Chapter 10 personality disorders

1. Define “personality disorder”

An enduring, rigid pattern of inner experience and outward behavior that impairs sense of self, emotional experience, goals, and capacity for empathy and/or intimacy.

there is reluctance to diagnose before adolescence

2. Approximately what % of adults in the US have a personality disorder?

10%

3. Is it common for a person with a personality disorder to suffer from another mental illness?

Yes

Paranoid PD:

The cluster of “odd” personality disorders includes:

·1. Paranoid personality disorder

·2. Schizoid personality disorder

·3. Schizotypal personality disorder

This disorder is characterized by deep distrust and suspicion of others

Although inaccurate, the suspicion is usually notdelusional – the ideas are not so bizarre or so firmly held as to clearly remove the individual from reality

Psychodynamic theorists trace the pattern back to early interactions with demanding parents

·-Cognitive theorists suggest that maladaptive assumptions such as “People are evil and will attack you if given the chance” are to blame

·-Biological theorists propose genetic causes and have looked at twin studies to support this model

People with paranoid personality disorder do not typically see themselves as needing help

 ·Object relations therapists try to see past the patient’s anger and work on the underlying wish for a satisfying relationship

·Behavioral and cognitive therapists try to help clients control anxiety and improve interpersonal skills

Cognitive therapists also try to restructure clients’ maladaptive assumptions and interpretations

 Drug therapy is of limited help

Schizoid PD

Schizoid Personality Disorder as a pervasive pattern of detachment from social relationships and a restricted range of expression of emotions in interpersonal settings, beginning by early adulthood and present in a variety of contexts, as indicated by four (or more) of the following:

1. neither desires nor enjoys close relationships, including being part of a family;

2. almost always chooses solitary activities;

3. has little, if any, interest in having sexual experiences with another person;

4. takes pleasure in few, if any, activities;

5. lacks close friends or confidants other than first-degree relatives;

6. appears indifferent to the praise or criticism of others;

7. shows emotional coldness, detachment, or flattened affectivity.

Many psychodynamic theorists, particularly object relations theorists, link schizoid personality disorder to an unsatisfied need for human contact

 Cognitive theorists propose that people with schizoid personality disorder suffer from deficiencies in their thinking. Their thoughts tend to be vague and empty, and they have trouble scanning the environment for accurate perceptions

·Cognitive-behavioral therapists have sometimes been able to help people with this disorder experience more positive emotions and more satisfying social interactions

·The cognitive end focuses on thinking about emotions

·The behavioral end focuses on the teaching of social skills

 Group therapy is apparently useful as it offers a safe environment for social contact

·Drug therapy is of little benefit

Schizotypal PD:

relationships, odd (even bizarre) ways of thinking, and behavioral eccentricities

Schizotypal Personality Disorder is a pervasive pattern of 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, beginning in early adulthood and present in a variety of contexts, as indicated by five (or more) of the following:

1. ideas of reference; experiencing innocuous events as very personal.

2. odd beliefs or magical thinking that influences behavior and is inconsistent with subcultural norms (e.g., superstitiousness, belief in clairvoyance, telepathy, or "sixth sense"; in children and adolescents, bizarre fantasies or preoccupations);

3. unusual perceptual experiences, including bodily illusions;

odd thinking and speech (e.g., vague, circumstantial, metaphorical, over-elaborate, or stereotyped);

4. suspiciousness or paranoid ideation;

5. inappropriate or constricted affect;

6. behavior or appearance that is odd, eccentric, or peculiar;

7. lack of close friends or confidants other than first-degree relatives;

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

resemble those of schizophrenia, researchers have hypothesized that similar factors are at work in both disorders

 Schizotypal symptoms are often linked to psychological disorders in parents

 Researchers have also begun to link schizotypal personality disorder to some of the same biological factors found in schizophrenia, such as high dopamine activity

The disorder has also been linked to mood disorders, especially depre

Antisocial personality disorder

a. The "Cluster" the Personality Disorder Belongs In

Antisocial Personality Disorder (ASPD) is classified under Cluster B of the DSM-5. Cluster B is characterized by dramatic, emotional, or erratic behaviors, and it includes disorders such as Borderline Personality Disorder, Narcissistic Personality Disorder, Histrionic Personality Disorder, and Antisocial Personality Disorder.

b. Primary Characteristics (Symptoms)

The primary characteristics of Antisocial Personality Disorder include:

• Disregard for the rights of others: A pervasive pattern of violating others' rights, through deceit, manipulation, or exploitation.

• Deceitfulness: Frequent lying, use of aliases, or conning others for personal gain or pleasure.

• Impulsivity: Difficulty planning ahead and a tendency to make spontaneous, reckless decisions.

• Irritability and aggression: Frequent fights or physical assaults.

• Reckless disregard for safety: Engaging in risky behavior without regard for personal or others' safety.

