Psychopathology – Personality Disorders

General personality disorder diagnostic criteria

pattern of inner experience and behavior which is pervasive and causes significant distress

1. thoughts about self and others

2. affect

3. interpersonal functioning

4. impulse control

Personality disorder risk factors and heritability

1. moderately high heritability

2. strongly related to childhood adversity

3. abuse is especially related to NPD and BPD

4. neglect only for avoidant

Problems with current approach to personality disorders

1. PDs are unstable → more than 90% remmit, symptoms tend to wax and wane

2. high co-morbidity → more than half of people with a pd meet diagnostic criteria for another pd

Cluster A personality disorders

1. odd or eccentric behavior

2. paranoid, schizoid, schizotypal

Cluster B Disorders

1. dramatic or erratic behavior

2. antisocial, borderline, histrionic, narcissistic

Cluster C Disorders

1. anxious or fearful behavior

2. avoidant, dependent, obsessive-compulsive

Personality trait domain model

1. PD diagnosis considered when there is persistent significant impairment from early adulthood

2. clinician considers how 5 personality trait domains and 25 specific personality traits explain difficulties in functioning

3. negative affect, detachment, antagonism, disinhibition, psychoticism

Strengths of focus on personality traits

1. personality trait ratings are more stable than pd diagnoses

2. pds vary a lot from person to person, model is more individualized

3. personality traits are related to many psychological disorders

4. personality traits predict outcomes of many major life aspects

5. clinicians rate model as more descriptive and easier to implement

Paranoid personality disorder DSMV

4+ signs of distrust and suspiciousness

1. suspicion of being harmed

2. suspicion of infidelity

3. doubt about trustworthiness of others

4. reluctance to confide in others

5. tendency to see hidden meanings

6. grudges

Schizoid personality disorder DSMV

4+ signs of aloofness and flat affect

1. lack of desire for close relationships

2. preference for solitude

3. lack of friends

4. little interest in sex

5. few pleasurable activities

6. emotional detachment

7. indifference to praise or criticism

Schizotypal personality disorder DSMV

5+ signs of unusual thinking, eccentric behavior, and interpersonal deficits

1. ideas of reference

2. odd beliefs or magical thinking

3. unusual perceptions

4. odd thought and speech

5. suspiciousness/paranoia

6. inappropriate or restricted affect

7. odd or eccentric behavior or appearance

8. lack of close friends

9. social anxiety and interpersonal fears that do not diminish with familiarity

ASPD DSMV

3+ signs of disregard for rights of others since the age of 15

1. repeated law breaking

2. lying

3. impulsivity

4. irritability/aggressiveness

5. disregard for safety of self and others

6. irresponsibility (employment, financial history)

7. lack of remorse

Risk factors for ASPD and psychopathy

harsh family environment, poverty, blunted threat response, difficulty learning from punishment

How psychopathy is different from ASPD

1. can develop after age 15

2. less linked to affect

BPD DSMV

5+ signs of unstable relationships, self image, and impulsivity from early adulthood

1. frantic efforts to avoid abandonment

2. unstable personal relationships with idealization and devaluation

3. unstable sense of self

4. self destructive, impulsive behaviors in at least two settings

5. recurrent suicidal behavior, gestures, or self harm

6. mood reactivity

7. chronic feelings of emptiness

8. recurrent bouts of intense anger

9. tendency to paranoid thoughts and dissociative symptoms during stress

Marsha Linehan’s diathesis-stress theory of BPD

1. biological diathesis causes emotional dysregulation in the child

2. parents invalidate child through punishment or ignoring of demands

3. child has emotional outbursts to which parents attend, which leads to further dysregulation

BPD neurobiological etiology

1. less connectivity in regions involved in emotion experience and regulatory control

2. explains poor emotional control and impulsivity when emotions are present

BPD etiology – abuse

1. even though a history of abuse is common in BPD it does not predict BPD

2. genetic factors present in parents could make them more likely to be abusive

HPD DSMV

5+ signs of excess emotionality and attention seeking from early adulthood

1. need to be the center of attention

2. inappropriate seductive behavior

3. rapidly shifting and shallow emotional expression

4. use of appearance to attract attention

5. impressionistic and undetailed speech

6. theatrical emotional over-expression

7. excess suggestibility

8. misreading of relationships as more intimate than are

NPD DSMV

5+ signs of grandiosity, need for admiration, and lack of empathy from early adulthood

1. grandiose sense of self

2. preoccupation with one’s superiority

3. belief that one is special and is of a higher class

4. need for admiration

5. sense of entitlement

6. exploitation of others

7. lack of empathy

8. envy

9. arrogant behavior and attitudes

NPD etiology – parenting

1. parents who overindulge and promote beliefs that child id special

2. parents who see their children as superior to others

NPD Etiology – fragile self esteem

1. those with NPD experience shame more often

2. those with NPD are particularly sensitive to negative social interactions

Avoidant PD DSMV

4+ signs of social inhibition, feeling of inadequacy, and hypersensitivity to criticism from early adulthood

1. avoidance of activities involving contact with others due to fears of criticism

2. reluctance to interact with others unless certain of being liked

3. restrain in intimate relationships due to fear of being shamed

4. preoccupation with criticism and rejection

5. restrain in new social situations due to feelings of inadequacy

6. viewing self as socially inept or inferior

7. reluctant to try new things because of embarrassment

Avoidant PD and social anxiety disorder

often co-occurs with social anxiety disorder and shares similar etiology to social anxiety

Dependent personality disorders DSMV

5+ signs of excess need to be taken care of from early adulthood

1. difficulty making decisions independently

2. need for others to take responsibility for major life areas

3. difficulty disagreeing with others for fear of losing them

4. difficulty doing things independently due to lack of self-confidence

5. doing unpleasant things to get support from others

6. feeling helpless when alone due to fear of not being able to care for oneself

OCPD DSMV

4+ signs of intense need for order, perfection, and control from early adulthood

1. preoccupation with rules and organization to the extent that the point of the activity is lost

2. extreme perfectionism that interferes with task completion

3. excess devotion to work to the exclusion of leisure and friendships

4. inflexible moral and values

5. difficulty discarding worthless items

6. reluctance to delegate unless others conform to one’s standards

7. miserliness

8. rigidity and stubbornness

Personality disorder treatments

1. Psychodynamic, cognitive behavioral, and pharmacological treatments are all used

2. Schitotypal personality disorder should be treated like schizophrenia, antipsychotics are helpful

3. DBT and psychodynamic therapy are helpful for BPD