CHAPTER 15 - PERSONALITY DISORDERS

personality disorders

enduring difficulties in forming a stable postive identity and maintaining close, constructive relationships

define the three clusters in the DSM-5

Cluster A; odd or eccentric behaviour
→ paranoid, shcizoid, schizotypal
Cluster B; dramatic or erratic behaviour
→ borderline, narcissistic, antisocial, histrionic
Cluster C; anxious or fearful behaviour
→ avoidant, dependent, obsessive-compulsive

what % of the global population meets the criteria for a personality disorder, and which coutnries have a higher prevalence

7.5% and higher in high-income countries

what are the comorbidites of personality disorder

mood, anxiety and substance use disorder, complicating treatment and increasing likelihood of encoutnering them in clinical settings

explain general personality disorder, and give three facts

inflexible pattern of behaviour and inner experince that:
1) deviates from cultural expectations and affects at least 2 of cogntiion, affect, interpersonal functioning or impulse control
2) causes signficant distress or impairment
3) is pervasive across stiuations, onset by eraly adulthood and stable over time

Name 3 problems with the DSM-5-TR approach to personality disorder

1) stability over time; personality disorders are less stable than expected (half don’t meet criteria anymore after 2 years)
2) high comorbidity with other personality disorders(over half meet criteria)
3) arbitrary diagnostic threshold
→ number of symptoms required is arbitrary
→ subsyndromal symptoms can still cause signficant problems

Paranoid personality disorder

pervasive distrust and suspicion, manifesting in behaviour such as:
-unjustified odubts baout loyalty or trustworthness
-reluctance to confide due to fear of exploitation
-reading hidden meanings into benign markers
-holding grudges or reacting angrily to perceived insults

schizoid personality disorder

emotional detachmenta nd limited interpersonal interaction. symtpoms include:
-preference for solitude
-lack of close relationships or interest in social activities
- emotional coldness and flat affect

histrionic personality disorder

excessive emotionality and attention-seeking. it involves
-strong need to be the centre of attention
-inappropriate sexually provocative beahviour
-dramatic or exaggerated emotional experiences
-misinterpretation of relationships as more intimate than they are

dependent personality disorders

excessive need for care and support, leading to behaviour such as:
-difficulty making decisions independently
-fears of being alone of helpless
-urgently seeking new relationships after 1 ends

schizotypal personality disorder

eccentric thoughts, behaviours and interpersonal difficulties
-ideas of reference and odd beliefs
-suspiciousness and social anxiety
-odd or inappropriate affect and behaviour
-lack of close friendships
-interaction of GxE remains complex

antisocial personality disorder (APD)

pervasive diregard for the right of others. manifesting as aggressive, impulsive and callous traits
→ individuals must show evidence of conduct disorder before age 15 and demonstrate patterns or irresponsible or harmful behaviour as adults (men are 5x more likely than women to meet APD crtieria)

psychopathy

emotional deficits
- superficially charming and manipulate others for personal gain
- impulsive rule-breaking behaviour, driven by thrill-seeking
-triarchic model: boldness, meanness and disinhibition

name 3 key differences between APD and psychopathy

1) PCL-R scale for psychopathy includes affective symptoms like shallow emotions and lack of empathy
2) APD requires conduct disorder before age 15
3) APD is a categorical diagnosis, while psychopathy is dimensional

what does genetic vulnerability for APD overlap with?

susbtance abuse

what predicts social factors?

social factors like poverty and childhood adversity

what does the triarchic model highlight?

psychological processes underlying psychopathy
→ threat sensitivity
→ lack of empathy

threat sensitivity

boldness is linked to reduced physiological and neural responses to aversive stimuli, imparing learning from punishment

lack of empathy

meanness correlates with reduced ability to recognize fear in others, diminishesd amygdala activity when imaging others’ pain and less connectivity between emotional processing brain regions

Borderline personality disorder

challenging disorder to threat, associated with impulsivity, emotional instability and intense interpersonal conflicts
- at least five of the following:
→ frantic efforts to avoid abandonment
→ unstable relationships with extremes of idealization and devaluation
→ unstable self-image
→ self-damaging impulse behaviours
→ suicidal or self-injurous behaviours
→ intense mood activity
→ chronic emptiness
→ intense anger or poorly controlled outbursts
→ stress-related paranoid or dissociative symptoms

what are the causes of borderline personality disorder

1) neurobiological factors
- heightened emotionality and impulsivity
- dysfunction in regualtory control regions and emotional response regions
2) interaction between a biological vulnerability to emotion dysregulation and an invalidating family environment

narcissistic personality disorder

grandiose self-view, a need for administration and a lack of empathy. They overestimate their abilities, seek admiration, and attribute successes to personality traits. It leads to idealizing high-status partners but frequently changing them for higher-status alternatives (martial dissatisfaction).

what are the symptoms of narcissistic personality disorder

• grandiosity

• preoccupation with fantasies of power

• belief in being uniquely understood by high-status people

• extreme need for admiration

• exploitative tendencies

• lack of empathy

• envy

  • arrogant attitudes

what are the causes of narcissistic personality disorder?

parenting: reinforcing beliefs of exceptionalism and toelrance of self-centered behaviours
fragile self-esteem: people with NPD experience frequent shame and are highly sensitive to external feedback

avoidant personality disorder

intense fear of criticism, rejection, and disapproval, leading to individuals to avoid jobs, or relationships.
-display timidity and restraint due to fear of embarassment

what are the symptoms of aovidant personality disorder

four of the following:

• avoidance of interpersonal occupational acitivties due to fear of criticism or rejection

• relucance ot engage iwht others unless certain of being liked

• restrained behaviour in intimate relationships due to fear of ridicule

• preoccupation with potential crtiicsm or rejection

• inhibition in new social situations due to feeligns of inadequacy

  • persistent view of oneself as socially inept or inferior

• relucatance to take risks or try new activities out of fear of embarassment

obsessive-compulsive personality disorder

perfectionism and preoccupation with details, rules and schedules
- at least four symptoms
→ preoccupation with details to the detriment of an activity’s purpose
→ perfectionism that interferes with task completion
→ excessive devotion to work, excluding leisure and friendships
→ rigid moral or value systems
→ difficulty discarding worthless items
→ reluctance ot delegate unless others conform to personal standards
→ miserliness
→ rigidity and stubbornness

what are the treatments for personality disorders

1) psychopathy
2) medications (antidepressants and antipsychotics)

what are theoretical approaches to treatment

psychodynamic therapy, CT, Specialized treatment for BPD, dialectical behaviour therapy, MBT, transference-focused therapy

psychodynamic therapy

exploring chidlhood experinces to uncover how they shape current behaviours and beliefs

cognitive therapy

identifies maldadaptive beliefs and assumptions

dialectical behaviour therapy

combines empathy and acceptance with cogntive behavioural strategies. There are 4 stages:
1)addressing impulsive behaviours
2)teaching meotion modulation and distress tolerance
3)imporving relationships and self-esteem
4)promoting happiness and connectedness

mentalization based therapy

reflect on emotions of self and others

transference-focused therapy

exploring risks for self-harm