Personality Disorders Overview

Cluster A Personality Disorders Review

Case Examples

Mario: Unique Behavior

  • 35-year-old man who dresses in a space suit.

  • Believes in detecting alien invasions.

  • Feels negative forces in his home affect his psychic state.

  • No auditory or visual hallucinations present.

  • Possible diagnosis:

    • Schizoid Personality Disorder

    • Schizotypal Personality Disorder

    • Paranoid Personality Disorder

Doreen: Social Discomfort

  • Watches parties from isolated perspectives.

  • Displays guardedness and distrust in social settings.

  • Engages in negative critiques of others' behaviors.

  • Possible diagnosis:

    • Schizoid Personality Disorder

    • Schizotypal Personality Disorder

    • Paranoid Personality Disorder

Harold: Social Isolation

  • Rarely talked and kept to himself.

  • Enjoys solitary activities, such as reading.

  • Has no friends and does not express a desire for social interaction.

  • Possible diagnosis:

    • Schizoid Personality Disorder

    • Schizotypal Personality Disorder

    • Paranoid Personality Disorder

Quick Review of Features

Schizotypal Personality Disorder

  • Resembles positive psychotic symptoms of schizophrenia (e.g., hallucinations, delusions) but do not reach full psychosis.

  • May indicate a prodromal phase leading to schizophrenia.

Schizoid Personality Disorder

  • Characterized by social withdrawal and flat affect.

  • Shares some neurobiological basis with autism spectrum disorders.

Cluster B Personality Disorders

  • Characteristics: Dramatic, Erratic, Emotional types of behavior.

  • Major disorders include:

    • Antisocial Personality Disorder

    • Borderline Personality Disorder

    • Narcissistic Personality Disorder

    • Histrionic Personality Disorder

Antisocial Personality Disorder

Definition & Features

  • Antisocial = anti-society; not to be confused with psychopathy or sociopathy, which are informal terms.

  • Diagnosis requires individual to be at least 18 years old.

  • Key characteristics include:

    • Noncompliance with social norms, violation of others' rights.

    • Irresponsibility, impulsiveness, deceitfulness.

    • Lack of conscience, empathy, and remorse.

    • Can be charming and manipulative.

Background

  • Often shows a history of conduct disorder in childhood.

  • The callous-unemotional subtype is more likely to develop into antisocial PD.

  • Family backgrounds often involve inconsistent parental support and histories of violence.

Causes

  • Neurobiological theories:

    • Under-arousal hypothesis: lower cortical arousal leads to risk-seeking behavior.

    • Fearlessness hypothesis: individuals have a higher threshold for fear.

    • Gray’s model: imbalance of inhibition and reward signals.

Treatment

  • Early intervention is crucial:

    • Focus on prevention, rehabilitation, and parental training.

    • Practical consequences approach for behavior modification.

Borderline Personality Disorder

Characteristics

  • Unstable moods and relationships with extreme highs and lows.

  • Exhibits impulsive behavior, fear of abandonment, and poor self-image.

  • Engages in black and white thinking; sees people as all good or all bad.

  • Self-harming and suicidal gestures are prevalent among individuals with BPD.

Prevalence & Comorbidities

  • Affects approximately 5.9% of U.S. adults.

  • Commonly coexists with depression, substance use disorders, PTSD, and eating disorders.

Causes

  • Vulnerability linked to emotional sensitivity and trauma/abuse in early life.

  • Poor validation from others contributes to ineffective self-regulation.

Treatment

  • Dialectical Behavior Therapy (DBT) is the most effective approach, focusing on

    • Balancing acceptance of current emotions with the need for change.

    • Skills training in mindfulness, interpersonal effectiveness, distress tolerance, and emotion regulation.

  • Challenges include effectiveness and accessibility of treatment.

Histrionic Personality Disorder

Characteristics

  • Individuals exhibit overly dramatic and attention-seeking behavior.

  • They may use sexual provocation and impulsivity to maintain focus on themselves.

Treatment

  • Emphasis on addressing attention-seeking behaviors and their long-term consequences.

  • Limited evidence for treatment effectiveness.

Narcissistic Personality Disorder

Characteristics

  • Involves an exaggerated sense of self-importance and a preoccupation with attention.

  • Displays lack of empathy and sensitivity towards others while being overly critical of feedback.

Causes

  • Unknown; may involve the failure to learn empathy and excessive praise during upbringing.

Treatment

  • Address issues of grandiosity and lack of empathy, focusing on realistic goal setting and coping skills.

  • Limited research supporting treatment effectiveness.

Cluster C Personality Disorders

General Characteristics

  • Marked by anxiety and fearfulness.

Avoidant Personality Disorder

Characteristics

  • Displays extreme sensitivity to opinions of others, leading to social avoidance.

  • Low self-esteem and high anxiety in interpersonal contexts.

Treatment

  • Similar to social phobia; aims to improve social skills and coping abilities.

Dependent Personality Disorder

Characteristics

  • Relies heavily on others for decisions and is fearful of abandonment.

  • Habitually submissive and clingy behaviors towards relationships.

Treatment

  • Limited efficacy and gradual progress due to dependency concerns.

Obsessive Compulsive Personality Disorder

Characteristics

  • Excessive fixation on order, perfectionism, and control.

  • Driven by rigidity rather than the presence of obsessions/compulsions.

Treatment

  • Targets cognitive reappraisal and issues of procrastination and self-worth.