PSYC 2285 - Chapter 13 Personality Disorders

Personality Disorder

Enduring maladaptive pattern for relating to the environment and oneself, exhibited in a wide range of contexts that cause significant functional impairment or subjective distress. They are chronic, originating in childhood and continuing throughout adulthood. A persistent pattern of emotions, cognitions, and behaviour that results in enduring emotional distress for the person affected and for others.

• The person may not have significant feelings of distress but others around them are impacted significantly, in this case others will have to decide if this behaviour is impacting the individual

• It was believed that these characteristic traits were more ingrained and inflexible and the disorders themselves were less likely to be successfully modified

• Displaying problem characteristics over extended periods and in many situations which can cause great emotional pain for them and for others

• Degree of problem - problems may just be extreme versions of the problems many of us experience on a temporary basis

• Debated if the DSM should include dimensional aspects, not only being diagnosed with it or not but also rated on a series of personality dimensions (advantages include retaining more information about each individual, more flexible, and it would avoid the arbitrary decisions of assigning a person to a category

DSM Section - Emerging Measures and Models

Model focuses on a continuum of disturbances of the self (how you view yourself and your ability to be self-directed) and interpersonal functioning (your ability to empathize and be intimate with others)

Big Five - Five Factor Model of Personality

People can be rated on a series of personality dimensions and the combination of five components describes why people are so different. Rated high or low on each. Used as a meaningful way of measuring personality traits. Argued that personality disorders are really just people who fall really high or really low on this scale and they are not truly disorders.

Extraversion - Talkative, assertive and active versus silent, passive and reserved

Agreeableness - Kind, trusting, and warm versus hostile, selfish and mistrustful

Conscientiousness - Organized, thorough, and reliable versus careless, negligent and unreliable

Neuroticism - Nervous, moody, and temperamental versus even-tempered

Openness - Imaginative, curious, and creative versus shallow and imperceptive

Cluster Division

They are based on resemblance.

Cluster A: Odd or Eccentric

• Including paranoid, schizoid and schizotypal personality disorder

Cluster B: Dramatic, Emotional, Or Erratic

• Including antisocial, borderline, histrionic and narcissistic personality disorders

• All 4 are characterized by elevated impulsivity

Cluster C: Anxious or Fearful

• Includes avoidant, dependent and obsessive-compulsive personality disorders

Statistics

• Those with cluster B disorders are more likely to have other health conditions (Psychological or physical)

• Women are more likely to be diagnosed with a personality disorder

• 9.1% prevalence for personality disorders - all associated with substance use problems, more suicide attempts, more trouble at work, being separated or divorced, having problems with friends and relatives and having problems with the law

• People with cluster A and B associated with various physical diseases

• Higher income countries have higher prevalence of personality disorders

Development

• Once thought to originate in childhood or adolescence and continue into the adult years

• Can remit over time but may be replaced by other symptoms (A person could receive a diagnosis of one personality disorder at one point in time but years later no longer meet the criteria for that original problem and now have characteristics of a second or third personality disorder

• Lack of understanding may be because people often do not seek treatment in the early development phases of their disorder but only after years of distress

• Ex. Borderline personality disorder, many attempt suicide and die from it but in their 30s

Gender Differences

• Men tend to be diagnosed with personality disorders more often than women over all and especially antisocial personality disorder

• Higher prevalence for women in Cluster C disorders but the difference isn’t too large - Largest difference for women is borderline personality disorder

• Biases in psychologists can cause different diagnoses, women being diagnosed more with histrionic personality rather than antisocial while men get diagnosed with antisocial rather than histrionic

• Clinician may associate certain behaviours with one gender

• Just because a certain disorder is more diagnosed in one gender than another does not always indicate a bias

• Men are more likely to be diagnosed with narcissistic personality disorder and women are more likely to be diagnosed with histrionic for similar symptoms

• Men seen as more aggressive so they get diagnoses of antisocial and narcissistic

• Women are seen as more emotional so they get diagnosed with borderline personality disorder and histrionic

Criterion Gender Bias

Criteria for the disorder may themselves be bias - criteria for personality disorder in general do not appear to have strong gender biases

