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Chapter 11

Chapter 11 - Very thorough textbook and class notes

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Psychology 2030A/B
David Vollick

Chapter 11 - Personality Disorders Personality Trait vs. Personality Disorder • What is the difference between a personality trait and a personality disorder? o It is important, although not always easy, to recognize at what point a per sonality style has become rigid and maladaptive o Also need to consider clinical state vs. personality trait ▯ State = expression of a personality characteristic that is related to a specific circumstance, clinical condition, or period of time (ego-dystonic) • State-dependent change (stressed out therefore angry and irritable) is normal and distinctly different from the person’s characteristic way ▯ Trait = specific and characteristic way that someone approaches the world; unlikely to change across situations, ti me and events (ego-syntonic) • 3 important aspects when diagnosing a personality disorder: o Must differentiate between a personality trait and a personality disorder o Personality disorders should never be diagnosed after a single brief behavioral observation because they represent enduring ways of dealing with the world o Clinicians should not diagnose personality disorders without known the surrounding context • It is also important to determine if the person is suffering from a personality disorder, or from another disorder that is influencing their personality • Determining whether a behavior is a disorder also considers impairment and distress • It is challenging to diagnose this disorder because there are few biological or observable signs; they cannot be detected by blood tests o A personality disorder is also not a dramatic or acute illness, but a long -term, chronic, pervasive pattern of inflexible and maladaptive functioning ▯ They are less of a illness than a “Way of being” o One characteristic of these disorder s is that they often cause more distress to other people than the person with the disorder • One way to distinguish personality disorders from other disorders is using the 3 P’s: o Behavior that is persistent over time o Pervasive (across people and situation) o Pathological (clearly abnormal) • General Personality disorder = an enduring pattern of inner experience and behavior that deviates markedly from the expectations of the individual’s culture, is pervasive and inflexible, has the onset in adolescence or early adulthood, is stable over time, and leads to distress and impairment • The DSM divides their personality disorders into 3 clusters depending on the overall style of behavior that is present across all disorders in the cluster o Cluster A - odd or eccentric o Cluster B - dramatic, emotional, or erratic o Cluster C - Anxious or fearful Personality Disorder Clusters • Categorical approach of characterizing personality disorders • Impairment is the hallmark of these disorders • Remember the 3 P’s: persistent, pervasive, and pathological Cluster A: Odd or Eccentric Disorders • Common features: behaviors that others would consider odd, quirky, or eccentric • Paranoid Personality Disorder o Pervasive distrust and suspiciousness of others such that their motives are interpretedas malevolent; Characterized by unjustified and pervasive distrust o People believe, without evidence, that people are out to exploit, harm, or deceive them; bear grudges and are unforgiving of perceived insults; hyper -vigilant for signs of disloyalty or untrustworthiness of friends, family, coworkers o Suspiciousness does not extend to delusional thoughts o Interpersonal difficulties are common • Schizoid Personality Disorder o Pervasive pattern of detachment from social relationships and a restricted range of emotional expression in interpersonal settings o People are often introverted, solitary, emotionally unexpressive, and isolated o Derive little enjoyment from or show little interest in belonging to families or social groups o Afraid of relationships that req uire closeness and intimacy o Experience few emotional extremes (anger, joy) o Can lead to impairment of both social and occupational functioning o Lack social skills - but do not have hallucinations, delusions, or complete disconnect from reality that occurs in untreated schizophrenia o Schizoid may run in families • Schizotype Personality Disorder o Pervasive pattern of social and interpersonal deficits marked by acute discomfort, reduced capacity for close relationships, cognitive or perceptual distortions, and behavioral eccentricities o Often described as a cluster of idiosyncrasies ▯ People often have offbeat, peculiar, or paranoid beliefs and thoughts o Have difficulty forming relationships and have extreme social anxiety o During interpersonal interactions, react inappropriately, show no emotion, or inappropriately talk to themselves o Also usually have odd, eccentric, or peculiar physical appearance o Often very suspicious of others and paranoid Cluster B: Dramatic, Emotional, or Erratic Disorders • Common feature: behaviors are exaggerated, inflated, dramatic, emotional, or erratic • Marked by extreme and often colorful