abpsych 4: personality disorders

what is a personality disorder?

an enduring pattern of inner experience and behavior that deviates markedly from the expectations of the individual’s culture, is pervasive and inflexible, has an onset in adolescence or early adulthood, is stable over time, and leads to distress or impairment

paranoid personality disorder

• cluster A

• extreme mistrust and suspicious of others

• tend to worry that others will disappoint them, manipulate them, or talk behind their back

• often think excessively about ensuring the loyalty of their friends and family

• propensity to hold grudges and blame others

  • unable to recognize their own mistakes

  • difficult to forgive others

• most often have superficial relationships and are relatively isolated

schizoid personality disorder

• cluster A

• extreme avoidance of social relationships because of lack of interest in social connection

• tend to have limited emotional expression

• most often finds physical contact in all its forms to be less pleasurable

• prefers isolation and rarely has any social relationships outside of first degree relatives

schizotypal personality disorder

• cluster A

• difficulty maintaining relationships due to eccentricities in behavior and thinking

• tends to engage in magical thinking where they think they have control or power over events that are seemingly unrelated

• most often displays ideas of reference where they believe that everything is casually linked to their own destiny

• often have a self-centered way of speaking that is socially inappropriate

• few social relationships, but a strong desire to have them

antisocial personality disorder

• cluster B

• pervasive pattern of disregard for moral values and societal norms

• can be very charming and willing to manipulate others for personal gain

• tend to have less empathy and diminished impulse control

• generally have little (if any) remorse or guilt about harming others

borderline personality disorder

• cluster B

• a pervasive pattern of extreme emotional instability beyond normal mood fluctuation

• a pervasive pattern of unstable interpersonal relationships where there is often fluctuation between deep feelings of connection and then explosive rage

• characterized by marked impulsivity where they may become physically aggressive or violent

• often terrified of abandonment and may threaten self-harm in attempts to avoid perceived rejection

• propensity to engage in “splitting” where they will view others as either “all good” or “all bad”

histrionic personality disorder

• cluster B

• a pervasive pattern of attention seeking and excessive emotionality

• often overly flirtatious and willing to use physical appearance to draw attention

• tends to tell highly dramatized stories that are full of extreme emotion and theatrical in nature

• may express having close and intimate relationships but in reality their relationships are shallow and superficial

narcissistic personality disorder

• cluster B

• tend to have a grandiose self-image thinking that they are more attractive, more intelligent, or more talented than they are in reality

• in general, lacks empathy and has a difficult time being aware of the feelings of others

• high desire for admiration and will exploit others for personal gain

• holds a deep sense of insecurity behind grandiose presentation

avoidant personality disorder

• cluster C

• pervasive pattern of social inhibition and feelings of inadequacy

• propensity to be hypersensitivity to criticism and negative feedback

• tend to be extremely shy and timid

• most desire close relationships but rarely take social risks

• tend to avoid almost all social situations

dependent personality disorder

• cluster C

• have a pervasive and excessive need to be taken care of by others

• often submissive and “clingy”

• tend to have intense fear of separation and rejection

• often find it nearly impossible to make decisions and require an inordinate amount of advice from others

• at times have susceptibility to get trapped in abusive relationships

obsessive-compulsive personality disorder

• cluster C

• a pervasive pattern of preoccupation with orderliness, perfectionism, and complete control

• are inefficient and inflexible

• obsessed with rules, details, and schedules

• often easily stressed and very rigid about beliefs and moral issues

• symptoms are ego-syntonic (uninterested in change)

hybrid model for classification

• diagnosis on both a dimensional and categorical model

• characterized by impairments in personality function and pathological personality traits

• limits to 5 disorders: antisocial, avoidant, borderline, narcissistic, obsessive-compulsive, and schizotypal

level of personality function scale (LPFS-SR)

self

• identity

  • experience of oneself as unique, with clear boundaries between self and others

  • stability of self-esteem and accuracy of self-appraisal

  • capacity for, and ability to, regulate a range of emotional experience

• self-direction

  • pursuit of coherent and meaningful short-term and life goals

  • utilization of constructive and prosocial internal standards of behavior

  • ability to self-reflect productively

interpersonal

• empathy

  • comprehension and appreciation of others’ experiences and motivations

  • tolerance of different perspectives

  • understanding of one’s own behavior on others

• intimacy

  • depth and duration of connection with others

  • desire and capacity for closeness

  • mutuality of regard reflected in interpersonal behavior

personality inventory for DSM-5 (PID-5)

• negative affect: emotional liability, anxiousness, separation insecurity

• detachment: withdrawal, anhedonia, intimacy avoidance

• antagonism: manipulativeness, deceitfulness, grandiosity

• disinhibition: irresponsibility, impulsivity, distractibility

• psychoticism: unusual beliefs and experiences, eccentricity, perpetual dysregulation

five-factor model

• extraversion

• agreeableness

• conscientiousness

• neuroticism

• openness

etiology of antisocial personality disorder

• heritability: 50% (20% shared environmental influences, 30% nonshared)

• physiological arousal deficits: low levels of physiological arousal and/or fear response, low resting heart rate and startle response deficits

• cognitive deficits: stable deficits in the cognitive domains of attention and response modulation

etiology of schizotypal personality disorder

• heritability: genetic link with schizophrenia

• attention deficits

• central nervous system dysfunction

• dopaminergic pathway dysregulation

etiology of borderline personality disorder

• shared genetic association with mood and impulse control disorders

• environmental factors: substantial empirical support with childhood abuse, parental conflict, loss, and neglect

dialectical behavior therapy

• strong est for bpd

• mindfulness, distress tolerance, emotion regulation, interpersonal effectiveness

schema-focused therapy

• modest est for bpd

• early maladaptive schemas: distort the manner in which they view themselves and others, causing interpersonal problems; developed when core emotional needs aren’t met in childhood

• core emotional needs: safety and nurturance; autonomy, competence, and sense of identity; freedom to express needs, emotions, and opinions; spontaneity and play; realistic limits and self-control

treatment for antisocial personality disorder

mixed findings: potentially counterproductive, potentially helpful

treatment for schizotypal personality disorder

neuroleptic medications: affective against perceptual aberrations and social anxiousness