PSYCH 430: Chapter 13
Define personality disorder.
A heterogeneous group of disorders that are long-standing, pervasive, and consist of inflexible patterns of behavior. Affects cognition, affectivity, interpersonal functioning, and/or impulse control.
What is the difference between a personality and a personality disorder?
Personality: not harmful, flexible.
Disorder: rigid, inflexible, self-defeating, structural instability, fragility
Name and describe Livesley et al.'s three life tasks.
Intrapersonal: forming stable, integrated, coherent self-representations of self and others
Interpersonal: to develop a capacity for intimacy
Social-group: to engage in pro-social and cooperative behaviors
Personality Cluster A (name three):
Paranoid, Schizoid, Schizotypal
Personality cluster B (name 4):
anti-social, borderline, histrionic, narcissistic
Personality cluster C (name three):
Avoidant, dependent, obsessive-compulsive
Does the DSM-5 use a dimensional or categorical approach to personality disorders?
Dimensional.
Which, of the three clusters, is most common?
Cluster C at 7%
Which disorders are comorbid with personality disorders?
anxiety, mood disorders, substance use, sexual difficulties
Discuss some challenges in personality disorder research.
- Diagnostic criteria are not sharply defined
- Low reliability and validity
- Hard to fit people in a box
- High level of comorbidity.
2 ways to assess disorders:
1. Clinical interviews
2. Self-reporting personality tests (MMPI or MCMI-4)
Name a challenge associated with clinical interviews.
Many personality disorders are ego syntonic; person lacks insight
Characterize cluster A:
Odd/Eccentric
Characteristics of paranoid PD:
- Suspicious of others
- Expected to be mistreated or exploited by others
- Tends to blame others
- Can be extremely jealous
- Reluctant to confide in others.
Why is paranoid PD not the same as paranoid schizophrenia?
Paranoid PD does not have the hallucinations or delusions that one would have in paranoid schizo. This personality disorder is also not disabling in social settings and not as extreme as schizophrenia.
Describe schizoid PD.
- Withdrawn
- No desire for or enjoyment of social relationships
- No interest in sex
- Flat affect
- Doesn't experience tons of pleasure
- Extremely high levels of introversion (low warmth and no positive emotions)
- Severe disruption in sociability due to impairment of underlying social and emtional bonds with others
How are maladaptive schemas shown in schizoid PD?
People with schizoid PD view themselves as slef-sufficient loners and other people as intrusive.
Which PD may be an early indicator of schizophrenia?
Schizoid
Which other disorder may be linked to schizoid?
Autism spectrum disorder
What is a similarity between schizoid and schizotypal?
They have similar interpersonal difficulties such as detachment and restricted affect.
Desrcibe schizotrypal PD:
- Odd beliefs or magical thinking
- Recurrent illusions
- Ideas of reference
- Suspiciousness
- Paranoid ideation
- Eccentric behavior and appearance
- Odd speech
Characterize cluster B:
Dramatic/eratic
Describe histrionic.
- Overly dramatic and attention-seeking
- Uses physical appearance to draw attention
- Self-centered
- Speech lacks detail
- Inappropriately sexually seductive and provocative.
Cogntive theory of histrionic PD:
Maladptive schemas revolving around the need for attention to validate self-worth
Psychoanalytic theory of histrionic PD:
Seductiveness was encouraged by parental upbringing.
What is histrionic PD comorbid with?
Depression, Borderline PD, antisocial, narcissistic, dependent Pds.
Describe narcissistic PD.
- Exaggerated sense of self-importance
- Preoccupation with being admired
- Preoccupied with fantasies of unlimited success, power, brilliance, beauty, love.
- Believes to be special or unique and wants to be associated with people of high status.
- Sense of entitlement and need for admiration.
Major characteristic of narcissism:
Lack of empathy and unwillingness to recognize or identify with feelings and needs of others
2 subtypes of Narcissistic PD:
Grandiose and Vulnerable
Describe grandiose narcissism:
Extreme grandiosity; oversestimates one's own abilities and accomplishments to underestimate those of others.
Describe vulnerable narcissism.
- Fragile and unstable self-esteem
- Arrogance and condescension is a facade for intense shame and hypersensitivity to rejection and criticism.
- Manipulation and false victimhood
- Intentional faking empathy
What is comorbid with Narcissistic Pd?
Borderline Personality disorder
Describe Kohut's view on personality.
Individuals who lack a sense of self-esteem, like those with narcissistic personality disorder tend to look for validation in others by getting them to conform to their appearance, beliefs, and opinions.
Meaning of selfobject experiences:
You don't know where you end and others begin. One's experience of another person (the object) is no longer individual.
They view themselves as part of the experience rather than individual or separate.
