| Chapter Outline (See related pages)
- Introduction
- Personality disorders are conditions that involve stable traits
of entire personality
- Personality traits are enduring patterns of perceiving, relating
to, and thinking about environment and oneself exhibited in wide range
of contexts
- Personality traits when inflexible and maladaptive and cause
significant functional impairment or subjective distress, constitute
personality disorder
- Debate over diagnostic value of personality disorders
- Not particularly reliable
- Diagnostic criteria more specific to address diagnostic overlap
- Assumes stable personality traits
- Odd/Eccentric Personality Disorders (Cluster A)
- Paranoid Personality Disorder
- Defining characteristic of paranoid personality disorder
is suspiciousness
- Suspiciousness causes constant scanning environment for evidence
to support suspicions
- Suspiciousness affects emotional adjustment and social relationships
- Individual sees problems originating from others, not themselves
- Paranoid personality disorder differs from paranoid schizophrenia
or delusional disorder; paranoid personality disorder is less disabling
- Schizotypal Personality Disorder
- Schizotypal personality disorder characterized by odd
speech, behavior, thinking, and/or perception, but not odd enough
for schizophrenia
- Often have histories of being teased and participating in fringe
groups
- Disorder added to improve diagnosis of schizophrenia
- Schizoid Personality Disorder
- Defining characteristic of schizoid personality disorder
is severely restricted range of emotions associated with social detachment
- Person appears to have little/no interest in relationships; does
not seem to experience ordinary emotions such as pleasure, warmth
- Appears to take pleasure in solitary activities; may appear to
be self-absorbed
- Does not show typical patterns of thoughts, behaviors, speech
of schizophrenia
- There may be biological relationship to schizophrenia
- Dramatic/Emotional Personality Disorders (Cluster B)
- Borderline Personality Disorder (BPD)
- Borderline personality disorder proposed by psychodynamic clinicians
- Syndrome has four core elements
- Difficulties in establishing secure self-identity
- Distrust
- Impulsive and self-destructive behavior
- Difficulty in controlling anger and other emotions
- May be due to abnormalities in limbic system
- Some have argued borderline personality disorder related to depression
- Is one of most frequently diagnosed personality disorders
- Histrionic Personality Disorder (HPD)
- Self-dramatization is essential feature of histrionic personality
disorder
- Emotional displays often manipulative to gain attention and sympathy
- Interpersonal relationships are fragile
- In relationships, can become demanding
- Typically flirtatious and sexually provocative
- Most of those diagnosed with histrionic personality disorder
are women
- Narcissistic Personality Disorder
- In narcissistic personality disorder individual has grandiose
sense of self-importance, sometimes with feelings of inferiority
- Bragging of talent and achievements often accompanied by fragile
self-esteem
- Individuals are poorly equipped for friendship or love
- Demand great deal from others such as affection, favors
- Typically have long histories of erratic interpersonal relationships
- Resembles histrionic personality disorder
- What narcissistic type wants is admiration
- What histrionic type wants is concern
- Psychoanalytic theory suggests cause is compensation for inadequate
affection and approval from parents in early childhood
- Social learning theory suggests parents' inflated views of their
children's talents leading to unrealistic expectation is cause
- Anxious/Fearful Personality Disorders (Cluster C)
- Avoidant Personality Disorder
- Avoidant personality disorder marked by social withdrawal
- Social withdrawal based on fear of rejection
- Has hypersensitivity to possibility of rejection, humiliation,
or shame
- Tends to avoid relationships unless sure of other's uncritical
affection
- Avoidant personalities have low self-esteem
- Difficult to differentiate from social phobia
- Social phobia restricted to specific situations
- Avoidant personality disorder affects almost every day of
person's life
- Dependent Personality Disorder
- Dependence on others characterizes dependent personality disorder
- Fear of abandonment underlies dependency
- May grow tolerant of unacceptable behaviors of others leading
to a vicious cycle leading to more helpless feelings
- Overlap with borderline personalities, borderline personality
is more disabling
- Obsessive-Compulsive Personality Disorder