• Lack of remorse: Indifference to or rationalization of harming others.

• Failure to conform to social norms: Consistently breaking the law or disregarding societal expectations.

c. Proposed Explanations for the Development of ASPD

• Psychodynamic Perspective: From a psychodynamic viewpoint, ASPD is believed to develop due to early parental neglect or abuse, particularly in childhood. The disorder may stem from unresolved fixations in the early stages of development, particularly in the oral or anal stages (according to Freud). These individuals might develop a distorted sense of self and fail to develop empathy or emotional connection, leading to antisocial behaviors.

• Cognitive Perspective: Cognitive theorists suggest that individuals with ASPD may have distorted thinking patterns, particularly around morality and social behavior. They may view others as objects to be manipulated for personal gain, with a lack of empathy or understanding of the emotional impact of their actions. Their thinking is often egocentric and justifies harmful behaviors.

• Behavioral Perspective: From a behavioral standpoint, ASPD could develop as a result of reinforced antisocial behaviors during childhood. If children are rewarded for aggressive or manipulative actions (e.g., getting their way through deceit or violence), they are more likely to continue these behaviors into adulthood.

• Biological Perspective: Biologically, ASPD has been linked to genetic factors (a family history of antisocial behavior) and brain abnormalities, particularly in areas like the prefrontal cortex, which is involved in decision-making, impulse control, and empathy. Studies also suggest low levels of serotonin, which are associated with aggression and impulsivity. Additionally, underactivity of the amygdala, the brain region involved in processing emotions like fear, may contribute to the lack of empathy and remorse seen in ASPD.

d. Treatment of Antisocial Personality Disorder

• Psychotherapy: Treatment for ASPD is often challenging due to the individual's lack of motivation to change and tendency to manipulate others. Cognitive-behavioral therapy (CBT) can help address distorted thinking patterns and promote more adaptive behavior. Therapy may focus on developing empathy and addressing impulsive or aggressive behaviors.

• Medication: Medications may be prescribed to manage symptoms associated with ASPD, such as irritability, impulsivity, or mood disturbances. For example, antidepressants or mood stabilizers might be used to treat comorbid conditions like depression or anxiety, which sometimes coexist with ASPD.

• Group Therapy: Group therapy may be used to help individuals with ASPD develop social skills, although it can be difficult due to the antisocial nature of the disorder. In a group setting, individuals may be encouraged to reflect on their behavior and how it affects others.

• Prevention and Early Intervention: Early intervention, especially for children or adolescents showing early signs of antisocial behavior (such as aggression or rule-breaking), can help prevent the development of full-blown ASPD. Programs focusing on parent training and social skills development can be beneficial.

Borderline personality disorder

a. The "Cluster" the Personality Disorder Belongs In

Borderline Personality Disorder (BPD) is classified under Cluster B of the DSM-5, which includes disorders characterized by dramatic, emotional, or erratic behavior. The other disorders in Cluster B include Antisocial Personality Disorder, Narcissistic Personality Disorder, and Histrionic Personality Disorder.

b. Primary Characteristics (Symptoms)

The primary characteristics of Borderline Personality Disorder include:

• Emotional instability: Intense and rapid mood swings.

• Fear of abandonment: Extreme efforts to avoid real or imagined abandonment.

• Unstable relationships: Intense, fluctuating relationships that often swing between idealization and devaluation.

• Impulsivity: Risky behaviors like reckless driving, binge eating, substance abuse, or spending sprees.

• Self-harm: Self-destructive behaviors such as cutting, burning, or suicidal gestures to cope with emotional distress.

• Identity disturbance: A poorly defined or unstable self-image and sense of self.

• Chronic feelings of emptiness: A pervasive sense of boredom or emotional emptiness.

• Intense anger: Difficulty controlling anger or frequent outbursts of rage.

• •

c. Proposed Explanations for the Development of BPD

Psychodynamic Perspective: Psychodynamic theorists suggest that early childhood trauma or emotional neglect, particularly from caregivers, plays a significant role in the development of BPD. Emotional invalidation, neglect, or abuse could lead to difficulties in forming a stable sense of self and managing emotions. Object relations theory suggests that disrupted attachments during early childhood may lead to an unstable self-image and difficulty in relationships.
Cognitive Perspective: Cognitive theorists propose that individuals with BPD develop maladaptive cognitive patterns due to early experiences of emotional invalidation. These individuals may develop black-and-white thinking, seeing things as either all good or all bad, leading to unstable self-images and fluctuating perceptions of others. Their thinking tends to be emotion-driven and irrational, making it difficult to regulate emotions and manage relationships.
Behavioral Perspective: From a behavioral viewpoint, BPD is seen as a result of learned behaviors from inconsistent reinforcement patterns in childhood. If individuals were rewarded for emotional outbursts or learned that self-destructive behaviors like self-harm reduce emotional pain, these behaviors are likely to persist. Behaviors like impulsivity or self-harm may also be coping mechanisms developed in response to chronic emotional distress.
Biological Perspective: Biological factors that may contribute to the development of BPD include genetic predispositions (a family history of mood disorders or personality disorders), neurobiological abnormalities, and neurochemical imbalances. Research suggests that individuals with BPD may have dysfunction in brain areasresponsible for emotional regulation, such as the prefrontal cortex and amygdala. Low levels of serotonin and dopamine have also been implicated in impulsivity and emotional dysregulation, key features of the disorder.

