Lecture 10- personality disorders

What is a personality disorder?

• Pattern of deviating behaviour

• Inflexible: leads to distress

• Varying criteria of characteristics

How are personality disorders different from clinical disorders?

• Often less severe

• Can be co-morbid with clinical disorders

What is a personality disorder?

• Pattern of deviating behaviour

• Inflexible: leads to distress

• Varying criteria of characteristics

How are personality disorders different from clinical disorders?

• Often less severe

• Can be co-morbid with clinical disorders

What is the diagnosis criteria for general personality disorder?

• Enduring pattern of behaviour that deviates from the norm (in terms of cognition, affectivity, interpersonal functioning, impulse control)

• Inflexible and pervasive across many social and personal situations

• Leads to distress or impairment in social or occupational functioning

• Stable and of long duration (onset can be traced back to adolescence/early adulthood)

• Not better explained as a consequence of another mental disorder

• Not attributed to drugs/medication or medical condition

What is the overlap between personality disorders and typical traits?

Personality disorders are extremes of normal personality

What are the big 5 personality disorders?

• Detachment (introversion-extraversion)

• Unconventionality (openness)

• Antagonism (Agreeableness)

• Disinhibition (Conscientiousness)

• Psychoticism (Neuroticism)

What environmental factors influence the development of personality disorders?

• Emotional/sexual abuse

• Neglect

• Childhood maltreatment

What other disorders are personality disorders co-morbid with?

• Anxiety disorders

• Mood disorders

• Substance use disorders

What is cluster A of personality disorders?

Odd or eccentric disorders

What is cluster B of personality disorders?

Dramatic, emotional, or erratic disorders

What is cluster C of personality disorders?

Anxious or fearful disorders

What personality disorders fall within cluster A?

• Schizotypal personality disorder

• Schizoid personality disorder

• Paranoid personality disorder

Describe paranoid personality disorder

• Pervasive distrust and suspiciousness

• Believing others are exploiting or deceiving the person

• Having a preoccupation with unjustified doubts about the trustworthiness of a friend or colleague

• Being reluctant to confide in others

• Seeing simple statements as having hidden meanings

• Bearing grudges

• Seeing others as attacking the person’s reputation

• Not trusting one’s sexual partner as being faithful

What is the prevalence rate of paranoid personality disorder?

2.3-4.4%

Describe schizoid personality disorder

• Pervasive pattern of detachment

• Not desiring or enjoying social relationships

• Mainly engaging in solitary activities

• Showing little interest in sexual activities with others

• Finding little pleasure in any activity

• Having no close friends

• Showing indifference to both praise and criticsm

• Showing emotional coldness or detachment

What is the prevalence rate of schizoid personality disorder?

3.1-4.9%

Describe schizotypal personality disorder

• Odd behaviour and cognitive distortions

• Initially confused with schizophrenia

• Makes connections between ideas and events that are not related

• Holds off beliefs or engages in magical thinking

• Experiences unusual perceptual experience

• Engages in odd thinking and speech

• Suspicious

• Shows inappropriate affect

• Appears odd to others

• Doesn’t have close friends

What is the prevalence rate of schizotypal personality disorder?

3.3%

What personality disorders fall within cluster B?

• Antisocial personality disorder

  • Conduct disorder

• Borderline personality disorder

• Histrionic personality disorder

• Narcissistic personality disorder

Describe antisocial personality disorder

• Detachment and moral insanity

• Psychopathy

  • Emotional detachment

  • Lack of empathy

  • Impulsivity

• Repeated participation in illegal acts

• Deceitfulness

• Impulsiveness

• Hostility and aggression

• Engagement in dangerous acts

• Irresponsible behaviour

• Absence of remorse

• No experience of regret or sympathy

• Often associated with violence

What is the prevalence rate of antisocial personality disorder?

Around 3%

What disorder does antisocial personality disorder have a high comorbidity with?

Substance use disorders (80%)

What is the different between antisocial personality disorder and conduct disorder?

