• Personality: A set of uniquely expressed characteristics that influence our behaviors, emotions, thoughts, and interactions

• Personalities are flexible

• Personality Disorder: When people display an enduring, rigid pattern of inner experience and outward behavior that impairs their sense of self, emotional experiences, goals, capacity for empathy, and/or capacity for intimacy

  • Have personality traits that are much more extreme and dysfunctional

  • Leads to significant problems and psychological pain for themselves or others

• Symptoms last for years

• Typically becomes recognizable in adolescence or early adulthood

• Among the most difficult psychological disorders to treat

• Many people with these disorders aren’t even aware of their personality problems

• Around 15% of all adults in the US display a personality disorder at some point

• Comorbidity: When a person with a personality also suffers from another disorder

• Categorical approach

  • Problematic personality traits are either present or absent in people

  • A personality disorder is either displayed or not displayed by a person

  • A person who suffers from a personality disorder is not markedly troubled by personality traits outside of that disorder

• Symptoms of personality disorders overlap so much that clinicians often find it hard to distinguish between disorders

• Dimensional Approach: Disorders are classified by the severity of personality traits rather than by the presence or absence of specific traits

“Odd” Personality Disorders

• Typically have odd or eccentric behaviors

• Extreme suspiciousness, social withdrawal, and peculiar ways of thinking and perceiving things

• Related to schizophrenia

  • Often qualify for an additional diagnosis of schizophrenia

  • Often have close relatives with schizophrenia

Paranoid Personality Disorder

• People deeply distrust other people and are suspicious of others’ motives

• Believe that everyone intends them harm

• Shun close relationships

• More likely to read hostile intentions into the actions of others

• More often choose anger as the appropriate response

• Remain cold and distant

• Suspicions are not usually delusional

• Critical of weakness and fault in others

• Unable to recognize their own mistakes

• Extremely sensitive to criticism

• Blame others for the things that go wrong in their lives

• More common in men than in women

• Theories

  • Psychodynamic theories

    • Distant, rigid fathers

    • Overcontrolling, rejecting mothers

    • Some people come to view their environment as hostile as a result of their parents’ persistently unreasonable demands

  • Cognitive-behavioral theories: People hold broad maladaptive assumptions

  • Biological theories: Genetic causes

• Treatments

  • Do not typically see themselves as needing help, and few come to treatment willingly

  • View the role of patient as inferior and distrust and rebel against their therapists

  • Object Relations Therapists: Try to see past the patient’s anger and work on what they view as their deep wish for a satisfying relationship

  • Self-therapists: Try to help clients reestablish self-cohesion

  • Cognitive-Behavioral Therapy

    • Master anxiety-reduction techniques

    • Improve skills at solving interpersonal problems

    • Develop more realistic interpretations of other people’s words and actions

    • Become more aware of other people’s POVs

  • Antipsychotic drug therapy is of limited help

Schizoid Personality Disorder

• People persistently avoid and are removed from social relationships and demonstrate little in the way of emotion

• Don’t have close ties with other people

• Genuinely prefer to be alone

• Make no effort to start or keep friendships, take little interest in having sexual relationships, and seem indifferent even to their families

• Social skills tend to be weak

• Focus mainly on themselves and are generally unaffected by praise or criticism

• Rarely show any feelings

• Seem to have no need for attention or acceptance

• Men are slightly more likely to experience it

• Men may be more impaired

• Theories

  • Psychodynamic theories

    • Schizoid personality disorder has its roots in an unsatisfied need for human contact

    • Parents have been unaccepting or abusive of their children

    • Children left unable to give or receive love and cope by avoiding all relationships

  • Cognitive-behavioral theories

    • Suffer from deficiencies in their thinking

    • Unable to pick up emotional cues from others

    • Cannot respond to emotions

    • Develop language and motor skills very slowly

• Treatments

  • Social withdrawal prevents most people with this disorder from entering therapy

