice and easy. Tell you what M,
go out and get ourself abused, loose that
charming smile of yours and come back and tell me
who's mentally ill", which was followed shortly
after by an apologetic one.)
43Continued
- It was difficult for me to predict from week to
week whether she would tell me I was dirt or
idealized. She was a good example of someone who
used splitting defenses where she saw other
people (me in particular) in all good or all bad
terms and made rapid shifts between these two
positions.
44Affective Instability
- Affective instability (went along with the wild
swings between this sort of coy, coquettish
behavior and the pronounced anger in session),
but also exhibited shallow affect and incongruent
affect. - For example, she often smiled or giggled when she
told me about her difficulties and began to
ocassionally exhibit sadness in session by
crying. However, a little later in therapy she
told me that in fact the tears were fake and that
she was using them because she felt closer to me
when I responded to her tears.
45More on Distrust
- She had a long history of interpersonal problems
and difficulty connecting with people. She was
quite paranoid about what others thought of her
and this was quite evident in her comments about
her co-workers whom she felt were against her
(and, frankly, she may have been right) and in
her desire to see her chart in the hopes that it
would finally reveal the intense dislike for her
that she imagined I felt.
46Termination Always difficult
- We spent about 2 months preparing for and
discussing termination and it still went poorly.
She was angry and her parting gift to me was a
plant that contained a set of tiny clay pots
(sort a decorative thing) partially submerged in
the soil. She gave the clinic secretary the same
thing, but she was careful to say "this one is
for the secretary, and this one is for you", when
I looked at the two later, the one that she gave
me had the tiny clay pots smashed, while
Geraldine's were intact. A final parting message.
47Self-Destructive Behaviour
- Drug abuse
- Suicide threats
- Lots of promiscuity
48Classification Models with respect to PD
- Classical Categorical Model Used by DSM - -
Views disorders as discrete syndromes (i.e.,
distinct boundaries between PDs and homogeneous
within the boundaries) - Consistent with traditional conception of medical
disorders
49Dimensional Assessment of Personality Pathology
- W. John Livesley at the University of British
Columbia - Dimensions of PD and their traits
- Emotional dysregulation
- Dissocial behaviour
- Inhibitedness
- Compulsivity
50Epidemiology
- gender similar prevalence rates overall
- consistent differences across disorders
- bias in diagnoses?
- temporal stability
- culture
- Wide variations in cultural expectations
51Further Thoughts Impulse Control Disorders
- psychological disorders characterized by lack of
control over inappropriate behaviour - Intermittent Control Disorder
- Pathological Gambling
- Trichotillomania
- Pyromania
52Schizotypal Personality Disorder
- increased prevalence among relatives of
individuals with schizophrenia - some response to antipsychotic and antidepressant
medications - poor response to insight-oriented psychotherapy
53Borderline Personality Disorder
- Historical
- Kernbergs psychodynamic theory borderlines see
people and events as good or bad - Etiology
- sexual abuse
- neurotransmitter dysregulation
- Treatment
- dialectical behaviour therapy (DBT)
54Psychopathy
- Associated with APD and Dissocial Personality
Disorder - Not a disorder itself
55Psychopathy
- egocentric, deceitful, shallow, impulsive
individuals who use and manipulate others - callous, lack of empathy
- little remorse.
