Prelim3- Personality Disorders

What is personality ?

• traits and characteristics that psychologically distinguish one person from another

• includes perceiving, feeling, thinking about and relating to both and environment 

• relatively consistent across situations and across time—although lots of debate about how stable personality is 

Big 5 personality

• openness to experience

• conscientiousness

• extraversion

• agreeableness

• neuroticism

openness to experience

curiosity, creativity, willingness to try new things

conscientiousness

diligence, dependability 

Extraversion

social interactiveness, talkative

agreeableness

willingness to cooperate, kindness, trusting

neuroticism 

trait to negative emotion

personality in non-persons

dispositions exist in species who don’t have elaborate language

Persoanlity in Non-persons experiment

• survey of people who evaluated dog’s personality

personality disorder

• enduring pattern of inner experience and behavior that deviates markedly from the norms and expectations of the individual’s culture, is pervasive and inflexible, has an onset in adolescence or early adulthood, is stable over time and leads to distress or impairment

How are they different?

• involve remarkable amount of impairment—particularly interpersonally

• may or may not be associated with distress in the person who has one

• not fully treatable— tend to be less treatable in short time frame than many other disorder using meds or other treatments

• some more treatable, lack research

What debate is there on PD?

• personality falls along continuum— PD are extreme versions of common personalities

• other believe PDs involve different way of behaving, thinking, relating to others and experiencing emotions than we see in most people

Prevalence of PD

• 10% 

• used to assume it was lifelong, its not remit or more be tractable 

• considerable overlap across diagnostic criteria

• massive comorbidity— mainly MDD and anxiety disorders  

why are some people prone to personality disorders?

• all associated with indicators of impaired family relationships in childhood

  • higher prevalence of childhood maltreatment

  • family conflict

  • lack of parental warmth and affection expressed towards child, harsh parenting, poor parental communication, less parent-child time

Stigma and PDs

• public stigma of personality disorders is high

• includes stigma in mental health providers— who tend to view personality disorders more negatively than other disorders and express a lack of empathy for people with PDs

Cluster A

• shared features with psychotic disorders

• symptoms cannot have appeared only during episodes of psychosis

• odd and eccentric

• paranoid

• schizoid

• schizotypal

Cluster B

• dramatic, emotional, erratic

• antisocial

• borderline

• histrionic

• narcissistic

Cluster C

• anxious and fearful 

• avoidant, dependent, OCD

Why was Cluster A first investigated ?

• traits were evident in relatives of people with schizophrenia visiting their family in asylums

• tend to have relatives with schizophrenia and psychotic disorders

• sometimes do develop schizophrenia and psychotic disorders later in life

paranoid PD

• persuasive distrust and suspiciousness of others

• motives are malevolent

• beginning by early adulthood and present in variety of contexts by >4

>4 symptoms for Persuasive PD

• suspects without sufficient basis that others are exploiting, harming, or deceiving him/her

• preoccupied with unjustified doubts about the loyalty or trustworthiness of friends or associates

• reluctant to confide in others because of unwarranted fear that the information will be used maliciously against him/her

• reads hidden demeaning pr threatening meanings into benign remarks or events

• persistently bears grudges

• perceives attacks on his/her character or reputation that are not apparent to others and is quick to react angrily or to counterattack

• has recurrent suspicions, without justification, regarding fidelity of spouse or sexual partner

do people with persuasive PD seek treatment?

no

difference between paranoid PD and delusional disorder with paranoid delusions

• level of functioning

• paranoid PD involves decline in functioning in all areas of life

• delusional disorder has less impairment and usually impairment only appears in relation to the delusion

  • centers on single belief 

Schizoid PD

• detachment from social relationships and a restricted range of expression of emotions

>4 Schizoid PD

• neither desires nor enjoys close relationships (being part of family)

• almost always chooses solitary activities

• little interest in having sexual experiences with another person

• takes pleasure in few if any activities

• lacks close friends or confidants other than first degree relatives

• appears indifferent to the praise or criticism of others

• shows emotional coldness, detachment, or flattened affectivity

How is Schizoid PD different from autism spectrum?

