psychopathology part 1 personality disorders

Personality Disorders

A persistent pattern of emotions, cognitions, and behavior that result in enduring emotional distress for the person affected and/or for others and may cause difficulty professionally and interpersonally

In general, high levels of co-morbidity - people could have more than one personality disorder

 Therapist reactions (countertransference) - way a therapy client makes us feeling sitting across from them (gut feeling)

 10 specific personality disorders

 In 3 separate Clusters

 Personality Disorder NOS (not otherwise specified)

Personality Disorders overview

Prevalence rates vary by diagnosis; overall approx. 6% have a personality disorder

 Less likely to receive treatment - not for the personality disorders - don’t usually seek help

 In general, less responsive to psychotherapy and less responsive to medication

 Chronic diagnoses

 Origins begin in childhood; never formally diagnosed until adulthood (at least 18 years of age) - personality is still forming, shouldn’t diagnose

 Symptom presentation may change over time; but condition unlikely to change

Personality Disorders: Cluster A

Odd & Eccentric Cluster:

- Paranoid Personality Disorder

- Schizoid Personality Disorder

- Schizotypal Personality Disorder

Paranoid Personality Disorder

labeled as: A pervasive pattern of unjustified mistrust and suspicion of others. Pathological levels of mistrust

-paranoia is possible but not realistic

-pathological level of mistrust, unable to move past it

Highly incapable of forming meaningful relationships with others

Assuming the motivations of others are always malevolent and deceptive

High levels of jealousy in interpersonal relationship

Tendency to volatile and; Described by others as distant and unfriendly

Not psychotic paranoia

More common among men

Tends to worsen with age - less and less people, sees it as proof to why you shouldn’t trust people

-common for abusive relationships

Paranoid personality disorder causes

History of abuse and trauma

- Parental modeling; families that have themes of mistrust etc. - sometimes entire families think everyone on the block hates them

- Family history of schizophrenia

Paranoid personality disorder treatment

Unlikely to seek treatment on own - critical of idea of therapy

- May do so when in crisis - not going to address real problem

- CBT moderately effective

- Overall, very poor improvement rate

schizoid personality disorder

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

Unable or unwilling to express emotion

Described by others as loners

Apathetic about forming relationships ; neither desires of enjoys close relationships - key difference between schizoid and avoidant

At times, uninterested in sexual/relational interactions - not interested in sex, dating, etc.

Takes pleasure in few, if any, activities - lack passion, don’t get excited

Emotionally cold, detached, and flat in affect

schizoid personality disorder causes

limited research

Parental modeling - not having a model for outward expression

- Childhood shyness - reinforced

- Relationship to Autism Spectrum Disorder

schizotypal personality disorder

Similar to Schizoid Personality Disorder as well as cognitive or perceptional distortions and eccentric behaviors

Described as odd or unusual by others; often make others feel uncomfortable

Excessive social anxiety

Odd thinking patterns and speech patterns

Odd beliefs/magical thinking inconsistent with subcultural norms - belief in astrology, crystals, tarot, etc.

Ideas of reference

Non-psychotic paranoia

Odd, stereotyped behaviors, dress, presentation style etc. - “uniform” same thing everyday with same variation, very connected to pattern and consistency

schizotypal personality disorder causes

limited research

Schizophrenia phenotype?

schizotypal personality disorder treatment

limited success on:

-Treating co-morbid disorders

- Social skills training

- Antipsychotic medication

Personality Disorders: cluster B

Dramatic & Erratic Cluster:

- Antisocial Personality Disorder

- Borderline Personality Disorder

- Histrionic Personality Disorder

- Narcissistic Personality Disorder

Antisocial personality disorder

A pervasive pattern of disregard for rand violation of rules, laws , and the rights of other people;

Social predators

Irresponsible, Impulsive, Deceitful

Lacking in: conscience, empathy, and remorse - more likely to hurt someone and less likely to say they did it

Common diagnosis among criminals (>80%)

