Chapter 10 Personality Disorders ABNORMAL PSYCHOLOGY, SIXTEENTH EDITION James N. Butcher/ Jill M. Hooley/ Susan Mineka Chapter 10 Personality Disorders © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Clinical Features of Personality Disorders Chronic interpersonal difficulties Problems with identity or sense of self Formerly known as “character disorders” © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Clinical Features of Personality Disorders DSM criteria include enduring behavior pattern Pervasive and inflexible Stable and of long duration Clinically significant distress or impairment in functioning Manifested in at least two areas Manifested in at least two areas: cognition, affectivity, interpersonal functioning, or impulse control Often cause significant problems in lives of others Gradually develop inflexible and distorted personality and behavior patterns © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Clinical Features of Personality Disorders Cluster A includes: Paranoid Schizoid Schizotypal Cluster B includes: Histrionic Narcissistic Antisocial Borderline Cluster C includes: Avoidant Dependent Obsessive-compulsive © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Clinical Features of Personality Disorders Prevalence Ranges from 4.4% to 14.8% About 75% comorbidity © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Difficulties Doing Research on Personality Disorders Diagnosing Studying causes © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Difficulties in Diagnosing Personality Disorders Diagnostic criteria not sharply defined Diagnostic categories not mutually exclusive Dimensional personality characteristics Difficulties in diagnosing personality disorders are caused by a number of factors, including: Diagnostic criteria are not sharply defined Diagnostic categories are not mutually exclusive Personality characteristics are dimensional in nature © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Difficulties in Diagnosing Personality Disorders Five-factor model of personality Openness to experience Conscientiousness Extraversion Agreeableness Neuroticism © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Difficulties in Diagnosing Personality Disorders PDs may represent extreme levels of normal personality traits Histrionic Dependent Obsessive-compulsive Histrionic—high extraversion and neuroticism Dependent—high agreeableness and neuroticism Obsessive-compulsive—high conscientiousness © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Difficulties in Studying the Causes of Personality Disorders Limited research on causal factors Relatively new area of study (1980) Less amenability to thorough study Retrospective approaches Little research has been conducted on causal factors Difficulties in studying the causes of personality disorders spring from The fact that such disorders have received consistent attention only since DSM-III was published in 1980 The fact that these disorders are less amenable to thorough study The fact that most studies to date are retrospective © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Cluster A Personality Disorders Paranoid Schizoid Schizotypal © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Paranoid Personality Disorder On guard for perceived attacks by others Tendency to see self as blameless Suspiciousness and mistrust of others © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Schizoid Personality Disorder Inability and lack of desire to form attachments to others Impaired social relationships © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Schizotypal Personality Disorder Oddities of perception and speech that interfere with communication and social interaction Peculiar thought patterns Causal factors Genetic abnormalities similar to schizophrenia Oddities of perception and speech that interfere with communication and social interaction © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Cluster B Personality Disorders Histrionic Personality Disorder Narcissistic Personality Disorder Antisocial Personality Disorder Borderline Personality Disorder © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Histrionic Personality Disorder Irritability and temper outbursts if attention seeking is frustrated Overconcern with attractiveness Self-dramatization © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Narcissistic Personality Disorder Lack of empathy Self-promoting Preoccupation with receiving attention Grandiosity Vulnerable narcissists have unstable self-esteem © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Antisocial Personality Disorder History of conduct problems as a child Shameless manipulation of others Deceitfulness Inability to follow approved models of behavior Lack of moral or ethical development History of conduct problems as a child © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Borderline Personality Disorder Attempts at self-mutilation or suicide Chronic feelings of boredom Drastic mood shifts Inappropriate anger Impulsiveness Causal factors Genetics, neurotransmitters, traumatic events © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Figure 10.1: Multidimensional Diathesis-Stress Theory of Borderline Personality Disorder © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Cluster C Personality Disorders Avoidant Personality Disorder Dependent Personality Disorder Obsessive-Compulsive Personality Disorder © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Avoidant Personality Disorder Insecurity in social interaction and initiating relationships Shyness Hypersensitivity to rejection or social derogation Causal factors inhibited temperament © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Dependent Personality Disorder Indecisiveness Subordination of needs to keep others involved in a relationship Discomfort at being alone Difficulty in separating in relationships Causal factors Inheritance of high neuroticism and agreeableness © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Obsessive-Compulsive Personality Disorder Difficulty in relaxing and having fun Lack of expressiveness and warmth Perfectionism Excessive concern with order, rules, and trivial details © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

