PERSONALITY DISORDERS - 1
I. Statistics and Development
A. 0.5% to 2.5% of the general population,
higher rates in inpatient and outpatient settings.
B. originate in childhood and continue into the adult years;
relatively little is known about the developmental course.
C. Significant comorbidity
about half of those diagnosed with a personality disorder also meet criteria
for another personality disorder.
D. Gender biases
borderline personality disorder is diagnosed much more frequently in
females, who make up 75% of the identified cases.
Knowledge of whether the client is male or female can influence whether a
client receives one personality disorder diagnosis over another. For example,
antisocial personality disorder is assigned more often when the patient is
male, whereas a similar description of antisocial personality features with a
fictitious female client is more likely to be labeled histrionic personality
disorder. Many features of histrionic personality disorder are characteristic of
the stereotypical Western female.
1. criterion gender bias
2. assessment gender bias). PERSONALITY DISORDERS - 2
II. Cluster A (odd, eccentric) Personality Disorders
A. Paranoid personality disorder (PPD)
1. Evidence for a biological contribution to PPD is limited, and
evidence for a psychological contribution is unclear. The most
salient psychological feature is a pervasive negative view of the world
and the motives of others; a view that may originate in early
2. Treatment for PPD is difficult
few persons with this disorder seek professional help on their own,
difficulty in developing trusting relationships
a. Treatment focuses on development of trust and may include
cognitive therapy to counter the person’s mistaken assumptions
b. There are no good studies showing that treatment is effective for
B. Schizoid personality disorder (SZPD)
Unlike the DSM-IV, the DSM-IV-TR recognizes that at least some people with
SZPD are sensitive to the opinions of others but are unwilling or unable to
express this emotion. For this group, social isolation may be painful.
Homelessness is quite prevalent in persons with SZPD.
1. The etiology of SZPD is unclear.
2. Treatment for SZPD focuses on the value of social relationships,
learning empathy skills,
social skills training.
Role playing is also used to help the person learn to establish and
maintain social relationships.
Treatment prognosis is poor for people with SZPD,
persons with this diagnosis rarely seek treatment, except in response
to a crisis. PERSONALITY DISORDERS - 3
C. Schizotypal personality disorder (STPD)
Some increased risk that many may go on to develop more severe
characteristics of schizophrenia.
1. Some consider STPD a phenotype of a schizophrenia genotype and
genetic research seems to support such a relationship.
Family, twin, and adoption studies have shown an increased
prevalence of STPD among relatives of people with schizophrenia who
do not have schizophrenia themselves.
Exposure to influenza during pregnancy may increase risk of STPD in
the unborn fetus.
2. Cognitive factors include mild-to-moderate deficits in memory and
learning, suggesting damage to the left hemisphere of the brain,
whereas MRI studies suggest more generalized brain abnormalities in
3. Few controlled treatment studies exist for STPD.
The main treatment focus tends to be on developing social skills.
Given that as many as 30% to 50% of persons with STPD who seek
treatment meet criteria for major depressive disorder, therapy also
tends to focus on alleviating depressed mood.
Medical treatment tends to follow that for people with schizophrenia.
Prognosis is poor for persons with STPD. PERSONALITY DISORDERS - 4
III. Cluster B (dramatic) Personality Disorders
A. Antisocial personality disorder (ASPD)
Substance abuse occurs in about 83% of persons with antisocial personality
Long-term outcome of persons with ASPD is poor, regardless of gender.
1. Dyssocial psychopathy (i.e., antisocial behavior that is thought to
originate in a person’s allegiance to a culturally deviant group, such as
a gang) may be included with ASPD, but not psychopathy. Dyssocial
psychopaths are presumed to have the capacity for guilt and loyalty.
2. Psychopathy and ASPD are not synonymous with legal problems.
Those that get into legal problems seem to have lower IQs.
3. The diagnosis of conduct disorder is reserved for children who
engage in behaviors that violate cultural norms.
Many with this disorder become juvenile offenders and tend to become
involved with drugs.
Lack of remorse is not part of the DSM-IV-TR criteria for conduct
disorder, but is present for ASPD.
4. Family, twin, and adoption studies all suggest a genetic influence
on ASPD and criminality.
A gene-environment interaction appears involved, suggesting that
genetic vulnerability interacts with environmental factors
a. The average concordance rate for criminality among
monozygotic twins is 55%, whereas with dizygotic twins the rate
drops to about 13%.
5. Neurobiological research suggests that general brain damage does
not explain why people become psychopaths or criminals.
Two theories have attracted a great deal of attention.
a. According to the underarousal hypothesis, psychopaths have
abnormally low levels or cortical arousal. Low cortical arousal is
used to explain antisocial risk taking behavior.
Future criminal behavior is predicted by low skin conductance
activity, lower heart rate during rest, and slow brain wave
activity. PERSONALITY DISORDERS - 5
b. The cortical immaturity hypothesis suggests that the cerebral
cortex of psychopaths is at a primitive stage of development and
may explain why the behavior of psychopaths is often childlike
c. According to the fearlessness hypothesis, psychopaths show
higher thresholds for experiencing fear than most persons.
Research suggests that psychopaths have difficulty associating
cues with impending punishment or danger.
6. Psychological and social dimensions of psychopathy and ASPD
include the following:
a. Family and social factors may also contribute to psychopathy and
ASPD, particularly inconsistent parental discipline, trust and
solidarity in the family and community neighborhood.
7. An integrative model of ASPD includes
genetic vulnerability, perhaps resulting from underarousal or
Family stress and family interaction styles may activate the biological
the resulting antisocial behavior, including problems at school, may
further alienate the individual from other children that may serve as
good role models.
8. Treatment for ASPD is complicated by the fact the few persons with
such problems see any need for treatment.
Antisocial behavior is generally predictive of po