• autism tends to be evident much earlier

• autism invokes stereotypes, repetitive motor movements, restricted interests, emphasis on ritual and sameness that are not present in schizoid PD

• many people with autism report loneliness and desires for social connections

Schizotypal PD

• social and interpersonal deficits marked by acute discomfort with, and reduced capacity for, close relationships as well as by cognitive or perceptual distortions and eccentricities of behavior

>5 Schizotypal

• ideas of reference

• odd beliefs or magical thinking that influences behavior and is inconsistent with subcultural norms

• unusual perceptual experiences, including bodily illusions

• odd thinking an speech

• suspiciousness or paranoid ideation

• inappropriate or constricted affect

• behavior or appearance that is odd, eccentric or peculiar

• lack of close friends or confidants other than first degree relatives

• excessive social anxiety that does not diminish with familiarity and tends to be associated with paranoid fears rather than negative judgements about self 

What % of people with Schizotypal PD develop a psychotic disorder

5-40%

What are we treating when treating a PD?

• varies by disorder— rarely attempts to change “personality”

• focus symptoms linked with impairment, social skills training

• Cluster A: antipsychotics, but not much evidence

• nature of symptoms often limit desire for treatment as well as prgnosis of treatment

Avoidant PD 

social inhibition, feelings of inadequacy and hypersensitivity to negative evaluation

>4 Avoidant PD

• avoids occupational activities that involve significant interpersonal contact b/c of fears of criticism, disapproval, or rejection

• unwilling to get involved with people unless certain of being liked

• shows restraint within intimate relationships b/c of the fear of being shamed or ridiculed

• preoccupied with being criticized or rejected in social situations

• inhibited in new interpersonal situations because of feelings of inadequacy

• views self as socially inept, personally unappealing, or inferior to others 

• unusually reluctant to take personal risks or to engage in any new acitvities because they may prove embarrassing 

Avoidant PD vs. Social Anxiety

• some psychopathologists believe that avoidant PD is a more severe form of social anxiety disorder

• suggests that they are different presentations of the same underlying problem

• 2/3 of people with avoidant PD would not meet criteria for SAD

• there aren’t necessarily physical symptoms of anxiety or worry in avoidant PD— when anxiety is present, it may not be specific to social situations

• much more negative views of self in avoidant PD

• treatment for social anxiety do improve symptoms of avoidant

How avoidant PD people feel about others?

• people with avoidant PD do have a profound desire to connect with others

• desire affection and acceptance and may fantasize about idealized relationships

• this desire is often not as strong as their fear of rejection

How do people with avoidant PD describe their parents?

• rejecting, unaffectionate, unencouraging of their efforts, and instilling guilt in them 

• believed to contribute to thoughts about one’s worth 

Obsessive compulsive PD

• preoccupation with orderliness, perfectionism, and mental and interpersonal control

• different from OCD

>4 OC PD

• preoccupied with details, rules, lists, organization, or schedules to the extent that the major point of the activity is lost

• shows perfectionism that interferes with task completion

• is excessively devoted to work and productivity to the exclusion of leisure activities and friendships

• is overconscientious, scrupulous, and inflexible about matters of morality, ethic, or values

• is unable to discard worn-out or worthless objects even when they have no sentimental value

• reluctant to delegate tasks or to work with others unless they submit to exactly his/her way of doing things

• adopts a miserly spending style toward both self and others; money is viewed as something to be hoarded for future catastrophes

• shows rigidity and stubbornness

was OCPD believed to be on of the most prevalent PD?

• yes 

• compared to other PDs, high levels of distress; tendency towards anger outbursts; perceived by others as controlling and cold 

Treatment for OCPD

• moderate support for CBT and for schema therapy— a type of long-term CBT that targets deeply rooted cognitions and behaviors

• currently no recommended medications