PP2 8: Etiology of personality disorders

Personality Disorders

Long-standing, maladaptive and inflexible ways of relating to others and self that cause problems for individuals and those around them, have early onset, Axis 2 in DSM-V

Axis 2

The classification system in the DSM that includes personality disorders.

Cluster A

Paranoid, schizoid, and schizotypical personality disorders; odd and eccentric

Paranoid Personality Disorder (PPD)

Characterized by long-term, widespread suspicion; suspect that others plan to harm or exploit them; very difficult to deal with; don’t fit in and aren’t good team players; interactions with others are characterized by suspicion and hostility; pathologically jealous and controlling

Symptoms of PPD

Include suspiciousness and mistrust, questioning hidden motives, feelings of certainty that others are there to harm them, social isolation, aggressiveness, hostility, little to no sense of humor

Causes of PPD

First degree relatives with schizophrenia; paranoid ways of thinking might be learned only when face unpredictable anger as a coping mechanism

Treatment of PPD

Psychotherapy, low doses of antipsychotics during periods of extreme agitation and high stress that produce delusions

Schizoid Personality Disorder (SzPD)

Characterized by being distant, detached, and indifferent to social relationships, loners who prefer solitary activities, rarely express strong emotions, can function fairly well, tend to choose solitary jobs

Symptoms of SzPD

Include detachment from others, lack of desire for relationships, indifference to praise and criticism, cold, uninterested, withdrawn, aloof, difficulty relating to others, don’t desire any close relationships.

Causes of SzPD

Emotionally reserved, highly formal families with aloof and impersonal communication style, parents express inadequate amounts of affection and provide insufficient amounts of emotional stimuli, affected person fails to learn basic communication skills

Treatment of SzPD

Psychodynamic, cognitive behavioral, group, family or marital therapies

Schizotypical Personality Disorder

View themselves as outcasts, may ramble endlessly, dress in a peculiar ways, have strange ways of viewing the world, believe in unusual ideas,

Symptoms of Schizotypical Personality Disorder

incorrect interpretation of events, indifferent thinking, belief in special powers, idiosyncratic speech, and perceptual alterations.

Causes of schizotypical PD

Same as SzPD, double bind communication: a person receives conflicting messages creating a dilemma they cannot resolve

Treatment of schizotypical PD

Psychodynamic, cognitive behavioral, group, interpersonal, meta cognitive behavioral therapies; anxiolytics and antidepressants

Cluster B

ASPD, HPD, BPD, NPD; dramatic or dangerous

Antisocial Personality Disorder (ASPD)

Characterized by destructive ways of thinking, perceiving a no relating, no of regard for right and wrong, often violating laws and the rights of others, lying, violent behavior, substance abuse, irresponsible

Symptoms of ASPD

Lack of conformity to laws, repeated criminal behavior, deceitfulness, failure to think ahead, irritability, aggression, disregard for safety, lack of guilt, and a persistent lack of responsibility.

Causes of ASPD

Born to parents diagnosed with ASPD, early childhood abuse, undiagnosed neurological disorders, low EQ

Treatment of ASPD

Long-term structured residential settings with a reward system for desired behavior

Borderline Personality Disorder (BPD)

Characterized by depth and variability of moods, black-and-white thinking (splitting), unstable relationships, poor self-image, identity, and behavior, disturbance in the sense of self which may lead to periods of dissociation

Symptoms of BPD

Pattern of unstable and intense interpersonal relationships, identity disturbance, impulsive and self-harming behavior, chronic feeling of emptiness, inappropriate intense anger, stress-related paranoid ideation or dissociation, distortions in cognition, and emotional instability.

Causes of BPD

Distressing childhood experiences: physical, emotional, sexual abuse, early separation, neglect, parent insensitivity, differences in emotional brain centers, mother-daughter diad, firstborn daughter

Treatment of BPD

Mentalization based therapy, DBT, schema therapy, brain working recursive therapy, antidepressants, anxiolytics, antipsychotics, mood stabilizers

Histrionic Personality Disorder

Characterized by an enduring pattern of attention-seeking and excessively dramatic behavior, highly emotional, charming, energetic, manipulative, seductive, impulsive, erratic, demanding, strong need to be the center of attention, exaggerate and throw tantrums if they aren’t

Symptoms of Histrionic Personality Disorder

Include being overly dramatic behavior and speech, seductive, seeking attention, highly suggestible, overestimating intimacy, and having shifting emotions.

Causes of HPD

Excessive parental attention, praise, emphasizing child’s emotions and expressions, parental attention conditional on certain emotional expressions, encouragement of extraversion and expressiveness in culture

Treatment of HPD

Group and family therapy, CBT

Narcissistic Personality Disorder

Characterized by an inflated sense of self-importance, need for admiration, and a lack of empathy for others, arrogant self-assurance and confidence, expect to be noticed as superior

Symptoms of Narcissistic Personality Disorder

Self-centered, consider themselves better than others, exaggerate own talents and achievements, fantasize about power and success, fail to recognize others’ emotions, expect others to go along with them, a constant need for attention, praise and admiration and a tendency to exploit others.