Assessment Gender Bias

The assessment measures and the way the criteria is used may be biased

Comorbidity

• People tend to be diagnosed with more than one personality disorder

• Comorbid was first used for diseases so there is so debate about if it should be used for psychological disorders

• Complicated to understand if people actually have more than one personality disorder

• People will also change diagnoses over time

Paranoid Personality Disorder

Cluster A (odd or eccentric) personality disorder involving pervasive distrust and suspiciousness of others such that their motives are interpreted as malevolent. Mistrustful without any justification. Defining characteristic is pervasive unjustified distrust

• Events that have nothing to do with them are interpreted as personal attacks

• Mistrust extends to people close to them and makes meaningful relationships difficult

• May be argumentative, may complain or may be quiet but they are obviously hostile towards others

• Very sensitive to criticism and have an excessive need for autonomy

• Increases risk of suicide attempts and violent behaviour and related to having a poor overall quality of life

• Related to paranoid type of schizophrenia and delusional disorder - Both involve delusions, persistent beliefs that are out of touch with reality

• Their suspiciousness does not reach delusional proportions

Causes of Paranoid Personality Disorder

• Evidence for biological contributions to paranoid personality disorder is limited

• Some research suggests that it is slightly more common among relatives of people who have schizophrenia but not a strong association

• Strong role of genetics for Cluster A disorders because they are related to schizophrenia

• Early mistreatment or traumatic childhood experiences may play a role in the development (May be a biased finding)

• Schemas of people with it may be the assumption of “People are malevolent and deceptive,” “They’ll attack you if they get the chance” - maladaptive but they persist in these individuals, some speculate that it is rooted in early upbringing, parents teaching them to be careful about making mistakes and to impress on them that they are different from other people, the vigilance cause them to see signs that other people are deceptive

• Cultural experiences - prisoners, refugees, people with hearing impairments and older adults are thought to be particularly susceptible because of their unique experiences

• Signs of paranoia are also an initial symptom of people who later develop Alzheimer’s disease

Treatment of Paranoid Personality Disorder

• Because they are mistrustful, they are unlikely to seek professional help when they need it and they have difficulty developing the trusting relationships necessary for therapy

• Developing a meaningful therapeutic alliance between the client and the therapist is an important first step

• When people do seek therapy the trigger is often a crisis in their lives or other problems like anxiety or depression and not necessarily their personality

• Therapists try to provide an atmosphere conductive to developing a sense of trust - using cognitive therapy to counter the person’s mistaken assumptions about others, focusing on changing the person’s beliefs

• No significant evidence that any form of treatment can significantly improve the lives of people with this disorder

• Cognitive restructuring can be helpful in reducing paranoid beliefs

Schizoid Personality Disorder

Cluster A (odd or eccentric) personality disorder featuring a pervasive pattern of detachment from social relationships and a restricted range of expression of emotions. Showing a pattern of detachment from social relationships and a very limited range of emotions in interpersonal situations, they seem aloof, cold and indifferent to other people.

• Seem to neither desire nor enjoy closeness with others including romantic or sexual relationships

• Seem cold, aloof and detached and do not seem affected by praise or criticism

• Homelessness appears to be prevalent among people with this disorder perhaps due to their lack of close friendships and lack of dissatisfaction about not having a relationship

• Social tendencies are similar to people with paranoid personality disorder, considering themselves more to be observers of the world

• Do not seem to have the very unusual thought processes like others in this cluster - sharing social isolation, poor rapport and constricted affect (showing neither positive nor negative emotion, more like negative symptoms of schizophrenia)

Causes of Schizoid Personality Disorder

• Very little research on the nature and causes of the disorder

• Childhood shyness is reported as a precursor to later diagnosis - May be that this personality trait is inherited and serves as an important determinant in the development

• Abuse and neglect in childhood are also reported among individuals with it

• Research points to biological causes of autism - significant overlap in the occurrence of autism spectrum disorder, possible that a biological dysfunction found in both autism and schizoid personality combines with early learning or early problems with interpersonal relationships to produce the social deficits that define schizoid personality

• People with a lower density of dopamine receptors scoring higher on a measure of detachment

• May be that dopamine (involved in schizophrenia) may contribute to the social aloofness

Treatment of Schizoid Personality Disorder

• Rare for someone to request treatment expect in response to a crisis such as extreme depression or losing a job