d. Treatment of Borderline Personality Disorder

• Dialectical Behavior Therapy (DBT): DBT, developed by Marsha Linehan, is one of the most effective treatments for BPD. It focuses on teaching skills in mindfulness, emotion regulation, distress tolerance, and interpersonal effectiveness. DBT helps patients learn to tolerate emotional pain without resorting to self-destructive behaviors and fosters healthier relationships.
  Cognitive-Behavioral Therapy (CBT): CBT is used to help individuals with BPD identify and challenge negative thought patterns and dysfunctional beliefs. It aims to alter patterns of thinking that contribute to emotional instability and relationship problems, promoting more balanced and adaptive behaviors.
  Schema-Focused Therapy: This approach combines elements of CBT with psychodynamic principles to target the core schemas or deeply ingrained beliefs about oneself and others. It helps individuals with BPD develop more stable and healthy patterns of thinking and behavior, addressing the dysfunctional patterns formed in childhood.
  Medications: While there is no medication specifically approved for BPD, individuals may be prescribed antidepressants (e.g., SSRIs) or mood stabilizers to manage symptoms of depression, anxiety, or mood swings. Antipsychotic medications may be used in some cases to address impulsivity or paranoia.
  Mentalization-Based Treatment (MBT): MBT is designed to improve individuals' ability to understand and interpret their own and others' thoughts and feelings (mentalization). This therapy helps improve emotional regulation and interpersonal relationships, which are often problematic in BPD.

• • Transference-Focused Psychotherapy (TFP): TFP is a psychodynamic approach that focuses on the therapeutic relationship to understand and address the patient's issues with emotional instability and interpersonal difficulties. The goal is to help patients better understand their emotions and relationship patterns.

Histrionic personality disorder

a. The "Cluster" the Personality Disorder Belongs In.     Histrionic Personality Disorder (HPD) is classified under Cluster B of the DSM-5, which includes disorders characterized by dramatic, emotional, or erratic behaviors. The other disorders in Cluster B include Antisocial Personality Disorder, Borderline Personality Disorder, and Narcissistic Personality Disorder.

b. Primary Characteristics (Symptoms)

The primary characteristics of Histrionic Personality Disorder include:

• Excessive emotionality: A pattern of seeking attention and displaying exaggerated emotions.

• Attention-seeking behaviors: Individuals with HPD often feel uncomfortable when they are not the center of attention and may engage in behaviors to draw attention to themselves.

• Shallow emotions: Their emotional expressions tend to be superficial and rapidly shifting.

• Inappropriate seductiveness: This may involve using physical appearance or seductive behavior to gain attention.

• Dramatic speech: Their speech may be overly impressionistic and lacking in detail.

• Exaggerated self-dramatization: Over-the-top expressions of emotion and behavior.

• Suggestibility: Easily influenced by others or circumstances.

• Consideration of relationships as more intimate than they are: Misinterpreting relationships and perceiving them as closer or more intimate than they truly are.

c. Proposed Explanations for the Development of HPD

• Psychodynamic Perspective: Psychodynamic theorists believe that HPD may stem from early childhood experiences, where children did not receive enough attention or nurturing, leading to the development of attention-seeking behavior later in life. The disorder might also be linked to unresolved conflicts from childhood, particularly in relation to emotional expression and validation.
  Cognitive Perspective: From a cognitive perspective, individuals with HPD might have developed maladaptive cognitive patterns, where they believe that they must be the center of attention to be loved or valued. They might have internalized the belief that attention is necessary for their emotional survival.
  Behavioral Perspective: Behavioral theorists suggest that HPD develops through reinforced attention-seeking behaviors. If attention-seeking behaviors are consistently rewarded with positive reinforcement (such as praise or affection), individuals may learn to continue these behaviors in an attempt to get their emotional needs met.
  

