Personality disorders

Personality disorder definition

A pattern of emotions, cognitions, and behavior that results in enduring emotional distress for the person affected and/or for others and may cause difficulties with work and relationships

Personality vs Personality disorders

• Personality disorders have the most extreme versions of personality traits

• Display problematic characteristics over extended periods of time across many situations

• DSM categorizes PD’s as categorical while most psychologists categorize them as dimensional

Cluster A

• Odd eccentric

• Paranoid PD

• Schizoid PD

• Schizotypal PD

Cluster B

• Emotional, dramatic and erratic

• Antisocial PD

• Borderline PD

• Histrionic PD

• Narcissistic PD

Cluster C

• Anxious fearful

• Avoidant PD

• Dependent PD

• OCPD

Gender differences in PD’s

• Males

  • Aggressive, structured, self-assertive, and detatched

• Females

  • Submissive, emotional, and insecure

• Criterion gender bias

  • Diagnostic criteria for some disorders are biased

• Assessment gender bias

  • Clinicians have biases

Comorbidity in PD"‘s

• High comorbidity among PD’s with other disorders

Paranoid personality disorder

• Pervasive pattern of distrust and suspiciousness of others such that their motives are interpreted as malevolent

• Preoccupied with unjustified doubts about the loyalty or trustworthiness of others

• Perceives many things as attacks on their character that are not apparent to others

Paranoid personality disorder causes: psychological + cultural + treatment

• Psychological

  • Early mistreatment/trauma

  • Negative schemas of people and the world

• Cultural factors

  • Prisoners, refugees, and the elderly exhibit a higher risk of PPD bc they don’t have a lot of control over their lives

• Treatment

  • Difficult because of lack of trust

Schizoid personality disorder

• A pervasive pattern of detachment from social relationships and a restricted range of expression of emotions in interpersonal settings

• Has little interest in any social interaction → lack of close friends or confidants other than first-degree relatives (only bc they force their way in)

• Not lonely

Schizoid personality disorder core fear and difference between schizotypal

• No unusual thought processes (main difference between schizoid and schizotypal)

• Core fear:

  • Being controlled, failing relational expectations, being misunderstood

Schizoid PD causes:

• Childhood shyness may be a precursor (may be inherited)

• Abuse/neglect

• Overlap with autism → challenges in social realm in general

Schizotypal PD + core fear

• A pervasive pattern of social and interpersonal deficits marked by acute discomfort with, and reduced capacity, for close relationships

• Cognitive or perceptual distortions and eccentricities of behavior

• Core fear:

  • Rejection, being different, the world being unpredictable

Schizotypal PD pt 2

• Unusual behaviors

  • Suspicious, odd beliefs, magical thinking

• Ideas of reference (everything is related to me)

• May be on schizophrenia spectrum, but without the hallucinations and delusions

Schizotypal PD causes:

Biological

• One phenotype of the schizophrenia genotype

• Exposure to influenza during pregnancy may increase the chance of Schizotypal PD in the child

• Damage to left hemisphere of the brain (responsible for analytical thinking, reasoning, logic etc…)

Antisocial PD

• A pervasive pattern of disregard for and violation of the rights of others, has to be 18 and has to be occurring since age 15 years

• Impulsivity, deceitfulness, and irresponsibility

• Lack of remorse for their actions

Antisocial PD comorbidity

• Substance use affcts 60%

Antisocial PD and media terms

• ASPD = clinical diagnosis

• Psychopathy = personality construct (not diagnosed)

• Sociopathy = an informal term used in media

Psychopathy

• A personality profile, not a DSM diagnosis

• Two-factor model:

  1. Affective - interpersonal (lack of empathy)

  2. Lifestyle - antisocial (behavior problems, impulsivity)

• Psychopaths = cold-blooded murderers who have a purpose for killing

• Antisocial PD = hot-blooded murderers who kill out of impulsivity

Antisocial PD: causes

• Genetic - criminality in the household?

  • Diathesis- stress model

• Neurobiology

  • the underarousal theory (abnormally low levels of cortical activity)

  • The fearlessness hypothesis (higher thresholds for experiencing fear)

Antisocial PD: Psychological and social causes + treatment

• Psychological and social factors

  • reward processing → conditioning doesn’t work properly on these people

  • Influence of family (criminality)

  • neighbourhood values

• Treatment is very diccult!

