1. Personality Disorders
Definition of Personality?
Definition of Personality Disorder
Manifest across many life areas
Inflexible
Maladaptive
Cause either significant impairment or distress to self or others

2. Personality Disorders
Dimensions or Categories?
DSM-IV
Consided as Categories (not dimensions)
Axis II of the multiaxial system
Not usually primary diagnosis
Ten Specific Labels
Cluster A: “Odd / Eccentric”
Cluster B: “Dramatic / Emotional”
Cluster C: “Anxious / Fearful”
High Rates of Comorbidity
Gender Bias in Diagnosis?

3. FIGURE 11. 1 Gender bias in diagnosing personality disorders (P. D. )
FIGURE 11.1  Gender bias in diagnosing personality disorders (P.D.). Data are shown for the percentage of cases clinicians rated as antisocial personality disorder or histrionic personality disorder, depending on whether the case was described as a male or a female. (From Ford, M. R., & Widiger, T. A., Sex bias in the diagnosis of histrionic and antisocial personality disorders. Journal of Consulting and Clinical Psychology, 57, 301–305.) 3

4. Paranoid Personality Disorder
Excessively Mistrustful
Excessively Suspicious
Without Justification
Treatment Options
Few seek professional help on their own
Treatment focuses on development of trust
Cognitive therapy to counter negativistic thinking
Lack good outcome studies

5. Schizoid Personality Disorder
Extreme Social Detachment (Loner)
Appear Aloof, Cold, Indifferent
Limited Range of Emotions
Treatment Options
Few seek professional help on their own
Focus on the value of interpersonal relationships, empathy, and social skills
Treatment prognosis is generally poor
Lack good outcome studies

6. Schizotypal Personality Disorder
Also Socially Isolated
BUT Behavior Is More Unusual
Often Considered Odd or Bizarre
Ideas of Reference
Magical Thinking
Illusions
Apparent Connection to Schizophrenia (but be careful!)
Treatment Options
Developing social skills
Treatment also addresses comorbid depression
Medical treatment is similar to that used for schizophrenia
Treatment prognosis is generally poor

7. Antisocial Personality Disorder
Long Histories of
Violating Cultural Norms
Violating Rights of Others
Impulsivity & Aggressiveness
Lack of Remorse, Conscience, Empathy
Not Always Criminal
Relation Between ASPD, Conduct Disorder, and Early Behavior Problems

8. Antisocial Personality
Neurobiological Theories
Underarousal, Fearlessness, & Behavioral Inhibition
Treatment
Few seek treatment on their own
Antisocial behavior is predictive of poor prognosis, even in children
Emphasis is placed on prevention and rehabilitation
Often incarceration is the only viable alternative 8

9. Borderline Personality Disorder
Unstable Relationships
Love/Hate Behavior
Fear of Abandonment
Poor Self-Image
Mood Swings, Feel Empty
Impulsivity
Substance Abuse, Sex, Suicidality
Self-mutilation

10. Borderline Personality Disorder
Runs in families
Early trauma and abuse seem to play some role
Treatment Options
Few good treatment outcome studies
Antidepressant medications provide some short-term relief
Dialectical behavior therapy is the most promising psychosocial approach

11. Histrionic Personality Disorder
Overly Dramatic
Center of Attention
Emphasis on Appearance
Emotions are Shallow
Seductive & Provocative
Treatment Options
Few good treatment outcome studies
Treatment focuses on attention seeking and long-term negative consequences
Targets may also include problematic interpersonal behaviors
Little evidence that treatment is effective

12. Narcissistic Personality Disorder
Grandiose Sense of Self
Exaggerated Self-Importance
Preoccupied with Attention
Requires Admiration
Little Empathy
Highly Sensitive to Criticism
Treatment Options
Focuses on grandiosity, lack of empathy, unrealistic thinking
Treatment may also address co-occurring depression
Little evidence that treatment is effective

13. Avoidant Personality Disorder
Sensitive to Other’s Opinions
Avoid Social Relationships
Extreme Low Self-Esteem
Takes Few Risks
Socially Inhibited & Anxious
Treatment Options
Several well-controlled treatment outcome studies exist
Treatment is similar to that used for social phobia
Treatment targets include social skills and anxiety

14. Dependent Personality Disorder
Excessive Reliance on Others
Submissive & Passive
Rely on Others to Make Even Minor Decisions
Fear Abandonment
Clingy
Treatment Options
Research on treatment efficacy is lacking
Therapy typically progresses gradually
Treatment targets include skills that foster independence

15. Obsessive-Compulsive Personality Disorder
NOT same thing as OCD
Fixation on Doing Things “The Right Way”
Preoccupation with
Perfectionism
Control
Orderliness, Details, and Rules
Obsessions and Compulsions Are Rare
Treatment Options
Data supporting treatment are limited
Treatment may address fears related to the need for orderliness
Other targets include rumination, procrastination, and feelings of inadequacy

16. Problems with Personality Disorders
The Causes of Personality Disorders Are Difficult to Pinpoint
Treatment of Personality Disorders Is Often Difficult
Often Comorbid Issues
Egosyntonic (vs. Egodystonic)