Cluster B PDs

cluster B

Dramatic, Emotional, or Erratic Personality Disorders

• Antisocial, Borderline, Histrionic, Narcissistic PD

 

antisocial PD criteria

• At least 18 yrs old

• Evidence of conduct disorder before 15 yrs old

  • Behavioral problem that involves breaking rules, not listening to authority, & symptoms of aggression (harming other people or animals)

  • They don't have to have had a diagnosis or the full range of conduct disorder symptoms at the age of 15, there just has to be evidence of behavior

• Pervasive disregard for rights of others since age 15 indicated by at least three of:

  • Repeatedly breaking the law, manipulative/lying behavior, impulsivity/failure to plan to get ahead, physical fights, disregard for safety of self/others, consistent irresponsibility, lack of remorse

• During adolescence, there is an increased likelihood of certain behaviors which is why they wait until they're a bit older to diagnose them

antisocial psychodynamic explanation

• From emotionally turbulent families prone to physical abuse --> helplessness ---> defense mechanism: identification with the aggressor

  • Take on attitude/personality of aggressor

• Disrupted child-parent relationship --> abnormal superego development

  • Superego - part of the self that knows the rules (conscious)

  • Develops through our relationship with out parents

antisocial cognitive-behavioral explanation

• Modeling behavior of antisocial parents

• Reinforcement of antisocial behavior

  • Ex. Anytime a bully gets what they want, the things they gain can be reinforcement

antisocial neurobiological explanation

• Genetics: criminality & psychopathy moderately heritable

• Anxiety deficiency

• Neuroanatomical & physiological differences

  • Decreased frontal lobe activity in many people with antisocial PD

  • Frontal lobe involved with checking your behavior, being more responsible

antisocial treatment

• is very tricky because people with antisocial PD are very good at pretending they're benefiting, going along with what the therapist is saying to make them happy, they have no problem lying

psychopathy (old disorder) & how it relates to antisocial

• Anybody who meets the diagnostic criteria for this has antisocial personality disorder, but not everybody with antisocial behavior has psychopathy

• Predates DSM's antisocial PD

• Focuses on internal thoughts & feelings as well as behaviors

• Checklist to assess psychopathy:

  • Emotional detachment: lack of remorse, lack of empathy

  • Antisocial behavior

• Lack of remorse isn't essential DSM criteria for Antisocial Personality

narcissistic pd criteria

• Preoccupied with fantasies of unlimited success, power, brilliance, beauty, or ideal love

• Believes that they are special/unique & can only by understood by or associate with high-status people

 

• Not coming out on top the way they expect to can lead to extreme distress

• Can be diagnosed if they go to therapy, typically after their mistreatment of others leads them to feel alone & "abandoned"

narcissistic psychodynamic criteria

• Underlying feelings of inadequacy due to emotional neglect by parents or being used as a "prop" by parents

  • Ex. Showing off child's achievements without showing love, warmth, or care

  • Will often push child to do well & succeed so they can show off that success

• Intervention: empathy & kind but consistent confrontation

narcissistic cognitive-behavioral explanation

• Unrealistic schemas about self & expectations

• Not the main approach to treating the underlying causes of a personality disorder, but there will be cognitive-behavioral tools that will help the behavior become more adaptive

histronic PD characterized by

dramatic attention seeking behaviors

histronic pd criteria

• Uncomfortable in situations where they aren't the center of attention

• Interaction with others is often characterized by inappropriate sexually seductive/provocative behavior

• Rapidly shifting & shallow expression of emotions

• Consistently uses physical appearance to draw attention to self

• Style of speech is excessively impressionistic & lacking in detail

• Self-dramatization

• Is suggestible (easily influenced by others/circumstances)

• Considers relationships to be more intimate than they actually are

histronic psychodynamic explanation & treatment

• Histrionic PD is a result of distant parenting

• Associated with not just emotionally distant parenting but also a parenting relationship with a sense of conditional love & expectations

• Primary approach for understanding & treating this disorder

• Intervention: group therapy is NOT a good idea because of their constant attention

borderline pd characterized by

emotional instability/difficulty regulating emotions

borderline criteria

• Frantic efforts to avoid real/imagined abandonment

• Pattern of unstable & intense interpersonal relationships characterized by alternating between extremes of idealization & devaluation

• Markedly & persistently unstable self-image/sense of self

• Impulsivity in at least two areas that are potentially self-damaging (ex. Promiscuous sex, eating disorders, substance abuse, reckless driving, etc.)

• Recurrent suicidal behavior, gestures, threats, or self-mutilating behavior

• Marked reactivity of mood

• Chronic feelings of emptiness/worthlessness

• Inappropriate bouts of anger/difficulty controlling anger

• Transient, stress-related paranoid ideation or severe dissociative symptoms

• If seeing a therapist they really love, and then say/do one thing it can really set off

borderline etiology: neurobiological factors

• Strong Genetic Component

  • May play a role in impulsivity & emotional dysregulation

  • Decreased functioning of serotonin system

  • Frontal lobe dysfunction

  • Increased activation of amygdala

borderline psychodynamic explanation

• Unreliable & inconsistent caregivers, never learned to regulate emotions

• Verbal & emotional abuse

• Splitting (not splitting personality/identity)

  • Defense mechanism - cognitive splitting where everything is split into either good or bad

  • Ex. Person is either reliable & trustworthy  or horrible

  • Helpful in one major way - saves you from a lot of confusing emotions & difficult thought processes ex. A friend doing something out of line with your morals, they are now moved into the bad category

borderline cognitive-behavioral explanation

• Maladaptive core beliefs

  • ex. Believing that they're worthless

borderline biological explanation

• Neurotransmitter imbalances

• Hard to separate BPD-associated abnormalities from comorbid depression

• Use of antidepressants is common

multi-perspective approach to treating borderline PD

• Negative stigmas developed about treating borderline because people with this PD have a hard time trusting their therapist

• Linehan's Dialectical Behavioral Therapy

  • Individuals with BPD have difficulty controlling their emotions

    • Possible due to biological diathesis

    • Some people are biologically predisposed to have difficulty regulating their emotions

  • Family invalidates or discounts emotional experiences & expression

  • Interaction between extreme emotional reactivity & invalidating family --> BPD

  • Very warm, accepting therapy

    • Treatment focused on suppressing harmful impulses, teaching emotional regulation techniques & social strategies