Borderline personality disorder + core fear

• Characterized by instability in emotion

  • intense mood swings (can be min to min)

  • Also includes instability of the perception of self (poor self image)

• Turbulent relationships → hating to loving someone in quick succesion

• Core fear = fear of abandonment

Borderline personality disorder pt 2 + comorbidities

• Complex trauma-related disorder

• Lies on the border of psychosis and neurosis

  • Neurosis = emotionality

• Parasuicidal behavior + suicide

• Comorbid with eating and substance use disorders

What wording suggest a personality disorder?

A pervasive pattern of…

Borderline PD Stigma and misunderstanding

• PPL may interpret people who have BPD as being manipulative → when their behavior is them trying to protect themselves against abandonment

• People think of people with BPD as being crazy and very difficult but they have just experienced intense trauma

Borderline PD Causes - genetic + cognitive

• Genetic

  • Twin studies show an association with mood disorders

  • High neuroticism may contribute to the diathesis of this disorder

• Cognitive factors

  • Memory bias for negative info to an extreme extent

Borderline PD causes: early experiences

• Early experiences where emotions are dismissed/minimized/punished → learns that emotions are not important

• Early trauma

  • Sexual and physical abuse (most of BPD patients experience this)

Borderline PD treatment

• Dialectical behavior therapy

  1. Support

  2. Identify and regulate emotions

  3. Problem solving

  4. Traumatic events are re-experienced

  5. Trust their own responses

     • Dialectical = Opposing forces can exist at the same time → you have big emotions but you can deal with them

Histrionic PD

• Attention as emotional regulation

• High interpersonal sensitivity

• Expressive communication style

• Relational vulnerability

• Desire for connection

Histrionic PD pt 2 + core fear

• Driving fear = being ignored, unseen or unimportant

• Emotions are described as being shallow (rapidly shifting as well) as opposed to the deep emotions ppl w BPD experience

• Interactions with others are often characterized as being sexually seductive or provocative behavior

Histrionic PD causes + treatment

Causes

• Emotional expression reinforced → Emotional needs met when child is dramatic

• Inconsistent attachment figures

Treatment

• Interpersonal therapies

• CBT

Narcissicism

• A pervasive pattern of grandiosity, need for admiration, and lack of empathy

  • Comes from a deep feeling of inferiority, their behavior is compensating for this

• Has a strong sense of entitlement

• Interpersonally exploitative

Narcissism causes: development + social + treatment

• Developmental theory

  • Early failure to learn empathy

• Large-scale social changes

  • Social media (selfie syndrome) , individualism, the American dream

Treatment

• ? → we are unsure!

Avoidant personality disorder

• A pervasive pattern of social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation

  • Avoidant PD is the more extreme version of SAD

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

• Reluctant to take risks or engage in new activities out of fear they may prove embarrassing

How is avoidant PD different from SAD and Schizoid disorder

• Low self-esteem/worth + fear of rejection = limited friendships and dependence (low worth not seen in SAD)

• Interpersonally anxious (unlike schizoid)

• Unlike SAD, APD extends to intimate relationships, familiar, and familial situations

Avoidant PD causes: psychosocial + treatment

• Psychosocial influences (early childhood experiences → bullying)

• Social anxiety spectrum

• Treatment

  • Similar to that for social anxiety

Dependent PD

• A pervasive and excessive need to be taken care of that leads to submissive and clinging behavior and fears of separation

• Needs excessive advice and reassurance from others + needs other to assume responsibility for most areas in their life

• Needs nurturance and support so bad they will volunteer to do things that are unpleasant for themself

What are people with DPD’s relationships like?

• They are clingy, need reassurance, needs partner to assume responsibility for most things

• Cling to relationships even after they are over or toxic

Dependent PD causes: social + treatment

• ppl w DPD may not have had the opportunity to be dependent in childhood (had everything done for them)

• Good chunk of eitology is about family relations

Treatment

• This person is a ppl pleaser so they will tell their therapist whatever they want to hear to make them happy

Obesessive-compulsive PD

• Rigid perfectionism + need for control (mental and interpersonal control)

• ↓ flexibility, efficiency, openness

• Not OCD (no compulsions)

OCPD causes: genetics + treatment

Causes:

• Weak genetic contribution

Treatment

• Very difficult bc the person with OCPD cannot give control to therapists

  • Therapists also try to put people in uncomfortable situations = big no no for ppl w OCPD

Schizoid character

Batman

Schizotypal character

Willy Wonka

Borderline character

Anakin skywalker

Narcissistic character

Walter White

Histrionic character

Olivia Montagano

Antisocial character

The Grinch

Dependent character

Buster Bluth

OCPD character

Sheldon from bbt