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Abnormal Psychology, Eleventh Edition by Ann M. Kring, Gerald C

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Presentation on theme: "Abnormal Psychology, Eleventh Edition by Ann M. Kring, Gerald C"— Presentation transcript:

1 PowerPoint  Lecture Notes Presentation Chapter 12 Personality Disorders
Abnormal Psychology, Eleventh Edition by Ann M. Kring, Gerald C. Davison, John M. Neale, & Sheri L. Johnson

2 Personality Disorders (PD)
Longstanding, pervasive, inflexible patterns of behavior and inner experience Patterns present in at least 2 areas: Cognition Emotions Relationships Impulse control Coded on Axis II Often comorbid with Axis I disorders More severe symptoms and poorer outcome when comorbid 50+% of people diagnosed with a personality disorder meet criteria for another personality disorder More than two-thirds meet lifetime criteria for an Axis I disorder (Lenzenwenger et al., 2007) Copyright 2009 John Wiley & Sons, NY

3 Table 12.1 Key Features of the DSM-IV-TR Personality Disorders
Copyright 2009 John Wiley & Sons, NY

4 Copyright 2009 John Wiley & Sons, NY
Table 12.2 Rates of DSM-IV Personality Disorders in the Community and in Treatment Settings Copyright 2009 John Wiley & Sons, NY

5 Table 12.3 Interrater Reliability for the Personality Disorders
Copyright 2009 John Wiley & Sons, NY

6 Classifying Personality Disorders
DSM-IV-TR categorical approach Classifies in 3 clusters: Cluster A Odd/Eccentric Cluster B Dramatic/Erratic Cluster C Anxious/Fearful Diagnostic reliability Initially poor; improved since DSM-III Test-retest reliability (diagnostic stability) ½ of those initially diagnosed with PD did not receive same diagnosis 1 year later (Shea et al., 2002) Gender bias Certain diagnoses applied more often to men, others to women Copyright 2009 John Wiley & Sons, NY

7 Copyright 2009 John Wiley & Sons, NY
Figure 12.1 Test–retest stability for personality disorders and major depressive disorder across 6-, 12-, and 24-month follow-up interviews Copyright 2009 John Wiley & Sons, NY

8 Dimensional Approach: Five-Factor Model
Five-factor model (McCrae & Costa, 1990) Neuroticism, extraversion/introversion, openness to experience, agreeableness/antagonism, and conscientiousness Five factors are heritable Personality traits form a continuum Individuals with PDs endorse the extremes Dimensional approach involves rating each individual on the five factors Avoids applying a categorical label which may not completely fit Copyright 2009 John Wiley & Sons, NY

9 Dimensional Approach: Five-Factor Model
Most personality disorders are characterized by high neuroticism and antagonism. High extraversion tied to histrionic and narcissistic disorders (involve dramatic behavior) Low extraversion linked to disorders that involve social isolation, such as schizoid, schizotypal, and avoidant personality disorders Copyright 2009 John Wiley & Sons, NY

10 Copyright 2009 John Wiley & Sons, NY
Table 12.4 Sample Items from the Revised NEO Personality Inventory assessing Five-Factor Model Copyright 2009 John Wiley & Sons, NY

11 Odd/Eccentric Cluster: Paranoid Personality Disorder
Suspicious Secretive; reluctant to confide in others Expects to be mistreated/exploited Vigilant for hints of abuse Blames others when things go wrong Questions loyalty No hallucinations or full blown delusions More common in men than women Cormorbidity high for Schizotypal Borderline Avoidant Copyright 2009 John Wiley & Sons, NY

12 Odd/Eccentric Cluster: Schizoid Personality Disorder
Avoids close interpersonal relationships Few close friends Aloof & distant Loner Likes solitary activities Rarely report strong emotions Little interest in sex Experiences anhedonia Comorbidity high for Schizotypal Avoidant Paranoid Copyright 2009 John Wiley & Sons, NY

13 Odd/Eccentric Cluster: Schizotypal Personality Disorder
Interpersonal difficulties similar to schizoid Odd beliefs or magical thinking Superstitious Telepathic Illusions Feels the presence of a force or person not actually present. Odd/eccentric behavior or appearance Wears strange clothes Talks to self Ideas of reference Copyright 2009 John Wiley & Sons, NY

14 Etiology of the PDS in Odd/Eccentric Cluster
Highly heritable Links to schizophrenia Relatives of individuals with schizophrenia at greater risk for schizotypal Individuals with schizotypal PD show problems similar to those found in schizophrenia Cognitive and neuropsychological deficits Enlarged ventricles Less temporal gray matter Copyright 2009 John Wiley & Sons, NY

