chapter ten personality disorders. clinical features of personality disorders personality disorders...

CHAPTER TEN

Personality Disorders

Clinical Features of Personality Disorders

Personality disorders

•Chronic interpersonal difficulties

•Problems with identity or sense of self

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Clinical Features of Personality Disorders

DSM criteria include enduring behavior

pattern

Pervasive and inflexible

Stable and of long duration

Clinically significant distress or

impairment in functioning

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Clinical Features of Personality Disorders

Prevalence Ranges from 4.4% to

14.8%

About 75% comorbidity

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Difficulties in Diagnosing Personality Disorders

Diagnostic criteria not sharply defined

Diagnostic categories not mutually exclusive

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Difficulties in Diagnosing Personality Disorders

PDs may represent extreme levels of normal personality

traits

• Histrionic• Dependent• Obsessive-compulsive

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Difficulties in Studying the Causes of Personality Disorders

Limited research on

causal factors

Less amenability to thorough study

Retrospective approaches

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Classifying Personality Disorders

• Cluster A are people who are perceived as odd or eccentric

Includes paranoid, schizoid, and schizotypal personality disorders

Classifying Personality Disorders

Cluster B are people whose behavior is overly dramatic, emotional, or erratic

– Includes antisocial, borderline, histrionic and narcissistic personality disorders

Classifying Personality Disorders

Cluster C are people who often appear anxious or fearful

Includes avoidant, dependent, and obsessive-compulsive personality disorders

Paranoid Personality Disorder (Cluster A)

On guard for perceived attacks by others

Tendency to see self as blameless

Suspiciousness and mistrust of others

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Schizoid Personality Disorder (Cluster A)

Inability and lack of desire to form attachments to others

Impaired social relationships

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Schizotypal Personality Disorder (Cluster A)

Oddities of perception and speech that interfere with communication and social

interaction

Peculiar thought patterns

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Histrionic Personality Disorder(Cluster B)

Irritability and temper outbursts if attention seeking is frustrated

Overconcern with attractiveness

Self-dramatization

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Narcissistic Personality Disorder(Cluster B)

Lack of empathy

Self-promoting

Preoccupation with receiving attention

Grandiosity

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Antisocial Personality Disorder(Cluster B)

History of conduct problems as a child (diagnosis of Conduct Disorder)

Shameless manipulation of others

Deceitfulness

Inability to follow approved models of behavior

Lack of moral or ethical development

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The Clinical Picture in Psychopathy and Antisocial Personality Disorder

Inadequate conscience development

Irresponsible and impulsive behavior

Ability to impress and exploit others

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Causal Factors in Psychopathy and Antisocial Personality

Causal factors • Genetic influences• Low levels of fear; poor conditioning of fear• More general emotional deficits• Early parental loss• Parental rejection• Inconsistent discipline

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Figure 10.4: Family Context and Antisocial Behavior

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Treatments and Outcomes in Psychopathic and Antisocial Personality

Cognitive-behavioral treatments offer some promise

Treatment of psychopaths is

difficult

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Borderline Personality Disorder (Cluster B)

Attempts at self-mutilation or suicide

Chronic feelings of boredom

Drastic mood shifts

Inappropriate anger

Impulsiveness

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Figure 10.1: Multidimensional Diathesis-Stress Theory of Borderline

Personality Disorder

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Avoidant Personality Disorder(Cluster C)

Insecurity in social interaction and initiating relationships

Shyness

Hypersensitivity to rejection or social derogation

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Dependent Personality Disorder(Cluster C)

Indecisiveness

Subordination of needs to keep others involved in a relationship

Discomfort at being alone

Difficulty in separating in relationships

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Obsessive-Compulsive Personality Disorder (Cluster C)

Difficulty in relaxing and having fun

Lack of expressiveness and warmth

Perfectionism

Excessive concern with order, rules, and trivial details

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Treatments and Outcomes for Personality Disorders

Difficulties

Clients resistance to

change

Relationships formation

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Treating Borderline Personality Disorder

Antidepressant medications

(SSRIs)

Dialectical behavior

therapy (DBT)

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Treating Other Personality Disorders

Few controlled studies of treatment

Antipsychotic or antidepressant

medication

Schizotypal PD

Cognitive-behavioral treatment and

antidepressant medication

Avoidant PD

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