Personality Disorders

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learning objective : define personality disorder, differentiate the clusters of personality disorders, and describe the characteristic symptoms of personality disorders, particularly borderline personality disorder and antisocial personality disorder

personality disorder : a disorder characterized by inflexible patterns of thinking, feeling, or relating to others that cause problems in personal, social, and work situations

  • personality disorders tend to emerge during late childhood or adolescence and usually continue throughout adulthood

  • personality disorders are categorized into three types : odd or eccentric behavior, dramatic or erratic behavior, and anxious or inhibited behavior

Descriptions of the Personality Disorders

Cluster

Personality Disorder

Characteristics

odd/eccentric

(cluster A)

schizotypal

Peculiar or eccentric manners of speaking or dressing. Strange beliefs. "Magical thinking" such as belief in ESP or telepathy. Difficulty forming relationships. May react oddly in conversation, not respond, or talk to self. Speech elaborate or difficult to understand. (Possibly a mild form of schizophrenia).

paranoid

Distrust in others, suspicion that people have sinister motives. Apt to challenge the loyalties of friends and read hostile intentions into others' actions. Prone to anger and aggressive outbursts but otherwise emotionally cold. Often jealous, guarded, secretive, overly serious.

schizoid

Extreme introversion and withdrawal from relationships. Prefers to be alone, little interest in others. Humorless, distant, often absorbed with own thoughts and feelings, a daydreamer. Fearful of closeness, with poor social skills, often seen as a "loner."

dramatic/erratic

(cluster B)

antisocial

Impoverished moral sense or "conscience." History of deception, crime, legal problems, impulsive and aggressive or violent behavior. Little emotional empathy or remorse for hurting others. Manipulative, careless, callous. At high risk for substance abuse and alcoholism.

borderline

Unstable moods and intense, stormy personal relationships. Frequent mood changes and anger, unpredictable impulses. Self-mutilation or suicidal threats or gestures to get attention or manipulate others. Self-image fluctuation and a tendency to see others as "all good" or "all bad."

histrionic

Constant attention seeking. Grandiose language, provocative dress, exaggerated illnesses, all to gain attention. Believes that everyone loves them. Emotional, lively, overly dramatic, enthusiastic, and excessively flirtatious.

narcissistic

Inflated sense of self-importance, absorbed by fantasties of self and success. Exaggerates own achievement, assumes others will recognize they are superior. Good first impressions but poor longer-term relationships. Exploitative of others.

anxious/inhibited

(cluster c)

avoidant

Socially anxious and uncomfortable unless they are confident of being liked. In contrast with schizoid person, yearns for social contact. Fears criticism and worries about being embarrassed in front of others. Avoids social situations due to fear of rejection.

dependent

Submissive, dependent, requiring excessive approval, reassurance, and advice. Clings to people and fears losing them. Lacking self-confidence. Uncomfortable when alone. May be devastated by end of close relationship or suicidal if breakup is threatened.

obsessive-compulsive

Conscientious, orderly, perfectionist. Excessive need to do everything "right." Inflexibly high standards and caution can interfere with their productivity. Fear of errors can make this person strict and controlling. Poor expression of emotions. (Not the same as obsessive-compulsive disorder.)

in summary : personality disorders are psychological disorders characterized by inflexible patterns of thinking, feeling, or relating to others that cause problems in personal, social, and work situations

  • the symptoms that make up personality disorders are common yet they may become problematic when they are rigid, overused, or interfere with everyday behavior

  • what is common to all the disorders is the person’s inability to accurately understand and be sensitive to the motives and needs of the people around them

  • it is frequently difficult for the clinician to accurately diagnose which of the many personality disorders a person has

  • the personality disorders highly comorbid; if a person has one, its likely that they have another

  • the number of people with personality disorders is estimated to be as high as 15% of the population

  • Borderline personality disorder is important because it is so often associated with suicide

  • antisocial personality disorder is the foundation of criminal behavior

  • bpd is known as an internalizing disorder because the behaviors that it entails are mostly directed toward the self

  • apd is known as an externalizing disorder in which the problem behaviors focus primarily on harm to others

Borderline Personality Disorder

learning objective : describe the characteristic symptoms of personality disorders, particularly borderline personality disorder and antisocial personality disorder

borderline personality disorder : a psychological disorder characterized by a prolonged disturbance of personality accompanied by mood swings, unstable personal relationships, identity problems, threats of self-destructive behavior, fears of abandonment, and impulsivity