• Biological Perspective: Biological explanations suggest that there may be a genetic predisposition for certain temperament traits (such as emotional expressiveness or impulsivity) that could make individuals more prone to developing HPD. Brain abnormalities in areas related to emotion regulation or social processing may also contribute.
  

d. Treatment of Histrionic Personality Disorder

• Psychotherapy: Cognitive-behavioral therapy (CBT) can be effective in helping individuals with HPD by targeting maladaptive thinking patterns and challenging the need for excessive attention-seeking behavior. Therapy can also help patients develop healthier ways to express their emotions and interact with others.
  Psychodynamic Therapy: Psychodynamic therapy focuses on exploring early childhood experiences and unconscious conflicts that may be contributing to the attention-seeking behavior and emotional instability in adulthood. By bringing these issues into awareness, the therapist helps the individual understand the root causes of their behaviors and emotions.
  Group Therapy: In group therapy, individuals with HPD may benefit from improving their interpersonal skillsand learning to relate to others in a less dramatic, more balanced way. It can also provide feedback on how their behavior affects others.
  

• Medications: While there is no specific medication approved to treat HPD, medications may be prescribed to manage comorbid conditions such as anxiety or depression that can co-occur with HPD. Antidepressants(SSRIs) or anti-anxiety medications may be used if needed.
  

Narcissistic personality disorder

1. The "Cluster" Narcissistic Personality Disorder Belongs In

Narcissistic Personality Disorder (NPD) is classified under Cluster B of the DSM-5, which includes disorders characterized by dramatic, emotional, or erratic behavior. The other disorders in Cluster B are Antisocial Personality Disorder (ASPD), Borderline Personality Disorder (BPD), and Histrionic Personality Disorder (HPD).

2. Primary Characteristics (Symptoms) of Narcissistic Personality Disorder

The primary characteristics of NPD include:

• Grandiosity: An exaggerated sense of self-importance and a belief that one is superior to others. This often involves a sense of entitlement and an expectation of special treatment.

• Need for admiration: A constant need for excessive admiration and validation from others.

• Lack of empathy: An inability or unwillingness to recognize the feelings or needs of others.

• Exploitation of others: A tendency to take advantage of others to achieve personal goals without considering their feelings or needs.

• Sense of entitlement: A belief that one deserves special treatment and privileges.

• Arrogance: Behaving in a haughty, superior, or condescending manner.

• Envy of others: Feeling envious of others or believing that others are envious of them.

• Preoccupation with success and power: Frequently fantasizing about unlimited success, power, brilliance, or beauty.

These individuals may appear self-assured, but often have fragile self-esteem and require external validation to maintain their self-image.

3. Proposed Explanations for the Development of NPD

• Behavioral Perspective:
  From a behavioral standpoint, narcissism may develop through early experiences where individuals received excessive praise, admiration, or special treatment. This can lead to an inflated sense of self-worth and unrealistic expectations for how they should be treated by others. On the other hand, individuals who were consistently criticized or neglected may develop narcissistic traits as a defense mechanism to protect against feelings of inadequacy or shame.
  

• Biological Perspective:
  From a biological perspective, there may be a genetic predisposition to narcissistic traits. Certain personality traits such as a heightened sense of self-importance, impulsivity, and low empathy could be influenced by genetics or brain structure. Research also suggests that abnormalities in brain regions related to empathy, social cognition, and emotional regulation (such as the prefrontal cortex and amygdala) could contribute to the lack of empathy and manipulative behaviors commonly seen in NPD.
  

• Cognitive Perspective:
  Cognitive theorists believe that individuals with NPD develop distorted thinking patterns, such as overestimating their worth, believing they are entitled to special treatment, and viewing others as inferior. These individuals may have unrealistic beliefs about their abilities and importance. They might internalize the idea that they must maintain a perfect, grandiose self-image, which leads to fragile self-esteem and difficulty handling criticism or failure.
  

• Psychodynamic Perspective:
  Psychodynamic theorists suggest that NPD might develop from early childhood experiences, such as inconsistent or excessive parental admiration or neglect. The child might develop a need to bolster self-worth through external validation if they didn’t receive sufficient emotional nurturing. Freud and later psychoanalysts theorized that narcissistic behavior could be a defense mechanism against deep feelings of insecurity or self-loathing, originating from early experiences of inadequate attachment or feelings of abandonment.
  

4. Treatment of Narcissistic Personality Disorder Treatment for NPD can be challenging because individuals with the disorder often have difficulty acknowledging their flaws and may resist therapy. However, treatment is possible and may include the following approaches:

• Psychotherapy:
  Cognitive-Behavioral Therapy (CBT) is commonly used to help individuals with NPD identify and challenge distorted thought patterns, such as beliefs of superiority or entitlement. Therapy focuses on improving self-esteem and promoting healthier ways of relating to others. In therapy, the individual may work on building empathy and improving emotional regulation.
  Psychodynamic Therapy:
  Psychodynamic therapy can help individuals explore unconscious thoughts and feelings about themselves and others. It may focus on the emotional wounds that led to the development of narcissistic defenses, helping them process underlying feelings of shame, inadequacy, or neglect. The goal is to help the person develop a more realistic self-image and improve emotional regulation.
  Group Therapy:
  Group therapy can help individuals with NPD recognize the impact of their behavior on others and learn more empathetic ways of interacting. It can also provide them with feedback from others about how their narcissistic traits may alienate or hurt relationships.
  Medication:
  While there is no specific medication to treat NPD, medications may be prescribed to treat co-occurring issues, such as depression, anxiety, or mood disorders. Antidepressants (e.g., SSRIs) or mood stabilizers may be used to address symptoms of anxiety or depression.
  Dialectical Behavior Therapy (DBT):
  Though more commonly used for Borderline Personality Disorder, DBT may also be useful for individuals with NPD, particularly if they exhibit emotional dysregulation. DBT focuses on improving emotional stability, developing mindfulness skills, and enhancing interpersonal effectiveness.
  