15 Dramatic/Erratic Cluster: Borderline Personality Disorder (BPD)
Impulsive, self-damaging behaviors Unstable, stormy, intense relationships Emotional reactivity Frantic efforts to avoid abandonment Unstable sense of self Anger control problems Chronic feelings of emptiness Recurrent suicidal gestures Transient psychotic or dissociative symptoms Copyright 2009 John Wiley & Sons, NY

16 Dramatic/Erratic Cluster: Borderline Personality Disorder (BPD)
Onset during adolescence or early adulthood Prognosis poor within 10 years of diagnosis Later in life, most no longer meet diagnostic criteria (Paris, 2002) Cormorbidity high with PTSD, MDD, substance-related, and eating disorders Comorbidity predicts symptoms 6 years later Suicide rates high Self-mutilation also a problem Copyright 2009 John Wiley & Sons, NY

17 Copyright 2009 John Wiley & Sons, NY
Etiology of Borderline Personality Disorder (BPD): Neurobiological factors Genetic component Highly heritable May play a role in impulsivity and emotional dysregulation Decreased functioning of serotonin system Frontal lobe dysfunction Increased activation of amygdala Copyright 2009 John Wiley & Sons, NY

18 Copyright 2009 John Wiley & Sons, NY
Etiology of Borderline Personality Disorder (BPD): Social Environmental Factors Parental separation Verbal and emotional abuse during childhood Object-Relations Theory (Kernberg, 1985) Introjection Object-representation BPD involves disturbed object representations, possibly due to inconsistent parenting Conflict between introjected values and current needs Splitting Copyright 2009 John Wiley & Sons, NY

19 Copyright 2009 John Wiley & Sons, NY
Etiology of Borderline Personality Disorder (BPD): Social Environmental Factors Linehan’s Diathesis-Stress Theory Individuals with BPD have difficulty controlling their emotions Possible biological diathesis Family invalidates or discounts emotional experiences and expression Interaction between extreme emotional reactivity and invalidating family → BPD Copyright 2009 John Wiley & Sons, NY

20 Figure 12.2 Linehan’s Diathesis-Stress Theory of BPD
Copyright 2009 John Wiley & Sons, NY

21 Dramatic/Erratic Cluster: Histrionic Personality Disorder
Formerly known as hysterical personality Overly dramatic and attention seeking behavior Craves attention Loves to be in the spotlight Emotionally shallow despite strong displays of emotion Easily influenced by others Overly concerned with physical attractiveness May be sexually provocative and seductive Copyright 2009 John Wiley & Sons, NY

22 Etiology of Histrionic Personality Disorder
Psychoanalytic theory Emotional displays and seductiveness result from parental seductiveness Father’s sexual attention towards daughter Conflicting family attitudes towards sexuality Negative attitudes towards sex while simultaneously acknowledging titillation Theory untested Copyright 2009 John Wiley & Sons, NY

23 Dramatic/Erratic Cluster: Narcissistic Personality Disorder
Grandiose view of self Preoccupied with fantasies of success Self-centered Demands constant attention and adulation Feelings of entitlement and arrogance Envious of others Little concern for needs and well being of others Lacks empathy Sensitive to criticism Seeks out high-status partners Copyright 2009 John Wiley & Sons, NY

24 Etiology of Narcissistic Personality Disorder
Kohut’s Self-Psychology Model Characteristics mask low self-esteem In childhood, narcissist valued as a means to increase parent’s own self-esteem Not valued for his or her own competency and self worth People with high levels of narcissism report cold parents who overemphasized child’s achievement Social cognitive model Narcissist has low self esteem Sense of self depends on “winning” Interpersonal relationships are a way to bolster sagging self esteem rather than increase closeness to others Lab studies reveal cognitive biases that maintain narcissism Copyright 2009 John Wiley & Sons, NY

25 Dramatic/Erratic Cluster: Antisocial Personality Disorder
Pervasive disregard for the rights of others since age 15 Lies Aggression Impulsiveness Violates the law Irresponsible Lacks remorse Conduct disorder before age 15 Truancy, running away, lying, theft, arson, destruction of property Substance abuse most common comorbid disorder Culture plays a role More common in US than Scotland More common among lower SES groups Copyright 2009 John Wiley & Sons, NY