  • Likely to remain emotionally distant from the therapist, seem not to care about their treatment, and make limited progress at best

  • Cognitive-behavior therapists

    • With this therapy, clients experience more positive emotions and more satisfying social interactions

    • Present clients with lists of emotions to think about

    • Have them write down and remember pleasurable experiences

    • Teach social skills

  • Group therapy is useful when it offers a safe setting for social contact

  • Drug therapy is of limited help

Schizotypal Personality Disorder

• People display a range of interpersonal problems marked by extreme discomfort in close relationships, very odd patterns of thinking and perceiving, and behavioral eccentricities

• Seek isolation

• Have few close friends

• More severe than the paranoid and schizoid personality disorders

• Thoughts and behaviors can be noticeably disturbed

  • Ideas of Reference: Beliefs that unrelated events pertain to them in some important way

  • Bodily Illusions: Sensing an external force or presence

  • See themselves as having special extrasensory abilities

  • Believe that they have magical control over others

• Emotions may be inappropriate, flat, or humorless

• Often have great difficulty keeping their attention focused

• Conversation is typically digressive and vague

• Tend to drift aimlessly and lead an idle, unproductive life

• Slightly more males than females

• Theories

  • Symptoms are often linked to family conflicts and to psychological disorders in parents

  • Defects in attention and short-term memory may contribute

  • Perform poorly on backward masking - have a hard time shutting out the first stimulus in order to focus on the second

  • Linked schizotypal personality disorder to some of the same biological factors found in schizophrenia

  • Also been linked to disorders of mood

    • Around ⅔ of ppl with schizotypal personality disorder also suffer from major depressive disorder or bipolar disorder

    • Relatives of ppl with depression have a higher than usual rate of schizotypal personality disorder and vice versa

• Treatments

  • Need to help these clients reconnect with the world and recognize the limits of their thinking and their powers

  • Work on helping the clients recognize where their views end and those of the therapist begin

  • Increase positive social contacts, ease loneliness, reduce overstimulation, help the individuals become more aware of their personal feelings

  • Cognitive-behavioral therapists

    • Help people function more effectively

    • Cognitive interventions

    • Evaluate their unusual thoughts or perceptions objectively

    • Ignore the inappropriate thoughts and perceptions

  • Antipsychotic drugs in low doses reduces certainty of their thought problems

“Dramatic” Personality Disorders

• More commonly diagnosed than the others

Antisocial Personality Disorder

• A personality disorder marked by a general pattern of disregard for and violation of other people’s rights

• Most closely linked to adult criminal behavior

• A person must be at least 18 to receive this diagnosis

• People with antisocial personality disorder lie repeatedly

• Usually careless with money

• Often impulsive

• Irritable, aggressive, and quick to start fights

• Little regard for their own safety or for that of others

• Self-centered

• Likely to have trouble maintaining close relationships

• Think of their victims as weak and deserving

• Four times more common among men than women

• At least 35% of people in prison meet the diagnostic criteria

• Criminal behavior of many people with this disorder declines after age 40

• People with antisocial personality disorder have higher rates of alcoholism and other substance use disorders than do the rest of the population

  • More than 80% of ppl with this disorder display a substance use disorder at some point in their lives

  • A number also display gamblind disorder

• Children with conduct disorder and ADHD have a heightened risk of developing antisocial personality disorder

  • Conduct Disorder - Persistently lie and violate rules and other people’s rights

  • ADHD - Lack foresight and judgment and fail to learn from experience

• Theories

  • Psychodynamic Factors

    • Begins with an absence of parental love during infancy, leading to a lack of basic trust

    • Some children respond to the early inadequacies by becoming emotionally distant, and they bond with others through the use of power and destructiveness

    • People with this disorder are more likely than others to have had significant stress in their childhoods