Avoidant Personality Disorder

a. The "Cluster" the Personality Disorder Belongs In

Avoidant Personality Disorder (AVPD) is classified under Cluster C of the DSM-5, which includes disorders characterized by anxious or fearful behavior. The other disorders in Cluster C include Dependent Personality Disorderand Obsessive-Compulsive Personality Disorder.

b. Primary Characteristics (Symptoms)

The primary characteristics of Avoidant Personality Disorder include:

• Fear of criticism or rejection: Intense fear of being judged, criticized, or not accepted by others.

• Avoidance of social situations: Avoiding work, social, or school activities due to fear of embarrassment or being ridiculed.

• Low self-esteem: A belief that they are socially inept or inferior to others.

• Sensitivity to rejection: Over-sensitivity to potential rejection or disapproval, often leading to feelings of inadequacy.

• Reluctance to take risks: Avoiding new activities or experiences because of fear of failure or criticism.

• Feelings of inadequacy: A pervasive sense of being unworthy or incapable of forming meaningful relationships.

• Desire for close relationships: Despite fears of rejection, people with AVPD often have a strong desire for close relationships but feel unable to form them due to fear.

c. Proposed Explanations for the Development of AVPD

• Psychodynamic Perspective: Psychodynamic theorists suggest that AVPD may develop from early experiences of emotional neglect or rejection from caregivers, which leads to deep-seated feelings of inadequacy and a belief that they are unworthy of love or respect. These experiences can create a fragile self-esteem that is highly sensitive to rejection.
  

• Cognitive Perspective: From a cognitive viewpoint, individuals with AVPD may develop negative self-beliefs and distorted thinking patterns. For example, they may believe they are socially inept or that others will inevitably reject them. These negative beliefs reinforce avoidance behaviors and make it difficult to confront social situations.
  

• Behavioral Perspective: Behavioral theorists argue that AVPD may arise from learning experiences where avoidance of social situations leads to temporary relief from anxiety, which reinforces the avoidance behavior. Over time, avoiding situations leads to greater isolation and social anxiety.
  

• Biological Perspective: While specific biological explanations for AVPD are less well-defined, genetic predispositions or temperament traits (such as heightened sensitivity to stress) may increase vulnerability to developing anxiety-based disorders like AVPD. Brain areas involved in social and emotional processing may also be implicated in the heightened fear of rejection or criticism.
  

d. Treatment of Avoidant Personality Disorder

• Cognitive-Behavioral Therapy (CBT): CBT is often the most effective treatment for AVPD. It helps individuals identify and challenge their negative self-beliefs, build self-esteem, and gradually face social situations in a more adaptive way. CBT also targets avoidance behaviors and provides strategies to cope with anxiety and fears of rejection.
  

• Psychodynamic Therapy: This approach focuses on exploring past experiences, particularly in childhood, to uncover the underlying emotional causes of avoidance and fear of rejection. It aims to build a stronger sense of self-worth and help individuals overcome their deep-seated feelings of inadequacy.
  

• Group Therapy: Group therapy can help individuals with AVPD practice social skills in a supportive, non-judgmental environment. It can also help reduce the fear of rejection by encouraging interactions with others who share similar experiences.
  

• Medications: Medications may be prescribed to treat comorbid conditions such as anxiety or depression that often accompany AVPD. Selective serotonin reuptake inhibitors (SSRIs), commonly used for anxiety and depression, may be prescribed to help alleviate emotional distress and reduce avoidance behaviors.

Dependent Personality Disorder

a. The "Cluster" the Personality Disorder Belongs In

Dependent Personality Disorder (DPD) is classified under Cluster C of the DSM-5, which includes disorders characterized by anxious or fearful behavior. The other disorders in Cluster C are Avoidant Personality Disorder (AVPD) and Obsessive-Compulsive Personality Disorder (OCPD).

b. Primary Characteristics (Symptoms)

The primary characteristics of Dependent Personality Disorder include:

• Excessive need for reassurance: A constant need for others to make decisions or provide approval.

• Difficulty making decisions: A tendency to rely heavily on others for guidance and reassurance, even in everyday matters.

