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Chapter 12 Personality Disorders. Personality Disorders: An Overview Enduring and pervasive predispositions Perceiving Relating Thinking Inflexible and.

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Presentation on theme: "Chapter 12 Personality Disorders. Personality Disorders: An Overview Enduring and pervasive predispositions Perceiving Relating Thinking Inflexible and."— Presentation transcript:

1 Chapter 12 Personality Disorders

2 Personality Disorders: An Overview Enduring and pervasive predispositions Perceiving Relating Thinking Inflexible and maladaptive Distress Impairment Coded on Axis II

3 Personality Disorders 10 specific personality disorders Several under review for DSM-V 3 clusters High comorbidity with Axis I disorders Poorer prognosis Therapist reactions Countertransference

4 Personality Disorders: An Overview Categorical vs. Dimensional Views Kind vs. Degree DSM is categorical Reifies concepts Less flexible Loss of individual information Sometimes arbitrary

5 Personality Disorders: An Overview Five factor model of personality (Big Five) Openness to experience Conscientiousness Extraversion Agreeableness Emotional stability

6 DSM Personality Disorder Clusters Cluster A Odd or eccentric Paranoid, schizoid, schizotypal Cluster B Dramatic, emotional, erratic Antisocial, borderline, histrionic, narcissistic Cluster C Fearful or anxious Avoidant, dependent, obsessive-compulsive

7 Personality Disorders: Facts and Statistics Prevalence = %, may be closer to 10% Outpatient = % Inpatient = 10 – 30% Origins and Course Begin in childhood Chronic course High comorbidity

8 Personality Disorders: Gender Differences Differences in diagnostic rates Borderline (75% female) Clinician bias Assessment bias Measures Criterion bias Histrionic = extreme stereotypical female No macho disorder

9 Personality Disorders: Gender Differences

10 Personality Disorders Under Study Individual disorders Sadistic Self-defeating Categories of disorders Depressive Negativistic Passive aggressive

11 Cluster A: Paranoid Personality Disorder Clinical Description Mistrust and suspicion Pervasive Unjustified Few meaningful relationships Volatile Tense Sensitive to criticism

12 Cluster A: Paranoid Personality Disorder Causes Possible relationship to schizophrenia Possible role of early experience Trauma Abuse Learning World is dangerous

13 Cluster A: Paranoid Personality Disorder Treatment Unlikely to seek on own Crisis Focus on developing trust Cognitive therapy Assumptions Negative beliefs No empirically-supported treatments

14 Cluster A: Schizoid Personality Disorder Clinical Description Appear to neither enjoy nor desire relationships Limited range of emotions Appear cold, detached Appear unaffected by praise, criticism Unable or unwilling to express emotion No thought disorder

15 Cluster A: Schizoid Personality Disorder Causes Limited research Precursor: childhood shyness Possibly related to: Abuse/neglect Autism Dopamine

16 Cluster A: Schizoid Personality Disorder Treatment Unlikely to seek on own Crisis Focus on relationships Social skills therapy Empathy training Role playing Social network building No empirically-supported treatments

17 Cluster A: Schizotypal Personality Disorder Clinical Description Psychotic-like symptoms Magical thinking Ideas of reference Illusions Odd and/or unusual Behavior Appearance Socially isolated Highly suspicious

18 Cluster A: Schizotypal Personality Disorder Causes Schizophrenia phenotype? Lack full biological or environmental contributions Preserved frontal lobes Cognitive impairments Left hemisphere? More generalized?

19 Cluster A: Schizotypal Personality Disorder Treatment Options Treatment of comorbid depression Multidimensional approach Social skill training Antipsychotic medications Community treatment

20 Cluster B: Antisocial Personality Disorder Clinical Description Noncompliance with social norms Social Predators Violate rights of others Irresponsible Impulsive Deceitful Lack a conscience, empathy, and remorse

21 Cluster B: Antisocial Personality Disorder Nature of psychopathy Glibness/superficial charm Grandiose sense of self-worth Proneness to boredom/need for stimulation Pathological lying Conning/manipulative Lack of remorse Overlap with ASPD, criminality Intelligence

22 Cluster B: Antisocial Personality Disorder

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24 Developmental considerations Early histories of behavioral problems Conduct disorder Families history of: Inconsistent parental discipline Variable support Criminality Violence