  • Cognitive-Behavioral Factors

    • May be learned through principles of modeling and imitation

    • Operant conditioning - Some parents unintentionally teach antisocial behavior by regularly rewarding a child’s aggressive behavior

      • Parents may give in to restore peace

      • May be teaching the child to be stubborn and violent

    • Hold attitudes that trivialize the importance of other people’s needs

    • People with this disorder have genuine difficulty recognizing POVs or feelings other than their own

  • Biological Factors

    • People may inherit a biological predisposition to the disorder

    • May be linked to particular genes

    • Lower serotonin activity

      • Linked to impulsivity and aggression

    • Deficient functioning in their prefrontal cortex and anterior cingulate cortex

      • Help people to plan and execute realistic strategies

      • Help people to have personal characteristics

    • Deficient functioning in the amygdala, hippocampus, and temporal cortex

      • Contributes to the individual’s inability to follow rules

    • Often respond to warnings or expectations of stress with low brain and bodily arousal

      • Enables them to readily tune out threatening or emotional situations

      • Makes them unaffected by them

      • More likely than others to take risks and seek thrills

    • Ultimately related to poor functioning by a brain circuit

      • Poor communication between the structures in this circuit may produce chronic low reactions to stress

• Treatments

  • Typically ineffective

  • Most of those in therapy have been forced to participate

  • Cognitive-behavioral therapists try to guide clients to think about moral issues and about the needs of other people

  • Psychotropic drugs

  • Antipsychotic drugs

Borderline Personality Disorder

• People display great instability, including major shifts in mood, an unstable self-image, and impulsivity

• Relationships are very unstable

• Swing in and out of very depressive, anxious, and irritable states

• Emotions seem to always be in conflict with the world around them

• Prone to bouts of anger

• Direct their impulsive anger inward and inflict bodily harm on themselves

• 85% also experience another psychological disorder

• Impulsive, self-destructive activities

• Many engage in self-injurious or self-mutilation behaviors

• Those with bpd often feel as if the physical discomfort offers relief from their emotional suffering

• 75% of ppl with bpd attempt suicide at least once

• Frequently form intense, conflict-ridden relationships in which their feelings aren’t necessarily shared by the other person

  • Come to idealize another person’s qualities and abilities after just a brief first encounter

  • Violate the boundaries of relationships

  • Quickly feel rejected and become furious when their expectations aren’t met

  • Have recurrent fears of impending abandonment

• Dramatic identity shifts

  • Unstable sense of self

  • Occasionally have a sense of dissociation from their own thoughts or bodies

• 75% are women

• Instability and risk of suicide peaks during young adulthood and gradually wanes with advancing age

• Tends to interfere with job performance even more than most other personality disorders

• Theories

  • Psychological Factors

    • Object Relations Theorists: Early lack of acceptance by parents may lead to a loss of self-esteem, increased dependence, and an inability to cope with separation

    • Their parents neglected or rejected them, verbally abused them, or otherwise behaved inappropriately

    • Early sexual abuse is a common contributor to the development of BPD

  • Biological Factors

    • Biological predisposition to develop BPD

    • Lower brain serotonin activity

      • Linked repeatedly to depression, suicide, aggression, and impulsivity

    • Tied to abnormal activity and anatomy of certain brain structures

  • Sociocultural Factors

    • Cases of bpd are particularly likely to emerge in cultures that change rapidly

    • As a culture loses its stability, it leaves many of its members with problems of identity

  • Integrative Explanations

    • Biosocial explanation: BPD results from a combination of internal and external forces

      • Internal forces: Difficulty identifying and controlling one’s emotions, social skill deficits, abnormal neurotransmitter activity

      • External forces: An environment in which a child’s emotions are punished, ignored, trivialized, or disregarded

      • Received some, but not consistent, research support

    • Developmental Psychopathology Explanation: Believe that internal and external factors intersect over the course of a person’s life to help produce this disorder

      • Early parent-child relationships are particularly influential in the development of BPD

