Personality Disorders

Personality Disorders (Axis 2)

• Behaviors similar to Schizophrenia.

• Flat affect, odd thought, or speech patterns.

• Aberrations/disturbances in understanding reality.

• Symptoms less severe than Schizophrenia.

• Comprises three disorders:

  • Paranoid Personality Disorder.

    • Paranoia in one aspect/situation, globally normal behavior.

    • Suspicion of other motives.

    • Trust issues.

  • Schizotypal personality disorder (cognitive & behavior).

General Personality Disorder: Criterion A

• An enduring pattern of inner experience and behavior that deviates from cultural expectations.

• Manifested in two or more areas:

  • Cognition (perceiving and interpreting self, others, and events).

  • Affectivity (range, intensity, lability, and appropriateness of emotional response).

  • Interpersonal functioning.

  • Impulse control.

General Personality Disorder: Criterion B

• The enduring pattern is inflexible and pervasive across a broad range of personal and social situations.

• Behavior is not explained by the situation.

• Behavior is not flexible enough to behave appropriately in different situations.

General Personality Disorder: Criterion C

• The enduring pattern leads to clinically significant distress or impairment in social, occupational, or other important areas of functioning.

• Only a problem if it's a problem.

• Interferes with functioning.

General Personality Disorder: Criterion D

• The pattern is stable, of long duration, and onset can be traced back to adolescence or early childhood.

• Personality is not fully developed until adolescence, cannot be diagnosed as a child.

• The 3 clusters of Personality disorder: (characteristic)

  • Cluster A: odd-eccentric.

  • Symptoms of Schizophrenia that are not severe enough to warrant a diagnosis of Schizophrenia.

Cluster A: Schizotypal Personality Disorder

• Mild perceptual and cognitive distortions:

  • Odd beliefs.

  • Unusual perceptual experiences.

• Odd/Eccentric behaviors:

  • Odd speech pattern.

  • No operational definition of odd.

  • Manipulative and potentially uncaring behaviors.

  • Show little regard for others and potentially their own safety.

  • low on the spectrum of empathy

Cluster B: Dramatic-Emotional Characteristics

*Emotional Dysregulation
* Can demonstrate highly erratic emotional responses.
* Inappropriately sexual and seductive behavior: Extreme focus on appearance.
* These disorders are similar in these symptoms but they are functionally different.
* Exaggerated emotionality that lacks depth, Emotions are shallow and shift rapidly.
*Discomfort when not center of attention
* Constantly seeks reassurance, approval, and praise.
*Cognitive-Behavioral Models (sense of self)
* Discomfort with and deficit in interpersonal relations:
* Want close relationships but often avoid them.
* Schizoid personality disorder (emotional).
* Flat affect- not responding in an appropriate way to what one is experiencing.
* Affective system not functioning properly.
* Interacting with the world based on the way the body feels (anxious, calm, etc).
* These individuals can’t always live independently.
*Cluster A: schizotypal personality disorder example: odd beliefs, interpreting thunderstorms as messages.
Jim behavior breaks out into a silly grin and laughs for no apparent reason.
*Cluster B: Dramatic-emotional (characteristic):
Histrionic personality disorder:

Histrionic Personality Disorder

• Core Beliefs:

  • Self: If I can’t entertain people, they will abandon me.

  • Other: If other people don’t respond to me, they are rotten.

• Learning History:

  • Selective interpersonal reinforcement by family and peer relationships leads to excessive attention-seeking behaviors.

  • Key thing to remember is that there is a difference between topography (what the behavior look like) and underlying functions.

  • The thing that differentiates disorders among this cluster, or any cluster, is the underlying functions= why the person is doing it what the behavior is trying to achieve.

  • Histrionic shifts in emotion are not comparable to those shifts in Bipolar disorder.

    • In BD, mood changes are due to brain chemistry, In HPD, the emotion shifts might last longer and are usually aimed at getting attention or connection from others.

    • However, these shifts tend to be for longer durations.

    • What these individuals display to people (topography) is different than what is going on internally (underlying function).

  • “Attention seeking disorder”.

• They will seek any attention, good or bad.

• Differs from narcissism which seeks attention primarily for ego boosts and they are more selective in what they want.

• Ex. kids may act out as a way to receive attention, and the attention is reinforcing, this is similar to how histrionic may act.

• They tend to have low insight.
  *Example of Low insight scenario- she starts to suspect he’s having an affair – it couldn’t possibly be her fault –low insight.
  She doesn’t believe what she’s doing is bad
  In the past, her charm and appearance did all the work for her, but now something has changed
  sensation-seeking
  Hilde, expressedes a senses of superficiality in both her outward and inward expression, “She’s larger than life”
  lack depth-At first they may draw people in but as relationship progress those involved start to realize there is not much below the surface.

Hilde Case Study.