• Often begin treatment by discussing the value in social relationships

• Person with it may need to be taught the emotions felt by others to learn empathy

• Because their social skills were never established or have atrophied through lack of use, people often receive social skills training

• Therapist takes the part of a friend or significant other with role playing and helps the patient practice establishing and maintaining social relationships

• This type of social skills training is helped by identifying a social network, a person or people who will be supportive

• Outcome research is limited so effectiveness is not known

Schizotypal Personality Disorder

Cluster A (odd or eccentric) personality disorder involving a pervasive pattern of interpersonal deficits featuring acute discomfort with, and reduced capacity for close relationships, as well as by cognitive or perceptual distortions and eccentricities of behaviour. Typically socially isolated and they behave in ways that would seem unusual, tending to be suspicious and having unusual beliefs. Considered to be on a continuum with schizophrenia but without the more debilitating symptoms like hallucinations and delusions.

• Have psychotic like (but not psychotic) symptoms like believing everything relates to them personally, social deficits, and sometimes cognitive impairments or paranoia

• Often considered odd or bizarre by other because of how they relate to other people, how they think and behave, and even how they dress

• Have ideas of reference where they might believe that somehow everyone on a passing city bus is talking about them yet they may be able to acknowledge this as unlikely (People with schizophrenia would not be able to test reality or see the illogic of their ideas, they won’t be able to tell the difference)

• Also have odd beliefs or engage in “magical thinking” like believing they are clairvoyant or telepathic

• They report unusual perceptual experiences including illusions as feeling the presence of another person when they are alone (feeling rather than reporting that someone is actually there which would happen with schizophrenia)

• Small proportion with this go on to develop full schizophrenia

• Tend to be suspicious and have paranoid thoughts, express little emotion and may dress or behave in unusual ways

• Children who later develop this tend to exhibit extreme social anxiety, hypersensitivity, being teased for oddness and peculiar thoughts and language

• Often have beliefs around religious or spiritual themes so clinicians must be aware that different cultural beliefs or practices may lead to a mistaken diagnosis

Causes of Schizotypal Personality Disorder

• Viewed by some to be one phenotype of a schizophrenia genotype - thought to have genes predisposing them to schizophrenia and yet because of the relative lack of biological or environmental influences some will have the less severe schizotypal personality disorder

• Many characteristics of schizotypal are similar but milder forms of behaviours observed among people with schizophrenia

• Increased prevalence of schizotypal personality disorder among relative of people with schizophrenia

• The environment can strongly influence it, Ex. a woman’s exposure to influenza in pregnancy may increase the chance for her child to develop it

• May be that a subgroup of people with schizotypal has a similar genetic makeup compared to people with schizophrenia

• Research suggesting some damage in the left hemisphere

• Problems with semantic association contribute to the thinking oddities

• Generalized brain differences in patients with schizotypal

Treatment for Schizotypal Personality Disorder

• Often seek help originally for anxiety and depression

• Relatedly the prescence of this disorder significantly increases the risk for developing MDD even years later

• Treatment includes some of the medical and psychological treatments for depression

• Combination of anti-psychotics, community treatment, and social skills training to treat symptoms either reduced symptoms or postponed the onset of later schizophrenia

• Treating younger people who have these symptoms with a combination of antipsychotics, cognitive behaviour therapy and social skills training could prove to be a promising prevention strategy

Antisocial Personality Disorder

Cluster B (dramatic, emotional, or erratic) personality disorder involving a pervasive pattern of disregard for and violation of the rights of others. Greater emphasis on overt behaviour rather than on personality traits like in psychopathy.

• Characterized as having a history of failing to comply with social norms

• Tend to be irresponsible, impulsive and deceitful

• Tend to have a long history of violating the rights of others (Conduct disorder)

• Described as being aggressive because they take wat they want, indifferent to the concerns of other people

• Lying and cheating seem to be second nature to them and often they appear unable to tell the difference between the truth and the lies they make up to further their own goals

• Show no remorse or concern over the sometimes devasting effects of their actions

• Problematic substance use is common, appears to be a lifelong pattern and they are at an increased risk for abusing multiple substances

• Long term outcome is usually poor

• Debate whether psychopathy and antisocial are really two distinct disorders or not