25 Causes of Antisocial Personality Gene-environment interaction Genetic predisposition Environmental triggers Arousal hypotheses Underarousal Fearlessness

26 Causes of Antisocial Personality Grays model of brain functioning Behavioral inhibition system (BIS) Low Reward system (REW) High Fight/flight system (F/F)

27 Causes of Antisocial Personality Interactive, integrative model Genetic vulnerability Neurotransmitters Environmental factors Family stress Reinforcement of antisocial behaviors Alienation from good role models Poor occupational/social function

28 Antisocial Personality Disorder Treatment Unlikely to seek on own High recidivism Incarceration Early intervention Parent training Prevention Rewards for pro-social behaviors Skills training Improve social competence

29 Cluster B: Borderline Personality Disorder Clinical Description Patterns of instability Labile, intense moods Turbulent relationships Impulsivity Fear of abandonment Very poor self-image Self-mutilation Suicidal gestures

30 Cluster B: Borderline Personality Disorder Comorbid disorders Depression – 24-74% Suicide – 6% Bipolar – 4-20% Substance abuse – 67% Eating disorders 25% of bulimics have BPD

31 Cluster B: Borderline Personality Disorder Causes Genetic/biological components Serotonin Frontolimbic circuit Cognitive biases Early childhood experience Neglect Trauma Abuse

32 Cluster B: Borderline Personality Disorder Treatment Highly likely to seek treatment Antidepressant medications Dialectical behavior therapy Reduce interfering behaviors Self-harm Treatment Quality of life Outcomes Demonstrated efficacy Cortical activation changes

33 Cluster B: Borderline Personality Disorder

34 Cluster B: Histrionic Personality Disorder Clinical Description Overly dramatic Sensational Sexually provocative Impulsive Attention-seeking Appearance-focused Impressionistic Vague, superficial speech Common diagnosis in females

35 Cluster B: Histrionic Personality Disorder Causes Little research Links with antisocial personality Sex-typed alternative expression?

36 Cluster B: Histrionic Personality Disorder Treatment Problematic interpersonal behaviors Attention seeking Long-term consequences of behavior Little empirical support

37 Cluster B: Narcissistic Personality Disorder Clinical Description Exaggerated and unreasonable sense of self-importance Require attention Lack sensitivity and compassion Sensitive to criticism Envious Arrogant

38 Cluster B: Narcissistic Personality Disorder Causes Deficits in early childhood learning Altruism Empathy Sociological view Increased individual focus Me generation

39 Cluster B: Narcissistic Personality Disorder Treatment focuses on: Grandiosity Lack of empathy Hypersensitivity to evaluation Co-occurring depression Little empirical support

40 Cluster C: Avoidant Personality Disorder Clinical Description Extreme sensitivity to opinions Avoid most relationships Interpersonally anxious Fearful of rejection

41 Cluster C: Avoidant Personality Disorder Causes Sub-schizophrenia disorder? Difficult temperament Early parental rejection Interpersonal isolation and conflict

42 Cluster C: Avoidant Personality Disorder Treatment Similar to social phobia Increase social skills Reduce anxiety Importance of therapeutic alliance Moderate empirical support

43 Cluster C: Dependent Personality Disorder Clinical Description Rely on others for major and minor decisions Unreasonable fear of abandonment Clingy Submissive Timid Passive Feelings of inadequacy Sensitivity to criticism High need for reassurance

44 Cluster C: Dependent Personality Disorder Causes Little research Early experience Death of a parent Rejection Attachment

45 Cluster C: Dependent Personality Disorder Treatment Limited empirical support Caution: dependence on therapist Gradual increases in: Independence Personal responsibility Confidence

46 Cluster C: Obsessive-Compulsive Personality Disorder Clinical Description Fixation on doing things the right way Rigid Perfectionistic Orderly Preoccupation with details Poor interpersonal relationships Obsessions and compulsions are rare

47 Cluster C: Obsessive-Compulsive Personality Disorder Causes Limited research Weak genetic contributions Predisposed to favor structure?

48 Cluster C: Obsessive-Compulsive Personality Disorder Treatment Similar to OCD Address fears related to the need for orderliness Decrease: Rumination Procrastination Feelings of inadequacy Limited efficacy data

49 Personality Disorders: Future Directions Completely rethinking personality disorders Dimensional models


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