- thrill-seeking
- human predators (Hare, 1993)
- no conscience
56Psychopathy Checklist-Revised (Hare, 1991) 2
factors
- FACTOR 2 social deviance
- (e.g., early behaviour problems, impulsivity)
- FACTOR 1 - emotional/ interpersonal
characteristics - (e.g., lack remorse, shallow affect)
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58Etiology
- Biological
- interaction of genetics and environment
- Social
- negative child/parent interactions
- Psychological
- affective impairment
- lack of inhibition
59Treatment
- little evidence for treatment effectiveness
- psychopaths may become worse
- increased violent crimes following treatment
- some treatment programs may help psychopaths
manipulate others better
60Dependent Personality Disorder
- Historical
- introduced in DSM-III
- sociotropy dependency leads to depression
- Etiology
- little research
- biological little evidence
- psychological anxious/insecure attachment
- Treatment
- assertiveness training
- problem-solving strategies
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62Problems with Classical Model
- Exaggerates similarity among patients
- Inconsistencies in idiosyncracies are ignored
- Focus on stereotypic features of patients
63Classification Models with respect to PD
- Prototype Categorical Model Used by Theodore
Millon (big wig) attempts to place people in
categories, but the categories are not
necessarily discrete but have fuzzy boundaries.
- Symptoms are often but not necessarily present
(e.g., concept of bird includes flying creatures
like blue jay, but also nonflying like penguins)
64Prototype Categorical Model
- Allows for multiple diagnoses
- Improves reliability of diagnoses disagreement
over single features less likely to affect
agreement over presence or absence of disorder
65Classification Models with respect to PD
- Dimensional Model Does not place people into
diagnostic categories - Key characteristics are identified and the degree
to which a person has the key characteristic is
determined. - Rather than asking is a PD present or absent, it
asks how much?
66Different Dimensions of PD
- Eysenck Neuroticism, Psychoticism, and
Introversion - Cloninger Novely seeking, Harm avoidance, and
Reward dependence - Costa/McCrae Neuroticism, Extroversion,
Openness, Agreeableness, and Conscientious
67PDs Being considered
An Impulse Control Disorder can be loosely
defined as the failure to resist an impulsive act
or behaviour that may be harmful to self or
others. For purposes of this definition, an
impulsive behaviour or act is considered to be
one that is not premeditated or not considered in
advance and one over which the individual has
little or no control
68There are six categories under this general
diagnosis Trichotillomania, Intermittent
Explosive Disorder, Pathological Gambling,
Kleptomania, Pyromania, and Not Otherwise
Specified. The first five are the most prevalent
and common Impulse Control Disorders.
69The Negativistic (Passive-Aggressive) Personality
Disorder appears in Appendix B of the Diagnostic
and Statistical Manual (DSM), titled "Criteria
Sets and Axes Provided for Further Study."
People suffering from this disorder are
pessimistic and have negativistic attitudes. They
say things like "good things don't last", "it
doesn't pay to be good", "the future is behind
me". They frustrate others' expectations and
requests and resist even reasonable and minimal
demands to perform in workplace and social
settings. Passive-aggressives resent authority
figures (boss, teacher, parent-like spouse).
70- There are many form of passive-aggressive
negativism procrastination, malingering,
perfectionism, forgetfulness, neglect, truancy,
intentional inefficiency, stubbornness, and
outright sabotage. This misconduct affects the
passive-aggressive's social milieu it obstructs
the efforts of his colleagues in the workplace,
for instance.
71People diagnosed with the Negativistic
(Passive-Aggressive) Personality Disorder
resemble narcissists they chronically complain
and criticize. They feel unappreciated,
underpaid, cheated, and misunderstood. They blame
their failures, misfortune, and defeats on
others. Passive-aggressives sulk and give the
"silent treatment" in reaction to real or
imagined slights. They are counterfactually
convinced that, behind their backs, they are the
subjects of derision, contempt, and condemnation
("ideas of reference"). Some passive-aggressives
are mildly paranoid and believe in a wide-ranging
conspiracy against them. In the words of the DSM
"They may be sullen, irritable, impatient,
argumentative, cynical, skeptical and contrary."
They are also hostile, explosive, lack impulse
control, and, sometimes, reckless.
72People diagnosed with the Negativistic
(Passive-Aggressive) Personality Disorder envy
the fortunate, the successful, the famous, their
superiors, those in favor, and the happy. They
are openly defiant, but, when reprimanded, they
immediately beg forgiveness, go on a charm
offensive,, and promise to behave and perform
better in the future.