• Earlier versions of the DSM criteria focused on observable behaviours because it is more difficult to assess personality traits but it shifted to including criteria like impulsivity and deceitfulness, this might reduce the reliability

• Some people manage to not get in trouble with the law, what separates people from this might be intelligence and other factors - having higher IQ may help protect some people from developing more serious problems or may prevent them from being caught

• Antisocial traits predict future criminal behaviour even among those who have already

• Starting with Conduct Disorder - Childhood onset (At least one criteria before the age of 10) or adolescent onset (the absence of criteria before age 10)

• Many children with conduct become juvenile offenders and tend to become involved with drugs

• Likelihood of having anitsocial increases if the child has both CD and Attention-deficit/hyper-activity disorder

Psychopathy

Non-DSM category similar to antisocial personality disorder but with less emphasis on overt behaviour, indicators include superficial charm, lack of remorse, and other personality characteristics.

Genetic Influences of Antisocial Personality Disorder

• Genetic influence on the disorder

• Some genetic influence on criminality and antisocial behaviour

• Gene-environment interaction - genetic factors may be important only in the presence of certain environmental influences (opposite is also true)

• Genetic factors may present a vulnerability but actual development of criminality may require environmental factors, such as deficit in early, high quality contact with parents or parent-surrogates

• Biological predisposition and exposed to chronic stress - greater risk for conduct problems

Neurobiological Influences of Antisocial Personality Disorder

• Evidence of deficits in ability to maintain a plan and to inhibit irrelevant information - suggesting executive cognitive function deficits

• Some children who are maltreated develop but not all are maltreated

• Maltreated and having low levels of MAOA which is involved in breaking down neurotransmitters, likely to have build up of neurotransmitters and not handle stress as well

1) Underarousal Hypothesis

• Associated with low levels of cortical arousal

• Inverted U-shaped relation between arousal and performance (Yerkes-Dodson curve) which suggests that people with either very high or very low levels of arousal tend to experience negative affect and perform poorly in many situations whereas individuals with intermediate levels of arousal tend to be relatively content and perform satisfactorily in most situations

• Low levels of cortical arousal characteristic of psychopathy are the primary cause of antisocial and risk-taking behaviour - an urge to seek stimulation to boost chronically low levels of arousal

• Low-frequency theta waves in children but largely disappears in adulthood - might have excessive theta waves when they are awake

• Cortical immaturity hypothesis - cerebral cortex is at a relatively primitively stage of development, cerebral cortices may be insufficiently developed

• Theta waves - indicates states of drowsiness or boredom, higher levels of these may simply reflect their relative absence of anxiety

2) Fearlessness Hypothesis

• Higher threshold for experiencing fear

• May involve difficulty associating certain cues or signals with impending punishment or danger, not developing capacity for impulse control

Psychological and Social Dimensions

• Once people with psychopathy set their sights on a reward goal, they are less likely to be deterred despite signs that the goal is no longer achievable - Failure to abandon an unattainable goal

• Aggression in children may escalate in part because of their interactions with their parents - parents give in to the problems displayed by children, yelling at their child and they yell back then giving up and letting them win (giving in results in short-term gains for bother the parent and the child but continuing problems), can result in less parental involvement, involved with the callous-unemotional traits that seem to later turn into psychopathy

• Shared environmental factors are important in criminality - low social status in adoptive parents increasing the risk of nonviolent criminality and individuals also receiving inconsistent parental discipline

• Degree of mutual trust and solidarity in a neighbourhood inversely related to violent crime - factors outside the family can influence behaviours

• trauma associated with combat may increase the likelihood of antisocial behaviour - the more traumatic events the more likely to engage in violence, illegal activities, lying and use of aliases

• Childhood trauma especially when severely traumatized by loved ones over time they might learn to turn off their emotions as a way of coping

Integrative Etiology of Antisocial Personality Disorder

• Genetic vulnerability to antisocial behaviours and personality traits, this may result in underarousal or fearlessness, which then might be the propensity for weak inhibition systems and overactive reward systems that could partially account for the evidence of difference in cognitions and emotions

• In a family that may already be under stress, there may be an interaction style that actually encourages antisocial behaviour on the part of the child, the child’s impulsive behaviour alienates other children who might be good role models and attracts others like them or who encourage their behaviour. May also result in dropping out and poor occupational history

