Personality Disorders (CH 6)

a mental health condition that involves a long-term pattern of behavior and inner experiences that differs from what is considered normal in a person's culture

Personality Disorders

_________________________ model of Personality Disorder: provide clinicians with transtheoretical operational criteria for mental disorder diagnoses, which are thought to provide clinicians both maximally inter-rater reliable and valid diagnostic criteria.

Alternative

Diagnosis of PD

-No formal assessment of the general PD criteria is required to carry out one or more specific PD diagnoses

-PD tends to covary rather than to co-occur

-does not allow tailoring treatment to a specific (personality) pathology

What does it mean that PDs tend to covary rather than to co-occur

means that personality disorders (PDs) often share overlapping traits that vary together, rather than existing as separate, fully distinct disorders that happen to appear at the same time.

Personality ______________ = person has deep-rooted problems in mental processes that form the foundation of personality

-Considered a "Mental" problem

Dysfunction

Personality ______________ = Real-world difficulties a person experiences because of their personality dysfunction

-Functional impairments (person struggles to function normally in daily life)

Disability

the study of how often diseases occur in different groups of people and why

Epidemiology

HIGHER PD prevalence occurs in urban or rural areas?

Higher in urban

PD is more common in men or women?

MEN

*But women are more likely to seek help

True or False:

2/3 of inmates were reported to meet PD diagnostic criteria

True

Clinical Presentation of PD

Greatly varies (could be sad, angry, tired, hyper)

1. Referral

2. Presenting symptoms

3. Additional background information

the cause and development of a disease or abnormal condition

Etiopathogenesis

Etiopathogenesis of PD

No established etiological factor has been reported in the literature for any PD

*BOTH GENETIC AND ENVIRONMENT TOGETHER = CAUSE*

-Most consistent = genetic connection of schizotypal PD to schizophrenia

-Moderately heritable = antisocial (genetic)

-Early brain imaging = borderline PD exhibits amygdala overactivity when judging others' emotions → increased rates of childhood sexual and physical abuse (environment)

Treatment for PD

-Overall evidence base for treating personality disorders is still limited

-Most research and treatment development has focused on Borderline personality disorder

-Psychotherapy

(Good for schizotypal PD)

-Pharmacotherapy (should only be used with psychotherapy and limited)

*NOT primary treatment*

What are the three clusters of PD

-Cluster A (Odd, eccentric)

-Cluster B (dramatic, emotional, erratic)

-Cluster C (Anxious, fearful)

People with ____________ PD are marked by pervasive distrust and suspicion of others, often interpreting benign remarks or events as malevolent

-difficult to engage in therapy due to their mistrust

Paranoid

Cluster A includes what 3 PD?

-parnoid

-Schizoid

-Schizotypical

People with ________________ PD involves a detachment from social relationships and a restricted range of emotional expression.

-Typically refer solitude

-Show little interest in forming close relationships

-seem indifferent to praise or criticism

Schizoid

People with _____________ personality disorder, includes peculiar thinking and behavior, magical beliefs, and social anxiety stemming from paranoid fears rather than poor social skills

-may benefit from low-dose antipsychotics and social skills training

Schizotypical

Cluster B includes what 4 PD?

-antisocial

-borderline

-histrionic

-narcissistic

_________________ characterized by a disregard for and violation of the rights of others, often including deceit, impulsivity, and a lack of remorse. It is more commonly diagnosed in males and has a strong association with criminal behavior and conduct disorder before age 15

(kind of PD)

Antisocial personality Disorder (ASPD)

_______________________ - marked by intense emotional instability, fear of abandonment, unstable relationships, impulsivity, recurrent suicidal behavior or self-harm, and chronic feelings of emptiness.

-These individuals may idealize then devalue others (splitting) and show rapid shifts in mood.

-Dialectical behavior therapy (DBT) is particularly effective, and pharmacotherapy (e.g., SSRIs or mood stabilizers) may help target symptoms such as mood lability and impulsivity.

(kind of PD)

Borderline personality disorder (BPD)

______________________ - involves excessive emotionality and attention-seeking behavior.

Patients may be dramatic, flirtatious, and uncomfortable when not the center of attention.

Therapy should help patients focus on deeper emotions rather than superficial appearance or approval.

