Personality Disorders

What is meant by the concept of Personality?

Aspects to the concept ‘Personality’ Identity Social skill Impression created in others Temperament Essence Patterns of perceiving,understanding and behaving in a social context

Definition and Theory of ‘Personality’ “personality is defined by the particular concepts that are part of the theory of personality used by the observer” Hall and Lindzey (1957, p. 9)

Goals of Personality Theory Kluckhohn & Murry (1953) –every human being is (1) like every other human being; (2) like some other human beings; and (3) like no other human being

Personality Disorders Clinical Features of Personality Disorders: –social, interpersonal concept –chronic, persistent and pervasive –often do not see themselves as having a problem –involve others

Personality Disorders Clinical Features of Personality Disorders: –inability to bring themselves into harmony with the social world, and use rigid, maladaptive behviour/interpersonal patterns to avoid negative emotions –lack authentic, straight-forward expressions of needs and desires

Five Criteria Two of the following areas must be disrupted: cognition, affectivity, interpersonal, or impulse control. Enduring, inflexible and pervasive Distress Early onset Not better accounted for by an other mental disorder

DSM-IV Definition “an enduring pattern of inner experience and behaviour that deviates markedly from the expectations of the individual’s culture, is pervasive and inflexible, has an onset in adolescence or early adulthood, is stable over time, and leads to distress or impairment”

Reliability

Paranoid Personality Disorder Suspiciousness Not seen in therapy very often may have a genetic link to schizophrenia

Schizotypal Personality Disorder Odd, socially eccentric Unusual thoughts/beliefs/perceptions

Schizoid Personality Disorder Social detachment, flat affect Anhedonia Does not seem to be biologically related to Schizophrenia

Borderline Personality Disorder Difficulties establishing a secure self-identity Extreme ambivalence towards others Impulsive, and self-destructive behaviour Poor emotional regulation

Histrionic Personality Disorder Self-dramatization Exaggerated display of emotion See themselves as “sensitive” often perceived by others to be “shallow/insecure”

Narcissistic Personality Disorder Grandiose sense of self importance Overly concerned with how others view them

Avoidant Personality Disorder Social withdrawal (want to be loved, but expect to be rejected)

Dependent Personality Disorder Fearful and incapable of making independent decisions/actions Self-effacement

Obsessive-Compulsive Personality Disorder Preoccupation with orderliness, perfectionism, efficiency and control Little spontaneity and experienced pleasure

Comorbidity Rare in general population, but common in clinical population Most do not seek help for PD Treatment is sought for specific problem, and PD is identified during treatment

Understanding Personality Disorders

Meta-Approaches to understanding personality disorders Extreme variation of normal personality Less acute versions of Axis I disorders Origin of Axis I disorders Personality and Psychopathology Theory

Extreme variation of normal personality Five factor dimensional model of personality –Extroversion –Agreeableness –Conscientiousness –Neuroticism –Openness

Less acute versions of Axis I disorders Early stages or less severe Schizotypal and Schizophrenia

Origin of Axis I disorders Personality disorders are the root of all other Axis I difficulties

Psychodynamic Approach Disturbed object relations (representations of self and others) and unstable sense of self Weak ego functioning Kohut (Narcissistic Personality Disorder) –lack love, approval and empathic responses from caretakers

Psychodynamic Approach Kernberg (Borderline Personality Disorder) –splitting Individuation Introjection

Research inspired by psychodynamic theory Feldman et al. (1999) –maternal synchrony with infant affect at 3 months and mutual synchrony at 9 were related to self-control at 2 years (stronger relation seen in difficult infants) Weston et al. (1990); Nigg et al. (1992) –individuals with BPD remember and perceive themes of malevolence

Cognitive Approach Negative beliefs about self, other and environment –eg Beliefs of an individual with BPD include: the world is dangerous and malevolent, I am vulnerable and powerless, I am unacceptable to others. Unlike Axis I disorders these schemas develop early

Cognitive Approach Unlike psychodynamic approach, less emphasis on how, or why maladaptive schemas arise Padesky (1987) –avoidant personality disorder- past history of critical and shaming parents - “I must be a bad, undesirable person to be treated so badly.” “If my parents don’t love me nobody will.”

Differences between Psychodynamic and Cognitive Explanations Content of experience vs Constituting of experience Different concept of self: –Negative view of self vs Unstable, incoherent experience of self as an entity, and as a perspective from which to view the world.

Family Systems Approach Poor parenting (lack of affection, inconsistent and rejecting) Retrospective and Prospective studies Caution

Behavioural Approach Defective capacity to learn Failure to develop social skills and emotional regulation skills Learn dysfunctional behaviours

Biological Approach Biological abnormalities Family studies suggest genetic involvement in Schizotypal and Borderline (equivocal) Look at genetic and neurotransmitter involvement in traits like impulsivity and sociability

Integrative Causal Models Millon (1983) Biosocial Model –constitutional differences set the stage for subsequent learning and experiences –how caretakers respond to a child’s disposition (dimensional) is critical