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Chapter 11


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Sara Campbell

1 CHAPTER 11: PERSONALITY DISORDERS OVERVIEW I. aspects of personality disorders ■ personality disorder- an enduring maladaptive pattern for relating to the environment and self, exhibited in a range of contexts that cause significant functional impairment or subjective distress ■ individuals with personality disorders may not feel distressed but it is others who feel distressed ■ considered part of axis II in the DSM because as a group personality disorders are distinct from other psychological disorders II. categorical and dimensional models ■ people with personality disorders experience the same problems of healthy people just experience a different degree of the problem (rather than kind) ■ according to the DSM you either have a personality disorder or you don't there is no in between ■ categorizing personality disorders is beneficial because it simplifies things but it is also bad because it gives a name to the disorder (is a personality disorder just an extreme version of a normal personality? or is it entirely different) ■ five factor model/ “big five”- people are rated on a series or personality dimensions describing why people are different; have found cultural differences on how people rate on this test 1. extroversion- talkative, assertive, and active 2. agreeableness- kind trusting and warm 3. conscientiousness- organized, thorough, and reliable 4. neuroticism- even tempered (versus moody) 5. open to experience- imaginative, curious, and creative III. personality disorder clusters PERSONALITY DISORDER DESCRIPTION CLUSTER A odd or eccentric disorders paranoid personality disorder the strong tendency to distrust the motives of others, leading to a high degree of suspiciousness schizoid personality disorder characterized by social detachment and a lack of emotional expression not due to societal anxiety schizotypal personality disorder social and interpersonal difficulties that are due to social anxiety but also involves distorted views of the world and unusual behavior CLUSTER B dramatic, emotional, or erratic disorders antisocial personality disorder characterized by behavior that shows limited regard for other people borderline personality disorder characterized by a high level of unstable relationships and emotional outbursts, poor self- image, and a difficulty controlling impulses histrionic personality disorder the tendency to display flamboyant emotions with the goal of seeking attention narcissistic personality disorder pervasive belief that the individual is better than everyone else, leads to attention-seeking and lack of concern for others CLUSTER C anxious or fearful disorders avoidant personality disorder characterized by strong feelings of being inadequate, which can result in inhibition in social situations and sensitivity to any negative feedback 2 dependent personality disorder a strong need to be cared for by others, including patterns of submissiveness and fear of separation obsessive compulsive personality disorder characterized by a desire for being perfect both mentally and interpersonally, a need for orderliness, and reduced flexibility and openness IV. statistics and development ■ 0.5-2.5% of the general population ■ as many as one in ten adults in the US may have a diagnosable personality disorder ■ 6% of adults worldwide ■ more women are diagnosed with borderline personality disorder and more men are diagnosed with antisocial personality disorder ■ thought to originate in childhood and continue into adult years ■ not much research has been done on its development because not many people seek treatment for personality disorders when they are a child ■ borderline personality disorder ○ characterized by volatile and unstable relationships, have persistent problems in early adulthood, depression, frequent hospitalization, suicidal gestures ○ 10% attempt suicide and 6% suceed ○ symptoms improve as individual enters their 30’s ■ antisocial personality disorder ○ characteristic disregard for the rights and feelings of others, continue behavior through adulthood ○ tend to “burn out” around age 40 and engage in less criminal activity V. gender differences ■ more women are diagnosed with borderline personality disorder (75% of total cases) ■ in the past more women were diagnosed with histrionic and dependent personality disorders but according to more recent studies the prevalence in the pop btwn man and women is about equal ■ study by maureen ford and thomas widiger- gave case studies to clinicians; one case described antisocial personality disorder and the other histrionic personality disorder ○ when the antisocial PD was labeled male the clinicians diagnosed correctly however when the case was said to be female most clinicians diagnosed it as histrionic PD instead of antisocial PD ■ being a woman increased the likeliness of a histrionic PD diagnosis ○ possible because of the distinctive female traits of the disorder: overdramatization, vanity, seductiveness, over concern with physical appearance ■ the issue of gender bias in diagnosing personality disorder remains highly controversial VI. comorbidity ■ there are higher accounts of cases of personality disorders compared to overall people with personality disorders because people often tend to be diagnosed with more than one ■ zimmerman, rothschild chelminski study on psychiatric outpatient- assessed how many PD one individual had and the likeliness an individual is to have another PD when diagnosed with one PD ○ example- person identified