patterns of behavior • Antisocial personality disorder (ASPD) o Pervasive pattern of disregard for and violation of the rights of others ▯ Failure to conform to social normal with respect to the law ▯ Impulsivity or lack of planning skills ▯ Irritability ▯ Regular irresponsibility ▯ Often lie, use aliases, harass others, and engage in behaviors and actions that violate the basic rights, wishes, safety, and feel ings of others ▯ Feel very little remorse o Males > females o Has many names: psychopathy, sociopathy, dys -social personality disorder o Pattern of antisocial behavior begins in childhood and then crystallized and intensifies over time o Case: Jeffrey Dahmer ▯ Brutally killed 17 men and boys ▯ Had classical symptoms of antisocial personality disorder - no remorse, impulsive, callous, manipulative, aggressive o 40% of convicted felons fit the criteria for this disorder • Narcissistic personality disorder o Pervasive pattern of grandiosity, need for admiration, and lack of empathy ▯ Exaggerated sense of importance ▯ Exploitation of others for personal ends, lack of empathy ▯ Envy of others or the belief that others are envious of oneself ▯ Arrogant, haughty behaviors or attitudes ▯ Seek constant attention and may try to win admiration from others by flaunting or boasting about their perceived special abilities ▯ Express a sense of entitlement - belief that they deserve only the best of everything ▯ Often patronizing towards others • Borderline personality disorder o Pervasive pattern of unstable interpersonal relationships, self -image, affect, and impulsivity ▯ Pattern of strained interpersonal relationships ▯ Significant, consistent, unstable self -perception ▯ Inappropriate irritability or expression of anger ▯ Suicidal behavior, gestures, or threats; chronic feelings of emptiness, emotional instability o Symptoms are often severe and rapidly fluctuating o Impulsive hostility, self-injury, drug or alcohol abuse common o Unstable and conflicted sen se of self and self-worth lead to frequent changes in long -term goals, career paths, jobs, friendships, gender identity, values o At the core is a deep fear of abandonment o The person may form an immediate attachment to someone else; then a minor conflict can lead to a rapid moodswing and strong negative emotions toward the person develop o Person is considered exhausting and high maintenance o Note: borderline personality disorder is persistent, pervasive, and pathological (contrast with the episodic nature of bipolar disorder) o Ethics and responsibility ▯ The label of borderline personality disorder has been associated with considerable stigma ▯ Difficult, treatment resistant, manipulative, demanding, attention seeking ▯ Such negative perspectives can lead to negativ e expectations of treatment, negative outcomes, and self-fulfilling prophecies • Histrionic personality disorder o Pattern of excessive emotion and attention -seeking behavior ▯ Use physical appearance as a means of getting attention ▯ Perceiving relationships as more intimate than they really are ▯ Inappropriate irritability ▯ Speaking in an impressionistic manner ▯ Being uncomfortable when not the center of attention ▯ Displaying superficial expression of emotions ▯ Showing inappropriate sexually seductive and end extreme emotionality o Histrionic = dramatic Cluster C: Anxious or Fearful Disorders • Common features: considerable anxiety and withdrawal; these disorders share features that reflect some sort of anxiety (social anxiety, obsessionality, or fear of independence) • Avoidant personality disorder o Pervasive pattern of social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation ▯ Avoid social or occupational interactions for fear of rejection, criticism, or disapproval ▯ Excessively shy and uncomfortable in social situations ▯ Worry about what they say ▯ Some also fear blushing or crying in front of others ▯ Very hurt by any real of perceived disapproval ▯ Avoid making new friends unless they have complete assurance that they will not be rejected ▯ Avoidance of intimacy in close relationships in fear of rejection o The shyness and sense of inadequacy leads to significant impairment in life both socially and occupationally o Social Anxiety Disorder vs. Avoidant Personality Disorder ▯ Both are defined by fears of criticism and avoidance of activities that involve different social interactions ▯ Individuals with Avoidant Personality Disorder tend to have more severe problems and greater functional impairment • Dependent personality disorder o Pervasive and excessive nee d to be taken care of, which leads to submissive and clinging behavior and fears of separation ▯ Have great difficulty making the simplest everyday decisions, let alone large life choices ▯ Allow others to take over responsibility for planning all aspects of their life ▯ Have trouble starting projects on their own ▯ Chronic need to check with others for guidance and reassurance (rather follow than lead) ▯ A sense of helplessness can develop if they are left alone ▯ Need to seek out new relationships when one ends • Obsessive-compulsive personality disorder o Pervasive pattern of pre
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