- Excessive preoccupation with orderliness, perfectionism, and
control describe obsessive-compulsive personality disorder
- Overly concerned with mechanics of efficiency
- Obsessive-compulsive personality disorder differs from obsessive-compulsive
disorder
- Personality disorder is milder and more pervasive
- Personality disorder is more common
- While seen as "workaholics," typically perfection prevents them
from making decisions and meeting deadlines
- Treatment is sought only after personal tragedies like divorces,
loneliness, and stress
- Groups at Risk
- Comorbidity
- Personality disorders rare in general population but may be common
in clinical populations
- People at risk for personality disorders are those who are in
psychological treatment for other disorders
- Most do not seek treatment for personality disorders
- Treatment is sought for more specific problems; in treatment
personality disorder is identified
- The Dispute over Gender Bias
- Men are at higher risk for some personality disorders (i.e.,
paranoid, schizotypal, schizoid, narcissistic, obsessive-compulsive,
antisocial)
- Women are at higher risk for some personality disorders (i.e.,
borderline, dependent)
- Diagnosticians view men and women differently
- Disorders that involve emotionalism more frequently diagnosed
in women
- Disorders that involve self-importance or callousness more
frequently diagnosed in men
- Differences may be due to idiom of distress
- DSM-IV and DSM-IV-TR changes reflect recognition
of gender bias and need for sex-blind criteria
- Cultural Bias
- Diagnosis assumes behavior is significantly different from expectations
of one's culture
- Diagnosticians must know individual's culture but may bend over
backward to respect culture
- Personality Disorders: Theory and Therapy
- The Psychodynamic Perspective
- Character Disorders
- Personality disorders due to disturbances in parent-child
relationship
- Severe personality disorders originate in separation, individual
process
- Results in weakened ego and poor adaptive functioning
- Fall between neurotics and psychotics in terms of ego strength
- Normal coping behavior has broken down
- Replaced by erratic, distorted, or deviant behavior
- Breakdown affects broad range of ego functions
- Introjection believed to play role in personality disorders
- Psychotherapy for Personality Disorders
- Individuals generally resistant to treatment
- Psychodynamic therapy takes more directive, more parental
approach with personality disorders than with other disorders
- Insight still believed to be mechanism of change
- The Behavioral Perspective
- Skills, Acquisition, Modeling, and Reinforcement
- Families often expect children to be cheerful; parents do
not coddle; child never able to get sympathy for minor upsets
- As children, individuals never learn emotional skills that
would allow them to take problems to parents
- Reinforcement and modeling may play role in personality disorders
- New Learning
- Patients need social skills training and assertiveness training
- Dialectical behavior therapy used with borderline
patients combining social skills training and how to regulate
emotions and tolerate distress
- The Cognitive Perspective
- Faulty Schemas
- Personality disorders seen as product of distortions or exaggerations
in underlying schemas
- Schemas are not perceived to be faulty; person will generate
perceptions and situations that confirm schemas
- Beliefs are acquired by learning and modeling in response
to developmental conditions
- In personality disorders, schemas, seen as being on continuum,
are at end of range
- Altering Schemas
- Goal of therapy is to alter the schema
- Therapists attempt to convince patient to modify, reinterpret,
or camouflage schema
- Reinterpretation refers to putting it to more functional
use
- Schematic camouflage refers to helping patient to act
in more socially acceptable ways
- The Sociocultural Perspective
- Personality disorders due to large-scale social processes
- Therapy should focus on changing society
- The Neuroscience Perspective
- Genes and Personality
- Genes play influential role in development of normal personality
- Studies reveal relationship of personality disorders to Axis
I disorders that have genetic component
- Drug Treatment
- Personality disorders can be alleviated by drugs used for
their Axis I counterparts
- Some personality disorders have no drug treatments as yet
- Drugs and Diagnosis
- Evidence raises diagnostic questions about reclassified
patients with Axis I disorders
- Drugs treat a symptom common to both personality disorders
and Axis I disorders
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