      • Children who experience early trauma and abuse and whose parents are markedly inattentive, uncaring, confusing, threatening, and dismissive, are likely to develop a disorganized attachment style

      • Central psychological deficit is the person’s inability to mentalize

      • Mentalization: People’s capacity to understand their own mental states and those of other people

      • People subjected to early dysfunctional attachment relationships emerge from their childhood with a weakened ability to mentalize and a poor ability to control their emotions, attention, thinking, and behavior

      • Cannot accurately understand either their own or other people’s underlying mental states

• Treatments

  • Psychotherapy can eventually lead to some degree of improvement

  • Wildly fluctuating interpersonal attitudes of clients with the disorder can make it difficult for therapists to establish collaborative working relationships with them

  • Clients with BPD may violate the boundaries of the client-therapist relationship

  • Traditional psychoanalytic therapy has not been effective

  • Contemporary psychodynamic approaches have been more effective than traditional psychoanalytic approaches

  • Dialectical Behavior Therapy: A comprehensive treatment approach, applied particularly in cases of borderline personality disorder and/or suicidal intent; includes both individual therapy sessions and group sessions

    • Cognitive-behavioral interventions

    • Social skill-building and support

    • Received considerable research support

    • Now considered the treatment of choice for people with bpd

  • Antidepressant, antibipolar, antianxiety, and antipsychotic drugs

    • Help calm the emotional and aggressive storms of some ppl with bpd

    • Use of drugs on an outpatient basis is unwise

    • Should be used largely as an adjunct to psychotherapy approaches

Histrionic Personality Disorder

• People are emotionally charged and continually seek to be the center of attention

• Keep changing themselves to attract and impress an audience

• Speech is scanty in detail and substance

• Lack a sense of who they really are

• Overreact to any minor event that gets in the way of their quest for attention

• Some make suicide attempts, often to manipulate others

• May draw attention to themselves by exaggerating their physical illnesses or fatigue

• Exaggerate the depth of their relationships

• Once believed to be more common in women than in men

• Males and females are equally affected

• Theories

  • Psychodynamic perspective

    • Parents were cold and controlling and left their children feeling unloved and afraid of abandonment

    • Children learned to behave dramatically so their parents would pay attention to them

    • Omg guys this reminds me of buck from 911, though i wouldn’t say he has histrionic personality disorder

  • Cognitive-Behavioral Perspective

    • People are less and less interested in knowing the world at large because they’re so self-focused and emotional

    • Hold a general assumption that they’re helpless to care for themselves

    • Constantly seek out others who will meet their needs

    • Wow this one reminds me of harry styles in ‘confessions of a gay disney prince’ though, again, i don’t think that character has histrionic personality disorder

  • Sociocultural perspective

    • Produced in part by cultural norms and expectations

    • Vain, dramatic, and selfish behavior may actually be an exaggeration of femininity as our culture once defined it

    • Diagnosed less in cultures that discourage overt sexualization

• Treatments

  • More likely to seek out treatment on their own

  • Working with them can be very difficult because of their demands

  • May pretend to have important insights or to change during treatment merely to please the therapist

  • Therapists must remain objective and maintain strict professional boundaries

  • Cognitive-behavioral therapists - change their belief that they’re helpless and develop better, more deliberate ways of thinking and solving problems

  • Psychodynamic therapy

  • Group therapy

  • Ultimate goal: Help their clients recognize their excessive dependency, find inner satisfaction, and become more self-reliant

  • Drug therapy is less successful

Narcissistic Personality Disorder

• People are generally grandiose, need much admiration, and feel no empathy with others

• Expect constant attention and admiration from those around them

• Exaggerate their achievements and talents

• Expect others to recognize them as superior

• Often appear arrogant

• Often make favorable first impressions but can rarely maintain long-term relationships