General Sociocultural Causal Factors for Personality Disorders What do you think? Is our emphasis on impulse gratification, instant solutions, and pain-free benefits leading more people to develop the self-centered lifestyles that we see in more extreme forms in personality disorders? © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Treatments and Outcomes for Personality Disorders Difficulties Treatment difficulties Varied goals Clients resistance to change Relationships formation challenges Personality disorders are generally very difficult to treat Goals may vary Clients may believe there is no need to change Relationships, including therapist/client relationships, can be difficult to form © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Adapting Therapeutic Techniques to Specific Personality Disorders Therapeutic technique adaptation Settings Cognitive therapy Therapeutic techniques may need to be adapted for each personality disorder Settings can have an impact Inpatient Partial hospitalization Outpatient Cognitive therapy attempts to change biased and dysfunctional schemas of PD clients © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Treating Borderline Personality Disorder Antidepressant medications (SSRIs) Dialectical behavior therapy (DBT) Regarding treatment, borderline has received more clinical and research attention than the other PDs Antidepressant medications (SSRIs) Dialectical behavior therapy (DBT) A unique kind of cognitive and behavioral therapy adapted specifically for borderline Systematic research supports DBT © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Treating Other Personality Disorders Few controlled studies of treatment Antipsychotic or antidepressant medication Schizotypal PD Cognitive-behavioral treatment and antidepressant medication Avoidant PD In general, few controlled studies of the treatment of most PDs have been conducted Antipsychotic or antidepressant medication may help with schizotypal PD Cognitive-behavioral treatment and antidepressant medication may help with avoidant PD © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Antisocial Personality Disorder and Psychopathy Diagnostic Criteria Age 18 years and over At least three behavioral problems occurring after age 15 At least three instances of deviant behavior before age 15 © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Dimensions of Psychopathy Psychopathy and ASPD Dimensions of Psychopathy Affective/interpersonal core Behavior Affective/interpersonal core of the disorder: lack of remorse, lack of empathy, glibness/charm, etc. Behavior: need for stimulation, poor behavior controls, irresponsibility, parasitic lifestyle © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

The Clinical Picture in Psychopathy and Antisocial Personality Disorder Inadequate conscience development Irresponsible and impulsive behavior Ability to impress and exploit others © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Causal Factors in Psychopathy and Antisocial Personality Genetic influences Low levels of fear; poor conditioning of fear More general emotional deficits Early parental loss Parental rejection Inconsistent discipline Low levels of fear; poor conditioning of fear © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Developmental Perspective on Psychopathy and Antisocial Personality True or false? Antisocial behavior in childhood is the single best predictor of antisocial personality disorder in adulthood. True. Antisocial behavior in childhood is the single best predictor of antisocial personality disorder in adulthood The younger the antisocial behavior starts, the higher the risk Antisocial personality disorder is often preceded by conduct disorder, oppositional defiant disorder, or ADHD © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Figure 10.4: Family Context and Antisocial Behavior © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Treatments and Outcomes in Psychopathic and Antisocial Personality Cognitive-behavioral treatments offer some promise Treatment of psychopaths is difficult © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.

Unresolved Issues In the future, the DSM may include a dimensional component in addition to or instead of the categorical system In what ways would this radically different approach affect the way these disorders are diagnosed and treated? What dimensions should be used? DSM-IV-TR was a categorical system © 2014, 2013, 2010 by Pearson Education, Inc. All rights reserved.