• Fear of abandonment: A pervasive fear of being left alone or abandoned, leading to clinging behavior.

• Inability to assert oneself: Individuals with DPD have trouble expressing disagreement or standing up for themselves.

• Submissive behaviors: They often go along with others’ wishes to avoid conflict or rejection.

• Difficulty initiating projects: A lack of confidence in their ability to complete tasks on their own.

• Strong reliance on others: They feel uncomfortable being alone and often rely on others to meet their emotional or physical needs.

• Low self-esteem: A pervasive sense of inadequacy and helplessness, leading to a dependence on others to feel secure.

c. Proposed Explanations for the Development of DPD

• Psychodynamic Perspective: Psychodynamic theorists suggest that DPD may arise from early childhood experiences of overprotective or controlling parenting, which could hinder the development of autonomy and self-confidence. This may lead individuals to feel incapable of managing life without help, fostering dependence on others.
  

• Cognitive Perspective: Cognitive theorists suggest that individuals with DPD have maladaptive thought patternsthat lead them to believe they are helpless or incapable of functioning independently. They may have internalized the belief that they need others to make decisions and feel secure, contributing to their dependency.
  

• Behavioral Perspective: Behavioral theorists propose that DPD may develop from reinforced dependencebehaviors. If individuals receive consistent rewards or attention when relying on others, this behavior may be reinforced over time, making them more dependent.
  

• Biological Perspective: Biological theories are less developed for DPD, but genetic factors or a temperamental tendency toward anxiety may make some individuals more prone to developing an excessive need for others. Imbalances in brain chemicals related to anxiety and attachment may also play a role.
  

d. Treatment of Dependent Personality Disorder

• Cognitive-Behavioral Therapy (CBT): CBT can be effective in helping individuals with DPD by addressing the negative thought patterns that contribute to their dependency. Therapy may focus on helping individuals become more assertive, make their own decisions, and develop a stronger sense of self-efficacy.
  

• Psychodynamic Therapy: This type of therapy can explore early life experiences and unresolved conflicts related to dependence. The goal is to help individuals understand how past experiences may have contributed to their current behaviors and to develop healthier, more independent coping strategies.
  

• Interpersonal Therapy (IPT): This approach focuses on improving relationship skills and social functioning by helping individuals recognize how their dependency affects their interactions with others and develop more balanced, autonomous relationships.
  

• Medications: Although there is no medication specifically for DPD, medications such as antidepressants or anti-anxiety medications may be prescribed if the individual experiences co-occurring issues such as depression or anxiety.
  

• Assertiveness Training: Therapy may also include assertiveness training, which helps individuals develop confidence in expressing their needs and standing up for themselves, reducing the need to rely on others for emotional support.
  

Obsessive-Compulsive

Obsessive-Compulsive

a. The "Cluster" the Personality Disorder Belongs In

Obsessive-Compulsive Personality Disorder (OCPD) is classified under Cluster C of the DSM-5, which includes disorders characterized by anxious or fearful behavior. The other disorders in Cluster C are Avoidant Personality Disorder (AVPD) and Dependent Personality Disorder (DPD).

b. Primary Characteristics (Symptoms)

The primary characteristics of Obsessive-Compulsive Personality Disorder include:

• Preoccupation with orderliness: A strong focus on rules, order, and control, often at the expense of flexibility or efficiency.

• Perfectionism: A tendency to focus on perfection, often leading to frustration when things don't go exactly as planned.

• Rigidity and stubbornness: Individuals with OCPD may resist change and have difficulty adapting to new circumstances.

• Overcommitment to work and productivity: A tendency to overwork and place work and productivity above leisure and relationships.

• Reluctance to delegate tasks: Difficulty delegating tasks to others due to a belief that only they can do things "right."

• Excessive devotion to work: This often interferes with relationships or leisure time, as work is seen as more important than other aspects of life.

• Difficulty relaxing: Individuals with OCPD may have a hard time relaxing or enjoying life because they are so focused on control and perfection.

• Miserliness: A tendency to be overly frugal or stingy, even in situations where it might not be necessary.

c. Proposed Explanations for the Development of OCPD

• Psychodynamic Perspective: Psychodynamic theorists suggest that OCPD may arise from early childhood experiences of excessive control, overprotection, or strict discipline. These experiences may lead to a need for control and perfectionism later in life as a way to feel secure.
  

• Cognitive Perspective: Cognitive theorists suggest that individuals with OCPD may develop maladaptive thought patterns that focus on the need for order, control, and perfection. They may have unrealistic standards and beliefs about the importance of these traits, leading them to maintain rigid behaviors.
  

• Behavioral Perspective: From a behavioral standpoint, OCPD may develop through reinforcement of perfectionistic and controlling behaviors. If individuals are praised or rewarded for being detail-oriented or "perfect" as children, they may continue these behaviors into adulthood.
  