Causes of NPD

Emotionally neglectful and critical early environment, unempathetic mother, formation of grandiose self → splitting → fragile self-esteem

formation of grandiose self in NPD

To protect themselves from pain of feeling unloved, the child constructs an internal grandiose self: an idealized self-image that helps them feel superior, powerful, deserving of attention

Splitting in NPD

The child uses splitting to separate their vulnerable unlovable self from grandiose self. Splitting allows to disconnect from feelings of low self-worth and neediness. This process lays the foundation for a fragile self-esteem

Reasons of fragile self-esteem in NPD

the unconscious repression of the unlovable and needy aspects of themselves means that, although they consciously present a confident and even arrogant facade, they retain a hidden sense of inferiority and vulnerability. their self-worth remains fragile, as itʼs heavily dependent on external admiration and validation to sustain the grandiose self-image

Avoidant Personality Disorder (AvPD)

Characterized by extreme shyness, sense of inadequacy, and sensitivity to rejection, feel inferior to others.

Symptoms of AvPD

Extreme shyness, sensitivity to criticism and rejection, low self-esteem, feelings of inadequacy, desire for closeness but difficulty forming relationships, avoidance of social situations, reluctance to participation in any social functions, preoccupation with criticism or rejection

Causes of AvPD

Parental criticism, rejection and neglect, avoidance as a defense mechanism

Parental criticism as a cause of AvPD

constant criticism from a parent can make a child feel they are never good enough. over time, this can erode the childʼs confidence and lead them to believe that they are inherently flawed or inadequate. may develop an expectation of failure or believe that others will inevitably see their perceived shortcomings, leading to a deep-seated fear of judgement and rejection

Early rejection and neglect as a cause of AvPD

lack of validation from primary caregivers leaves them with a sense of insecurity and low self-worth. as they grow older, they may come to expect similar rejection from others, resulting in extreme caution in social situations and a tendency to avoid close relationships to protect

Avoidance as a defense mechanism

as a way to cope with these feelings of inadequacy and fear of rejection, they learn to withdraw or avoid social settings altogether. this strategy, while protective in the short term, reinforces their isolation and prevents them from forming meaningful connections, perpetuating their loneliness and feelings of unworthiness

Treatment AvPD

CBT, schema and psychodynamic therapy, social skills training

Dependent Personality Disorder

Characterized by feelings of nervousness and fear, helplessness, inability to make decisions, a pervasive need to be taken care of and for reassurance, and submissive behavior.

DPD symptoms

chronic and pervasive pattern of dependent, submissive, and needy behavior, seek out excessive advice, approval, encouragement sensitivity to criticism and rejection, low confidence and self-esteem, an inability to make decisions without directions from others, feelings of helplessness when alone, inability to disagree with others, extreme devastation when close relationships end and a need to immediately begin a new one, difficulty making everyday decisions

DPD causes

Overinvolved and intrusive behavior of caregivers, emotionally restrictive family environment

Overinvolved and intrusive behavior of caregivers as a cause of DPD

overly involved or controlling caretakers can limit a childʼs ability to develop a sense of independence. when parents make all the decisions for the child or step in to manage challenges, the child may come to believe they are incapable of handling things on their own

Emotionally restrictive family environment as a cause of DPD

in families where emotions arenʼt openly expressed, children may learn to suppress their feelings, leading to difficulties in asserting themselves or expressing their own needs and desires. this emotional restraint can contribute to a passive, compliant behavior pattern, as they may feel expressing their true feelings would be unacceptable or ignored

Treatment of DPD

Psychodynamic, group, cognitive behavioral therapy; anxiolytics and antidepressants

Obsessive-Compulsive Personality Disorder (OCPD)

Characterized by rigidity, control, perfectionism, and an over-concern with work at the expense of close interpersonal relationships, trouble relaxing because of preoccupation with details, rules, and productivity, often perceived as stubborn, stingy, self-righteous, and uncooperative.

OCPD Symptoms

preoccupation with details, rules, lists, order, organization

excessive concern for perfection in small details that interferes with the completion of projects

dedication to work and productivity that shits out friendships and leisure time activities

excessive moral rigidity

OCPD Causes

Overcontrolling, emotionally withholding, or overly critical parenting

Excessive criticism as a cause of OCPD

if children are raise with high expectations and little room for error, they may learn that mistakes are intolerable, fostering an obsessive need to achieve perfection in all aspects of their life

Emotional withholding

refers to the act of a parent being emotionally unavailable, distant, or inconsistent in providing emotional support, understanding, and validation

What happens when children experience emotional withholding?

when children experience emotional withholding, they may feel that their emotions are either unimportant or burdensome to others. this lack of validation teaches the, to suppress or hide their feelings rather than express them openly

consequently, they may develop a heightened need for control as a way to manage anxiety, uncertainty, and vulnerability that arise from their unmet emotional needs. this need to control can manifest in several ways, such as overcontrol of emotions, perfectionism

Treatment of OCPD

Psychodynamic and cognitive behavioral therapy, anxiolytics and antidepressants

Treatment of Personality Disorders

May include psychotherapy, medication, and behavioral therapies.

Double Bind Communication

When a person receives conflicting messages, creating a dilemma.