Treatment for Antisocial Personality Disorder

• Rarely self-identify as needing treatment

• Can be very manipulative with their therapists

• Because of these factors, clinicians are very pessimistic about the outcomes of treatment and there are few documented success stories

• Poor prognosis even in childhood

• Recommended to identify high-risk children so treatment can be attempted before adulthood

• Some evidence that cognitive behavioural therapy can help reduce the likelihood of violence 5 years after treatment

• CBT negative correlated with ratings of traits like selfish, callous and remorseless use of others - higher the score on this trait the less successful the group was in refraining from violence after their treatment

• More treatments are focused on enabling individuals to better examine their own states of mind and understand others minds and to behave more prosocially

• Treatment for children involves parent training - parents taught how to recognize behaviour problems early and how to use praise and privileges to reduce problem behaviour and encourage prosocial behaviours - issues with not succeeding or dropping out early like high degrees of family dysfunction, socioeconomic disadvantage, high family stress, parent history of antisocial behaviour or severe conduct disorder of the child

• Efforts to combine behavioural approaches with efforts to improve family relationship and provide services to the families in their communities

Prevention of Antisocial Personality Disorder

• Preschool programs combine teaching good parenting skills with a variety of support for families with social and economic disadvantages

• Obstacle to these type of prevention efforts is that there are relatively poor methods for identifying which children will grow up to have antisocial

Borderline Personality Disorder

Cluster B (dramatic, emotional or erratic) personality disorder involving a pervasive pattern of instability of interpersonal relationships, self-image, affects, and control over impulses.

• Moods and relationships are unstable and usually they have very poor self-images, often feeling empty and are at great risk of dying by suicide

• One of the most common personality disorders

• Tend to have very turbulent relationships, fearing abandonment and lacking control over their emotions

• Frequently engage in suicidal or self-mutilating behaviours

• Very intense, going from anger to deep depression in a short time - characterized by impulsivity (From substance misuse to self-mutilation)

• Self-injurious behaviours are described as tension reducing by people who engage in these behaviours

• Chronically bored and have difficulties with their own identity

• Depression, eating disorders, bipolar, and substance use (Way to cope) are commonly comorbid

• Tends to improve during their 30s and 40s although they may continue to have difficulties

• Link between borderline and intimate partner violence in men - men with it are susceptible to abusing their partners because they set excessively high standards for others and blame their partners when things go wrong

Cause of BPD

• More prevalent in families with the disorder and linked with mood disorders - supporting role of genetics

• Limbic network involvement - involved in emotion regulation and serotonin neurotransmission, low serotonergic activity is involved with the regulation of mood and impulsivity

• Reports of greater emotional fluctuations an greater emotional intensity primarily in negative emotions such as anger and anxiety - sensitive to the emotions of others

• Remembering more words related to the disorder like abandon, emptiness etc. rather than words not related to the symptoms

• Contribution of early trauma, specifically sexual and physical abuse - don’t know the correlation, but it would explain why women are affected more often than men (Girls more likely to be sexually abused then men)

• Similar to PTSD - difficulties in the regulation of mood, impulse control and interpersonal relationships

• Debate that it is truly how PTSD is presented in women but not all cases resemble PTSD

• Observed in people who have gone through rapid cultural changes - problems of identity, emptiness, fears of abandonment and low anxiety threshold found in child and adult immigrants

• Some have no apparent history with trauma - not necessary or sufficient for the cause

• Combines with a predisposing temperament or personality and a stressful triggering event causes the unstable behaviours

Treatment for BPD

• Efforts of success are complicated by problems with drug misuse, compliance with treatment and suicide attempts - many clinicians are hesitant to work with them

• Some respond positively to medications like antidepressants and even antipsychotics and anticonvulsants (Comparison showed not much actual efficiency)

• CBT adapted into dialectical behaviour therapy - involves helping people cope with the stressors that seem to trigger suicidal behaviours and other maladaptive responses, weekly individual sessions where clients are provided support and taught how to identify and regulate their emotions, problem solving is emphasized so they can handle difficulties more effectively

• Also receive treatment similar to PTSD treatment where prior traumatic events are re-experienced to help extinguish the fear associated with them

• The final stage of therapy clients learn to trust their own responses rather than to depend on the validation of others