3 types of needs of children:
- Mirroring: caregiver should mirror/empathize with child's emotions
- Idealization: child looks up to caregiver
- Twin ship or alter ego: recall phallic stage; child wants to be like caregiver
According to Kohut, there are five narcissistic personality types:
- Mirror-hungry
- Ideal-hungry
- Alter-ego
- Merger-hungry
- Contact-shunning
7 components of pathological narcissism:
Entitlement rage, exploitativeness, grandiose fantasty, self-entitlement, contingent self-esteem, hiding the self, devaluing.
Components of the Dark Triad of narcissistic pd:
Narcissism, psychopathy, machiavellianism. Add sadism
Describe Borderline Personality Disorder (BPD):
- Attitudes and feelings toward others vary dramatically
- Emoitnos are erratic and can shift abruptly
- Argumentative, irritable, sarcastic, quick to take offense
- Low of trust
- Experiences intense and unstable social relationships
- Lack of emotional skin
3 dimensions of BPD:
1. Affect instability
2. Dysfunctional relationships
3. Impulsivity (self-harm, suicide)
How is suicide used as a coping mechanism in BPD?
Attempting suicide may not be due to the person actually wanting to die but merely a cry for help.
Psychosocial factors of BPD:
Negative experiences in childhood of abuse, neglect, separation or loss, trauma;
Parental psychopathology
Explain how the diathesis stress model is associated with the etiology of BPD.
Stress can include abandonment, loss/rejectoin, parental failure. Genetic/biological traits such as impulsivity and affectivity can all predispose a person to to developing BPD
Who is Marsha Linehan and what is she known for?
Linehan is a psychologist that advocates for the treatment of BPD as an emotional dysregulation disorder. She created the diathesis-stress theory of BPD and dialectical behavior therapy.
What is the most effective treatment for BPD?
Dialectical behavior therapy encourages patients to accept negative affect without engaging in self-destructive or other maladaptive behaviors.
- problem focused
- phone therapy
- group therapy CBT
2 main components of antisocial PD:
1. Conduct disorder before 15 years old
2. Pattern of anti-social behavior continues into adulthood
Give some examples of anti-social behavior
Breaks laws, physically aggressive, works inconsistently, irresponsible behavior
Potential causes of antisocial personality disorder (genetic and environmental):
Criminality is heritable; high parental conflict increases negativity; low parental warmth; monozygotic twins.
What aspects of parent psychopathology are related to ineffective parenting?
- Education and occupation
- employment
- divorce and transitions
- neighborhood and school
- stressful events
What are some developmental causes of antisocial lifestyle?
- childhood antisocial behaviors
- deviant peers
- ineffective parenting
- early arrest
What is the key characteristic to antisocial Pd? Describe it.
poverty of emotions.
- lack of remorse
- no sense of shame
- superificially charming
- manipulates others for personal gain
What can you say about the relationship between APD and psychopathy?
All psychopaths can also be diagnosed with APD but not everyone with APD can be diagnosed as a psychopath
Biological causes of psychopathy:
- Reduced size of amygdala
- Reduced response to aversive conditioning, fearful, and sad faces
- Reduced amygdala response to negative stimuli
- Decreased prefrontal activity
Describe Avoidant pd:
- Sensitive to possibility of criticism, rejection, or disapproval
- Reluctant to enter relationships unless they will surely be liked
- Higher levels of life impairment compared to other personality disorders
2 main components of avoidant Pd:
Feeling inept and socially inadequate.
What is comorbid with avoidant pd?
Dependent pd, depression and generalized social phobia
Discuss the etiology of avoidance personality disorder.
- Inhibited temperament
- Fear of being negatively evaluated
- introversion and neuroticism
- shy and inhibited in novel and ambiguous situations
Describe dependent Pd.
- Intense need to be taken care of
- Lack of self-reliance
- Overly dependent on others
- Uncomfortable being alone
What is comorbid with dependent personality disorder?
Bipolar disorder, depression, anxiety disorders, bulimia.
Discuss the etiology of dependent personality disorder.
Neuroticism and agreeableness are genetic; predispositions to dependence and anxiousness make them prone to effects of parents who are authoritarian and over protective; underlying maladaptive schemas
Characteristics of obsessive-compulsive PD:
- Perfectionistic approach to life
- Preoccupied with details, rules, schedules
- Serious, rigid, formal, inflexible
What is the difference between Obsessive-Compulsive Personality Disorder and Obsessive-Compulsive disorder?
The PD doesn't have the obsessions and compulsions
Discuss the etiology of OCPD.
Psychoanalytic: fixation at the anal stage.
High levels assertiveness and harm avoidance behavior
Low levels of novelty seeking and reward dependence
Why do you think CBT is the best approach to treatment and why don't we see a lot of people come in for therapy?
People with cluster B and A PDs may not typically come in for treatment due to their low levels of trust, compliance, and potentially high self-esteem. In other words, they might not see anything wrong with their personality/behavior. CBT is the best method to treat PDs because it focuses on reducing subjective stress and modifying maladaptive schemas and automatic thoughts. It teaches behavioral tasks and challenges faulty logic.