  • bpd is widely diagnosed

  • up to 20% of psychiatric patients are given the diagnosis

  • up to 2% of the general population

  • about three quarters of diagnosed cases of bpd are women

  • people with bpd fear being abandoned by others

  • often show a clinging dependency on the other person and engage in manipulation to try to maintain the relationship. they become angry if the other person limits the relationship, but also deny that they care about the person

  • as a defense against fear of abandonment, those with bpd are compulsively social

  • their behaviors, including their intense anger, demands, and suspiciousness, repel people

  • people with bpd often deal with stress by engaging in self-destructive behaviors

  • these behaviors are designed to call forth a saving response from another person

  • people with bpd often utilize the services of police, hospitals, and therapists at a higher rate than others

  • individuals with bpd also show disturbance in their concepts of identity : uncertainty about self-image, gender identity, values, loyalties, and goals

  • they may have chronic feelings of emptiness, boredom, or shame and be unable to tolerate being alone

  • shame is a dominant emotion for those with bpd

  • patients with bpd describe shame when describing intense feelings of emotional pain

  • bpd has both genetic and environmental roots

  • research has found that those with bpd frequently have neurotransmitter imbalances and the disorder is heritable

  • many theories about the causes of bpd focus on a disturbed early relationship between the child and their parents (environmental reasoning)

  • some theories focus on the development of attachment in early childhood, while others point to parents who fail to provide adequate attention to the child’s feelings

  • others focus on parental abuse in adolescence, as well as on divorce, alcoholism, and other stressors

  • the dangers of bpd are greater when they are associated with childhood sexual abuse, early age of onset, substance abuse, and aggressive behaviors.

  • the problems are amplified when the diagnosis is comorbid with other disorders

Research Focus : Affective and Cognitive Deficits in BPD

  • Posner and colleagues hypothesized that the difficulty that individuals with BPD have in regulating their lives may be due to imbalances in the fast and slow emotional pathway through the amygdala

  • they hypothesized that the fast emotional pathway through the amygdala is too active, and the slow cognitive-emotional pathway through the prefrontal cortex is not active enough in those with BPD

  • the participants in their research were 16 patients with BPD and 14 healthy comparison participants

  • all participants were tested in an fMRI while they performed a task that required them to read emotional and non emotional words, and then press a button as quickly as possible whenever a word appeared in a normal font and not press the button whenever the word appeared in a normal font and not press the button whenever the word appeared in an italicized font

  • the researchers found that while all participants performed the task well, the patients with bpd had more errors than the controls

  • these errors primarily occurred on the negative emotional words

  • those with bpd showed relatively larger affective responses when they were attempting to quickly respond to the negative emotions, and showed less cognitive activity in the prefrontal cortex in the same conditions

  • the research suggests that excessive affective reactions and lessened cognitive reactions to emotional stimuli may contribute to the emotional and behavioral volatility of patients with BPD

Antisocial Personality Disorder (ASPD)

learning objective : describe the characteristic symptoms of personality disorders, particularly borderline personality disorder and antisocial personality disorder

antisocial personality disorder : characterized by a disregard of the rights of others, and a tendency to violate those rights without being concerned about doing so

  • apsd is a pervasive pattern of violation of the rights of others that begins in childhood or early adolescence and continues into adulthood

  • it is about three time more likely to be diagnosed in men than in women

  • to be diagnosed with aspd the person must be 18 years of age or older and have a documented history of conduct disorder before the age of 15

  • many years ago people who had antisocial personality disorder were referred to as sociopaths or psychopaths

  • the disorder ‘psychopathy’ is not in the dsm, but aspd is a distinct personality disorder characterized by lack of remorse and deficits in empathy

  • people with aspd feel little distress for the pain that they cause others

  • they lie, engage in violence against animals and people, and frequently have drug and alcohol abuse problems

  • they are egocentric and frequently impulsive

  • people with ASPD soon end up with a criminal record and often spend time incarcerated

  • the intensity of antisocial symptoms tends to peak during the 20s and then may decrease over time

  • biological and environmental factors are both implicated in the development of aspd

  • twin and adoption studies suggest a genetic predisposition and biological abnormalities include : low autonomic activity during stress, biochemical imbalances, right hemisphere abnormalities, and reduced gray matter in the frontal lobes

  • environmental factors include neglectful and abusive parenting styles