26 Dramatic/Erratic Cluster: Antisocial Personality Disorder
Psychopathy (sociopathy) (Cleckley, 1941) Predates DSM-IV-TR category Focuses on internal thoughts and feelings Poverty of emotion Negative emotions Lacks shame and anxiety Positive emotions Used to manipulate others Impulsivity Behave irresponsibly for thrills Psychopathy Checklist – revised (Hare, 2008) Interpersonal symptoms Pathological lying, manipulativeness, and charm Affective symptoms Lack of remorse and empathy, shallow affect Onset before age 15 not required. Copyright 2009 John Wiley & Sons, NY

27 Etiology of Antisocial Personality Disorder
Genetics Antisocial behavior heritable Estimates as high as .96 Genetic risk for APD, psychopathy, conduct disorder, and substance abuse related. Family environment Lack of warmth, negativity, and parental inconsistency predict APD Poverty, exposure to violence Family environment interacts with genetics Copyright 2009 John Wiley & Sons, NY

28 Etiology of Antisocial Personality Disorder
Emotion and psychopathy Lack of fear or anxiety Low baseline levels of skin conductance Skin conductance reactivity at age 3 predicted APD at age 28 (Glenn et al., 2007) Makes it difficult for them to avoid behavior that leads to punishment Also show less SCR to other’s distress Lack empathy Figure 12.3 Copyright 2009 John Wiley & Sons, NY

29 Anxious/Fearful Cluster: Avoidant Personality Disorder
Avoids interpersonal situations Fears criticism or rejection Hesitant about involvement with others Wants to be certain of acceptance Restrained and inhibited in interpersonal situations Fears ridicule Feelings of inadequacy Avoids taking risks or trying new activities Doesn’t want to risk embarrassment High comorbidity with major depression and generalized social phobia Related toJapanese syndrome called taijin kyofusho (taijin means “interpersonal” and kyofusho means “fear”). Copyright 2009 John Wiley & Sons, NY

30 Anxious/Fearful Cluster: Dependent Personality Disorder
Lack of self confidence Excessive reliance on others Intense need to be cared for Uncomfortable when alone Feels helpless to care for self Behavior focused on maintaining relationships Quickly initiates new relationship if current one fails Prevalence higher in India and Japan than US Copyright 2009 John Wiley & Sons, NY

31 Anxious/Fearful Cluster: Obsessive-Compulsive Personality Disorder
A perfectionist Preoccupied with rules, details, & organization Rigid and inflexible Overly focused on work Little time for leisure, family, & friends Tendency to hoard Difficulty discarding worthless items Reluctant to delegate Moral inflexibility Does not have the obsessions/compulsions of OCD Most frequently comorbid with Avoidant PD Copyright 2009 John Wiley & Sons, NY

32 Etiology of Personality Disorders in the Anxious/Fearful Cluster
Not much available research Avoidant PD Overly protective and authoritarian parents Obsessive-Compulsive PD Fixation at anal stage of development (Freud) More recent theorists Cope with fears of losing control by overcompensation Dependent PD Disruption of early childhood attachment by death, neglect, rejection, or overprotectiveness Copyright 2009 John Wiley & Sons, NY

33 Treatment of Personality Disorders
Axis I disorder usually drives individual to treatment Presence of PD, reduces success of treatment for Axis I Medications Avoidant PD Antianxiety medication or antidepressants Schizotypal PD Antipsychotic medications Psychotherapy Psychodynamic Seek awareness of early childhood problem Cognitive behavioral Break personality disorder down into discrete problems Treat sensitivity to criticism with social skills training Copyright 2009 John Wiley & Sons, NY

34 Copyright 2009 John Wiley & Sons, NY
Table 12.5 Maladaptive Cognitions Associated with Personality Disorders Copyright 2009 John Wiley & Sons, NY

35 Treatment of Borderline PD
Difficult to treat Interpersonal problems play out in therapy Attempts to manipulate therapist Object Relations Therapy (Kernberg et al., 1985) Dialectical Behavioral Therapy (Linehan, 1987) Acceptance and empathy plus CBT, emotion regulation, and social skills Schema-Focused Cognitive Therapy for BPD Identify maladaptive assumptions that underlie cognitions Medications Antidepressants Antipsychotics Olanzapine Copyright 2009 John Wiley & Sons, NY

36 Treatment of Psychopathy
Intensive psychoanalytic therapy Cognitive behavioral therapy Issue remains Are therapy successes ‘faking good’ or genuinely improved? Copyright 2009 John Wiley & Sons, NY

37 Copyright 2009 John Wiley & Sons, NY
Copyright 2009 by John Wiley & Sons, New York, NY. All rights reserved. No part of the material protected by this copyright may be reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording or by any information storage and retrieval system, without written permission of the copyright owner. Copyright 2009 John Wiley & Sons, NY


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