• Her husband struggles to feel seen and heard in their relationship because it's all about Hilde.

• Hilde’s upbringing.

  • She was praised her her appearance, not her intellect.

  • What is reinforced or punished by others in our environment calibrates our sense of self worth.

  • Hilde’s personality trait that could have blossomed remain dormant bc they were not reinforced, rather they were punished.

• Had a history of reinforcement during a critical period of her development for certain behaviors that are now maintained in her adult life.

• Those old behaviors that were once adaptive in another environment don’t make sense.

Antisocial Personality Disorder (ASPD)

• Characterized by a disregard for and violation of the rights of others.

• Early history:

  • Moral insanity: (early term ASPD).

    • Not psychotically deranged.

    • Not deficit in reasoning abilities.

    • “Constitutionally deficient in moral faculties”.

Psychopathy/sociopath is not the same thing as ASPD,ASPDis a DSM diagnosis that tries to capture psychopathy but only capture some features.

• Failure to conform to social norms with respect to lawful behavior.

• Deceitfulness.

• Impulsivity or failure to plan ahead.

• Irritability and aggressiveness.

• Reckless disregard for safety of others.

• Consistent irreparability.

• Lack of remorse for behaviors.

ASPD Diagnosis

• ASPD DSM 3: Diagnosis focused on antisocial behaviors and social deviance.

  • Critiqued for de-emphasis on trait and personality characteristics.

Psychopathy

• Term similar to ASPD, but includes:

  • Grandiosity, arrogance, superficiality.

  • An inability to form emotional bonds.

  • A lack of anxiety.

*Genetic contribution:
* The environmental factors don’t seem to have a strong as an influence as the genetic factors (psychopathic traits an amenable to environmental influence, but have a strong genetic basis).

Early Learning Environment.

• Characterized by either:

  • Passive or neglectful parenting attitudes (don’t really pay attention to the child).

  • Overly harsh parenting styles (strict, punishing, abusive).
    Passive or neglectful parenting attitudes,No demands for responsible and non-aggressive behaviors.

• Children who receives little response- contingent attention for (+) behaviors might engage in (-) behaviors for attention.
  *Behavior learned example: If a child only gets attention when they do something bad (and get ignored when they behave well), they might keep doing bad things just to get noticed

Harsh Parenting Styles.

• Use of aggression for discipline.

  • Modeling conflict and problem-solving (the child learns from watching their parents).

  • Develop hostile information processing style in social interaction (the child believe someone is out to get them as a result they often react with anger and aggression in social situations).

Learning and Performance Deficits.

• Deficits in acquiring learning responses:

  • Incapable of profiting from reward/punishment: Psychopaths performed as well as controls when incorrect responses resulted in loss of cigarettes or money.

  • Not responsive to shock or positive or negative social comments.

Deficits in acquiring fear responses: Psychopaths slow to develop conditioned response to fear
Psychopaths inclined to ignored painful shocks that control learned to avoid : Less influences by fear reaction: Behaviors unfettered by psychological deterrents such as anxiety and fears of consequences
Not guided by fear or anxiety, they don’t seem to feel much fear, guilt, or worry (so they don't feel anxious about getting in trouble)
Chronic low levels of arousal: Aversive physiological state resulting from a lack of novel/rewarding stimuli.
Lower baseline levels of arousal and rapid adaptation to novel stimuli
Need to increase arousal levels, ASPD individuals will engage in higher-risk sensation-seeking

Cluster C: Anxious-Fearful.

Extreme concern of criticism and abandonment that leads to impaired relationships.
Cluster C disorders: Avoidant personality disorder: Feelings of extreme social inhibition, inadequacy, and sensitivity to negative criticism and rejection
Avoidance of activities of daily living (e.g. work) involving people for fear of criticism or rejection
nDependent personality disorder: Feelings of helplessness, submissiveness, dependence, reassurance seeking.
Difficulty making independent decisions & Avoidance of adult activities and tolerance of abuse and maltreatment\nNarcissistic personality disorder: Background: What is a Narcissistic personality:

Becuasue of that they way it’s diagnosed can vary
It been compared to “Tower of Babel” meaning everyone is speaking different languages when it comes to defining narcissism.
Experts from different field describe narcissism differently

Narcissism

Experts from different field describe narcissism differently,Because of that they way it’s diagnosed can vary,It been compared to “Tower of Babel” meaning everyone is speaking different languages when it comes to defining narcissism.
Clinical and social/personality psychologists differ in how they conceptualize and measure narcissism
There is not one gold standard definition or theatrical model of narcissism : Healthy Narcissism

Consensus that there exist both healthy expressions and maladaptive form of narcissism: psychologists agree that narcissism isn’t always bad: There are healthy/unhealthy (maladaptive form):-
Healthy narcissism means: you look for validation or encouragement from other sometimes (like praise or support), but not in extreme was