• DBT may help reduce attempts, dropping out of therapy and hospitalization

• Couples therapy is also recommended due to the pattern of unstable and intense interpersonal relationships characteristic of people with BPD

• 3 subtypes: 1) impulsive (history of impulsive, self-destructive, and treatment-threatening behaviour); 2) identity disturbance (those with a markedly and persistently unstable self-image or sense of self); and 3) affective cluster (those with marked mood swings and difficulty controlling anger)

• Recommended couples therapy for 2 and 3

Histrionic Personality Disorder

Cluster B (dramatic, emotional or erratic) personality disorder involving a pervasive pattern of excessive emotionality and attention seeking.

• Inclined to express their emotions in an overstated fashion

• Tend to be vain and self-centered and uncomfortable when they are not in the lime light

• Often seductive in appearance and behaviour and they are typically very concerned with their appearance (Often why women get diagnosed with this, key word is seductive)

• Seek reassurance and approval constantly and may become upset or angry when other do not attend to them or praise them

• Also tend to be impulsive and have great difficulty delaying gratification

• Tendency to view situations in global, black-and-white terms, speech is often vague, lacking in detail and characterized by exaggeration

Causes of Histrionic Personality Disorder

• Origins of hysteria - wandering uterus

• Possible relationship with antisocial personality disorder - co-occur very often, sex-typed alternative expression of the same unidentified underlying condition, women predisposed to exhibit a predominantly histrionic pattern whereas men may exhibit a antisocial pattern (Still controversial)

Treatment for Histrionic Personality Disorder

• Therapy often focuses on their problematic interpersonal relationships

• Often manipulate others through emotional crises, using charm, sex, seductiveness or complaining

• Often need to learn how the short-term gains derived from this interactional style result in long-term costs and they need to be taught more appropriate way of negotiating their wants and needs

Narcissistic Personality Disorder

Cluster B (dramatic, emotional, or erratic) personality disorder involving a pervasive pattern of grandiosity in fantasy or behaviour, need for admiration and lack of empathy.

• Exaggerated sense of self-importance and are preoccupied with receiving attention

• Unreasonable sense of self-importance and are so preoccupied with themselves that they lack sensitivity and compassion for other people

• Aren’t comfortable unless someone is admiring them

• Their exaggerated feelings and their fantasies of greatness (Grandiosity) create negative attributes, they require and expect a great deal of special attention

• Tend to use or exploit others for their own interests and show little empathy, when confronted with other successful people they can be extremely envious and arrogant and because they often fail to live up to their own expectations they are frequently depressed

Causes of Narcissistic Personality Disorder

• May arise from a profound failure of empathic “mirroring” by parents very early in a child’s development, a child then remains fixated at a self-centered, grandiose stage of development - the children become involved in an essentially endless search for the ideal person who will meet their unfulfilled empathic needs

• Increasing in prevalence in most Western societies, primarily as a consequence of large-scale social changes including greater emphasis on short-term hedonism, individualism, competitiveness and success (Increase may be due to more research though)

• Some questions whether this and antisocial are related - sharing elevated disagreeableness and a tendency to be self-enhancers but nothing else, overlapping but distinct

Treatment for Narcissistic Personality Disorder

• When therapy is attempted, it focuses on grandiosity, hypersensitivity to evaluation and lack of empathy towards others

• Cognitive therapy aims to replace fantasies with a focus on the day-to-day pleasurable experiences that are truly attainable

• Coping strategies like relaxation training, are used to help face and accept criticism

• Greater focus on the feelings of others is also a goal

• Because individual are vulnerable to severe depressive episodes, particularly in middle age, treatment is often initiated for depression

Avoidant Personality Disorder

Cluster C (anxious or fearful) personality disorder featuring a pervasive pattern of social inhibition, feelings of inadequacy, and hypersensitivity to criticism

• Extremely sensitive to the opinions of others and although they desire social relationships, their anxiety leads them to avoid such associations

• Extremely low self-esteem coupled with a fear of rejection causes them to be limited in their friendships and to be very dependent on those they feel comfortable with

• Important to distinguish between people who are asocial because that are apathetic, affectively flat, and relatively uninterested in interpersonal relationships and individuals who are asocial because they are interpersonally anxious and fearful of rejection