To be diagnoses with antisocial personality disorder the individual must be at least 18, conduct disorder is diagnosed for those before the age of 15

Describe conduct disorder

• Cruelty to animals

• Attacking or harming adults or other children

• Theft

• Setting fires and destroying property

Describe boderline personality disorder

• Instability in mood, relationships, self-esteem

• Self-harm is prevalent

• Splitting, things are either ‘all good’ or ‘all bad’

• Fearful preoccupation, intense need for attention and fear of abandonment

• Frantic effort to avoid abandonment

• Pattern of unstable, intense interpersonal relationships

• Unstable self-image

• Impulsivity in areas such as ex, substance use, driving, binge eating

• Recurrent suicidal/self-mutilating behaviours

• Emotional instability lasting only a few hours

• Chronic feelings of emptiness

• Inappropriate anger and instability to control anger

• Short-term, stress-related dissociative experiences or paranoid ideation

Describe histrionic personality disorder

• Extreme attention seeking behaviour

• Constant want to be centre of attention

• Excessively dramatic and make up stories to draw attention to themselves, uncomfortable if not centre of attention

• Inappropriate sexually seductive or provocative behaviour

• Consistent use of physical appearance to draw attention

• Excessively impressionistic style of speech

• Self-dramatisation, theatrically, exaggerated emotions

• Suggestibility

• Considering relationships are more intimate than they are

Describe narcissistic personality disorder

• Constant need for admiration

• Sense of privilege and entitlement

• Ignoring needs of others (lack of empathy)

• Loss of close contact with others

• Grandiose sense of self-importance

• Preoccupation with ideas of unlimited success/attractiveness

• Seeing one’s self as special

• Entitlement

• Taking advantage of others for one’s own needs

• Envio

What personality disorders fall within cluster C?

• Avoidant personality disorder

• Dependent personality disorder

• Obsessive-compulsive personality dis

What is avoidant personality disorder?

• Pervasive pattern of social inhibition

• Fear of criticism, feelings of inadequacy

• Avoidance of occupational activities involving interpersonal contact that could lead to criticism

• Unwillingness to be involved with others

• Restraint within intimate relationship

• Preoccupation with being criticised

• Inhibition in new interpersonal situations

• View of one’s self as socially inept, unappealing, or inferior

• Reluctance to take personal risks/engage in new activities for fear of being embarrassed

What is the prevalence rate of avoidant personality disorder?

2.3-5.1%

Describe dependent personality disorder

• Pervasive pattern of being submissive

• Difficulty in making everyday decisions

• Relies on reassurance from others

• Need for others to assume responsibility for one’s life

• Difficulty with beginning projects

• Need to work hard to receive support from others

• Uncomfortable feeling when alone

• Beginning new relationship when old one is over as source of care

• Feeling fearful that one cannot take care on one’s self

What is the prevalence rate of dependent personality disorder?

0.4-0.6%

What is obsessive-compulsive personality disorder?

• Preoccupation with orderliness (details, rules, lists, order, schedules)

• Perfectionism and wanting of control over environment

• Perfectionism that interferes with task completion

• Inflexibility concerning morals and values

• Preoccupation with work to exclusion of fun and friendships

• Reluctance to delegate tasks

• Hoarding of m

What is the prevalence rate of obsessive-compulsive personality disorder?

2.4-7.8%

How is obsessive-compulsive personality disorder different to OCD?

• Those with OCD attempt to control something outside of themselves

• Obsessive-compulsive personality disorder is a way of life rather than a reaction to external processes

Why is obsessive-compulsive personality disorder often confused with behavioural addictions?

• Behaviours from OCPD and addiction are similar

• Compulsive behaviour for OCPD comes from perfectionism

• While for addiction it from the behaviours being rewarding

Why is psychotherapy more individually focused for those with personality disorders?

• Those with personality disorders find it difficult to maintain a close, intimate relationship with their therapist

• So psychotherapy for personality disorders is more individually focused than it is for other disorders

How are medications used for personality disorders?

• Used as adjunct

• Not as direct treatment!!

What problems arise with therapy for cluster A personality disorders>

What problems arise with therapy for cluster B personality disorders?

• Clients push limits of therapeutic relationship by being demanding/seeking constant approval

What problems arise with therapy for cluster C personality disorders?

Clients tend to be emotionally inhibited and avoid interpersonal conflict