Histrionic personality disorder

______________________ - features grandiosity, a need for admiration, and a lack of empathy.

While these individuals may seem confident, they often have fragile self-esteem and can become enraged at criticism.

Therapy can focus on developing empathy and more realistic self-assessment.

Narcissistic personality disorder

Difference between Histrionic PD and Narcissistic PD

HPD = "Notice me, love me, watch me!" (focus on attention)

-Wants attention — any kind of attention (good or bad).

NPD = "Admire me, respect me, I'm the best." (focus on superiority)

-Thinks they are better than others and may look down on people.

Cluster C includes what 3 PD?

-Avoidant

-Dependent

-OCD

____________________ - is characterized by social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation.

-Unlike schizoid PD, these individuals desire close relationships but avoid them due to fear of rejection.

-CBT and SSRIs may be helpful (especially is social anxiety is present)

(kind of PD)

Avoidant PD

_____________________ - involves an excessive need to be cared for, leading to submissiveness, clinginess, and fear of separation.

These individuals have difficulty making decisions without reassurance and may remain in unhealthy relationships due to fear of abandonment.

Therapy focuses on fostering independence and self-efficacy

(Kind of PD)

Dependent PD

__________________ - is marked by a preoccupation with orderliness, perfectionism, and control

-ego-syntonic (patients view their behavior as appropriate), and compulsions are less prominent.

These individuals often have difficulty delegating tasks, become upset when things deviate from their standards, and may struggle with inefficiency due to over-attention to detail.

-Treatment may involve CBT and SSRIs to reduce rigidity and anxiety.

(Kind of PD)

OCPD

***DIFF FROM OCD***

Difference of OCD and OCPD

-OCD = anxiety disorder

-OCPD = PD

Core issue:

-Obsessions + compulsions (OCD)

-Rigid perfectionism + control (OCPD)

Motivation:

Reduce anxiety (OCD)

Maintain control and order (OCPD)

Distress:

Causes distress to the person (OCD)

May cause distress to others, not self (OCPD)

Treatment of PD typically centers on?

Psychotherapy with pharm tx used to address specific symptom clusters rather than the disorder itself

PD Treatment:

_________________ = the most evidence-based intervention for borderline PD, focusing on emotion regulation, interpersonal effectiveness, distress tolerance, and mindfulness.

Dialectical behavior therapy (DBT)

PD Treatment:

useful across multiple PDs, particularly in Cluster C disorders

CBT

PD Treatment:

Pharmacotherapy may include _______________ for mood lability or anxiety, ___________________ for cognitive-perceptual distortions (e.g., in schizotypal or borderline PD), and __________________ for impulsivity or aggression

SSRIs

Antipsychotics

Mood stabilizers

Prognosis and Course of PD:

Which cluster?

May show significant symptom reduction over time, particularly with treatment.

Cluster B

Prognosis and Course of PD:

Which cluster?

Tend to be more persistent. Functional impairment can be substantial, especially when comorbid disorders are present. Early intervention, consistent therapy, and a strong therapeutic alliance can improve outcomes, but managing PDs often requires patience and a long-term approach.

Cluster A and C

How is schizoid personality disorder different from avoidant personality disorder?

While both disorders involve social detachment, schizoid PD is marked by a lack of interest in social relationships and emotional detachment—these individuals often prefer to be alone.

In contrast, avoidant PD involves intense fear of rejection and criticism; these individuals want social relationships but avoid them due to anxiety and feelings of inadequacy.

What are some common comorbidities with personality disorders

frequently co-occur with mood disorders

Depression, bipolar disorder, anxiety disorders (especially social anxiety with Cluster C), substance use disorders (especially with antisocial and borderline PD), eating disorders (notably with borderline PD), and PTSD.

How does cultural context affect the diagnosis of personality disorders?

Cultural norms heavily influence what behaviors are deemed "abnormal." Traits that appear maladaptive in one culture may be considered typical in another. Therefore, clinicians must consider the individual's cultural background when diagnosing PDs to avoid pathologizing culturally normative behavior.

Which personality disorders are most associated with childhood trauma or abuse?

-Borderline personality disorder has the strongest association with childhood trauma, including physical, emotional, and sexual abuse

-Antisocial and dependent PDs also show higher rates of early life adversity