Chapter 22 - Personality Disorders

Maladaptive

Behaviour that causes distress to oneself or others, impairs day-to-day functioning, or increases the risk of injury of harm to oneself or others

Personality Disorders

particularly unusually patterns of behaviour (relative to one’s cultural context), that are maladaptive, distressing to oneself, or others, and resistant to change

• difficult to change

Schizotypy

unusually way of expressing one’s self

Classifying Personality Disorders

Class A - Odd/eccentric behaviour

• Paranoid, Shizoid, Schizotypal\

Class B - Dramatic/erratic behaiour

• Antisocial, Borderline, Histronic, and Narcissistic

Class C - Anxious/fearful behaviour

• Avoidant, Depdendent, Obsessive-Compulsive

Cluster A Personality Disorders

• Hippocampal Hypoactivity (less activity) may trigger branching by the amygdala in Cluster A Personality Disorders

Paranoid Personality Disorder

pattern of distrust and suspiciousness that others’ motives are interpreted as malevolent/aggressive

• beliefs are immune to disconfirming evidence

• difficult to treat due to suspicion of the therapist

• get stuck in a loop of:

  • a social situation

  • activation of paranoid cognitive biases and behaviour

  • negative emotions and rumination

  • vigilance for new threats

• Cluster A

Schizoid Personality Disorder

pattern of detachment from social relationships and a restricted range of emotional expression

• completely detached from others and don’t really care about others

• very solitary kind of lifestyle

• Cluster A

Schizotypal Personality Disorder

• pattern of acute discomfort in social relationships, cognitive, or perceptual distortions

  • don’t really enjoy social interactions

• eccentric beliefs and unusual speech patterns

• reduced gray matter volume in the superior temporal gyrus

• Cluster A

Schizotypy Screening Items

• I often feel uneasy in social situations and prefer to be alone

• I occasionally have strange or magical thoughts that don’t align with reality

• My speech patterns can sometimes be difficult for other people to follow

Borderline Personality Disorder

characterized by intense extremes between positive and negaive emotions, an unstable sense of self, impulsivity, and difficult social relationships

• Cluster B

PRAISE

• P - Paranoid Ideas

• R - Relationship instability

• A - Angry outbursts, affective instability, abandonment fears

• I - Impulsive behaviour identity distrubance

• S - Suicidal behaviour

• E - Emptiness

Borderline Screening Itmes

• Have any of your closest relationships been troubled by a lot of arguments or repeated breakups?

• made desperate efforts to avoid feeling abandoned or being abandoned

• had at least two problems with impusivity?

Causes of BPD

• genetics

• abusive or neglectful parenting

• brain abnormalities (hyperactive amygdala and hypoactive PFC) related to aggression and emotional regulation

• sometimes treated with dialectical behavioural therapy

Dialectical Behavioural Therapy

• involves individual cognitive therapy

• also involves group therapy dedicated to emotional regulation, distress tolerance, and social skills

Narcissistic Personality Disorder

characterized by an inflated sense of self-importance and an excessive need for attention and admiration, as well as intense self-doubt and fear of abandonment

• turns everything about themselves

• have a sense of entitlement and little empathy for others

• Cluster B

Histrionic Personality Disorder

• Cluster B

characterized by excessive attention seeking and dramatic behaviour

• engage in indulgent and risky behaviours

• difficult to treat

I CRAVE SIN

• Inappropriate behaviour - seductive or provocative

• Center of Attention

• Relationships are seen as closer than they really are

• Appearance is most important

• Vulnerable to others’ suggestions

• Emotional expression is exaggerated

• Shifting emotions, Shallow

• Impressionistic manner of speaking (lacks details)

• Novelty is craved

Antisocial Personality Disorder (Psychopathy)

• Cluster B

characterized by:

1. profound lack of empathy or emotional connection with others

2. disregard for others’ rights or preferences

3. tendency toward inserting their own desires, often violently, onto others regardless of the consequences for others

• occurs in 3% of all males and 1% of all females

• slow to develop startle responses

• slower to develop classically conditioned responses to emotional stimuli

  • these responses indicate normal anxiety

APD and brain activity

no brakes in frontal lobe, so when they get emotional, they can’t stop

Psychopath vs. nonpsychopaths

Psychopaths - greater activity frontal lobe areas related to attention and outcome monitoring

• more attentive to the rules and the outcome of the activity

Nonpsychopaths - showed activity in mirror neurons system

DSM criteria for APD

Must have 3 of these criteria

• repeatedly break the law

• deceitful, using aliases and lies to con others

• impulsive and unable to plan ahead

• repeatedly get into physical fights or assaults

• show reckless disregard for their own safety or that of others

• are irresponsible, failing to meet obligations to others

• lack remorse for actions that harm others

Treatment of APD

• extremely difficult

  • since patients tend to not take medication, not trust therapists, and tend to manipulate situation during therapy

Acquired Sociopathy

• damage to the VMPFC leads to psychopathic-type behaviour

  • VMPFC might be involved with social behaviour, but not the cognitive appreciation of rules

• impulsive

• know what they should do, but still act badly

Avoidant Personality Disorder

• Cluster C

pattern of social inhibition, feelings of inadequacy, and very sensitive to being negatively evaluated

• hereditability = 0.64

• associated with a fearful attachment style (and sometimes adverse childhood experiences)

symptoms:

• poor self image

• sensitive to criticism

• fear of being embarrased

• would rather be alone

Dependent Personality Disorder

• Cluster C

pattern of submissive and clinging behaviour related to an excessive need to be taken care of

symptoms:

• intensive anxiety

• great fear of being alone

• don’t disagree with others in fear of being abandoned

Obsessive-Compulsive Personality Disorder

• Cluster C

pattern of preoccupation with orderliness, perfectionism, and control

symptoms:

• excessive doubt and indecisiveness

• unwilling to compromise

• unwilling to throw out broken or worthless obkects

• perfectionism interferes with completing tasks

• overly fixated on a single idea, task, or belief

• difficulty coping with criticism

Dissociative disorder

category of mental disorders characterized by a split between a person’s conscious awareness and their feelings, cognitions, memory, and identity

Dissociative Identity Disorder (DID)

when a person experiences a split in identity such that they feel different aspects of themselves as though they were separated from each other

• can be severe enough that the person constructs entirely separate personalities, only one will be in control at a time

• formerly known as Multiple Personality Disorder (MPD)

DID as a coping mechanism

some therapists believe that DID is common and under-diagnosed

• traumatized personality gives birth to other personalities to deal with the emotional horror of abuse

• defence mechanism

Sybil Case Study

Shirly Ardell Mason = Sybil Isabel Dorsett

• started having blackouts and breakdowns

• 16 personalities were distinguished, presumably as a result of severe child abuse

• diagnosed with DID but was able to integrate these personalities into 1

• Doctor’s tapes showed that she called different feelings by different names

Is DID caused by therapy?

clinicians may generate DID in their patients, knowingly or unknowingly

• some have use intense interview techniques or hypnotism to cause the patient to believe their personality is split

How to test DID claims

neuroimaging study that puts clients in brainscanner to see brain activity when patients claim they switch to a particular personality

• however this may just show that the person is thinking about and experiencing things differently in the two states of mind

DID treatment

involves (at least) 3 stages

• stabilize the patient’s symptoms in a compassionate and non-judging manner

  • make the patient feel safe

• help the patient gain more control over their mood and understanding their trauma

• help the patient integrate their various identities into one