• Biological Perspective: There may be a genetic predisposition to traits associated with OCPD, such as a heightened sense of responsibility and need for control. Brain abnormalities, particularly in areas responsible for decision-making and regulating emotions, may also contribute to the rigidity seen in OCPD.
  

d. Treatment of Obsessive-Compulsive Personality Disorder

• Cognitive-Behavioral Therapy (CBT): CBT can be highly effective for individuals with OCPD. Therapy focuses on helping individuals challenge perfectionistic thoughts, reduce the need for control, and adopt more flexible thinking and behavior patterns. It also helps patients learn to manage stress and anxiety related to their rigid behaviors.
  

• Psychodynamic Therapy: Psychodynamic therapy can help individuals with OCPD understand the underlying emotional conflicts that contribute to their perfectionism and need for control. This therapy explores past experiences and unconscious factors that may have shaped these behaviors.
  

• Relaxation Training: Since individuals with OCPD often have difficulty relaxing, relaxation techniques like mindfulness and meditation can help them reduce anxiety and increase emotional flexibility.
  

• Group Therapy: Group therapy can help individuals with OCPD interact with others in a more relaxed and less controlling way, providing feedback and support in social interactions.
  

• Medications: While there is no medication specifically for OCPD, medications such as selective serotonin reuptake inhibitors (SSRIs) may be prescribed to help manage co-occurring symptoms like anxiety or depres

Personality Disorder

a. The "Cluster" the Personality Disorder Belongs In
Personality disorders in the DSM-5 are grouped into three clusters based on common traits:

• Cluster A: Includes disorders characterized by odd or eccentric behavior (e.g., Paranoid, Schizoid, Schizotypal Personality Disorders).

• Cluster B: Includes disorders characterized by dramatic, emotional, or erratic behavior (e.g., Antisocial, Borderline, Histrionic, Narcissistic Personality Disorders).

• Cluster C: Includes disorders characterized by anxious or fearful behavior (e.g., Avoidant, Dependent, Obsessive-Compulsive Personality Disorders).

Each cluster reflects different core traits and challenges faced by individuals with these disorders.

b. Primary Characteristics (Symptoms)
Personality disorders involve long-standing patterns of thoughts, behaviors, and emotions that significantly deviate from cultural expectations. Key characteristics generally include:

• Cluster A (Odd/Eccentric Behavior):

  • Paranoid: Mistrust and suspicion of others.

  • Schizoid: Detachment from social relationships.

  • Schizotypal: Odd beliefs, eccentric behavior, and interpersonal difficulties.

• Cluster B (Dramatic/Emotional/Erratic Behavior):

  • Antisocial: Disregard for others' rights and lack of empathy.

  • Borderline: Instability in relationships, self-image, and emotions.

  • Histrionic: Excessive emotionality and attention-seeking.

  • Narcissistic: Grandiosity and a lack of empathy.

• Cluster C (Anxious/Fearful Behavior):

  • Avoidant: Fear of criticism and rejection, leading to social withdrawal.

  • Dependent: Excessive reliance on others for decision-making and emotional support.

  • Obsessive-Compulsive: Preoccupation with order, perfectionism, and control.

c. Proposed Explanations for the Development of Personality Disorders

Psychodynamic Perspective:
Psychodynamic theories focus on how early childhood experiences shape personality traits. Unresolved conflicts or traumatic experiences, such as emotional neglect or overprotectiveness, can lead to maladaptive behaviors and emotional regulation difficulties later in life.

Cognitive Perspective:
Cognitive theorists believe that personality disorders develop through distorted thought patterns, such as black-and-white thinking, unrealistic beliefs about the self and others, and faulty interpretations of interpersonal interactions. These patterns lead to dysfunctional behaviors and emotional responses.

Behavioral Perspective:
Behavioral theories suggest that personality disorders arise from learned behaviors, often through reinforcement or punishment. If individuals were rewarded for maladaptive behaviors, like avoiding social situations or being controlling, these patterns may persist into adulthood.

Biological Perspective:
Biological explanations point to genetic factors, brain abnormalities, and neurochemical imbalances that contribute to the development of personality disorders. Research suggests that neurotransmitters, such as serotonin, play a role in emotional regulation, impulsivity, and aggression, which can contribute to disorders like Borderline or Antisocial Personality Disorder.

d. Treatment of Personality Disorders

• Psychotherapy:
  The cornerstone of treatment for personality disorders is therapy, particularly Cognitive-Behavioral Therapy (CBT), Dialectical Behavior Therapy (DBT) for Borderline Personality Disorder, and Psychodynamic Therapy. Therapy helps individuals recognize their maladaptive patterns and develop healthier coping strategies.
  Medications:
  Medications are often used to treat co-occurring conditions like depression, anxiety, or mood swings. For example, SSRIs (Selective Serotonin Reuptake Inhibitors) may be prescribed for anxiety or depression in Avoidant or Obsessive-Compulsive Personality Disorders.
  Group Therapy:
  Group therapy can be beneficial for improving social skills and interpersonal relationships, especially for individuals with Histrionic or Dependent Personality Disorders.
  Skill-Building:
  Programs that teach emotional regulation, assertiveness, and relaxation techniques are valuable in helping individuals manage their disorder. For example, DBT helps those with Borderline Personality Disorder learn how to manage intense emotions without resorting to self-destructive behaviors.
  Family Therapy:
  For some disorders, family therapy can help improve understanding and communication, particularly in cases where family dynamics play a role in the development or exacerbation of the disorder.

