SET 9: Personality Disorders

Describe controversies and special considerations in diagnosing personality disorders.

Diagnosis of personality disorders is controversial because the person’s personality IS the disorder, so they don’t see anything wrong and rarely seek help. As a result, diagnosis relies heavily on clinician judgement and reports from others. There is also debate about whether these are true disorders or just what society finds unacceptable. Diagnosing children can be problematic because it risks labeling them with something they might not even have. Men and women also tend to be diagnosed with different disorders.

Identify and describe Cluster A personality disorders, including the defining feature, causes, and treatment options for each.

Paranoid Personality Disorder:

• Defining Feature: Extreme suspicion.

• Causes: Genes (overlap with schizophrenia), childhood abuse, and the development of negative cognitive schemas.

• Treatment: CBT to challenge paranoid cognitions (often difficult because the patient doesn’t trust the therapist).

Schizoid Personality Disorder

• Defining Feature: Social Isolation.

• Causes: Genes (overlap with autism and schizophrenia), lack of dopamine receptors, and childhood abuse, neglect, or shyness.

• Treatment: Social skills training and helping the patient build or recognize value in relationships.

Schizotypal Personality Disorder

• Defining Feature: Suspicion + odd behaviour.

• Causes: Genes (overlap with schizophrenia) and brain abnormalities.

• Treatment: Prevention of progression to full psychosis through a combination of meds, therapy, and social skills training.

Identify and describe Cluster B personality disorders, including the defining feature, causes, and treatment options for each.

Antisocial

• Defining Feature: Violation of others’ rights.

• Causes: Genes, low baseline arousal, childhood abuse, and coercive parenting.

• Treatment: CBT to prevent future antisocial behaviour, and parent training to identify antisocial behaviours, reward prosocial behaviours, and improve communication.

Borderline

• Defining Feature: Tumultuous instability.

• Causes: Genetic contribution tied to mood and early trauma.

• Treatment: Dialectical behaviour therapy (DBT), which targets emotion regulation.

Histrionic

• Defining Feature: Excessively emotional.

• Causes: Possibly a “female version” of antisocial PD.

• Treatment: Examining interpersonal relationships.

Narcissistic

• Defining Feature: Excessive interest in oneself.

• Causes: Failure to develop empathy, hypersensitivity to evaluation.

• Treatment: Cognitive therapy focused on addressing sensitivity to evaluation, or treatment of comorbid depression.

Identify and describe Cluster C personality disorders, including the defining feature, causes, and treatment options for each.

Avoidant

• Defining Feature: Hypersensitivity to evaluation.

• Causes: Parental rejection, increased behavioural inhibition.

• Treatment: Behavioural techniques and social skills training in groups.

Dependent

• Defining Feature: Dependence on others.

• Causes: Genes, excessive sociotropy (relationships > autonomy).

• Treatment: Focuses on autonomy and personal responsibility.

Obsessive

• Defining Feature: Fixation on details.

• Causes: Parental reinforcement of conformity, neatness, and orderliness, high levels of perfection, worry, and rumination.

• Treatment: CBT and relaxation.