Personality Disorders (Cluster B & C)

Cluster B

• Historic

• Narcissistic

• Antisocial

• Borderline

Dramatic, emotional, erratic

Histrionic PD

• pattern of excessive emotionally and attention-seeking

  • uncomfortable when NOT the center of attention

• inappropriately sexual/seductive

• rapidly shifting or shallow emotions

• impressionistic speech

• easily influenced by others

• sees relationships as closer than they are

Histrionic PD : Causes

• psychodynamic:

  • unloving parents —> dramatic displays for help

• Cognitive:

  • believe they are helpless

  • self-focused and emotional so vague memories force them to rely on others for social cues

• Sociocultural:

  • exaggeration of cultural feminity?

  • diagnosed less often in less sexualized cultures

behaviors possibly pop up more when it is more acceptable to dress certain ways and feminine behavior shows up

Narcissistic PD

• A pervasive pattern of grandiosity in fantasy OR behavior

  • Exaggerates achievements or is preoccupied with fantasies of power, brilliance

• Believes they are special; should only associate with the best

• Need for admiration

• Sense of entitlement/lack of empathy

  • Takes advantage of others

Narcissistic PD: Causes

• Psychodynamic

  • Cold, rejecting parents —> defend against feeling unsatisfieed or rejected

  • Grandiosity convinces they’re self-sufficient

• Cognitive:

  • Overly warm parents —> grandiose self-image

• Sociocultural:

  • Modern Western values promote narcissism?

    • “I’m special”

    • “Everyone’s winner!”

Narcissistic PD: Treatments

• Psychodynamic:

  • Work through insecurities and defenses

• Cognitive:

  • Redirect clients to think about others

  • Reach a more balanced interpretation of criticism

  • Reduce all-or-nothing thinking

• Difficult because clients rarely admit weakness or incorporate others’ feedback

Antisocial PD

• 18 years or older ( younger —→ conduct disorder)

• Repeatedly breaking the law

• Deceitful; repeated lying

• Impuslivitiy

• Involved in many fights

• Reckless disregard for safety of self or others

• Irresponsibility at work or with finances

• Lack of remorse

• 4x more common in men than women

Different than Psychopathy

• Psycopathy Psychopathy

  • Superficial charm

  • Lack of empathy

  • Calculating and manipulative

  • “Successful” vs. “Unsuccessful”

Antisocial PD: Causes

• Psychodynamic:

  • Absence of parental love —> lack of basic trust

• Behavioral:

  • Antisocial behaviors learned through modeling/unintentional reinforcement from parents

• Cognitive:

  • Hold beliefs that others are not important

• Biological:

• - Low serotonin —? impulsivity/ aggression

• PFC deficits —> lack of empathy?

• Less anxiety —? difficulty learning from punishment

Antisocial PD : Treatments

• Very limited success

  • Lack of empathy —> lack of motivation

• Cognitive:

  • Help clients see others’ needs

• Group:

  • Teach responsibility to others

  • But may actually increase antisocial traits

    • Learn new techniques from each other

Iatrogenic: if treatment has negative effects (develop new symptoms than they came in)

Borderline

• Pattern of unstable relationships

  • Highly sensitive to potential rejection

  • Oscillate btw,. idealization and devaluation

• Unstable self-image

• Rapidly fluctuating affect

• Marked impulsivity

  • Driiving, life foals, sex, financial

  • Including, suicidality, or self-harm

• 75% women, 25% men

  • Female version of antisocial PD?

Borderline PD: Causes

• Psychodynamic:

  • Parental lack of acceptance —> lost self-esteem

• Biological:

  • Overly reactive amygdala

  • Under-reactive prefrontal cortex

  • Under-reactive serotonin transporter gene

• Sociocultural:

  • Interaction of biological vulnerability with punishing social environment

  • invalidating family environment

  • Children don’t know how to trust their own feelings, rely on others

  • Don’t develop emotion regulation skills

Borderline PD: Treatments

• Dialectical Behavior Therapy (DPT)

  • Combined CBT and mindfulness.acceptance

  • Balances acceptance with change

  • Targets therapy-interfering behaviors first

    • ex. suicidality, not attending sessions

  • Individual therapy and skills groups simultaneously

    • promotes validation of clients

    • Teaches emotion regulation skills

    • Practice of interpersonal skills

Cluster B main ideas:

How can you distinguish Antisocal PD and Borderline PD?

• gender differences

How can you distinguish Narcissistic PD from Histrionic PD?

• Narcisitic using others for yourself and Histrionic no reliance for self importance and more stand alone

What is the role of culture or context in the Cluster B disorder?

• messages of society might be telling us may be internalized

Cluster C

• Avoidant

• Dependent

• Obsessive-compulsive

• “Anxious or fearful”

Avoidant PD

• Pervasive social inhibition

  • Avoid jobs requiring social interaction

• Feelings of inadequacy

  • Avoids jobs requiring social interaction

  • Inhibition in social situations

• Hypersensitivity to negative evaluation

  • Spend a lot of time worrying about social situations

Avoidant PD Causes

• Psychodynamic:

  • Early bowel or bladder accidents —> punishment by parents —> general social shane

• Cognitive:

  • Early harsh rejection —> expectation/ fear of it from others

• Behavioral:

  • Fail to develop social skills

  • Because they avoid social situations

Avoidant PD : Treatments

• Difficult for clients to trust therapist

• Psychodynamic:

  • Help clients resolve early-rooted conflicts

• Cognitive:

  • Challenge distressing beliefs, tolerate anxiety I social situations, improve self-image

• Behavioral:

  • Teach social skills

Dependent PD

• Pervasive, excessive need to be taken care of

• Leads to submissive, clinging behavior

  • Depend on others for most decisions, from what to wear to whom to marry

  • Difficulty initiating projects due to lack of self-confidence

• Fears of separation

  • Rarely expresses disagreement

  • Volunteers to of unpleasant things for others

  • Urgently seeks new relationships if old ones terminate

Dependent PD: Causes

• Psychodynamic:

  • Conflicts during oral stage —> need for nurturance

  • Early parental loss —> separation issues

  • Parental over-involvement —> increased dependency

• Cognitive:

  • Maladaptive beliefs: “ I am helpless” and “I must find someone to protect me”

• Behavioral

  • Parents reward clinging and punish independence

Dependent PD: Treatments

Psychodynamic:

• Transfer dependency needs to therapist in order to work through

Cognitive

• Challenge assumptions of helplessness

Behavioral:

• Assetiveness training; group therapy

Biological:

• Antidepressants to manage symptoms

Obsessive-Compulsive PD

• Preoccupation with orderliness, perfectionism, and interpersonal control

  • Focus on details to the exclusion of major point of activity

  • Excessively devoted to work

  • Miserly attitude toward money

• Leads to inflexibility and inefficiency

  • Overly scrupulous in matters of morality

  • Many projects left unfinished

OCPD: Causes

• Psychodynamic:

  • Overly harsh toilet training (anal retentive) —> anger and resentment —> efforts to control anger

• Cognitive:

  • Holds all-or-nothing beliefs like “ if it;s not done perfectly, it shouldn’t be done at all”

• Behavioral:

  • “Doing things very well often leads to a lot of praise and rewards; many reinforce excessive detail-orientation

    • e.g.: graduation students

OCPD: Treatments

Psychodynamic:

• Psychodynamics:

  • Help clients recognize and accept their underlying insecurities

  • Help clients take risks

• Cognitive:

  • Challenge dichotomous thinking, procrastination, perfectionism, and worrying

1. ?

2. no

3. psychodynamic