• Seldom interested in the feelings of others

• Theories

  • Psychodynamic theories

    • Cold, rejecting parents

    • People with narcissistic personality disorder spend their lives defending against feeling rejected and wary of the world

    • Repeatedly tell themselves that they’re actually perfect and desirable

    • Seek admiration from others

  • Object Relations Theorists: Grandiose self-image is a way for these people to convince themselves that they’re totally self-sufficient and without need of warm relationships with their parents or anyone else

  • Children who are neglected, abused, and/or lose their parents are at particular risk for the later development of narcissistic personality disorder

  • Cognitive-behavioral theories

    • Narcissistic personality disorder develops when people are treated too positively in early life

    • Admiring or doting parents teach them to overvalue their self-worth

    • Repeatedly rewarded for minor or no accomplishments

  • Sociocultural theories: Link between narcissistic personality disorder and eras of narcissism

    • Family values and social ideals in certain societies periodically break down

    • Produces generations of young people who are self-centered and materialistic

    • Western cultures are considered likely to produce generations of narcissism

• Treatments

  • One of the most difficult to treat

    • Clients are unable to acknowledge weakness

    • Clients are unable to appreciate the effect of their behavior on others

    • Clients are unable to incorporate feedback from others

  • Clients may try to manipulate the therapist

  • Psychodynamic therapists help them recognize and work through their basic insecurities and defenses

  • Cognitive-behavioral therapists try to redirect the clients’ focus onto the opinions of others and increase their ability to emphasize

  • No approaches have had clear success

“Anxious” Personality Disorders

• Typically display anxious and fearful behavior

• Research support for explanations is very limited

• Treatments are considerably more helpful than that for other personality disorders

Avoidant Personality Disorder

• People are very uncomfortable and inhibited in social situations, overwhelmed by feelings of inadequacy, and extremely sensitive to negative evaluation

• So fearful of being rejected that they give no one an opportunity to reject them

• Actively avoid occasions for social contact

• Believe themselves to be unappealing or inferior to others

• Few or no close friends

• Similar to social anxiety disorder

  • High comorbidity rate

  • People with social anxiety disorder primarily fear social circumstances

  • People with avoidant personality disorder primarily fear social relationships

• 2.4% of adults have avoidant personality disorder

• Theories

  • Often assumed to have the same causes as anxiety disorders

  • Psychodynamic Theories

    • Shame and insecurity tied to childhood experiences

    • If parents repeatedly punish/ridicule their child, the child may develop a negative-self image

    • Leads to the child feeling unlovable and distrusting the love of others

  • Cognitive-Behavioral Theories

    • Harsh criticism and rejection in early childhood may lead certain people to assume that others in their environment will always judge them negatively

    • Come to expect rejection

    • Fail to develop effective social skills

• Treatments

  • Often distrust the therapist’s sincerity and start to fear their rejection

  • Treated similarly to people with social anxiety disorder and other anxiety disorders

Dependent Personality Disorder

• People have a pervasive, excessive need to be taken care of

• Clinging and obedient

• Fear separation from people with whom they’re in a close relationship

• Rely on others so much that they can’t make decisions for themselves

• Constantly need assistance with everything and have extreme feelings of inadequacy and helplessness

• Theories

  • Psychodynamic Theories:

    • Unresolved conflicts during the oral stage can give rise to a lifelong need for nurturance

    • Early parental loss or rejection may prevent normal experiences of attachment and separation

    • Many parents of people with this disorder were over involved and overprotective, increasing their children’s dependency and separation anxiety

      • Buster Bluth

  • Cognitive-Behavioral Theories:

    • Behavior

      • Parents unintentionally rewarded their children’s clinging and loyal behavior

      • Parents punished acts of independence

      • Some parents’ dependent behaviors may have served as models

    • Cognitive

      • Maladaptive attitudes

        • I am inadequate and helpless

        • I must find a person to provide protection

        • Jerry - Rick and Morty

      • Dichotomous thinking

• Treatments

  • Help patients accept responsibility for themselves

  • Couple or family therapy

  • Psychodynamic therapy focuses on the same issues as therapy for depressed people