2. Which PD is associated with psychological disorders in the patients parents?

Borderline personality disorder

3. What % of people in the US meet the criteria for Antisocial PD?

1-3%

4. What area of the brain, when damaged, seems to decrease the ability to feel guilt and show concern for others?

Ventromedial prefrontal cortex

5. Be able to describe the difficulties with moods, self-image, impulsivity and relationships that people with Borderline PD experience

Mood instability

Self image and identity disturbance

Impulsivity

Relationship difficulties

Self harm and suicidal

6. What % of people with Borderline PD are woman? Why is this believed to be the case?

Around 70-75% of those with Borderline Personality Disorder (BPD) are women, likely due to diagnostic biases, differences in symptom expression, and social factors. Women may be more prone to emotional instability and trauma, leading to a higher diagnosis rate, while men’s symptoms might be underdiagnosed or recognized differently.

7. How are serotonin levels related to impulsivity?

Serotonin plays a key role in regulating mood, behavior, and impulse control. Low serotonin levels are associated with increased impulsivity. This means individuals with low serotonin activity may have a harder time controlling impulsive behaviors, leading to actions like aggression, risk-taking, or poor decision-making without considering the consequences. Research suggests that serotonin helps modulate emotional responses and inhibits impulsive actions, so when serotonin levels are low, this regulatory function is weakened, increasing the likelihood of impulsive behavior. This relationship is often observed in conditions like Borderline Personality Disorder (BPD), Depression, and Impulsive Disorders.

8. Describe “Dialectical Behavior Therapy.”

Help clients ID strengths and build on them

•ID thoughts, beliefs, assumptions that make life harder

•work on relationships with therapist and staff. role play ways of interacting with others

Describe the 4 modules used in “Dialectical Behavior Therapy.”

1. mindfulness - bringing one’s complete attention and awareness to the present experience on a moment-to-moment basis. Paying attention, on purpose, non-judgmentally

•2. interpersonal effectiveness - effective strategies for asking for what one needs, saying no, and coping with interpersonal conflict.

3. Distress Tolerance - natural development from mindfulness skills.  Accepting, in a non-evaluative and nonjudgmental fashion, both oneself and the current situation. Accepting, finding meaning for, and tolerating distress.

4. Emotion regulation - Borderline and suicidal individuals are emotionally intense and labile – frequently angry, intensely frustrated, depressed, and anxious. DBT skills for emotion regulation

10. What is the difference between Avoidant, PD and Social Anxiety Disorder

Avoidant Personality Disorder (AVPD) is a chronic, pervasive condition characterized by deep feelings of inadequacy and fear of rejection, leading individuals to avoid most social situations and relationships. In contrast, Social Anxiety Disorder (SAD) is more situational, focused on intense fear of negative judgment in specific social settings, like public speaking or meeting new people. While AVPD involves avoidance in many areas of life due to a sense of inferiority, SAD is typically tied to particular situations where social evaluation is feared. AVPD is a broader, long-term pattern, while SAD tends to be more episodic and context-specific

11. What is the difference between OCD and Obsessive-Compulsive Personality Disorder?

Obsessive-Compulsive Disorder (OCD) involves intrusive, unwanted thoughts (obsessions) and repetitive behaviors or mental acts (compulsions) performed to reduce anxiety, often causing significant distress and interference with daily life. In contrast, Obsessive-Compulsive Personality Disorder (OCPD) is a personality disorder characterized by a rigid need for control, perfectionism, and orderliness, without the intrusive thoughts or compulsive behaviors seen in OCD. People with OCPD tend to believe their way of doing things is the only correct way and may not recognize their behavior as problematic, unlike those with OCD, who are typically aware of the irrationality of their actions.

12. Might there be better ways to classify personality disorders? What are some of the concerns about diagnosing personality disorders?

There are concerns about the current classification of personality disorders (PDs), including symptom overlap between disorders, diagnostic subjectivity, and the stigma associated with PD labels. The lack of objective biomarkers and the failure to account for cultural differences further complicate diagnosis. A proposed dimensional model views PDs as extreme variations of normal traits, offering a more flexible, personalized approach. This model could address the limitations of the categorical system, leading to more accurate diagnoses and better treatment planning.