with borderline PD is also likely to be diagnosed for paranoid, schizotypal, antisocial, narcissistic, avoidant, and dependent PD VII. personality disorders under study ■ other PD have been studied and considered for DSM (ex sadistic PD a person who likes to inflict pain on others) 3 ■ two new personality disorders are being studied for DSM V- ○ depressive personality disorder- includes self criticism, dejection, a judgemental stance towards others, and a tendency to feel guilt; may be similar to dysmanthic disorder ○ passive aggressive (negativistic) PD- characterized by passive aggression in which people develop a negativistic attitude to resist routine demands and expectations; expansion of the previous DSm category passive-aggressive PD CLUSTER A (ODD OR ECCENTRIC) PERSONALITY DISORDERS I. paranoid personality disorder- excessively mistrustful and suspicious of others without any justification; assume people are out to harm them therefore they do not often confide in others A. clinical description ■ pervasive unjustified distrust ■ mistrust extends to those close to them and makes relationships difficult ■ may be argumentative and complain or may be quiet ■ often to appear tense ■ sensitive to criticism and have an excessive need for autonomy (self-govern) B. causes ■ biological evidence is limited but it is thought to be common in those with relatives who have schizophrenia (similar to many other cluster A disorder) ■ psychological contributions are unclear ○ theory is that the thought of the world being cruel and that people are out to get you was engraved in them early in childhood ■ cultural factors ○ refugees, prisoners, people with hearing impairments, and older adults are thought to be more susceptible because of their unique experiences ○ these factors interact to produce suspiciousness C. treatment ■ because they are distrusting they are unlikely to seek professional help ■ use cognitive therapy and try to develop a sense of trust ■ survey indicated that only 11% of therapists who treated paranoid PD thought the patient would continue therapy long enough to be helped II. schizoid personality disorder- show a pattern of detachment from social relationships and a limited range of emotions in interpersonal situations ; schizoid was term used by Bleuler to describe someone who turns inward and away from the outside world, a loner A. clinical description ■ do not desire or enjoy closeness with others ■ seem cold and detached and they aren’t phased by praise or criticism ■ they “consider themselves to be observers rather than participants in the world around them” ■ do not have the similar thought processes that characterize the other disorders in cluster A ○ people with paranoid and schizotypal PD have ideas of reference- mistaken believe that meaningless events relate just to them; these are positive symptoms ○ people with schizoid PD show negative symptoms- passive manifestation and social isolation alone B. causes and treatment ■ childhood shyness is reported as a precursor for the disorder in adulthood; could be a trait that is inherited and an important factor in development of the disorder 4 ■ abuse and neglect have also been reported among those with disorder ■ link with autism- parents with children who have autism are often schizoid PD ■ rare for a person with this condition to seek treatment unless it is accompanied by a crisis such as extreme depression or loss of job ■ begin treatment by pointing out value in social relationships ■ go through social training, role playing, and help establish relationships III. schizotypal personality disorder- socially isolated and behave in ways that would appear unusual, tend to be suspicious and have odd beliefs; considered to be on a continuum with schizophrenia. involves a pervasive pattern of interpersonal deficits featuring acute discomfort with, and reduced capacity for close relationships, as well as cognitive and perceptual distortions and odd behavior A. clinical description ■ typically have psychotic-like symptoms ■ have social deficits and sometimes cognitive impairment and paranoia ■ have ideas of reference- everything related to them ■ often have odd beliefs or engage in “magical thinking” for example they believe they are telepathic ■ as children tend to be passive, unengaged, and highly sensitive to criticism B. causes ■ historically schizotypy was used to describe those predisposed to schizophrenia ■ thought to have “schizophrenia genes” and because of lack of environmental stress or biological influences such as a prenatal illness the person shows less severe signs of schizophrenia ■ milder forms of the same symptoms associated with schizophrenia- ideas or reference, paranoid thinking, illusions, ■ family twin and adoption studies have found that there is an increase in prevalence of schizotypal personality disorder in those with relatives who have schizophrenia ■ strongly influenced by the environment ○ associated with childhood maltreatment resulting in PTSD symptoms ■ brain abnormalities C. treatment ■ 30-50% of those with disorder who seek treatment are also diagnosed with major depressive disorder ■ may be treated for depression ■ growing interest to treating disorder because it is being viewed as a precursor to schizophrenia ■ includes antipsychotic medication, community treatment, and social skills ■ found that treatment either reduces symptoms or delays onset of schizophrenia CLUSTER B PERSONALITY DISORDERS (DRAMATIC, EMOTIONAL, OR ERRATIC) I. antisocial personality disorder- involves a pervasive disregard for and violat
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