  • Cognitive-Behavioral Therapists

    • Combine behavioral and cognitive interventions to help the clients take control of their lives

    • Assertiveness training

    • Challenge and change their assumptions of incompetence and helplessness

  • Antidepressant drug therapy

  • Group therapy format

Obsessive-Compulsive Personality Disorder

• People are so preoccupied with order, perfection, and control that they lose all flexibility, openness, and efficiency

• 7.9% of the population

• Men are twice as likely

• May became so focused on organization and details that they fail to grasp the point of the activity

• Set unreasonably high standards for themselves and others

• Rigid and stubborn

• Theories

  • Freud

    • People with OCPD are anal retentive

    • Fixated at the anal stage

    • Become filled with anger

    • Persistently resist both their anger and their instincts to have bowel movements

    • Become extremely orderly and restrained

    • Any early struggles with parents over control and independence may ignite the aggression

  • Cognitive-Behavioral Theories

    • Illogical thinking processes help keep OCPD going

    • Dichotomous thinking may produce rigidity and perfectionism

    • People with OCPD tend to misread or exaggerate the potential outcomes of mistakes or errors

• Treatments

  • Ppl with OCPD don’t think there’s anything wrong with them

  • Often respond well to psychodynamic or cognitive-behavioral therapy

  • SSRIs

Multicultural Factors: Research Neglect

• Lack of multicultural research

• Gender and other cultural differences may be particularly important in both the development and diagnosis of borderline personality disorder

  • 75% of all people who have a diagnosis of bpd are female

  • Could be that the traumas women experience as children are prereqs for the development of bpd

    • Should be viewed and treated as a special form of ptsd

  • Could be a reaction to persistent feelings of marginality, powerlessness, and social failure

    • Disorder may be more attributable to social inequalities than to psychological factors

Are There Better Ways to Classify Personality Disorders?

• Personality disorders differ more in degree than in type of dysfunction

• Should be classified by dimensions rather than by categories

The “Big Five” Theory of Personality and Personality Disorders

• Neuroticism, extroversion, openness to experiences, agreeableness, conscientiousness

• Everyone’s personality can be summarized by a combination of the five traits

• Would be best to describe all people with personality disorders as being high, low, or in between on the five supertraits

  • Drop the use of personality disorders altogether

DSM-5’s Proposed Dimensional Approach

• Personality Disorder-Trait Specified (PDTS): A personality disorder currently undergoing study for possible inclusion in a future revision of DSM-5. People would receive this diagnosis if they had significant impairment in their functioning as a result of one or more very problematic traits

• Negative Affectivity: People experience negative emotions frequently and intensely

  • Emotional Lability: Unstable emotions

  • Anxiousness

  • Separation insecurity

  • Preservation: Repetition of certain behaviors despite repeated failures

  • Submissiveness

  • Hostility

  • Depressivity

  • Suspiciousness

  • Strong emotional reactions (overreactions to emotionally arousing situations)

• Detachment: People tend to withdraw from other people and social interactions

  • Restricted Emotional Reactivity: Little reaction to emotionally arousing situations

  • Depressivity

  • Suspiciousness

  • Withdrawal

  • Anhedonia: Inability to feel pleasure or take interest in things

  • Intimacy avoidance

• Antagonism: People behave in ways that put them at odds with other people

  • Manipulativeness

  • Deceitfulness

  • Attention seeking

  • Hostility

• Disinhibition: People behave impulsively, without reflecting on potential future consequences

  • Irresponsibility

  • Distractibility

  • Risk taking

• Psychoticism: People have unusual and bizarre experiences

  • Unusual beliefs and experiences

  • Eccentricity

  • Cognitive and perceptual dysregulation: Odd thought processes and sensory experiences