ASP vs. Psychopathy vs. Sociopathy

Glibness/superficial charm/verbally facile - speak well, savy in language

Early behavioral problems

Need evidence of Conduct Disorder in childhood

Antisocial personality disorder causes

-runs in families, mainly father, doesn’t mean its genetic

Gene-environment interaction

Genetic predisposition

Increased testosterone levels - among men

Under-arousal: Fearlessness; need for stimulation - proneness to boredom

Frontal lobe damage – information processing deficits - associated with criminality

Family stress and dysfunction - yelling, abuse violence

Parental modeling - Lack of good role models

ACE - Adverse Childhood Experience leads to this

antisocial personality disorder treatment

Unlikely to seek treatments - don’t have regard for behavior

High recidivism of criminal behavior - repeat offenders

Therapy unlikely to help

Mood stabilizing medication may have minor effects - lessen symptoms, takes “edge off” aggression

Borderline Personality Disorder (unstable personality)

Pervasive pattern of instability, especially as it applies to mood, behavior, interpersonal relationships, and sense of identity

Intense mood; rapid mood swings - gradual, unpredictable, minute to minute, hour to hour, day to day

Turbulent relationships

Intense fear of abandonment (real or imagined) - get close to someone quickly, then worry you don’t like them, fear rejection but act on it

Self-sabotage

Borderline Personality Disorder facts

Self mutilation; suicidal gestures

Impulsivity

Very poor self-image; feelings of emptiness; highly impressionistic

1-2% prevalence rate

More common among women; diagnostic bias?

Borderline Personality Disorder causes

Underdeveloped limbic system - poor emotional regulation

Serotonin imbalance - explains mood difficulty

Cognitive distortions

Early childhood trauma

- Sexual abuse (especially from trusted adult)

- Physical abuse

- Abandonment

Borderline Personality Disorder treatment

More likely to seek treatment than other PDs; often in treatment - extended or lifetime

Often requires hospitalization

Therapy can be very difficult - relationship dynamics - therapist and client

Dialectic Behavioral Therapy - primarily used for BPD, body control, deep thinking, works well

Histrionic Personality Disorder (aka dramatic)

Pervasive pattern of intense attention seeking and superficiality in terms of interpersonal relationships physical appearance; pathologically superficial

-Intense discomfort when not the center of attention - crave attention, are uncomfortable

-More likely to be sexually provocative - dress, jokes, speak, physical appearance

-Shallow, shifting, artificial emotion - don’t feel things, but good at mocking things going on

-Obsessed with the one’s physical appearance. Bases value of other son physical appearance and

-materialistic factors

Histrionic Personality Disorder facts

Overly suggestive, impressionistic

Overly dramatic

Misinterprets the nature of relationships - good at socializing, don’t have the ability to go deeper

Very little research on causes/treatment - observed behavior, if you have parents like this

Likely to seek treatment/therapy ineffective - let down by people they are close to

Links with ASPD – gender bias?

-commonly diagnosed in women

Narcissistic Personality Disorder

Pervasive pattern of grandiosity in which the person believes they are superior to other people and are entitled to praise and special treatment

Exaggerated and unreasonable sense of self-importance - think they are better than other people, needs and opinions are most important, others don’t matter

Lacks sensitivity, empathy, compassion for others

Incapable of seeing things from the perspective of others

narcissistic personality disorder facts

Highly sensitive to criticism (narcissistic wound) - things hurt more to them

Described by others as: arrogant and envious

See it as sign of disrespect if others don’t attend to them or see things the same

they do

Unconscious, intense insecurity; self-hatred (compensatory narcissism) - compensating for deeper insecurities

narcissistic personality disorder causes

Most likely to be a psychological condition originating in childhood

Deficits in empathy; parental modeling

Overly indulged parenting; spoiling

Paired with: self consciousness, self-hatred

Need to compensate

Similar causes as ASPD

narcissistic personality disorder treatment

Patients may seek treatment but not for narcissism - they like to be the center with them

Unlikely to follow through on therapy

Does not respond well to medication or therapy

Some limited success with CBT - not good for treating narcissism