• Feeling chronically rejected by others and are pessimistic about their future

Causes of Avoidant Personality Disorder

• Some evidence showing that it is related to other schizophrenia-related disorder, occurring most often in relatives of people who have schizophrenia

• Individuals may be born with a difficult temperament, as a result, parents may reject them or at least not provide them enough early uncritical love and this rejection may result in low self-esteem and social alienation, conditions that persist into adulthood (Limited support for psychosocial influences)

• Parenting may contribute to the development

• More likely to report childhood experiences of neglect, isolation, rejection and conflict with other (Careful with these types of reports, could be the other aspects they remember aka remembering wrong or they might be more sensitive to the way they are treated)

• Similarity to social anxiety disorder - part of the social anxiety spectrum

• Research linking behavioural inhibition - may be the core underlying vulnerability for cluster C personality disorders more generally, overactive behavioural inhibition

Treatment for Avoidant Personality Disorder

• Behavioural intervention techniques for anxiety and social skills problems have had some success

• Social skills training within a support group is useful to help people become more assertive with others

• Many of the same treatments for social anxiety are used - CBT graduated exposure to feared situations

• Medical interventions for anxiety can be effective

• Therapeutic alliance a strong predictor of success in treatment

Dependent Personality Disorder

Cluster C (anxious or fearful) personality disorder characterized by a person’s pervasive and excessive need to be taken care of, a condition that leads to submissive and clinging behaviour and fears of separation.

• Relying on others to make ordinary decisions and important ones

• Motivated by anxiety

• Sometimes agree with other people when their own opinion differs so not to be rejected

• Desire to obtain and maintain supportive and nurturing relationships may lead to their other behavioural characteristics like submissiveness, timidity and passivity

• Similar to those with avoidant in their need for reassurance but respond by clinging to relationships

• Cultural aspect - for some cultures dependence may be desirable

Causes for Dependent Personality Disorder

• Disruptions like early death of a parent or neglect or rejection by caregivers could cause people to grow up fearing abandonment

• Genetic influences

• Role of constructs like sociotropy (personality orientation involving a strong investment in positive social interactions) and autonomy (personality style involving a strong investment in independence from others, mobility, and freedom of choice)

• Dependent associated with sociotropy

Treatment for Dependent Personality Disorder

• Because of their attentiveness and eagerness to give responsibility for their problems to the therapist they can appear to be ideal patients but that submissiveness negates the goal of making a person more independent and personally responsible

• Therapy progresses gradually and the patient develops confidence in their ability to make decisions independently

• Particular need for care that the patient does not become overly dependent on the therapist

Obsessive-Compulsive Personality Disorder

Cluster C (anxious or fearful) personality disorder featuring a pervasive pattern of preoccupation with orderliness, perfectionism, and mental and interpersonal control at the expense of flexibility, openness and efficiency

• Fixation on things to be done the right way

• Obsession with details prevents them from actually completing much of anything

• Due to their general rigidity, people tend to have poor interpersonal relationships

• Only distantly related to obsessive compulsive disorder - tend to not have the obsessive thoughts and the compulsive behaviours seen in OCD

• One of the most common personality disorders in the general population

Causes for Obsessive-Compulsive Personality Disorder

• Moderate genetic contribution - some may be predisposed to favouring structure in their lives but to reach this level it may require parental reinforcement of conformity and neatness

Treatment for Obsessive-Compulsive Personality Disorder

• Therapy often attacks the fears that seem to underlie the need for orderliness

• Individuals are often afraid that what they do will be inadequate so they procrastinate and excessively ruminate about both important issues and minor detail

• Therapists help the individual relax or use cognitive reappraisal techniques to reframe compulsive thoughts

• Perfectionism is an important aspect and cognitive behavioural therapy can be effective in treating this feature

Personality Disorder Under Study

Sadistic Personality Disorder - People who receive pleasure by inflicting pain on others

Passive-Aggressive Personality Disorder - People who are defiant and refuse to cooperate with requests, attempting to undermine authority figures

• Idea of creating dimensions of different personality traits along the lines of the Big Five but because of the difficulty in making a diagnosis (too many permutations) and potential problems in using that information to design treatments

• Change proposed to remove 5 of the disorders due to a lack of research